TY - JOUR A1 - Wech, Tobias A1 - Ankenbrand, Markus Johannes A1 - Bley, Thorsten Alexander A1 - Heidenreich, Julius Frederik T1 - A data-driven semantic segmentation model for direct cardiac functional analysis based on undersampled radial MR cine series JF - Magnetic Resonance in Medicine N2 - Purpose Image acquisition and subsequent manual analysis of cardiac cine MRI is time-consuming. The purpose of this study was to train and evaluate a 3D artificial neural network for semantic segmentation of radially undersampled cardiac MRI to accelerate both scan time and postprocessing. Methods A database of Cartesian short-axis MR images of the heart (148,500 images, 484 examinations) was assembled from an openly accessible database and radial undersampling was simulated. A 3D U-Net architecture was pretrained for segmentation of undersampled spatiotemporal cine MRI. Transfer learning was then performed using samples from a second database, comprising 108 non-Cartesian radial cine series of the midventricular myocardium to optimize the performance for authentic data. The performance was evaluated for different levels of undersampling by the Dice similarity coefficient (DSC) with respect to reference labels, as well as by deriving ventricular volumes and myocardial masses. Results Without transfer learning, the pretrained model performed moderately on true radial data [maximum number of projections tested, P = 196; DSC = 0.87 (left ventricle), DSC = 0.76 (myocardium), and DSC =0.64 (right ventricle)]. After transfer learning with authentic data, the predictions achieved human level even for high undersampling rates (P = 33, DSC = 0.95, 0.87, and 0.93) without significant difference compared with segmentations derived from fully sampled data. Conclusion A 3D U-Net architecture can be used for semantic segmentation of radially undersampled cine acquisitions, achieving a performance comparable with human experts in fully sampled data. This approach can jointly accelerate time-consuming cine image acquisition and cumbersome manual image analysis. KW - undersampling KW - cardiovascular magnetic resonance (CMR) KW - deep learning KW - radial KW - semantic segmentation Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-257616 VL - 87 IS - 2 ER - TY - JOUR A1 - Grunz, Jan-Peter A1 - Pennig, Lenhard A1 - Fieber, Tabea A1 - Gietzen, Carsten Herbert A1 - Heidenreich, Julius Frederik A1 - Huflage, Henner A1 - Gruschwitz, Philipp A1 - Kuhl, Philipp Josef A1 - Petritsch, Bernhard A1 - Kosmala, Aleksander A1 - Bley, Thorsten Alexander A1 - Gassenmaier, Tobias T1 - Twin robotic x-ray system in small bone and joint trauma: Impact of cone-beam computed tomography on treatment decisions JF - European Radiology N2 - Objectives Trauma evaluation of extremities can be challenging in conventional radiography. A multi-use x-ray system with cone-beam CT (CBCT) option facilitates ancillary 3-D imaging without repositioning. We assessed the clinical value of CBCT scans by analyzing the influence of additional findings on therapy. Methods Ninety-two patients underwent radiography and subsequent CBCT imaging with the twin robotic scanner (76 wrist/hand/finger and 16 ankle/foot/toe trauma scans). Reports by on-call radiologists before and after CBCT were compared regarding fracture detection, joint affliction, comminuted injuries, and diagnostic confidence. An orthopedic surgeon recommended therapy based on reported findings. Surgical reports (N = 52) and clinical follow-up (N = 85) were used as reference standard. Results CBCT detected more fractures (83/64 of 85), joint involvements (69/53 of 71), and multi-fragment situations (68/50 of 70) than radiography (all p < 0.001). Six fractures suspected in radiographs were ruled out by CBCT. Treatment changes based on additional information from CBCT were recommended in 29 patients (31.5%). While agreement between advised therapy before CBCT and actual treatment was moderate (κ = 0.41 [95% confidence interval 0.35–0.47]; p < 0.001), agreement after CBCT was almost perfect (κ = 0.88 [0.83–0.93]; p < 0.001). Diagnostic confidence increased considerably for CBCT studies (p < 0.001). Median effective dose for CBCT was 4.3 μSv [3.3–5.3 μSv] compared to 0.2 μSv [0.1–0.2 μSv] for radiography. Conclusions CBCT provides advantages for the evaluation of acute small bone and joint trauma by detecting and excluding extremity fractures and fracture-related findings more reliably than radiographs. Additional findings induced therapy change in one third of patients, suggesting substantial clinical impact. KW - cone-beamcomputed tomography KW - extremities KW - fractures, bone KW - radiography Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-235233 SN - 0938-7994 VL - 31 ER - TY - THES A1 - Heidenreich, Julius Frederik T1 - Characterization of the widely used Rac1-inhibitors NSC23766 and EHT1864 in mouse platelets T1 - Untersuchung der Rac1-Inhibitoren NSC23766 und EHT1864 in murinen Thrombozyten N2 - Platelet activation and aggregation at sites of vascular injury is critical to prevent excessive blood loss, but may also lead to life-threatening ischemic diseases, such as myocardial infarction and stroke. Extracellular agonists induce platelet activation by stimulation of platelet membrane receptors. Signal transduction results in reorganization of the cytoskeleton, shape change, platelet adhesion and aggregation, cumulating in thrombus formation. Several Rho GTPases, including Rac1, Cdc42 and RhoA, are essential mediators of subsequent intracellular transduction of ITAM- and GPCR-signaling. Therefore, inhibition or knockout can result in severely defective platelet signaling. Mice with platelet specific Rac1-deficiency are protected from arterial thrombosis. This benefit highlights further investigation of Rac1-specific functions and its potential as a new pharmacological target for prevention of cardiovascular diseases. Two newly developed synthetic compounds, NSC23766 and EHT1864, were proposed to provide highly specific inhibition of Rac1 activity, but both drugs have never been tested in Rac1-deficient cell systems to rule out potential Rac1-independent effects. This study revealed significant off-target effects of NSC23766 and EHT1864 that occurred in a dose-dependent fashion in both wild-type and Rac1-deficient platelets. Both inhibitors individually affected resting platelets after treatment, either by altering membrane protein expression (NSC23766) or by a marked decrease of platelet viability (EHT1864). Platelet apoptosis could be confirmed by enhanced levels of phosphatidylserine exposure and decreased mitochondrial membrane potential. Phosphorylation studies of the major effector proteins of Rac1 revealed that NSC23766 and EHT1864 abolish PAK1/PAK2 activation independently of Rac1 in wild-type and knockout platelets, which may contribute to the observed off-target effects. Additionally, this study demonstrated the involvement of Rac1 in G protein-coupled receptor-mediated platelet activation and GPIb-induced signaling. Furthermore, the data revealed that Rac1 is dispensable in the process of integrin IIb 3-mediated clot retraction. This study unveiled that new pharmacological approaches in antithrombotic therapy with Rac1 as molecular target have to be designed carefully in order to obtain high specificity and minimize potential off-target effects. N2 - Die Aktivierung und Aggregation von Thrombozyten nach Gefäßverletzungen ist entscheidend um starken Blutverlust zu vermeiden. Allerdings können diese Prozesse auch zu lebensbedrohlichen ischämischen Erkrankungen führen, wie beispielsweise Myokardinfarkt und Schlaganfall. Die Stimulation der Membranrezeptoren durch Triggersubstanzen leitet die Thrombozytenaktivierung und somit die Reorganisation des Zytoskeletts ein. Dies ermöglicht die Adhäsion und Aggregation der Thrombozyten und führt letztendlich zur Thrombusbildung. Die Rho GTPasen Rac1, Cdc42 und RhoA sind als wichtige Mediatoren an der intrazellulären Signaltransduktion beteiligt. Eine medikamentöse Hemmung oder ein genetischer Knockout kann daher die intrazellulären Signalkaskaden so stark beeinträchtigen, dass eine effiziente Aktivierung der Thrombozyten nicht mehr möglich ist. In Mäusen mit thrombozytenspezifischem Knockout von Rac1 wurde festgestellt, dass der Funktionsverlust von Rac1 gleichzeitig auch Schutz vor der Entwicklung von arterieller Thrombose bedeutet. Könnte man sich diese Tatsache pharmakologisch zunutze machen, würde die Hemmung von Rac1 möglicherweise einen neuen, erfolgsversprechenden Ansatz in der Prävention von kardiovaskulären Erkrankungen darstellen. Für den Forschungseinsatz wurden die zwei synthetischen Inhibitoren NSC23766 und EHT1864 entwickelt um Rac1-vermittelte Funktionen zu studieren. Beide Substanzen versprechen eine hochspezifische Hemmung der Rac(1)-Aktivität, wurden bisher jedoch nicht in Zellsystemen mit Rac1-Defizienz verwendet um die Substanzen kritisch auf mögliche, unerwünschte Nebenwirkungen zu untersuchen. In dieser Dissertation wurde gezeigt, dass NSC23766 und EHT1864 zwar effektive Hemmstoffe für Rac1 sind, allerdings genauso Rac1-unabhängige Nebenwirkungen verursachen. Beide Hemmstoffe führten zu Veränderungen der Thrombozyten: Während unter NSC23766 eine verminderte Expression von Membranrezeptoren beobachtet wurde, führte EHT1864 zu einer stark beeinträchtigten Vitalität der Thrombozyten. Anhand von erhöhten Phosphatidylserin-Werten und einer Veränderung des mitochondrialen Membranpotenzials in den behandelten Thrombozyten konnte die EHT1864-vermittelte Apoptose nachgewiesen werden. Letztendlich wurde anhand der verminderten Phosphorylierung von PAK1/PAK2 gezeigt, dass die Aktivierung dieser Rac1-Effektorproteine durch NSC23766 und EHT1864 direkt unterdrückt wird. Zusätzlich zu den Inhibitor-vermittelten Effekten wurde anhand von Rac1-defizienten Thrombozyten nachgewiesen, dass Rac1 auch an GPCR- und GPIb-vermittelten Signalkaskaden beteiligt ist. Außerdem wurde beobachtet, dass Rac1 für die Integrin IIb 3-vermittelte clot retraction entbehrlich ist. Die Ergebnisse dieser Studie legen dar, dass neue pharmakologische Substanzen für die antithrombotische Therapie mit Rac1 als Zielmolekül gründlich erforscht und hinterfragt werden müssen um die Spezifität zu maximieren und vor allem das Nebenwirkungsprofil zu minimieren. KW - Thrombozyt KW - Thrombose KW - Signaltransduktion KW - Enzyminhibitor KW - Rho-Proteine KW - mouse platelets KW - rac1 inhibitors Y1 - 2018 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-165453 ER -