Zusammenfassung: Hintergrund Der Ultraschall der Bewegungsorgane findet breite Anwendung in der Diagnostik von Pathologien und in der Intervention. Die frühe Implementierung von Ultraschallkursen in das medizinische Curriculum könnte zu einer besseren medizinischen Versorgung führen. Die Sonografie wird häufig mit der „See one, do one“-Methode angeleitet, obgleich unklar bleibt, ob dies die beste Herangehensweise darstellt. Die vorliegende Arbeit untersucht, ob die 4-Schritt-Methode nach Peyton konventionellen Lehrstrategien in der Vermittlung des muskuloskelettalen Ultraschalls durch Peer-Dozierende überlegen ist und wie die Technik von den Studierenden beurteilt wird. Material und Methoden Insgesamt absolvierten 491 Studierende (342 Frauen, 149 Männer) eine curriculare Lehrveranstaltung zum Thema Gelenksonografie. Ausgesuchte Schnitte an Knie und Schulter wurden randomisiert auf konventionelle Weise und nach der 4-Schritt-Methode nach Peyton von speziell geschulten Peer-Dozierenden unterrichtet. Die erlernten Fertigkeiten wurden in einer Objective structured practical Examination (OSPE) geprüft. Beurteilt wurde die benötigte Zeit zum Einstellen der Schnitte, die technische Durchführung und die Bildqualität. Die Studierenden wurden gebeten, den Kurs zu evaluieren. Ergebnisse Bezüglich der praktischen Ausführung und der Qualität der Schnittbilder zeigten sich die beiden Lehrmethoden sowohl für die Schulter- als auch für die Kniegelenksonografie als ebenbürtig. Der Vergleich der Lehrinhalte (Knie vs. Schulter) hatte signifikante Differenzen bezüglich der Bildauswertung (Knie 6,5 ± 1,7 Punkte, Schulter 6,0 ± 1,9 Punkte; p < 0,001), der benötigten Zeit (Knie 36 ± 21 s, Schulter 43 ± 20 s; p < 0,001) und des Erreichens der Bestehensgrenze von 60% (Knie: 73% der Studierenden, Schulter: 61% der Studierenden; p < 0,001) gezeigt. Unabhängig von der Lehrmethode bewerteten die Studierenden die Peer-Dozierenden als kompetent und befanden die Inhalte als adäquat für den Unterricht durch Gleichgestellte. Über 70% der Studierenden hatten Spaß an den Kursstunden. Sowohl der Knie- als auch der Schultergelenkkurs wurden im Mittel mit über 8 von 10 Punkten bewertet. Schlussfolgerung Für die Vermittlung von Grundkenntnissen der Gelenksonografie sind die konventionelle Methode und die 4-Schritt-Methode nach Peyton ebenbürtig. Die Durchführung des Unterrichts durch Peer-Dozierende wird positiv bewertet und findet hohe Akzeptanz bei den Studierenden. Unterschieden im Schwierigkeitsgrad und der Komplexität der Lehrinhalte ist in künftigen Kursen Rechnung zu tragen.

The aim of this study was to identify prognostic factors affecting intrahepatic progression-free survival (ihPFS) and overall survival (OS) in patients with colorectal cancer liver metastases (CRCLM) undergoing portal vein embolization (PVE) and subsequent (extended) right hemihepatectomy. A total of 59 patients (mean age: 60.8 ± 9.3 years) with CRCLM who underwent PVE in preparation for right hemihepatectomy were included. IhPFS and OS after PVE were calculated using the Kaplan–Meier method. Cox regression analyses were conducted to investigate the association between the following factors and survival: patient age, laterality of the colorectal cancer (right- versus left-sided), tumor location (colon versus rectal cancer), time of occurrence of hepatic metastases (synchronous versus metachronous), baseline number and size of hepatic metastases, presence or absence of metastases in the future liver remnant (FLR) before PVE, preoperative carcinoembryogenic antigen (CEA) levels, time between PVE and surgery, history of neoadjuvant or adjuvant chemotherapy, and the presence or absence of extrahepatic disease before PVE. Median follow up was 18 months. The median ihPFS was 8.2 months (95% confidence interval: 6.2–10.2 months), and median OS was 34.1 months (95% confidence interval: 27.3–40.9 months). Laterality of the primary colorectal cancer was the only statistically significant predictor of ihPFS after PVE (hazard ratio (HR) = 2.242; 95% confidence interval: 1.125, 4.465; p = 0.022), with patients with right-sided colorectal cancer having significantly shorter median ihPFS than patients with left-sided cancer (4.0 ± 1.9 months versus 10.2 ± 1.5 months; log rank test: p = 0.018). Other factors, in particular also the presence or absence of additional metastases in the FLR, were not associated with intrahepatic progression-free survival. The presence of extrahepatic disease was associated with worse OS (HR = 3.050, 95% confidence interval: 1.247, 7.459; p = 0.015).

Purpose: To examine the safety and short-term oncologic outcomes of computer-tomography-guided (CT-guided) irreversible electroporation (IRE) of recurrent, irresectable colorectal liver metastases (CRLM) after major hepatectomy deemed unsuitable for thermal ablation. Patients and Methods: Twenty-three patients undergoing CT-guided IRE of recurrent CRLM after major hepatectomy were included in this study. All tumors were located adjacent to sole remaining intrahepatic blood vessels and bile ducts, precluding thermal ablation. Patients underwent systematic clinical and imaging follow-up, including magnetic resonance imaging of the liver at 1-month and 3-month intervals thereafter. Time to local and intrahepatic tumor progression within 12 and 36 months and associated risk factors were assessed using Kaplan Meier and Cox regression analysis, respectively. Results: Complete ablation with a safety margin of at least 0.5 cm was achieved in 22/23 (95.6%) patients. No vessel injury or thrombosis occurred. Five patients developed moderate biliary stenosis after a median of 4 weeks, without requiring treatment. Local tumor-progression-free rates within 12/36 months were 64%/57.4%, respectively. Intrahepatic-progression-free rate within 12/36 months was 36.4%/19.5%, respectively. Five (23%) patients were tumor-free at the end of follow-up. Multivariate Cox regression analysis did not show any association between local tumor-progression-free rates and patient age, target tumor size, primary tumor side or synchronicity of liver metastases. Conclusion: In this highly selected patient population with local recurrences of CRLM after major surgery, IRE was shown to be a safe salvage treatment option when thermal ablation is unsuitable.

The aim of this study was to correlate the pre-procedural magnetic-resonance-imaging-based hepatic fat fraction (hFF) with the degree of hypertrophy after portal vein embolization (PVE) in patients with colorectal cancer liver metastases (CRCLM). Between 2011 November and 2020 February, 68 patients with CRCLM underwent magnetic resonance imaging (MRI; 1.5 Tesla) of the liver before PVE. Using T1w chemical shift imaging (DUAL FFE), the patients were categorized as having a normal (5%) hFF. The correlation of hFF, age, gender, initial tumor mass, history of chemotherapy, degree of liver hypertrophy, and kinetic growth rate after PVE was investigated using multiple regression analysis and Spearman’s test. A normal hFF was found in 43/68 patients (63%), whereas 25/68 (37%) patients had an elevated hFF. The mean hypertrophy and kinetic growth rates in patients with normal vs. elevated hFF were 24 ± 31% vs. 28 ± 36% and 9 ± 9 % vs. 8 ± 10% (p > 0.05), respectively. Spearman’s test showed no correlation between hFF and the degree of hypertrophy (R = −0.04). Multivariable analysis showed no correlation between hFF, history of chemotherapy, age, baseline tumor burden, or laterality of primary colorectal cancer, and only a poor inverse correlation between age and kinetic growth rate after PVE. An elevated hFF in a pre-procedural MRI does not correlate with the hypertrophy rate after PVE and should therefore not be used as a contraindication to the procedure in patients with CRCLM.