Orbital masses include a broad spectrum of benign and malignant entities. Often these masses are asymptomatic or show a slow growth rate, so that emergence of clinical symptoms is prolonged. In this context, cross-sectional imaging plays an elementary role in the characterization of these lesions. Aside from the characterization of the underlying entity, an evaluation of the involved compartments is possible by sufficient imaging, which also facilitates optimal treatment and surgery planning. The purpose of this review is to explore different benign and malignant orbital tumors and their typical appearance in imaging together with histopathologic findings.

The imaging evaluation of computed tomography (CT), CT angiography (CTA), and CT perfusion (CTP) is of crucial importance in the setting of each emergency department for suspected cerebrovascular impairment. A fast and clear assignment of characteristic imaging findings of acute stroke and its differential diagnoses is essential for every radiologist. Different entities can mimic clinical signs of an acute stroke, thus the knowledge and fast identification of stroke mimics is important. A fast and clear assignment is necessary for a correct diagnosis and a rapid initiation of appropriate therapy. This pictorial review describes the most common imaging findings in CTP with clinical signs for acute stroke or other acute neurological disorders. The knowledge of these pictograms is therefore essential and should also be addressed in training and further education of radiologists.

The growth of adipose tissue and its vasculature are tightly associated. Angiogenic factors have been linked to obesity, yet little is known about their expression during early childhood. To identify associations of angiogenic factors with characteristics on individual and tissue level, subcutaneous white adipose tissue samples were taken from 45 children aged 0–9 years undergoing elective surgery. We measured the expression of vascular endothelial growth factor A (VEFGA), fibroblast growth factor 1 and 2 (FGF1, FGF2), angiopoietin 1 and 2 (ANGPT1, ANGPT2), TEK receptor tyrosine kinase (TEK), and von Willebrand factor (VWF). In addition, we determined the mean adipocyte size in histologic tissue sections. We found positive correlations of age with FGF1 and FGF2 and a negative correlation with ANGPT2, with pronounced differences in the first two years of life. FGF1, FGF2, and ANGPT1 correlated positively with adipocyte size. Furthermore, we identified a correlation of ANGPT1 and TEK with body mass index-standard deviation score (BMI-SDS), a measure to define childhood obesity. Except for ANGPT2, all angiogenic factors correlated positively with the endothelial marker VWF. In sum, our findings suggest that differences related to BMI-SDS begin early in childhood, and the analyzed angiogenic factors possess distinct roles in adipose tissue biology.

Due to the increasing use of cross-sectional imaging techniques and new technical possibilities, the number of incidentally detected cystic lesions of the pancreas is rapidly increasing in everyday radiological routines. Precise and rapid classification, including targeted therapeutic considerations, is of essential importance. The new European guideline should also support this. This review article provides information on the spectrum of cystic pancreatic lesions, their appearance, and a comparison of morphologic and histologic characteristics. This is done in the context of current literature and clinical value. The recommendations of the European guidelines include statements on conservative management as well as relative and absolute indications for surgery in cystic lesions of the pancreas. The guidelines suggest surgical resection for mucinous cystic neoplasm (MCN) ≥ 40 mm; furthermore, for symptomatic MCN or imaging signs of malignancy, this is recommended independent of its size (grade IB recommendation). For main duct IPMNs (intraductal papillary mucinous neoplasms), surgical therapy is always recommended; for branch duct IPMNs, a number of different risk criteria are applicable to evaluate absolute or relative indications for surgery. Based on imaging characteristics of the most common cystic pancreatic lesions, a precise diagnostic classification of the tumor, as well as guidance for further treatment, is possible through radiology.

Background: Assessment of inflammatory activity in Crohn’s disease (CD) remains challenging. Bowel wall vascularization is an established marker of transmural inflammation and is typically evaluated using semiquantitative ultrasound scoring systems. In contrast, quantitative vascularization analysis is not yet widely used in clinical practice. To compare these approaches, this study evaluated semiquantitative and quantitative methods in the same patient cohort. Methods: This prospective single-center study included 50 patients with CD and sonographically detectable bowel wall thickening. Bowel wall vascularization was assessed using power Doppler (PD), color-coded superb microvascular imaging (cSMI) and monochrome mode superb microvascular imaging (mSMI). Video sequences were independently evaluated by three blinded readers using the Limberg classification. Quantitative vascularization was assessed using a vendor-derived vascular index and retrospective ImageJ analysis. Crohn’s Disease Activity Index (CDAI) and laboratory parameters were documented. Results: Interobserver agreement differed between imaging modalities. Krippendorff’s α values were 0.735 (PD), 0.655 (cSMI) and 0.527 (mSMI), indicating higher reliability for PD than for the SMI techniques. According to Fleiss’ κ (0.480 (PD), 0.376 (cSMI) and 0.367 (mSMI)), agreement was moderate for PD and fair for both SMI techniques. Complete concordance among all three readers was observed in 24 (PD), 18 (cSMI), and 22 (mSMI) patients, respectively. SMI-based techniques consistently resulted in higher Limberg grades compared to PD. Exploratory analyses showed strong correlations between different quantitative vascularization parameters (ρ up to 0.898, p < 0.001), but only moderate correlations with fecal calprotectin (FC) (ρ up to 0.389 with p = 0.017). Significant negative correlations were observed between vascular indices and body mass index (BMI) and skin-to-bowel distance (ρ up to −0.614, p < 0.001). The same trend was observed in the semiquantitative Limberg classification. Conclusions: Semiquantitative assessment of bowel wall vascularization seems to be limited by interobserver variability and Doppler technique, with SMI yielding higher Limberg grades than conventional Doppler. Standardized quantitative approaches may improve objectivity, but their reproducibility requires further validation. Patient-related factors should be considered when interpreting vascularization findings.

Das abdominelle Kompartmentsyndrom ist definiert als eine intraabdominelle Druckerhöhung über 20 mmHg (Normaldruck 5 mmHg) (Engelhardt M. Unfallchirurg 2001; 104: 99–100). Unterschieden werden können dabei primäre abdominelle Kompartmentsyndrome durch ein akutes Krankheitsgeschehen (z. B. Ileus, abdominelle Blutung, Pankreatitis, Bauchtraumata) von sekundären Ursachen nach iatrogener Bauchdeckeneröffnung und Wiederverschließung (Engelhardt M. Unfallchirurg 2001; 104: 99–100, Bouveresse S et al. Eur Radiol 2019; 29: 3839–3846). Durch die Druckerhöhung können abdominelle Blutgefäße komprimiert und dadurch die Organdurchblutung von Abdominalorganen eingeschränkt oder gar komplett aufgehoben werden; besonders anfällig dafür sind die Nieren mit Zeichen der Oligurie und die intestinalen Darmstrukturen mit Zeichen der mesenterialen Ischämie. In der Regel ist eine rasche chirurgische Therapiezuführung mit druckentlastender Laparotomie erforderlich. Bei protrahierter Diagnose bzw. Therapie können die Folgen für den Patienten schwerwiegend oder tödlich sein. Publication Date: 03 September 2020 (online) © Georg Thieme Verlag KG Stuttgart · New York