@phdthesis{KlinnertVlachopoulou2023, author = {Klinnert Vlachopoulou, Cristina Maria}, title = {Comparison between Dual-Energy-CT perfusion imaging and perfusion-weighted SElf-gated Non-Contrast-Enhanced FUnctional MR imaging of the lung in patients with pulmonary artery embolism}, doi = {10.25972/OPUS-31303}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-313034}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2023}, abstract = {Pulmonary artery embolism (PE) is a common condition and an even more common clinical suspect. The computed tomography pulmonary angiogram (CTPA) is the main medical imaging tool used to diagnose a suspected case of PE. To gain a better impression of the effects of a PE on the perfusion and hence the gas exchange, a functional imaging method is beneficial. One approach for functional imaging using radiation exposure is the generation of color-coded iodine perfusion maps acquired by Dual-Energy Computed Tomography (DECT), which enable the detection of perfusion defects in the pulmonary parenchyma. In contrast to the existing approach of DECT with iodine color-coded maps, the SElf-gated Non-Contrast-Enhanced FUnctional Lung (SENCEFUL) MRI technique offers the possibility to interpret perfusion maps without any radiation exposure or application of contrast agents. The measurement in SENCEFUL MRI can be performed during conditions of free breathing and without electrocardiogram triggering. The purpose of this study was to determine whether PE can be diagnosed on the basis of visible perfusion defects in the perfusion maps of SENCEFUL MRI and in the iodine-coded maps of DECT and to compare the diagnostic performance of these methods. Both SENCEFUL-MRI and iodine distribution maps from DECT have been compared with the CTPA of ten patients with PE. Additionally, the functional images were compared with each other on a per-patient basis. The iodine perfusion maps of DECT had a sensitivity of 84.2 \% and specificity of 65.2 \% for the diagnosis of PE. The SENCEFUL technique in MRI showed a sensitivity of 78.9 \% and a specificity of 26.1 \%. When comparing the whole lung depicted in both series of functional images, the main perfusion defect location matched in four of ten patients (40 \%). In conclusion, this work found that DECT iodine maps have higher sensitivity and specificity in the diagnosis of pulmonary embolism compared with SENCEFUL MRI.}, subject = {Lungenembolie}, language = {en} } @phdthesis{Kuesters2018, author = {K{\"u}sters, Franziska}, title = {Charakterisierung persistierend symptomatischer Patienten im Langzeitverlauf nach Lungenembolie}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-156743}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2018}, abstract = {Im Rahmen eines symptom-orientierten Interviews fand sich eine große Anzahl an noch subjektiv belastungsintoleranten Patienten nach einer akuten Lungenembolie. Ein Hauptaugenmerk der Arbeit lag auf der weiteren Differenzierung des funktionellen Outcomes dieser Patienten anhand der objektivierbaren Leistungseinschränkung in der Spiroergometrie und den differentialdiagnostischen Ursachen dieser anhaltenden Beschwerden. So gaben im Follow-Up nach akuter Lungenembolie nach drei Monaten 40\% der Patienten, nach sechs, zwölf und 24 Monaten jeweils {\"u}ber 20\% der Patienten subjektive Belastungsintoleranz an. Neben einer chronisch-thromboembolischen pulmonalen Hypertonie und einer chronisch- thromboembolischen Erkrankung leiden diese Patienten bedingt durch entsprechende Komorbiditäten auch an anderen präkapillären und postkapillären Non-CTEPH-PH-Entitäten sowie kardialer und ventilatorischer Limitierung, was Ausdruck anderer kardiopulmonaler Begleiterkrankungen sein kann. Danach sollte ebenso im Rahmen einer Lungenembolienachsorge gefahndet werden, um nach Diagnosestellung schnellstmöglich eine adäquate, zielgerichtete Therapie einzuleiten. Ein symptom-basiertes Follow-Up Programm basierend auf einem Telefonmonitoring mit Fragebogen gefolgt von weiterf{\"u}hrender klinischer Diagnostik kann helfen Patienten mit einer chronisch-thromboembolischen pulmonalen Hypertonie zu detektieren. Diese Studie hat die Spiroergometrie als wichtige komplementäre diagnostische Methode f{\"u}r eine fr{\"u}hzeitige CTEPH-Diagnose weiter etabliert. Sowohl das Telefonmonitoring als auch die Spiroergometrie zeigten sich effektiv und f{\"u}hrten so zu einer CTEPH-Inzidenz von 5,4\%. Ein solches Follow-Up Programm nach einer Lungenembolie sollte umgesetzt werden, um eine CTEPH fr{\"u}hzeitig zu diagnostizieren. Neben der oben genannten Auswertung des funktionellen Outcomes der noch symptomatischen Patienten liegen weitere Schwerpunkte dieser Arbeit auf der Analyse des zwölf- und 24 Monats-Follow-Up, auf der Risikostratifizierung anhand der Baseline- Parameter aus Echokardiografie und Spiroergometrie sowie dem Mortalitäts-Outcome. So konnten Prädiktoren f{\"u}r eine CTEPH aus den Baseline-Untersuchungen zum Zeitpunkt der akuten Lungenembolie ermittelt werden und die Erhebung der Komorbiditäten bei Einschluss die Risikostratifizierung von CTEPH-Patienten verdeutlichen. Eine Auswertung der oralen Antikoagulationstherapie konnte Hinweise auf das Blutungs- bzw. Rezidivrisiko geben sowie einen Vergleich der herkömmlichen Vitamin-K-Antagonisten mit den neuen oralen Antikoagulantien leisten. Über eine inkomplette Thrombusresolution nach akuter Lungenembolie ohne Symptome zu verursachen wurde berichtet. Nat{\"u}rlich wäre es interessant anhand von quantitativen und qualitativen Daten zu sehen wie viele solch asymptomatischer Patienten mit pathologischem Lungenperfusionsscan eine CTEPH entwickeln. Jedoch ist solch eine umfassende Follow-Up Untersuchung inklusive aller technischer Modalitäten wie Echokardiografie, CT und Ventilations-/Perfusionsscans von allen Patienten mit akuter Lungenembolie zu kostenintensiv und aus strahlenhygienischer Sicht nicht vertretbar. Daher stellt ein auf symptomatische Patienten fokussiertes strukturiertes Nachsorgeprogramm eine ethisch vertretbare und effektive Herangehensweise dar und ein wirksames Konzept um relevante CTEPH-Erkrankungen zu detektieren.}, subject = {Chronisch thromboembolische pulmonale Hypertonie}, language = {de} } @article{BiedererMirsadraeeBeeretal.2012, author = {Biederer, J{\"u}rgen and Mirsadraee, S. and Beer, M. and Molinari, F. and Hintze, C. and Bauman, G. and Both, M. and Van Beek, E. J. R. and Wild, J. and Puderbach, M.}, title = {MRI of the lung (3/3)—current applications and future perspectives}, series = {Insights into Imaging}, volume = {3}, journal = {Insights into Imaging}, number = {4}, doi = {10.1007/s13244-011-0142-z}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-124348}, pages = {373-386}, year = {2012}, abstract = {Background MRI of the lung is recommended in a number of clinical indications. Having a non-radiation alternative is particularly attractive in children and young subjects, or pregnant women. Methods Provided there is sufficient expertise, magnetic resonance imaging (MRI) may be considered as the preferential modality in specific clinical conditions such as cystic fibrosis and acute pulmonary embolism, since additional functional information on respiratory mechanics and regional lung perfusion is provided. In other cases, such as tumours and pneumonia in children, lung MRI may be considered an alternative or adjunct to other modalities with at least similar diagnostic value. Results In interstitial lung disease, the clinical utility of MRI remains to be proven, but it could provide additional information that will be beneficial in research, or at some stage in clinical practice. Customised protocols for chest imaging combine fast breath-hold acquisitions from a "buffet" of sequences. Having introduced details of imaging protocols in previous articles, the aim of this manuscript is to discuss the advantages and limitations of lung