German Radiology Congress 2008

Interventional Radiology

 

International exchange will also be promoted; guests at this year’s congress

will come from France, Korea and Turkey. Asked about recent developments in interventional radiology, Prof. Vorwerk observed that the field is split into two areas: vascular and non-vascular intervention. ‘In the first, there has been particular progress in therapy for vessels of the lower leg. We can now intervene right down to the ankle. Initially, the problem was how to cover the long distance with a catheter, and also the vessels are very thin there. New developments now allow us to treat these indications with a high rate of success and, as the case may be, prevent amputation.

 

‘Developments in neuro-intervention in the invasive therapy for strokes, where we can significantly reduce the severity of an event, are also worth particular mention. There have always been efforts to keep the damaged brain areas as small as possible, which used to be done exclusively with medication – requiring a certain amount of treatment time. Now, we have mechanical procedures, intravascular and angiographic, to reduce a thrombus. Interventional therapy is usually combined with subsequent lysis therapy. Therefore, we can treat a stroke much faster and, as the case may be, more successfully. All in all these innovations in the vascular field are based on the development of new, more stable and thinner materials,’ he concluded. Interventional oncology In the non-vascular field, another topic of interest is interventional oncology, which is also partly carried out through the vessels. ‘In interventional oncology there is no surgery, or systemic chemotherapy to shrink and destroy a tumour. Currently, this therapy is focused on the liver, but increasingly also on the lungs, kidney and adrenal gland. Tumours on these organs are treated with physical media, with access through the skin. What we mean by physical media are particularly heat and cold; both can destroy tumours. We generate heat through microwaves, but primarily through radiofrequency ablation. ‘This treatment can be combined with medical therapy, where small “submarines” take chemotherapeutics to tumour locations, so systemic chemotherapy is not needed, and the effect is exclusively directed at a tumour. We can also treat a tumour radioactively in this way, so that ist routes of supply are interrupted and the carcinoma is destroyed through radiation. This is called SIRT therapy, which is now covered by medical insurers.

 

‘With these procedures it remains to be seen how often they can be used and which kinds of tumour should be treated. Several studies are aiming to find answers to these questions.’ At the congress, the professor said radiologists and vascular surgeons will discuss ways to optimise vascular disease therapies, e.g. by setting up vascular treatment centres. ‘As radiologists we see our main task is in the diagnosis of these diseases and in providing minimally invasive therapy. Surgeons undertake difficult vascular surgery, which is becoming increasingly challenging. Vascular surgery must keep up with the increasing demand, and meet it comprehensively.

The entire field of interventional radiology will remain exciting and the congress offers a forum where the current state of affairs and future developments will be discussed.’

 

Padiatric Radiology

 

 ‘One of the topics will be the fluent transition from paediatric radiology to adult radiology. Due to outstanding medical care, patients with severe and complex congenital diseases now have life expectancies that often go far beyond middle age. This means that adult radiology is confronted with medical issues that differ significantly from the usual issues and diseases in adult radiology,’ explained Prof. Fotter. ‘The first generation of those children who underwent highly complex corrective heart surgery are now of adult age. They currently make up 80% of patients who present with conditions after Fallot’s Tetralogy. Paediatric radiologists therefore do not exclusively care for children and adolescents but also adults, i.e. those with congenital diseases and their secondary complications.

 

‘MRI and CT have become invaluable tools for the follow-up and planning of further corrective surgery, along with ultrasound scanning,’ he pointed out. ‘As paediatric radiology is familiar with pathology, pathophysiology and corrective surgery, by way of its special qualifications it is increasingly assuming responsibility for the imaging requirements of these adult patients.

 

This means that paediatric radiology needs to be partly redefined. The German Radiology Congress will pick up on this issue of changing definitions and responsibilities.’ Asked what technological advances for paediatric radiology are of particular interest, Prof. Fotter said that it is important to point out that paediatric radiology does not define itself via equipment and technology as is often and increasingly happening in adult radiology. ‘Paediatric radiology is defined through the perceived requirements of children and adolescents whose inviolacy is of outstanding importance. New technologies and procedures must be seen as instruments to be used according to requirements. The basis of each use of established or new imaging procedures is optimisation with regards to exposure to radiation and invasiveness. The quality of results must be adapted to the respective medical issue. Ultrasound, MRI, CT and digital imaging procedures are in the foreground of developments. We are at the brink of the clinical introduction of the first 320-slice CTs. The volume acquisition promises significant advantages for the examination

of children and adolescents.

 

The acquisition of large volumes with a single rotation will allow us to achieve outstanding image quality and three-dimensional reconstructions of the highest quality with a lower dose compared with Spiral-CT. ‘In MRI, apart from whole-body MRI, which is due to be combined with diffusion technology, we need to mention MRI of the heart and the large vessels, foetal MRI and MRI of the urinary tract in the newborn, children and adolescents. The latter will replace nuclear medical procedures in the medium term and will make IV urography and CT examinations, for this  purpose, obsolete. We should also mention MRI in children combined with ultrasound procedures, because these provide an almost complete alternative to the invasive DSA [digital subtraction angiography]. However, fMRI to capture addictive behaviour in adolescents with eating disorders, and Advanced MRI for the musculoskeletal system, are also of particular importance. Particular emphasis here is on diffusion- and perfusion imaging for certain diseases such as Perthes disease.’