Objectives The aim was to assess the type, frequency and impact of MRI-related complications in patients with cochlear implants (CI) and MRI indications in different body regions. Methods For that purpose, the institutional radiology database of a single tertiary hospital was searched for patients with a CI who underwent MRI between 2001 and 2018. The number of MRI examinations and complications were retrieved from the patient record. Examinations were categorized into five distinct body regions or combinations thereof. Records of CI artifacts in the head also included basic information on diagnostic image quality. Results Out of 1017 MRI database entries (examinations) of patients with a CI, 91 records were after implantation (71 patients) and 66 were attempted (no contraindications, 49 patients). In four cases (4/66, 6.1%), the magnet was dislocated and had to be replaced surgically. Three out of four severe complications occurred for examination regions outside the head. Thirteen MRI examinations were aborted due to pain (19.7%) and one because of artifacts—resulting in 48 scans (72.7%) completed successfully (36 patients). All cranial scans featured device artifacts in all sequences, but the majority of them did not affect proper imaging diagnostics in the respective region. Conclusion This retrospective, single-center analysis of patients with MRI-conditional cochlear implants shows that MRI-related complications were common, at least in models with a fixed magnet, despite appropriate precautions and compliance with the manufacturers’ guidelines. MRI examinations of CI patients should therefore be indicated strictly until the exact causes have been clarified.

Purpose Comparison of puncture deviation and puncture duration between computed tomography (CT)- and C-arm CT (CACT)-guided puncture performed by residents in training (RiT). Methods In a cohort of 25 RiTs enrolled in a research training program either CT- or CACT-guided puncture was performed on a phantom. Prior to the experiments, the RiT’s level of training, experience playing a musical instrument, video games, and ball sports, and self-assessed manual skills and spatial skills were recorded. Each RiT performed two punctures. The first puncture was performed with a transaxial or single angulated needle path and the second with a single or double angulated needle path. Puncture deviation and puncture duration were compared between the procedures and were correlated with the self-assessments. Results RiTs in both the CT guidance and CACT guidance groups did not differ with respect to radiologic experience (p = 1), angiographic experience (p = 0.415), and number of ultrasound-guided puncture procedures (p = 0.483), CT-guided puncture procedures (p = 0.934), and CACT-guided puncture procedures (p = 0.466). The puncture duration was significantly longer with CT guidance (without navigation tool) than with CACT guidance with navigation software (p < 0.001). There was no significant difference in the puncture duration between the first and second puncture using CT guidance (p = 0.719). However, in the case of CACT, the second puncture was significantly faster (p = 0.006). Puncture deviations were not different between CT-guided and CACT-guided puncture (p = 0.337) and between the first and second puncture of CT-guided and CACT-guided puncture (CT: p = 0.130; CACT: p = 0.391). The self-assessment of manual skills did not correlate with puncture deviation (p = 0.059) and puncture duration (p = 0.158). The self-assessed spatial skills correlated positively with puncture deviation (p = 0.011) but not with puncture duration (p = 0.541). Conclusion The RiTs achieved a puncture deviation that was clinically adequate with respect to their level of training and did not differ between CT-guided and CACT-guided puncture. The puncture duration was shorter when using CACT. CACT guidance with navigation software support has a potentially steeper learning curve. Spatial skills might accelerate the learning of image-guided puncture. Key Points:  Citation Format

Question: A 29-year-old man presented with acute abdominal pain and highly elevated inflammation parameters (leukocytes 59 Gpt/L, C-reactive protein 23.4 mg/dL). He had undergone upper endoscopy one week earlier with a histopathologic diagnosis of gastritis owing to nonsteroidal anti-inflammatory drugs (NSAIDs). An episode of pharyngitis some weeks ago was treated by his general practitioner without antibiotic treatment but with the use of NSAIDs. Meanwhile, the patient had stopped intake of analgesics. Further medical history was unremarkable.The patient immediately underwent magnetic resonance imaging (Figure A) and urgent esophagogastroduodenoscopy (Figure B) including gastric biopsy (Figure C; stain: hematoxylin and eosin; original magnification Â400).What is your diagnosis? See the Gastroenterology web site (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and Images in GI.