Raya Juliane Ocker-Serger

Purpose: To evaluate technical success, diagnostic yield, and complication rates of image-guided percutaneous splenic biopsies based on multicenter registry data from the German Society for Interventional Radiology and Minimally Invasive Therapy. Materials and Methods: This retrospective multicenter study analyzed image-guided percutaneous splenic biopsies documented in the prospective DeGIR registry between 2018 and 2024. Technical success was defined as needle placement within the target lesion. Diagnostic yield was defined as histologically adequate samples enabling clinical diagnosis. Results: Four hundred splenic biopsies from 92 centers were included. Technical success was achieved in 99.00% of procedures. The complication rate was 5.00%, including 2.50% major complications with no procedure-related deaths. Complication rates were higher for procedures performed under local anesthesia than analgesic sedation ( p = 0.042). Histopathological reports were available for 338 procedures, resulting in a diagnostic yield of 90.83%. Diagnostic yield increased with the number of biopsy samples, reaching a maximum with three samples. Procedures performed under analgesic sedation showed a higher diagnostic yield than those under local anesthesia ( p = 0.019). Conclusion: Image-guided percutaneous splenic biopsy is a safe and effective diagnostic procedure with high technical success and diagnostic yield. Analgesic sedation and obtaining up to three biopsy samples may improve diagnostic performance without increasing complication rates.

Image-guided lung biopsies play a key role in diagnosing pulmonary lesions. However, comprehensive safety and efficacy data remain limited. As lung screening expands across Europe, more indeterminate nodules require histologic clarification. This study evaluates technical success, diagnostic yield, and complications based on registry data from the German Society for Interventional Radiology and Minimally Invasive Therapy (DeGIR). A total of 27559 image-guided lung biopsies from 212 centers (2018–2024) were analyzed. Technical success was defined as verified needle placement and diagnostic yield as adequate histological sampling. Complications were classified by the Society of Interventional Radiology (SIR) criteria. Most biopsies (95.9%) were inpatient. Local anesthesia was used in 97.5% of cases. CT guidance was used in 99.4% of cases. Technical success was 97.7%, and the diagnostic yield was 94.3%. Inpatient procedures showed slightly higher technical success rates (97.8% vs. 96.8%, p = 0.032), while the diagnostic yield was similar (94.3% vs. 92.9%, p = 0.063). Overall complications occurred in 19.4% of cases, major complications in 4.9% of cases and mortality in 0.06%. Coagulation disorders increased risk. Image-guided lung biopsies are effective, with high success and diagnostic yield. However, complication rates were substantial, with nearly 20% overall and 5% major events. Careful patient selection and individualized risk stratification are essential to optimize procedural safety.

Although the radiation dose impact of planning scans prior to the actual computed tomography (CT) scan has been addressed in previous studies, their systematic assessment across paediatric age groups and their relevance for establishing local diagnostic reference levels (DRLs) have not been thoroughly investigated and are not currently included in guideline recommendations. To investigate the influence of radiation dose from topogram, pre-monitoring, and monitoring scans by age on total radiation exposure and whether their doses need to be considered in DRLs and to establish local DRLs for these scan components. 102 chest CT scans with contrast material monitoring from 101 children (median age 12 years, interquartile range (IQR) 7–16 years) and 4498 chest CT scans from 4476 adults (⩾18 years) between January 2021 and May 2023 were retrospectively analysed. Paediatric scans were grouped into 5 age groups and compared with adult scans. The dose-length product (DLP) of topogram, pre-monitoring, and monitoring scans were evaluated and their effect on total radiation dose was analysed. Local DRLs were established for 5 different age groups. Radiation dose proportions of planning scans to total DLP in chest CT increased with decreasing age group (mainly p < 0.05), with the monitoring scan having the greatest impact. The median topogram proportion increased from 0.3% (⩾18 years) to 1.6% (<1 year), the pre-monitoring proportion from 0.5% (⩾18 years) to 3.5% (<1 year), and the monitoring proportion from 2.2% (⩾18 years) to 26.9% (<1 year). In children under 10 years, monitoring scans in chest CT have a large impact on radiation dose, contributing a median of 13%–27% of the total radiation dose compared to adults (median: 2.2%). Therefore, these planning scans should be monitored and included in radiation dose optimization efforts such as DRLs.

Purpose: In emergency diagnostics, head CT and CT angiography (CTA) of craniocervical vasculature are indispensable for children, despite their increased radiation sensitivity. This study assesses the radiation dose metrics of head CT and CTA in pediatric patients managed in the trauma resuscitation unit (TRU). Methods: All patients aged 0–<15 years who underwent head CT and CTA in the TRU between April 2020 and August 2023 were included. CT dose index volume (CTDIvol) and dose-length product (DLP) were extracted from the Radimetrics Enterprise Platform, which also provided organ doses estimated via Monte Carlo simulations and effective doses (ED) derived from these estimates. Dose metrics were compared with national diagnostic reference levels (DRLs), defined for three pediatric age groups: I (0–<5 years), II (5–<10 years), and III (10–<15 years). Results: Of 212 pediatric TRU patients, 62.7% (133/212) underwent CT and 72.2% (96/133) received combined CT and CTA. Median CTDIvol and DLP increased with age, whereas ED decreased. For head CT, CTDIvol ranged from 18.9 mGy to 29.4 mGy, DLP from 282 to 460 mGycm, and ED from 1.6 to 1.3 mSv. For CTA, CTDIvol ranged from 1.4 to 2.2 mGy, DLP from 40 to 83 mGycm, and ED from 1.0 to 0.8 mSv. All doses remained below national DRLs. Conclusion: Head CT and CTA in pediatric trauma can be performed with radiation doses well below national DRLs. Careful dose management is important to reduce potential long-term cancer risks and deterministic effects such as lens cataract formation.