MRI in current clinical practice. Conclusion New developments and future perspectives such as motion-compensated imaging with self-navigated sequences or fast Fourier decomposition MRI for non-contrast enhanced ventilation- and perfusion-weighted imaging of the lung are discussed. Main Messages • MRI evolves as a third lung imaging modality, combining morphological and functional information. • It may be considered first choice in cystic fibrosis and pulmonary embolism of young and pregnant patients. • In other cases (tumours, pneumonia in children), it is an alternative or adjunct to X-ray and CT. • In interstitial lung disease, it serves for research, but the clinical value remains to be proven. • New users are advised to make themselves familiar with the particular advantages and limitations.}, language = {en} } @article{HeldHesseGoettetal.2014, author = {Held, Matthias and Hesse, Alexander and G{\"o}tt, Franziska and Holl, Regina and H{\"u}bner, Gudrun and Kolb, Philipp and Langen, Heinz Jakob and Romen, Tobias and Walter, Franziska and Sch{\"a}fers, Hans Joachim and Wilkens, Heinrike and Jany, Berthold}, title = {A symptom-related monitoring program following pulmonary embolism for the early detection of CTEPH: a prospective observational registry study}, series = {BMC Pulmonary Medicine}, volume = {14}, journal = {BMC Pulmonary Medicine}, doi = {10.1186/1471-2466-14-141}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-119281}, pages = {141}, year = {2014}, abstract = {Background Chronic thromboembolic pulmonary hypertension (CTEPH) is a long-term complication following an acute pulmonary embolism (PE). It is frequently diagnosed at advanced stages which is concerning as delayed treatment has important implications for favourable clinical outcome. Performing a follow-up examination of patients diagnosed with acute PE regardless of persisting symptoms and using all available technical procedures would be both cost-intensive and possibly ineffective. Focusing diagnostic procedures therefore on only symptomatic patients may be a practical approach for detecting relevant CTEPH. This study aimed to evaluate if a follow-up program for patients with acute PE based on telephone monitoring of symptoms and further examination of only symptomatic patients could detect CTEPH. In addition, we investigated the role of cardiopulmonary exercise testing (CPET) as a diagnostic tool. Methods In a prospective cohort study all consecutive patients with newly diagnosed PE (n=170, 76 males, 94 females within 26 months) were recruited according to the inclusion and exclusion criteria. Patients were contacted via telephone and asked to answer standardized questions relating to symptoms. At the time of the final analysis 130 patients had been contacted. Symptomatic patients underwent a structured evaluation with echocardiography, CPET and complete work-up for CTEPH. Results 37.7\%, 25.5\% and 29.3\% of the patients reported symptoms after three, six, and twelve months respectively. Subsequent clinical evaluation of these symptomatic patients saw 20.4\%, 11.5\% and 18.8\% of patients at the respective three, six and twelve months time points having an echocardiography suggesting pulmonary hypertension (PH). CTEPH with pathological imaging and a mean pulmonary artery pressure (mPAP) ≥ 25 mm Hg at rest was confirmed in eight subjects. Three subjects with mismatch perfusion defects showed an exercise induced increase of PAP without increasing pulmonary artery occlusion pressure (PAOP). Two subjects with pulmonary hypertension at rest and one with an exercise induced increase of mPAP with normal PAOP showed perfusion defects without echocardiographic signs of PH but a suspicious CPET. Conclusion A follow-up program based on telephone monitoring of symptoms and further structured evaluation of symptomatic subjects can detect patients with CTEPH. CPET may serve as a complementary diagnostic tool.}, language = {en} }