Purpose: The aim of the study was to investigate whether the ventriculoperitoneal (VP) shunt valve setting can be reliably assessed using maximum intensity projection (MIP) reconstructions from non-contrast, full-dose head CT scans, and how this method performs in comparison to conventional lateral skull radiographs. Methods: This retrospective study included 41 adult patients (mean age 59 ± 25 years) with Codman Certas programmable VP shunt valves who underwent lateral skull X‑ray and a same-day, non-contrast head CT scan between January and July 2024. From the CT data, MIP reconstructions of the valve region were generated. Three neuroradiologists, blinded to each other’s assessments, independently rated valve settings and image quality using a 5-point Likert scale. Mean reconstruction time was recorded. Radiation dose data were extracted from institutional dose-monitoring software. Results: Valve settings were identifiable in all 44 CT/X-ray image pairs, with 95% agreement between MIP and X-ray readings. MIP reconstructions were successfully generated (median CTDI _vol 35.34 mGy (30.42; 40.32); mean reconstruction time 70 s). Image quality was rated lower for MIP (median 2 [IQR 2]) than for X‑ray (median 4 [IQR 1]; p < 0.001). In 45% of cases scanned with photon-counting CT, MIP quality was significantly higher (median 3 vs. 1; p < 0.001). Inter-reader reliability was good for MIPs (ICC = 0.82) and excellent for X‑rays (ICC = 0.97). Conclusion: MIP reconstructions from non-contrast head CT allow reliable VP shunt valve setting assessment and may reduce the need for additional radiographs, especially when advanced CT systems are used.

Purpose: This study evaluates the technical success, diagnostic yield, and complication rates of image-guided percutaneous renal biopsies based on multicenter registry data from the German Society for Interventional Radiology and Minimally Invasive Therapy. Materials and Methods: This retrospective analysis included 5,235 renal biopsies at 176 centers in Germany, Austria, and Switzerland between 2018 and 2024. Technical success was defined as image-guided confirmed needle placement within the target lesion. Diagnostic yield is defined as proportion of procedures providing adequate samples for clinical diagnosis. Results: CT was used for image guidance in 78.53% followed by ultrasound in 12.32%. Technical success was 98.38% and diagnostic yield 94.92%. Technical success was high in both inpatients (98.33%) and outpatients (99.26%; OR = 0.44, 95%CI 0.11–1,80; p = 0.241). The overall complication rate was 5.04%, with major complications in 0.74%. Complications were more frequent with pathological platelet counts and INR values, but none of these coagulation parameters remained independently associated in multivariable analysis. CT-guided biopsies showed higher complication rates than ultrasound-guided procedures, and this association remained after adjustment (adjusted OR 8.57, 95%CI 3.40–21.58; p < 0.001) . No fatal complications occurred within 24 h; however, three delayed deaths were documented among hospitalized patients. Conclusion: Percutaneous image-guided renal biopsies are effective and safe, with low complication rates and high diagnostic yield. Ultrasound guidance remained independently associated with a lower complication risk, likely reflecting selection bias. Graphical

Tularämie oder umgangssprachlich Hasenpest ist eine seltene, meldepflichtige Zoonose, die durch das Bakterium Francisella tularensis verursacht wird. Die Übertragung erfolgt typischerweise durch direkten oder indirekten Kontakt mit infizierten Wildtieren. In Europa ist die Erkrankung selten, jedoch zeigen die Meldedaten des Robert-Koch-Instituts bis zum Jahr 2021 eine steigende Inzidenz [Robert-Koch-Institut. Infektionsepidemiologisches Jahrbuch meldepflichtiger Krankheiten für 2022; 2024]. Tularämie tritt häufiger in ländlichen Gebieten auf, wo Menschen engeren Kontakt zu Hasen oder anderen Nagetieren haben. Die Symptome sind unspezifisch und umfassen kutane Manifestationen, grippeähnliche Beschwerden, gastrointestinale Symptome bis hin zu fulminanten Krankheitsverläufen [Frischknecht et al. Infection 2019; 47: 683–695]. Die folgende Fallbeschreibung verdeutlicht die differenzialdiagnostischen Herausforderungen der Tularämie in der radiologischen Schnittbildgebung. Received: 26 September 2024 Accepted after revision: 03 February 2025 Article published online: 04 March 2025 © 2025. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany