TY - THES A1 - Klinnert Vlachopoulou, Cristina Maria T1 - 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 T1 - Vergleich zwischen Perfusionskarten der Lunge des DECT und "SElf-gated Non-Contrast-Enhanced Functional” MRT bei Patienten mit einer Lungenembolie N2 - 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. N2 - Die Lungenembolie (LE) ist eine häufige Erkrankung und eine noch häufigere Verdachtsdiagnose. Die Computertomographie der Pulmonalarterien (CTPA) ist die Bildgebung erster Wahl für die Diagnose einer LE. Für eine bessere Darstellung der Folgen einer LE dienen Perfusionskarten. Eine existierende Bildgebungstechnik mit ionisierender Strahlung sind die Iodkarten der Dual-Energy-Computertomographie (DECT), welche bei einer LE Perfusionsdefekte im Lungenparenchym wiedergeben. Eine weitere strahlungsfreie und kontrastmittelfreie Methode ist die „SElf-gated Non-Contrast-Enhanced FUnctional Lung” (SENCEFUL) Magnet-Resonanz-Tomographie (MRT). Diese Technik kann ohne Atemhaltemanöver und ohne EKG-Monitoring stattfinden. Ziel der Arbeit war es zu bestimmen, ob eine LE aufgrund eines Perfusionsdefekts in den Iodkarten des DECT und SENCEFUL MRT diagnostiziert werden kann. Beide Bildgebungstechniken wurden mit der CTPA von zehn Patienten mit LE verglichen. Außerdem wurden die Perfusionsbilder untereinander verglichen. Die Iodkarten hatten eine Sensitivität von 84.2 % und eine Spezifizität von 65.2 %. Die SENCEFUL MRT Bilder zeigten eine Sensitivität von 78.9 % und eine Spezifizität von 26.1 %. Der Vergleich beider funktioneller Bildgebungstechniken bezogen auf die gesamte Lunge ergab, dass in vier von zehn Patienten die prädominierende Lokalisation der Minderperfusion übereinstimmte. Zusammenfassend konnte in dieser Arbeit festgestellt werden, dass die Iodkarten des DECTs im Vergleich zum SENCEFUL MRT eine höhere Sensitivität und Spezifizität in der Diagnose einer Lungenembolie aufweisen. KW - Lungenembolie KW - pulmonary embolism KW - perfusion map Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-313034 ER - TY - JOUR A1 - Thurner, Annette A1 - Augustin, Anne Marie A1 - Bley, Thorsten Alexander A1 - Kickuth, Ralph T1 - 2D-perfusion angiography for intra-procedural endovascular treatment response assessment in chronic mesenteric ischemia: a feasibility study JF - BMC Medical Imaging N2 - Background Endovascular revascularization has become the first-line treatment of chronic mesenteric ischemia (CMI). The qualitative visual analysis of digital subtraction angiography (DSA) is dependent on observer experience and prone to interpretation errors. We evaluate the feasibility of 2D-Perfusion Angiography (2D-PA) for objective, quantitative treatment response assessment in CMI. Methods 49 revascularizations in 39 patients with imaging based evidence of mesenteric vascular occlusive disease and clinical signs of CMI were included in this retrospective study. To assess perfusion changes by 2D-PA, DSA-series were post-processed using a dedicated, commercially available software. Regions of interest (ROI) were placed in the pre- and post-stenotic artery segment. In aorto-ostial disease, the inflow ROI was positioned at the mesenteric artery orifice. The ratios outflow to inflow ROI for peak density (PD), time to peak and area-under-the-curve (AUC) were computed and compared pre- and post-interventionally. We graded motion artifacts by means of a four-point scale. Feasibility of 2D-PA and changes of flow parameters were evaluated. Results Motion artifacts due to a mobile vessel location beneath the diaphragm or within the mesenteric root, branch vessel superimposition and inadequate contrast enhancement at the inflow ROI during manually conducted DSA-series via selective catheters owing to steep vessel angulation, necessitated exclusion of 26 measurements from quantitative flow evaluation. The feasibility rate was 47%. In 23 technically feasible assessments, PD\(_{outflow}\)/PD\(_{inflow}\) increased by 65% (p < 0.001) and AUC\(_{outflow}\)/AUC\(_{inflow}\) increased by 85% (p < 0.001). The time to peak density values in the outflow ROI accelerated only minimally without reaching statistical significance. Age, BMI, target vessel (celiac trunk, SMA or IMA), stenosis location (ostial or truncal), calcification severity, plaque composition or the presence of a complex stenosis did not reach statistical significance in their distribution among the feasible and non-feasible group (p > 0.05). Conclusions Compared to other vascular territories and indications, the feasibility of 2D-PA in mesenteric revascularization for CMI was limited. Unfavorable anatomic conditions contributed to a high rate of inconclusive 2D-PA results. KW - 2D-perfusion angiography KW - chronic mesenteric ischemia KW - endovascular treatment KW - mesenteric stenting Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-301131 VL - 22 ER - TY - JOUR A1 - Traub, Jan A1 - Grondey, Katja A1 - Gassenmaier, Tobias A1 - Schmitt, Dominik A1 - Fette, Georg A1 - Frantz, Stefan A1 - Boivin-Jahns, Valérie A1 - Jahns, Roland A1 - Störk, Stefan A1 - Stoll, Guido A1 - Reiter, Theresa A1 - Hofmann, Ulrich A1 - Weber, Martin S. A1 - Frey, Anna T1 - Sustained increase in serum glial fibrillary acidic protein after first ST-elevation myocardial infarction JF - International Journal of Molecular Sciences N2 - Acute ischemic cardiac injury predisposes one to cognitive impairment, dementia, and depression. Pathophysiologically, recent positron emission tomography data suggest astroglial activation after experimental myocardial infarction (MI). We analyzed peripheral surrogate markers of glial (and neuronal) damage serially within 12 months after the first ST-elevation MI (STEMI). Serum levels of glial fibrillary acidic protein (GFAP) and neurofilament light chain (NfL) were quantified using ultra-sensitive molecular immunoassays. Sufficient biomaterial was available from 45 STEMI patients (aged 28 to 78 years, median 56 years, 11% female). The median (quartiles) of GFAP was 63.8 (47.0, 89.9) pg/mL and of NfL 10.6 (7.2, 14.8) pg/mL at study entry 0–4 days after STEMI. GFAP after STEMI increased in the first 3 months, with a median change of +7.8 (0.4, 19.4) pg/mL (p = 0.007). It remained elevated without further relevant increases after 6 months (+11.7 (0.6, 23.5) pg/mL; p = 0.015), and 12 months (+10.3 (1.5, 22.7) pg/mL; p = 0.010) compared to the baseline. Larger relative infarction size was associated with a higher increase in GFAP (ρ = 0.41; p = 0.009). In contrast, NfL remained unaltered in the course of one year. Our findings support the idea of central nervous system involvement after MI, with GFAP as a potential peripheral biomarker of chronic glial damage as one pathophysiologic pathway. KW - myocardial infarction KW - STEMI KW - glial fibrillary acidic protein KW - GFAP KW - neurofilament light chain KW - NfL KW - glial damage KW - cardiac magnetic resonance imaging KW - MRI KW - infarction size Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-288261 SN - 1422-0067 VL - 23 IS - 18 ER - TY - JOUR A1 - Woznicki, Piotr A1 - Laqua, Fabian A1 - Bley, Thorsten A1 - Baeßler, Bettina T1 - AutoRadiomics: a framework for reproducible radiomics research JF - Frontiers in Radiology N2 - Purpose Machine learning based on radiomics features has seen huge success in a variety of clinical applications. However, the need for standardization and reproducibility has been increasingly recognized as a necessary step for future clinical translation. We developed a novel, intuitive open-source framework to facilitate all data analysis steps of a radiomics workflow in an easy and reproducible manner and evaluated it by reproducing classification results in eight available open-source datasets from different clinical entities. Methods The framework performs image preprocessing, feature extraction, feature selection, modeling, and model evaluation, and can automatically choose the optimal parameters for a given task. All analysis steps can be reproduced with a web application, which offers an interactive user interface and does not require programming skills. We evaluated our method in seven different clinical applications using eight public datasets: six datasets from the recently published WORC database, and two prostate MRI datasets—Prostate MRI and Ultrasound With Pathology and Coordinates of Tracked Biopsy (Prostate-UCLA) and PROSTATEx. Results In the analyzed datasets, AutoRadiomics successfully created and optimized models using radiomics features. For WORC datasets, we achieved AUCs ranging from 0.56 for lung melanoma metastases detection to 0.93 for liposarcoma detection and thereby managed to replicate the previously reported results. No significant overfitting between training and test sets was observed. For the prostate cancer detection task, results were better in the PROSTATEx dataset (AUC = 0.73 for prostate and 0.72 for lesion mask) than in the Prostate-UCLA dataset (AUC 0.61 for prostate and 0.65 for lesion mask), with external validation results varying from AUC = 0.51 to AUC = 0.77. Conclusion AutoRadiomics is a robust tool for radiomic studies, which can be used as a comprehensive solution, one of the analysis steps, or an exploratory tool. Its wide applicability was confirmed by the results obtained in the diverse analyzed datasets. The framework, as well as code for this analysis, are publicly available under https://github.com/pwoznicki/AutoRadiomics. KW - radiomics KW - radiology KW - machine learning KW - reproducibility KW - workflow KW - image analysis Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-284813 SN - 2673-8740 VL - 2 ER - TY - JOUR A1 - Herzberg, Moriz A1 - Dorn, Franziska A1 - Trumm, Christoph A1 - Kellert, Lars A1 - Tiedt, Steffen A1 - Feil, Katharina A1 - Küpper, Clemens A1 - Wollenweber, Frank A1 - Liebig, Thomas A1 - Zimmermann, Hanna T1 - Middle cerebral artery M2 thrombectomy: safety and technical considerations in the German Stroke Registry (GSR) JF - Journal of Clinical Medicine N2 - There is ongoing debate concerning the safety and efficacy of various mechanical thrombectomy (MT) approaches for M2 occlusions. We compared these for MT in M2 versus M1 occlusions. Subgroup analyses of different technical approaches within the M2 MT cohort were also performed. Patients were included from the German Stroke Registry (GSR), a multicenter registry of consecutive MT patients. Primary outcomes were reperfusion success events. Secondary outcomes were early clinical improvement (improvement in NIHSS score > 4) and independent survival at 90 days (mRS 0–2). Out of 3804 patients, 2689 presented with M1 (71%) and 1115 with isolated M2 occlusions (29%). The mean age was 76 (CI 65–82) and 77 (CI 66–83) years, respectively. Except for baseline NIHSS (15 (CI 10–18) vs. 11 (CI 6–16), p < 0.001) and ASPECTS (9 (CI 7–10) vs. 9 (CI 8–10, p < 0.001), baseline demographics were balanced. Apart from a more frequent use of dedicated small vessel stent retrievers (svSR) in M2 (17.4% vs. 3.0; p < 0.001), intraprocedural aspects were balanced. There was no difference in ICH at 24 h (11%; p = 1.0), adverse events (14.4% vs. 18.1%; p = 0.63), clinical improvement (62.5% vs. 61.4 %; p = 0.57), mortality (26.9% vs. 22.9%; p = 0.23). In M2 MT, conventional stent retriever (cSR) achieved higher rates of mTICI3 (54.0% vs. 37.7–42.0%; p < 0.001), requiring more MT-maneuvers (7, CI 2–8) vs. 2 (CI 2–7)/(CI 2–2); p < 0.001) and without impact on efficacy and outcome. Real-life MT in M2 can be performed with equal safety and efficacy as in M1 occlusions. Different recanalization techniques including the use of svSR did not result in significant differences regarding safety, efficacy and outcome. KW - mechanical thrombectomy KW - M2 KW - distal occlusion KW - endovascular therapy KW - aspiration KW - stent retriever KW - outcome Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-286052 SN - 2077-0383 VL - 11 IS - 15 ER - TY - JOUR A1 - Kippnich, Maximilian A1 - Duempert, Maximilian A1 - Schorscher, Nora A1 - Jordan, Martin C. A1 - Kunz, Andreas S. A1 - Meybohm, Patrick A1 - Wurmb, Thomas T1 - Simultaneous treatment of trauma patients in a dual room trauma suite with integrated movable sliding gantry CT system: an observational study JF - Scientific Reports N2 - The trauma center of the University Hospital Wuerzburg has developed an advanced trauma pathway based on a dual-room trauma suite with an integrated movable sliding gantry CT-system. This enables simultaneous CT-diagnostics and treatment of two trauma patients. The focus of this study was to investigate the quality of the concept based on defined outcome criteria in this specific setting (time from arrival to initiation of CT scan: tCT; time from arrival to initiation of emergency surgery: tES). We analyzed all trauma patients admitted to the hospital’s trauma suite from 1st May 2019 through 29th April 2020. Two subgroups were defined: trauma patients, who were treated without a second trauma patient present (group 1) and patients, who were treated simultaneously with another trauma patient (group 2). Simultaneous treatment was defined as parallel arrival within a period of 20 min. Of 423 included trauma patients, 46 patients (10.9%) were treated simultaneously. Car accidents were the predominant trauma mechanism in this group (19.6% vs. 47.8%, p < 0.05). Prehospital life-saving procedures were performed with comparable frequency in both groups (intubation 43.5% vs. 39%, p = 0.572); pleural drainage 3.2% vs. 2.2%, p = 0.708; cardiopulmonary resuscitation 5% vs. 2.2%, p = 0.387). At hospital admission, patients in group 2 suffered significantly more pain (E-problem according to Advanced Trauma Life Support principles©; 29.2% vs. 45.7%, p < 0.05). There were no significant differences in the clinical treatment (emergency procedures, vasopressor and coagulant therapy, and transfusion of red blood cells). tCT was 6 (4–10) minutes (median and IQR) in group 1 and 8 (5–15.5) minutes in group 2 (p = 0.280). tES was 90 (78–106) minutes in group 1 and 99 (97–108) minutes in group 2 (p = 0.081). The simultaneous treatment of two trauma patients in a dual-room trauma suite with an integrated movable sliding gantry CT-system requires a medical, organizational, and technical concept adapted to this special setting. Despite the oftentimes serious and life-threatening injuries, optimal diagnostic and therapeutic procedures can be guaranteed for two simultaneous trauma patients at an individual medical level in consistent quality. KW - dual-room trauma suite KW - movable sliding gantry KW - CT Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-299695 VL - 12 IS - 1 ER - TY - JOUR A1 - Jordan, Martin C. A1 - Bröer, David A1 - Fischer, Christian A1 - Heilig, Philipp A1 - Gilbert, Fabian A1 - Hölscher-Doht, Stefanie A1 - Kalogirou, Charis A1 - Popp, Kevin A1 - Grunz, Jan-Peter A1 - Huflage, Henner A1 - Jakubietz, Rafael G. A1 - Ergün, Süleyman A1 - Meffert, Rainer H. T1 - Development and preclinical evaluation of a cable-clamp fixation device for a disrupted pubic symphysis JF - Communications Medicine N2 - Background Traumatic separation of the pubic symphysis can destabilize the pelvis and require surgical fixation to reduce symphyseal gapping. The traditional approach involves open reduction and the implantation of a steel symphyseal plate (SP) on the pubic bone to hold the reposition. Despite its widespread use, SP-fixation is often associated with implant failure caused by screw loosening or breakage. Methods To address the need for a more reliable surgical intervention, we developed and tested two titanium cable-clamp implants. The cable served as tensioning device while the clamp secured the cable to the bone. The first implant design included a steel cable anterior to the pubic symphysis to simplify its placement outside the pelvis, and the second design included a cable encircling the pubic symphysis to stabilize the anterior pelvic ring. Using highly reproducible synthetic bone models and a limited number of cadaver specimens, we performed a comprehensive biomechanical study of implant stability and evaluated surgical feasibility. Results We were able to demonstrate that the cable-clamp implants provide stability equivalent to that of a traditional SP-fixation but without the same risks of implant failure. We also provide detailed ex vivo evaluations of the safety and feasibility of a trans-obturator surgical approach required for those kind of fixation. Conclusion We propose that the developed cable-clamp fixation devices may be of clinical value in treating pubic symphysis separation. KW - pubic symphysis KW - cable-clamp implants KW - SP-fixation Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-299800 VL - 2 IS - 1 ER - TY - JOUR A1 - Heinz, Tizian A1 - Meller, Felix A1 - Luetkens, Karsten Sebastian A1 - Horas, Konstantin A1 - Schäfer, Thomas A1 - Rudert, Maximilian A1 - Reppenhagen, Stephan A1 - Weißenberger, Manuel T1 - Can the MRI based AMADEUS score accurately assess pre-surgery chondral defect severity according to the ICRS arthroscopic classification system? JF - Journal of Experimental Orthopaedics N2 - Purpose The AMADEUS (Area Measurement And DEpth and Underlying Structures) scoring and grading system has been proposed for the MRI based evaluation of untreated focal chondral defects around the knee. The clinical practicability, its correlation with arthroscopically assessed grading systems (ICRS – International Cartilage Repair Society) and thereby its clinical value in terms of decision making and guiding prognosis was yet to determine. Methods From 2008 to 2019 a total of 89 individuals were indicated for high tibial valgus osteotomy (HTO) due to tibial varus deformity and concomitant chondral defects of the medial compartment of the knee. All patients received a preoperative MRI (1.5 Tesla or 3.0 Tesla) and pre-osteotomy diagnostic arthroscopy. Chondral defects of the medial compartment were scored and graded with the MRI based AMADEUS by three independent raters and compared to arthroscopic defect grading by the ICRS system. Interrater and intrarater reliability as well as correlation analysis with the ICRS classification system were assessed. Results Intraclass correlation coefficients for the various subscores of the AMADEUS showed an overall good to excellent interrater agreement (min: 0.26, max: 0.80). Intrarater agreement turned out to be substantially inferior (min: 0.08, max: 0.53). Spearman correlation revealed an overall moderate correlative association of the AMADEUS subscores with the ICRS classification system, apart from the defect area subscore. Sensitivity of the AMADEUS to accurately identify defect severity according to the ICRS was 0.7 (0.69 for 3.0 Tesla MRI, 0.67 for 1.5 Tesla MRI). The mean AMADEUS grade was 2.60 ± 0.81 and the mean ICRS score 2.90 ± 0.63. Conclusions Overall, the AMADEUS with all its subscores shows moderate correlation with the arthroscopic chondral grading system according to ICRS. This suggests that chondral defect grading by means of the MRI based AMADEUS is well capable of influencing and guiding treatment decisions. Interrater reliability shows overall good agreement. KW - MRI KW - knee KW - cartilage defect KW - grading system of chondral defects KW - AMADEUS KW - ICRS Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-300781 SN - 2197-1153 VL - 9 IS - 1 ER - TY - JOUR A1 - Grunz, Jan-Peter A1 - Sailer, Lukas A1 - Lang, Patricia A1 - Schüle, Simone A1 - Kunz, Andreas Steven A1 - Beer, Meinrad A1 - Hackenbroch, Carsten T1 - Dual-energy CT in sacral fragility fractures: defining a cut-off Hounsfield unit value for the presence of traumatic bone marrow edema in patients with osteoporosis JF - BMC Musculoskeletal Disorders N2 - Background Demographic change entails an increasing incidence of fragility fractures. Dual-energy CT (DECT) with virtual non-calcium (VNCa) reconstructions has been introduced as a promising diagnostic method for evaluating bone microarchitecture and marrow simultaneously. This study aims to define the most accurate cut-off value in Hounsfield units (HU) for discriminating the presence and absence of bone marrow edema (BME) in sacral fragility fractures. Methods Forty-six patients (40 women, 6 men; 79.7 ± 9.2 years) with suspected fragility fractures of the sacrum underwent both DECT (90 kVp / 150 kVp with tin prefiltration) and MRI. Nine regions-of-interest were placed in each sacrum on DECT-VNCa images. The resulting 414 HU measurements were stratified into “edema” (n = 80) and “no edema” groups (n = 334) based on reference BME detection in T2-weighted MRI sequences. Area under the receiver operating characteristic curve was calculated to determine the desired cut-off value and an associated conspicuity range for edema detection. Results The mean density within the “edema” group of measurements (+ 3.1 ± 8.3 HU) was substantially higher compared to the “no edema” group (-51.7 ± 21.8 HU; p < 0.010). Analysis in DECT-VNCa images suggested a cut-off value of -12.9 HU that enabled sensitivity and specificity of 100% for BME detection compared to MRI. A range of HU values between -14.0 and + 20.0 is considered indicative of BME in the sacrum. Conclusions Quantitative analysis of DECT-VNCa with a cut-off of -12.9 HU allows for excellent diagnostic accuracy in the assessment of sacral fragility fractures with associated BME. A diagnostic “one-stop-shop” approach without additional MRI is feasible. KW - virtual noncalcium imaging KW - dual-energy computed tomography KW - fragility fracture KW - bone bruise KW - bone marrow edema Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-301125 VL - 23 IS - 1 ER - TY - JOUR A1 - Gietzen, Carsten Herbert A1 - Kunz, Andreas Steven A1 - Luetkens, Karsten Sebastian A1 - Huflage, Henner A1 - Christopoulos, Georgios A1 - van Schoonhoven, Jörg A1 - Bley, Thorsten Alexander A1 - Schmitt, Rainer A1 - Grunz, Jan-Peter T1 - Evaluation of prestyloid recess morphology and ulnar-sided contrast leakage in CT arthrography of the wrist JF - BMC Musculoskeletal Disorders N2 - Background In wrist arthrograms, aberrant contrast material is frequently seen extending into the soft tissue adjacent to the ulnar styloid process. Since the prestyloid recess can mimic contrast leakage in CT arthrography, this study aims to provide a detailed analysis of its morphologic variability, while investigating whether actual ulnar-sided leakage is associated with injuries of the triangular fibrocartilage complex (TFCC). Methods Eighty-six patients with positive wrist trauma history underwent multi-compartment CT arthrography (40 women, median age 44.5 years). Studies were reviewed by two board-certified radiologists, who documented the morphology of the prestyloid recess regarding size, opening type, shape and position, as well as the presence or absence of ulnar-sided contrast leakage. Correlations between leakage and the presence of TFCC injuries were assessed using the mean square contingency coefficient (r\(_{ɸ}\)). Results The most common configuration of the prestyloid recess included a narrow opening (73.26%; width 2.26 ± 1.43 mm), saccular shape (66.28%), and palmar position compared to the styloid process (55.81%). Its mean length and anterior–posterior diameter were 6.89 ± 2.36 and 5.05 ± 1.97 mm, respectively. Ulnar-sided contrast leakage was reported in 29 patients (33.72%) with a mean extent of 12.30 ± 5.31 mm. Leakage occurred more often in patients with ulnar-sided TFCC injuries (r\(_{ɸ}\) = 0.480; p < 0.001), whereas no association was found for lesions of the central articular disc (r\(_{ɸ}\) = 0.172; p = 0.111). Conclusions Since ulnar-sided contrast leakage is more common in patients with peripheral TFCC injuries, distinction between an atypical configuration of the prestyloid recess and actual leakage is important in CT arthrography of the wrist. KW - prestyloid recess KW - arthrography KW - tomography KW - x-ray computed KW - triangular fibrocartilage complex Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-301113 VL - 23 IS - 1 ER - TY - THES A1 - Laas, Susanne Franziska T1 - Stellenwert der kontrastmittelverstärkten MRT bei traumatischen Verletzungen und posttraumatischen Veränderungen an der Hand T1 - The importance of contrast-enhanced MRI in traumatic and posttraumatic injuries of the hand N2 - Die vorliegende Arbeit hat zum Ziel, den Stellenwert von kontrastverstärkten MR- Sequenzen in der bildgebenden Diagnostik von Hand und Fingern zu untersuchen. Denn trotz einer breiten empirischen Anwendung von gadoliniumhaltigen Kontrastmitteln im europäischen Raum besteht keine ausreichende wissenschaftliche Datengrundlage zur kontrastverstärkten Hand-MRT nach einem Trauma. Zu diesem Zweck wurden zwischen Januar 2016 und August 2018 am Rhön-Klinikum Campus Bad Neustadt 165 MRT-Untersuchungen von distalem Unterarm, Karpus, Metakarpus und/oder Fingern selektiert. Einschlusskriterien waren eine positive Traumaanamnese, standardisierte MRT-Sequenzen und das Fehlen von Kontraindikationen. Zur Definition eines diagnostischen Referenzstandards wurden alle Fälle vorab durch einen Senior-Investigator mit 36 Jahren Erfahrung in muskuloskelettaler Radiologie analysiert. Für die Bildevaluation wurden aus jeder MRT-Untersuchung zwei Datensätze erstellt, wobei der erste Datensatz nur die nativen Sequenzen (PD / T2 FSE fs und T1 FSE ) und der zweite Datensatz zusätzlich zu eine kontrastverstärkte Sequenz als T1 FSE fs nach Gadolinium-Applikation enthielt. Als Observer fungierten zwei radiologische Fach- bzw. Oberärzte des Universitätsklinikum Würzburgs. In der vorliegenden Studie wurde ein diagnostisch relevantes Kontrastmittelenhancement an Patienten mit traumatischen Handverletzungen nachgewiesen. Der Kontrastmitteleffekt war mit subjektiven und objektiven Messgrößen statistisch signifikant bei Läsionen der Ligamente und an den ligamentähnlichen Insertionen des ulnaren TFCC-Abschnittes. Als Erklärung für das Kontrastmittelenhancement in der MRT dient in erster Linie die bereits früher beschriebene Hyperämie, die posttraumatisch am Traumaort mit Ausgang von der Synovialis entsteht. Anhand der Studienergebnisse kann die Empfehlung ausgesprochen werden, in der MRT-Diagnostik von traumatischen Läsionen der Hand immer dann intravenöses Kontrastmittel auf Gadolinium-Basis zu verabreichen, wenn am vermuteten Läsionsort der T2-Kontrast für eine sichere Diagnose unzureichend ist. N2 - The aim of this study was to examine the impact of contrast-enhanced MRI-sequences in radiological diagnostics of the wrist and fingers. In spite of widespread empirical usage of gadolinium-enhanced contrast agents in Europe, there is insufficient scientific data regarding the contrast-enhanced MRT of the posttraumatic hand. In this study, 165 MRT scans of the distal forearm, carpus, metacarpus and/or fingers were selected at the Rhön-Klinikum Campus Bad Neustadt between January 2016 and August 2018. Inclusion criteria included a positive trauma anamnesis, standardized MRT sequences and the lack of contra-indications. In order to define a diagnostic standard as a reference, each case was analyzed beforehand by a senior-investigator with 36 years of professional experience in musculoskeletal radiology. Two data records were generated from each MRI-Scan, the first data record containing only the native sequences (PD / T2 FSE fs and T1 FSE) and the second record containing an additional contrast-enhanced sequence as T1 FSE fs after gadolinium. Two radiological specialists/assistant medical directors of the Universitätsklinikum Würzburg served as observers. This study succeeded in demonstrating diagnostically relevant contrast enhancement in patients with traumatic hand injuries. It is known that enhancement in MRI scans is linked to posttraumatic synovial hyperemia. The positive diagnostic effect of gadolinium enhancement was demonstrated in ligament lesions and insertions of the ulnar TFCC and proved statistically significant in the subjective and objective radiological examination. Taking these results into account, intravenous application of gadolinium may be beneficial when interpreting traumatic lesions of the hand, especially when T2-contrast is not sufficient for diagnosis. KW - Intravenöse Applikation KW - Kontrastmittel KW - Kernspintomographie KW - Hand KW - Trauma KW - MRT KW - gadoliniumhaltiges Kontrastmittel KW - intravenös KW - traumatisch KW - Karpus KW - TFCC KW - Triangulärer fibrokartilaginärer Komplex KW - SL-Band KW - Hyperämie Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-299370 ER - TY - JOUR A1 - Augustin, Anne Marie A1 - Wolfschmidt, Franziska A1 - Elsässer, Thilo A1 - Sauer, Alexander A1 - Dierks, Alexander A1 - Bley, Thorsten Alexander A1 - Kickuth, Ralph T1 - Color-coded summation images for the evaluation of blood flow in endovascular aortic dissection fenestration JF - BMC Medical Imaging N2 - Background To analyze the benefit of color-coded summation images in the assessment of target lumen perfusion in patients with aortic dissection and malperfusion syndrome before and after fluoroscopy-guided aortic fenestration. Methods Between December 2011 and April 2020 25 patients with Stanford type A (n = 13) or type B dissection (n = 12) and malperfusion syndromes were treated with fluoroscopy-guided fenestration of the dissection flap using a re-entry catheter. The procedure was technically successful in 100% of the cases and included additional iliofemoral stent implantation in four patients. Intraprocedural systolic blood pressure measurements for gradient evaluation were performed in 19 cases. Post-processed color-coded DSA images were obtained from all DSA series before and following fenestration. Differences in time to peak (dTTP) values in the compromised aortic lumen and transluminal systolic blood pressure gradients were analyzed retrospectively. Correlation analysis between dTTP and changes in blood pressure gradients was performed. Results Mean TTP prior to dissection flap fenestration was 6.85 ± 1.35 s. After fenestration, mean TTP decreased significantly to 4.96 ± 0.94 s (p < 0.001). Available systolic blood pressure gradients between the true and the false lumen were reduced by a median of 4.0 mmHg following fenestration (p = 0.031), with significant reductions in Stanford type B dissections (p = 0.013) and minor reductions in type A dissections (p = 0.530). A moderate correlation with no statistical significance was found between dTTP and the difference in systolic blood pressure (r = 0.226; p = 0.351). Conclusions Hemodynamic parameters obtained from color-coded DSA confirmed a significant reduction of TTP values in the aortic target lumen in terms of an improved perfusion in the compromised aortic region. Color-coded DSA might thus be a suitable complementary tool in the assessment of complex vascular patterns prevailing in aortic dissections, especially when blood pressure measurements are not conclusive or feasible. KW - angiography KW - fenestration KW - color-coding KW - aortic dissection KW - DSA KW - endovascular Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-301107 VL - 22 IS - 1 ER - TY - THES A1 - Portmann, Johannes T1 - Accelerated inversion recovery MRI of the myocardium using spiral acquisition T1 - Beschleunigte Inversion-Recovery MR-Bildgebung des Myokards mit spiralen Auslesezügen N2 - This work deals with the acceleration of cardiovascular MRI for the assessment of functional information in steady-state contrast and for viability assessment during the inversion recovery of the magnetization. Two approaches are introduced and discussed in detail. MOCO-MAP uses an exponential model to recover dynamic image data, IR-CRISPI, with its low-rank plus sparse reconstruction, is related to compressed sensing. MOCO-MAP is a successor to model-based acceleration of parametermapping (MAP) for the application in the myocardial region. To this end, it was augmented with a motion correction (MOCO) step to allow exponential fitting the signal of a still object in temporal direction. Iteratively, this introduction of prior physical knowledge together with the enforcement of consistency with the measured data can be used to reconstruct an image series from distinctly shorter sampling time than the standard exam (< 3 s opposed to about 10 s). Results show feasibility of the method as well as detectability of delayed enhancement in the myocardium, but also significant discrepancies when imaging cardiac function and artifacts caused already by minor inaccuracy of the motion correction. IR-CRISPI was developed from CRISPI, which is a real-time protocol specifically designed for functional evaluation of image data in steady-state contrast. With a reconstruction based on the separate calculation of low-rank and sparse part, it employs a softer constraint than the strict exponential model, which was possible due to sufficient temporal sampling density via spiral acquisition. The low-rank plus sparse reconstruction is fit for the use on dynamic and on inversion recovery data. Thus, motion correction is rendered unnecessary with it. IR-CRISPI was equipped with noise suppression via spatial wavelet filtering. A study comprising 10 patients with cardiac disease show medical applicability. A comparison with performed traditional reference exams offer insight into diagnostic benefits. Especially regarding patients with difficulty to hold their breath, the real-time manner of the IR-CRISPI acquisition provides a valuable alternative and an increase in robustness. In conclusion, especially with IR-CRISPI in free breathing, a major acceleration of the cardiovascular MR exam could be realized. In an acquisition of less than 100 s, it not only includes the information of two traditional protocols (cine and LGE), which take up more than 9.6 min, but also allows adjustment of TI in retrospect and yields lower artifact level with similar image quality. N2 - Diese Arbeit behandelt die Beschleunigung der kardiovaskulären MRT zum Erfassen funktioneller Information bei Steady-State-Kontrast und zur Unter- suchung der Vitalität bei Wiederherstellung der Magnetisierung nach ihrer Inversion. Zwei Ansätze werden eingeführt und im Detail diskutiert: MOCO- MAP, welches ein exponentielles Modell nutzt, um dynamische Daten zu rekonstruieren, und IR-CRISPI, welches mit seinem “low-rank plus sparse"- Algorithmus mit Compressed Sensing verwandt ist. MOCO-MAP ist der Nachfolger der modellbasierten Beschleunigung des Parameter-Mappings (MAP) für die Anwendung im Bereich des Myokards. Hierzu wurde es mit einer Bewegungskorrektur (MOCO) versehen, um expo- nentielles Fitten eines unbewegten Objects in Zeitrichtung zu ermöglichen. Das Einbringen dieses physikalischen Vorwissens zusammen mit dem Erzwin- gen von Konsistenz mit den Messdaten wird dazu genutzt, iterativ eine Bildfolge aus Daten einer deutlich kürzeren Messung als herkömmlich zu rekonstruieren (< 3 s gegenüber ca. 10 s). Die Ergebnisse zeigen die Umsetz- barkeit der Methode sowie die Nachweisbarkeit von Delayed Enhancements im Myokard, aber deutliche funktionelle Abweichungen und Artefakte bereits aufgrund von kleinen Ungenauigkeiten der Bewegungskorrektur. IR-CRISPI geht aus CRISPI hervor, welches zur Auswertung von funk- tionellen Echtzeitdaten bei konstantem Kontrast dient. Mit der Rekon- struktion durch getrennte Berechnung von niedrigrangigem und dünnbe- setztem Matrixanteil wird hier bei der Datenrekonstruktion weniger stark eingeschränkt als bei einem strikten exponentiellen Modell. Die pirale Auf- nahmeweise erlaubt hierzu ausreichend effiziente k-Raumabdeckung. Die “low-rank plus sparse"-Rekonstruktion ist kompatibel mit dynamischen und mit Inversion-Recovery-Daten. Eine Bewegungskorrektur ist folglich nicht nötig. IR-CRISPI wurde mit einer Rauschunterdrückung durch räumliche Wavelet- Filterung versehen. Eine Studie, die 10 Patienten einschließt, zeigt die Eignung für die medizinische Anwendung. Der Vergleich mit herkömm- lichen Aufnahmetechniken lässt auf den gewonnenen diagnostischen Nutzen schließen. Besonders für Patienten, die Schwierigkeiten mit dem Luftanhal- ten haben, eröffnet diese Echtzeitaufnahmemethode eine wertvolle Alterna- tive und erhöhte Stabilität. Am Ende konnte gerade mittels IR-CRISPI eine bemerkenswerte Beschleu- nigung der kardiovaskulären MR-Untersuchung verwirklicht werden. Trotz der kurzen Aufnahmezeit von weniger als 100 s für den kompletten linken Ven- trikel schließt es nicht nur die Information zweier herkömmlicher Protokolle mit ein (Cine und LGE), die zusammen mehr als 9,6 min dauern, sondern es erlaubt zusätzlich auch das Einstellen der TI-Zeit im Nachhinein und liefert Ergebnisse mit geringerem Artefaktlevel bei ähnlicher Bildqualität KW - Kernspintomografie KW - Herzfunktion KW - Herzmuskel KW - Bildgebendes Verfahren KW - Echtzeit KW - cine loop KW - late enhancement KW - late gadolinium-enhancement KW - magnetic resonance imaging KW - real-time imaging KW - spiral trajectory Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-302822 ER - TY - THES A1 - Heuer, Anjana T1 - Aktive Gefäßverschlusssysteme in der interventionellen Radiologie: Sicherheit und Effektivität des neuartigen Doppelclip-basierten Celt ACD® Systems T1 - Active vascular closure devices in interventional radiology: safety and efficacy of a novel double-clip-based Celt ACD® system N2 - Mit steigender Nachfrage an minimal-invasiven Therapieoptionen wächst auch das Interesse an innovativen Alternativen im Bereich des arteriellen Gefäßverschlusses nach PVI. Ziel der vorliegenden Arbeit war es, die Effektivität und Sicherheit eines neu auf dem Markt befindlichen, Doppelclip-basierten aktiven VVS zu prüfen. Eine hohe technische Erfolgsrate von 98,8 % bei einer geringen Komplikationsrate von 3,6 % wurde verzeichnet. Bei Anwesenheit der Komorbiditäten Dm und CNI 5 zeigte sich eine signifikante Assoziation zu einem vermehrten Auftreten von Komplikationen. Ein nachgewiesener signifikanter Zusammenhang bestand zudem zwischen einem erhöhten Kalzifikationsgrad der Punktionsstelle bei Vorliegen einer pAVK und eines Dm. Eine erhöhte Gefäßrigidität aufgrund von Komorbiditäten und vaskulären Kalzifikationen, intrinsische Fremdkörperreaktionen, vasoregulatorische Reaktionen oder Produktversagen bieten hypothetische Erklärungsansätze für die einzelnen komplikativen Fälle. Die Nutzung des VVS in spezifischen, bisher nicht beschriebenen Situationen (Unterdimensionierung, Anwendung nach Gefäßpunktionen mit Zugangsschleusen bis 9F, antegrade Punktionsrichtung, anspruchsvolle Eingriffe multimorbider Patienten mit komplexem vaskulärem Status) erwies sich als suffizient. Zur Prävention schwerwiegender Komplikationen während zukünftiger Interventionen wurden die Empfehlung ausgesprochen, eine Durchleuchtungsaufnahme zur Lagekontrolle vor Implantation des proximalen Clips anzufertigen. Eine speziell für Gefäßverschlüsse nach antegrader Punktion konzipierte Zugangsschleuse könnte das Abknicken von Zugangsschleusen bei VVS Applikation verhindern. Zusammenfassend kann das untersuchte aktive VVS mit einzigartigem Wirkmechanismus und spezifischen Design als effektiv und sicher angesehen werden. N2 - The need of minimally invasive therapy options is constantly growing and so is the need for alternative options of vascular closure after peripheral vascular interventions. The aim of this thesis was to assess the efficacy and safety of the novel double-clip-based vascular closure device (VCD). The overall technical success rate was 98,8% with an overall low complication rate of 3,6 %. The comorbidities diabetes and chronical kidney disease proof to be significant risk factors for the appearance of complications. There was a significant association between an increased degree of calcification of the puncture site in the presence of peripheral artery disease and diabetes. Increased vascular rigidity due to comorbidities and vascular calcifications, intrinsic foreign body reactions, vasoregulatory reactions, or product failure offer hypothetical explanations for the individual complicative cases. The use of the VCD during previously not analyzed settings e.g. undersizing in relation to the introducer sheath, accesses of up to 8 or 9 Fr with a 7 Fr device, antegrade puncture and challenging patient collective, proofed to be sufficient. To prevent major complications during future application, it is recommended to check the position of the VCD fluoroscopically, before implantation of the proximal wing. A specially designed introducer sheath may be helpful to prevent kinking of the introducer sheath during VCD application in antegrad punctures. In conclusion, the novel VCD proved to be effective and safe. KW - Gefäßverschluss KW - Vascular closure devices KW - antegrade puncture KW - femoral access KW - access site complications Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-300986 ER - TY - JOUR A1 - Seefried, Lothar A1 - Genest, Franca A1 - Baumann, Jasmin A1 - Heidemeier, Anke A1 - Meffert, Rainer A1 - Jakob, Franz T1 - Efficacy of Zoledronic Acid in the Treatment of Nonmalignant Painful Bone Marrow Lesions: A Triple‐Blind, Randomized, Placebo‐Controlled Phase III Clinical Trial (ZoMARS) JF - Journal of Bone and Mineral Research N2 - Bone marrow lesions (BML) represent areas of deteriorated bone structure and metabolism characterized by pronounced water‐equivalent signaling within the trabecular bone on magnetic resonance imaging (MRI). BML are associated with repair mechanisms subsequent to various clinical conditions associated with inflammatory and non‐inflammatory injury to the bone. There is no approved treatment for this condition. Bisphosphonates are known to improve bone stability in osteoporosis and other bone disorders and have been used off‐label to treat BML. A randomized, triple‐blind, placebo‐controlled phase III trial was conducted to assess efficacy and safety of single‐dose zoledronic acid (ZOL) 5 mg iv with vitamin D 1000 IU/d as opposed to placebo with vitamin D 1000 IU/d in 48 patients (randomized 2:1) with BML. Primary efficacy endpoint was reduction of edema volume 6 weeks after treatment as assessed by MRI. After treatment, mean BML volume decreased by 64.53% (±41.92%) in patients receiving zoledronic acid and increased by 14.43% (±150.46%) in the placebo group (p = 0.007). A decrease in BML volume was observed in 76.5% of patients receiving ZOL and in 50% of the patients receiving placebo. Pain level (visual analogue scale [VAS]) and all categories of the pain disability index (PDI) improved with ZOL versus placebo after 6 weeks but reconciled after 6 additional weeks of follow‐up. Six serious adverse events occurred in 5 patients, none of which were classified as related to the study drug. No cases of osteonecrosis or fractures occurred. Therefore, single‐dose zoledronic acid 5 mg iv together with vitamin D may enhance resolution of bone marrow lesions over 6 weeks along with reduction of pain compared with vitamin D supplementation only. KW - bone biology KW - osteoporosis KW - bone marrow lesion/edema KW - bisphosphonates KW - zoledronic acid Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-276368 VL - 37 IS - 3 SP - 420 EP - 427 ER - TY - JOUR A1 - Mihatsch, Patrick W. A1 - Beissert, Matthias A1 - Pomper, Martin G. A1 - Bley, Thorsten A. A1 - Seitz, Anna K. A1 - Kübler, Hubert A1 - Buck, Andreas K. A1 - Rowe, Steven P. A1 - Serfling, Sebastian E. A1 - Hartrampf, Philipp E. A1 - Werner, Rudolf A. T1 - Changing threshold-based segmentation has no relevant impact on semi-quantification in the context of structured reporting for PSMA-PET/CT JF - Cancers N2 - Prostate-specific membrane antigen (PSMA)-directed positron emission tomography/computed tomography (PET/CT) is increasingly utilized for staging of men with prostate cancer (PC). To increase interpretive certainty, the standardized PSMA reporting and data system (RADS) has been proposed. Using PSMA-RADS, we characterized lesions in 18 patients imaged with \(^{18}\)F-PSMA-1007 PET/CT for primary staging and determined the stability of semi-quantitative parameters. Six hundred twenty-three lesions were categorized according to PSMA-RADS and manually segmented. In this context, PSMA-RADS-3A (soft-tissue) or -3B (bone) lesions are defined as being indeterminate for the presence of PC. For PMSA-RADS-4 and -5 lesions; however, PC is highly likely or almost certainly present [with further distinction based on absence (PSMA-RADS-4) or presence (PSMA-RADS-5) of correlative findings on CT]. Standardized uptake values (SUV\(_{max}\), SUV\(_{peak}\), SUV\(_{mean}\)) were recorded, and volumetric parameters [PSMA-derived tumor volume (PSMA-TV); total lesion PSMA (TL-PSMA)] were determined using different maximum intensity thresholds (MIT) (40 vs. 45 vs. 50%). SUV\(_{max}\) was significantly higher in PSMA-RADS-5 lesions compared to all other PSMA-RADS categories (p ≤ 0.0322). In particular, the clinically challenging PSMA-RADS-3A lesions showed significantly lower SUV\(_{max}\) and SUV\(_{peak}\) compared to the entire PSMA-RADS-4 or -5 cohort (p < 0.0001), while for PSMA-RADS-3B this only applies when compared to the entire PSMA-RADS-5 cohort (p < 0.0001), but not to the PSMA-RADS-4 cohort (SUV\(_{max}\), p = 0.07; SUV\(_{peak}\), p = 0.08). SUV\(_{mean}\) (p = 0.30) and TL-PSMA (p = 0.16) in PSMA-RADS-5 lesions were not influenced by changing the MIT, while PSMA-TV showed significant differences when comparing 40 vs. 50% MIT (p = 0.0066), which was driven by lymph nodes (p = 0.0239), but not bone lesions (p = 0.15). SUV\(_{max}\) was significantly higher in PSMA-RADS-5 lesions compared to all other PSMA-RADS categories in \(^{18}\)F-PSMA-1007 PET/CT. As such, the latter parameter may assist the interpreting molecular imaging specialist in assigning the correct PSMA-RADS score to sites of disease, thereby increasing diagnostic certainty. In addition, changes of the MIT in PSMA-RADS-5 lesions had no significant impact on SUV\(_{mean}\) and TL-PSMA in contrast to PSMA-TV. KW - \(^{18}\)F-PSMA-1007 KW - PET/CT KW - staging KW - prostate cancer KW - standardized reporting system KW - PSMA-RADS Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-254782 SN - 2072-6694 VL - 14 IS - 2 ER - TY - JOUR A1 - Pietro-Garcia, Christian A1 - Hartmann, Oliver A1 - Reissland, Michaela A1 - Fischer, Thomas A1 - Maier, Carina R. A1 - Rosenfeldt, Mathias A1 - Schülein-Völk, Christina A1 - Klann, Kevin A1 - Kalb, Reinhard A1 - Dikic, Ivan A1 - Münch, Christian A1 - Diefenbacher, Markus E. T1 - Inhibition of USP28 overcomes Cisplatin-resistance of squamous tumors by suppression of the Fanconi anemia pathway JF - Cell Death and Differentiation N2 - Squamous cell carcinomas (SCC) frequently have an exceptionally high mutational burden. As consequence, they rapidly develop resistance to platinum-based chemotherapy and overall survival is limited. Novel therapeutic strategies are therefore urgently required. SCC express ∆Np63, which regulates the Fanconi Anemia (FA) DNA-damage response in cancer cells, thereby contributing to chemotherapy-resistance. Here we report that the deubiquitylase USP28 is recruited to sites of DNA damage in cisplatin-treated cells. ATR phosphorylates USP28 and increases its enzymatic activity. This phosphorylation event is required to positively regulate the DNA damage repair in SCC by stabilizing ∆Np63. Knock-down or inhibition of USP28 by a specific inhibitor weakens the ability of SCC to cope with DNA damage during platin-based chemotherapy. Hence, our study presents a novel mechanism by which ∆Np63 expressing SCC can be targeted to overcome chemotherapy resistance. Limited treatment options and low response rates to chemotherapy are particularly common in patients with squamous cancer. The SCC specific transcription factor ∆Np63 enhances the expression of Fanconi Anemia genes, thereby contributing to recombinational DNA repair and Cisplatin resistance. Targeting the USP28-∆Np63 axis in SCC tones down this DNA damage response pathways, thereby sensitizing SCC cells to cisplatin treatment. KW - USP28 KW - Cisplatin KW - squamous tumors Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-273014 SN - 1476-5403 VL - 29 IS - 3 ER - TY - JOUR A1 - Fabritius, Matthias Philipp A1 - Wölfer, Teresa A. A1 - Herzberg, Moriz A1 - Tiedt, Steffen A1 - Puhr-Westerheide, Daniel A1 - Grosu, Sergio A1 - Maurus, Stefan A1 - Geyer, Thomas A1 - Curta, Adrian A1 - Kellert, Lars A1 - Küpper, Clemens A1 - Liebig, Thomas A1 - Ricke, Jens A1 - Dimitriadis, Konstantinos A1 - Kunz, Wolfgang G. A1 - Zimmermann, Hanna A1 - Reidler, Paul T1 - Course of early neurologic symptom severity after endovascular treatment of anterior circulation large vessel occlusion stroke: association with baseline multiparametric CT imaging and clinical parameters JF - Diagnostics N2 - Background: Neurologic symptom severity and deterioration at 24 hours (h) predict long-term outcomes in patients with acute large vessel occlusion (LVO) stroke of the anterior circulation. We aimed to examine the association of baseline multiparametric CT imaging and clinical factors with the course of neurologic symptom severity in the first 24 h after endovascular treatment (EVT). Methods: Patients with LVO stroke of the anterior circulation were selected from a prospectively acquired consecutive cohort of patients who underwent multiparametric CT, including non-contrast CT, CT angiography and CT perfusion before EVT. The symptom severity was assessed on admission and after 24 h using the 42-point National Institutes of Health Stroke Scale (NIHSS). Clinical and imaging data were compared between patients with and without early neurological deterioration (END). END was defined as an increase in ≥4 points, and a significant clinical improvement as a decrease in ≥4 points, compared to NIHSS on admission. Multivariate regression analyses were used to determine independent associations of imaging and clinical parameters with NIHSS score increase or decrease in the first 24 h. Results: A total of 211 patients were included, of whom 38 (18.0%) had an END. END was significantly associated with occlusion of the internal carotid artery (odds ratio (OR), 4.25; 95% CI, 1.90–9.47) and the carotid T (OR, 6.34; 95% CI, 2.56–15.71), clot burden score (OR, 0.79; 95% CI, 0.68–0.92) and total ischemic volume (OR, 1.01; 95% CI, 1.00–1.01). In a comprehensive multivariate analysis model including periprocedural parameters and complications after EVT, carotid T occlusion remained independently associated with END, next to reperfusion status and intracranial hemorrhage. Favorable reperfusion status and small ischemic core volume were associated with clinical improvement after 24 h. Conclusions: The use of imaging parameters as a surrogate for early NIHSS progression in an acute LVO stroke after EVT reached limited performance with only carotid T occlusion as an independent predictor of END. Reperfusion status and early complications in terms of intracranial hemorrhage are critical factors that influence patient outcome in the acute stroke phase after EVT. KW - stroke KW - large vessel occlusion KW - multiparametric CT KW - CT perfusion KW - CT angiography KW - NIHSS KW - EVT Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-242681 SN - 2075-4418 VL - 11 IS - 7 ER - TY - JOUR A1 - Huflage, Henner A1 - Karsten, Sebastian A1 - Kunz, Andreas Steven A1 - Conrads, Nora A1 - Jakubietz, Rafael Gregor A1 - Jakubietz, Michael Georg A1 - Pennig, Lenhard A1 - Goertz, Lukas A1 - Bley, Thorsten Alexander A1 - Schmitt, Rainer A1 - Grunz, Jan-Peter T1 - Improved diagnostic accuracy for ulnar-sided TFCC lesions with radial reformation of 3D sequences in wrist MR arthrography JF - European Radiology N2 - Objectives Triangular fibrocartilage complex (TFCC) injuries frequently cause ulnar-sided wrist pain and can induce distal radioulnar joint instability. With its complex three-dimensional structure, diagnosis of TFCC lesions remains a challenging task even in MR arthrograms. The aim of this study was to assess the added diagnostic value of radial reformatting of isotropic 3D MRI datasets compared to standard planes after direct arthrography of the wrist. Methods Ninety-three patients underwent wrist MRI after fluoroscopy-guided multi-compartment arthrography. Two radiologists collectively analyzed two datasets of each MR arthrogram for TFCC injuries, with one set containing standard reconstructions of a 3D thin-slice sequence in axial, coronal and sagittal orientation, while the other set comprised an additional radial plane view with the rotating center positioned at the ulnar styloid. Surgical reports (whenever available) or radiological reports combined with clinical follow-up served as a standard of reference. In addition, diagnostic confidence and assessability of the central disc and ulnar-sided insertions were subjectively evaluated. Results Injuries of the articular disc, styloid and foveal ulnar attachment were present in 20 (23.7%), 10 (10.8%) and 9 (9.7%) patients. Additional radial planes increased diagnostic accuracy for lesions of the styloid (0.83 vs. 0.90; p = 0.016) and foveal (0.86 vs. 0.94; p = 0.039) insertion, whereas no improvement was identified for alterations of the central cartilage disc. Readers' confidence (p < 0.001) and assessability of the ulnar-sided insertions (p < 0.001) were superior with ancillary radial reformatting. Conclusions Access to the radial plane view of isotropic 3D sequences in MR arthrography improves diagnostic accuracy and confidence for ulnar-sided TFCC lesions. KW - joint instability KW - wrist KW - arthrography KW - magnetic resonance imaging KW - triangular fibrocartilage Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-266512 SN - 1432-1084 VL - 31 IS - 12 ER - TY - JOUR A1 - Müller, Sophie A1 - Köhler, Franziska A1 - Hendricks, Anne A1 - Kastner, Carolin A1 - Börner, Kevin A1 - Diers, Johannes A1 - Lock, Johan F. A1 - Petritsch, Bernhard A1 - Germer, Christoph-Thomas A1 - Wiegering, Armin T1 - Brain metastases from colorectal cancer: a systematic review of the literature and meta-analysis to establish a guideline for daily treatment JF - Cancers N2 - Colorectal cancer (CRC) is the third most common malignancy worldwide. Most patients with metastatic CRC develop liver or lung metastases, while a minority suffer from brain metastases. There is little information available regarding the presentation, treatment, and overall survival of brain metastases (BM) from CRC. This systematic review and meta-analysis includes data collected from three major databases (PubMed, Cochrane, and Embase) based on the key words “brain”, “metastas*”, “tumor”, “colorectal”, “cancer”, and “malignancy”. In total, 1318 articles were identified in the search and 86 studies matched the inclusion criteria. The incidence of BM varied between 0.1% and 11.5%. Most patients developed metastases at other sites prior to developing BM. Lung metastases and KRAS mutations were described as risk factors for additional BM. Patients with BM suffered from various symptoms, but up to 96.8% of BM patients were asymptomatic at the time of BM diagnosis. Median survival time ranged from 2 to 9.6 months, and overall survival (OS) increased up to 41.1 months in patients on a multimodal therapy regimen. Several factors including age, blood levels of carcinoembryonic antigen (CEA), multiple metastases sites, number of brain lesions, and presence of the KRAS mutation were predictors of OS. For BM diagnosis, MRI was considered to be state of the art. Treatment consisted of a combination of surgery, radiation, or systemic treatment. KW - brain metastases KW - cerebral metastases KW - BM KW - colorectal cancer KW - CRC KW - systematic review KW - meta-analysis Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-228883 SN - 2072-6694 VL - 13 IS - 4 ER - TY - JOUR A1 - Hendricks, Anne A1 - Lenschow, Christina A1 - Kroiss, Matthias A1 - Buck, Andreas A1 - Kickuth, Ralph A1 - Germer, Christoph-Thomas A1 - Schlegel, Nicolas T1 - Evaluation of diagnostic efficacy for localization of parathyroid adenoma in patients with primary hyperparathyroidism undergoing repeat surgery JF - Langenbeck's Archives of Surgery N2 - Purpose Repeat surgery in patients with primary hyperparathyroidism (pHPT) is associated with an increased risk of complications and failure. This stresses the need for optimized strategies to accurately localize a parathyroid adenoma before repeat surgery is performed. However, evidence on the extent of required diagnostics for a structured approach is sparse. Methods A retrospective single-center evaluation of 28 patients with an indication for surgery due to pHPT and previous thyroid or parathyroid surgery was performed. Diagnostic workup, surgical approach, and outcome in terms of complications and successful removement of parathyroid adenoma with biochemical cure were evaluated. Results Neck ultrasound, sestamibi scintigraphy, C11-methionine PET-CT, and selective parathyroid hormone venous sampling, but not MRI imaging, effectively detected the presence of a parathyroid adenoma with high positive predictive values. Biochemical cure was revealed by normalization of calcium and parathormone levels 24-48h after surgery and was achieved in 26/28 patients (92.9%) with an overall low rate of complications. Concordant localization by at least two diagnostic modalities enabled focused surgery with success rates of 100%, whereas inconclusive localization significantly increased the rate of bilateral explorations and significantly reduced the rate of biochemical cure to 80%. Conclusion These findings suggest that two concordant diagnostic modalities are sufficient to accurately localize parathyroid adenoma before repeat surgery for pHPT. In cases of poor localization, extended diagnostic procedures are warranted to enhance surgical success rates. We suggest an algorithm for better orientation when repeat surgery is intended in patients with pHPT. KW - Primary hyperparathyroidism (pHPT) KW - preoperative localization KW - repeat surgery KW - diagnostics KW - imaging Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-267520 SN - 1435-2451 VL - 406 IS - 5 ER - TY - JOUR A1 - Luetkens, Karsten Sebastian A1 - Ergün, Süleyman A1 - Huflage, Henner A1 - Kunz, Andreas Steven A1 - Gietzen, Carsten Herbert A1 - Conrads, Nora A1 - Pennig, Lenhard A1 - Goertz, Lukas A1 - Bley, Thorsten Alexander A1 - Gassenmaier, Tobias A1 - Grunz, Jan-Peter T1 - Dose reduction potential in cone-beam CT imaging of upper extremity joints with a twin robotic x-ray system JF - Scientific Reports N2 - Cone-beam computed tomography is a powerful tool for 3D imaging of the appendicular skeleton, facilitating detailed visualization of bone microarchitecture. This study evaluated various combinations of acquisition and reconstruction parameters for the cone-beam CT mode of a twin robotic x-ray system in cadaveric wrist and elbow scans, aiming to define the best possible trade-off between image quality and radiation dose. Images were acquired with different combinations of tube voltage and tube current–time product, resulting in five scan protocols with varying volume CT dose indices: full-dose (FD; 17.4 mGy), low-dose (LD; 4.5 mGy), ultra-low-dose (ULD; 1.15 mGy), modulated low-dose (mLD; 0.6 mGy) and modulated ultra-low-dose (mULD; 0.29 mGy). Each set of projection data was reconstructed with three convolution kernels (very sharp [Ur77], sharp [Br69], intermediate [Br62]). Five radiologists subjectively assessed the image quality of cortical bone, cancellous bone and soft tissue using seven-point scales. Irrespective of the reconstruction kernel, overall image quality of every FD, LD and ULD scan was deemed suitable for diagnostic use in contrast to mLD (very sharp/sharp/intermediate: 60/55/70%) and mULD (0/3/5%). Superior depiction of cortical and cancellous bone was achieved in FD\(_{Ur77}\) and LD\(_{Ur77}\) examinations (p < 0.001) with LD\(_{Ur77}\) scans also providing favorable bone visualization compared to FD\(_{Br69}\) and FD\(_{Br62}\) (p < 0.001). Fleiss’ kappa was 0.618 (0.594–0.641; p < 0.001), indicating substantial interrater reliability. In this study, we demonstrate that considerable dose reduction can be realized while maintaining diagnostic image quality in upper extremity joint scans with the cone-beam CT mode of a twin robotic x-ray system. Application of sharper convolution kernels for image reconstruction facilitates superior display of bone microarchitecture. KW - medical research KW - preclinical research Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-270429 VL - 11 IS - 1 ER - TY - JOUR A1 - Herzberg, Moritz A1 - Scherling, Korbinian A1 - Stahl, Robert A1 - Tiedt, Steffen A1 - Wollenweber, Frank A. A1 - Küpper, Clemens A1 - Feil, Katharina A1 - Forbrig, Robert A1 - Patzig, Maximilian A1 - Kellert, Lars A1 - Kunz, Wolfgang G. A1 - Reidler, Paul A1 - Zimmermann, Hanna A1 - Liebig, Thomas A1 - Dieterich, Marianne A1 - Dorn, Franziska T1 - Late Thrombectomy in Clinical Practice: Retrospective Application of DAWN/DEFUSE3 Criteria within the German Stroke Registry JF - Clinical Neuroradiology N2 - Background and Purpose To provide real-world data on outcome and procedural factors of late thrombectomy patients. Methods We retrospectively analyzed patients from the multicenter German Stroke Registry. The primary endpoint was clinical outcome on the modified Rankin scale (mRS) at 3 months. Trial-eligible patients and the subgroups were compared to the ineligible group. Secondary analyses included multivariate logistic regression to identify predictors of good outcome (mRS ≤ 2). Results Of 1917 patients who underwent thrombectomy, 208 (11%) were treated within a time window ≥ 6–24 h and met the baseline trial criteria. Of these, 27 patients (13%) were eligible for DAWN and 39 (19%) for DEFUSE3 and 156 patients were not eligible for DAWN or DEFUSE3 (75%), mainly because there was no perfusion imaging (62%; n = 129). Good outcome was not significantly higher in trial-ineligible (27%) than in trial-eligible (20%) patients (p = 0.343). Patients with large trial-ineligible CT perfusion imaging (CTP) lesions had significantly more hemorrhagic complications (33%) as well as unfavorable outcomes. Conclusion In clinical practice, the high number of patients with a good clinical outcome after endovascular therapy ≥ 6–24 h as in DAWN/DEFUSE3 could not be achieved. Similar outcomes are seen in patients selected for EVT ≥ 6 h based on factors other than CTP. Patients triaged without CTP showed trends for shorter arrival to reperfusion times and higher rates of independence. KW - late thrombectomy KW - stroke KW - endovascular therapy KW - outcome Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-264765 VL - 31 IS - 3 ER - TY - JOUR A1 - Weng, Andreas M. A1 - Köstler, Herbert A1 - Bley, Thorsten A. A1 - Ritter, Christian O. T1 - Effect of short-term smoking & L-arginine on coronary endothelial function assessed by cardiac magnetic resonance cold pressor testing: a pilot study JF - BMC Cardiovascular Disorders N2 - Background The effect of smoking on coronary vasomotion has been investigated in the past with various imaging techniques in both short- and long-term smokers. Additionally, coronary vasomotion has been shown to be normalized in long-term smokers by L-Arginine acting as a substrate for NO synthase, revealing the coronary endothelium as the major site of abnormal vasomotor response. Aim of the prospective cohort study was to investigate coronary vasomotion of young healthy short-term smokers via magnetic resonance cold pressor test with and without the administration of L-Arginine and compare obtained results with the ones from nonsmokers. Methods Myocardial blood flow (MBF) was quantified with first-pass perfusion MRI on a 1.5 T scanner in healthy short-term smokers (N = 10, age: 25.0 ± 2.8 years, 5.0 ± 2.9 pack years) and nonsmokers (N = 10, age: 34.3 ± 13.6) both at rest and during cold pressor test (CPT). Smokers underwent an additional examination after administration of L-Arginine within a median of 7 days of the naïve examination. Results MBF at rest turned out to be 0.77 ± 0.30 (smokers with no L-Arginine; mean ± standard deviation), 0.66 ± 0.21 (smokers L-Arginine) and 0.84 ± 0.08 (nonsmokers). Values under CPT were 1.21 ± 0.42 (smokers no L-Arginine), 1.09 ± 0.35 (smokers L-Arginine) and 1.63 ± 0.33 (nonsmokers). In all groups, MBF was significantly increased under CPT compared to the corresponding rest examination (p < 0.05 in all cases). Additionally, MBF under CPT was significantly different between the smokers and the nonsmokers (p = 0.002). MBF at rest was significantly different between the smokers when L-Arginine was given and the nonsmokers (p = 0.035). Conclusion Short-term smokers showed a reduced response to cold both with and without the administration of L-Arginine. However, absolute MBF values under CPT were lower compared to nonsmokers independently of L-Arginine administration. KW - MRI KW - myocardial perfusion KW - cold pressor test KW - endothelium KW - L-arginine KW - smoking Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-260559 VL - 21 ER - TY - JOUR A1 - Weng, Andreas M. A1 - Heidenreich, Julius F. A1 - Metz, Corona A1 - Veldhoen, Simon A1 - Bley, Thorsten A. A1 - Wech, Tobias T1 - Deep learning-based segmentation of the lung in MR-images acquired by a stack-of-spirals trajectory at ultra-short echo-times JF - BMC Medical Imaging N2 - Background Functional lung MRI techniques are usually associated with time-consuming post-processing, where manual lung segmentation represents the most cumbersome part. The aim of this study was to investigate whether deep learning-based segmentation of lung images which were scanned by a fast UTE sequence exploiting the stack-of-spirals trajectory can provide sufficiently good accuracy for the calculation of functional parameters. Methods In this study, lung images were acquired in 20 patients suffering from cystic fibrosis (CF) and 33 healthy volunteers, by a fast UTE sequence with a stack-of-spirals trajectory and a minimum echo-time of 0.05 ms. A convolutional neural network was then trained for semantic lung segmentation using 17,713 2D coronal slices, each paired with a label obtained from manual segmentation. Subsequently, the network was applied to 4920 independent 2D test images and results were compared to a manual segmentation using the Sørensen–Dice similarity coefficient (DSC) and the Hausdorff distance (HD). Obtained lung volumes and fractional ventilation values calculated from both segmentations were compared using Pearson’s correlation coefficient and Bland Altman analysis. To investigate generalizability to patients outside the CF collective, in particular to those exhibiting larger consolidations inside the lung, the network was additionally applied to UTE images from four patients with pneumonia and one with lung cancer. Results The overall DSC for lung tissue was 0.967 ± 0.076 (mean ± standard deviation) and HD was 4.1 ± 4.4 mm. Lung volumes derived from manual and deep learning based segmentations as well as values for fractional ventilation exhibited a high overall correlation (Pearson’s correlation coefficent = 0.99 and 1.00). For the additional cohort with unseen pathologies / consolidations, mean DSC was 0.930 ± 0.083, HD = 12.9 ± 16.2 mm and the mean difference in lung volume was 0.032 ± 0.048 L. Conclusions Deep learning-based image segmentation in stack-of-spirals based lung MRI allows for accurate estimation of lung volumes and fractional ventilation values and promises to replace the time-consuming step of manual image segmentation in the future. KW - MRI KW - lung KW - deep learning KW - image segmentation Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-260520 VL - 21 ER - TY - JOUR A1 - Gerhard-Hartmann, Elena A1 - Wiegering, Verena A1 - Benoit, Clemens A1 - Meyer, Thomas A1 - Rosenwald, Andreas A1 - Maurus, Katja A1 - Ernestus, Karen T1 - A large retroperitoneal lipoblastoma as an incidental finding: a case report JF - BMC Pediatrics N2 - Background Lipoblastoma is a rare benign mesenchymal neoplasm of infancy that most commonly occurs on the extremities and trunk but can arise at variable sites of the body. Retroperitoneal lipoblastomas are particularly rare but can grow to enormous size, and preoperative diagnosis is difficult with diverse, mostly malignant differential diagnoses that would lead to aggressive therapy. Since lipoblastoma is a benign tumor that has an excellent prognosis after resection, correct diagnosis is crucial. Case presentation A case of a large retroperitoneal tumor of a 24-month old infant that was clinically suspicious of a malignant tumor is presented. Due to proximity to the right kidney, clinically most probably a nephroblastoma or clear cell sarcoma of the kidney was suspected. Radiological findings were ambiguous. Therefore, the mass was biopsied, and histology revealed an adipocytic lesion. Although mostly composed of mature adipocytes, in view of the age of the patient, the differential diagnosis of a (maturing) lipoblastoma was raised, which was supported by molecular analysis demonstrating a HAS2-PLAG1 fusion. The tumor was completely resected, and further histopathological workup led to the final diagnosis of a 13 cm large retroperitoneal maturing lipoblastoma. The child recovered promptly from surgery and showed no evidence of recurrence so far. Conclusion Although rare, lipoblastoma should be included in the differential diagnoses of retroperitoneal tumors in infants and children, and molecular diagnostic approaches could be a helpful diagnostic adjunct in challenging cases. KW - retroperitoneal tumor KW - pediatric KW - lipoblastoma KW - PLAG1 rearrangement KW - case report Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-260173 VL - 21 ER - TY - JOUR A1 - Reichel, Thomas A1 - Herz, Stefan A1 - el Tabbakh, Mohammed A1 - Bley, Thorsten Alexander A1 - Plumhoff, Piet A1 - Rueckl, Kilian T1 - Less than 9.5-mm coracohumeral distance on axial magnetic resonance imaging scans predicts for subscapularis tear JF - JSES International N2 - Background Diagnosis of subscapularis (SSC) tendon lesions on magnetic resonance imaging (MRI) can be challenging. A small coracohumeral distance (CHD) has been associated with SSC tears. This study was designed to define a specific threshold value for CHD to predict SSC tears on axial MRI scans. Methods This retrospective study included 172 shoulders of 168 patients who underwent arthroscopic surgery for rotator cuff tear or glenohumeral instability. Diagnostic arthroscopy confirmed an SSC tear in 62 cases (36.0%, test group a), rotator cuff tear tears other than SSC in 71 cases (41.3%, control group b) and glenohumeral instability without any rotator cuff tear in 39 cases (22.7%, zero-sample group c). All patients had a preoperative MRI of the shoulder (1.5T or 3T). Minimum CHD was measured on axial fat-suppressed proton density-, T2-, or T1-weigthed sequences. Receiver operating characteristics analysis was used to determine the threshold value for CHD, and sensitivity and specificity were calculated. Results CHD measurement had a good interobserver reliability (Intraclass correlation coefficient 0.799). Mean CHD was highly significantly (P < .001) less for test group a (mean 7.3 mm, standard deviation ± 2.2) compared with control group b (mean 11.1 mm, standard deviation ± 2.3) or zero-sample group c (mean 13.6 mm, standard deviation ± 2.9). A threshold value of CHD <9.5 mm had a sensitivity of 83.6% and a specificity of 83.9% to predict SSC tears. Conclusion A CHD <9.5 mm on MRI is predictive of SSC lesions and a valuable tool to diagnose SSC tears. KW - subscapularis tear KW - coracohumeral distance KW - rotator cuff tear KW - coracohumeral impingement Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-259118 VL - 5 IS - 3 ER - TY - JOUR A1 - Augustin, Anne Marie A1 - Welsch, Stefan A1 - Bley, Thorsten Alexander A1 - Lopau, Kai A1 - Kickuth, Ralph T1 - Color-coded summation images in the evaluation of renal artery stenosis before and after percutaneous transluminal angioplasty JF - BMC Medical Imaging N2 - Background: Endovascular therapy is the gold standard in patients with hemodynamic relevant renal artery stenosis (RAS) resistant to medical therapy. The severity grading of the stenosis as well as the result assessment after endovascular approach is predominantly based on visible estimations of the anatomic appearance. We aim to investigate the application of color-coded DSA parameters to gain hemodynamic information during endovascular renal artery interventions and for the assessment of the procedures technical success. Methods: We retrospectively evaluated 32 patients who underwent endovascular renal artery revascularization and applied color-coded summation imaging on selected monochromatic DSA images. The differences in time to peak (dTTP) of contrast enhancement in predefined anatomical measuring points were analyzed. Furthermore, differences in systolic blood pressure values (SBP) and serum creatinine were obtained. The value of underlying diabetes mellitus as a predictor for clinical outcome was assessed. Correlation analysis between the patients gender as well as the presence of diabetes mellitus and dTTP was performed. Results: Endovascular revascularization resulted in statistically significant improvement in 4/7 regions of interest. Highly significant improvement of perfusion in terms of shortened TTP values could be found at the segmental artery level and in the intrastenotical segment (p<0.001), significant improvement prestenotical and in the apical renal parenchyma (p<0.05). In the other anatomic regions, differences revealed not to be significant. Differences between SBP and serum creatinine levels before and after the procedure were significant (p=0.004 and 0.0004). Patients ' gender as well as the presence of diabetes mellitus did not reveal to be predictors for the clinical success of the procedure. Furthermore, diabetes and gender did not show relevant correlation with dTTP in the parenchymal measuring points. Conclusions: The supplementary use of color-coding DSA and the data gained from parametric images may provide helpful information in the evaluation of the procedures ' technical success. The segmental artery might be a particularly suitable vascular territory for analyzing differences in blood flow characteristics. Further studies with larger cohorts are needed to further confirm the diagnostic value of this technique. KW - digital subtraction angiography KW - color-coded KW - endovascular KW - renal artery KW - PTA Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-259086 VL - 21 IS - 1 ER - 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 - Ankenbrand, Markus Johannes A1 - Lohr, David A1 - Schlötelburg, Wiebke A1 - Reiter, Theresa A1 - Wech, Tobias A1 - Schreiber, Laura Maria T1 - Deep learning-based cardiac cine segmentation: Transfer learning application to 7T ultrahigh-field MRI JF - Magnetic Resonance in Medicine N2 - Purpose Artificial neural networks show promising performance in automatic segmentation of cardiac MRI. However, training requires large amounts of annotated data and generalization to different vendors, field strengths, sequence parameters, and pathologies is limited. Transfer learning addresses this challenge, but specific recommendations regarding type and amount of data required is lacking. In this study, we assess data requirements for transfer learning to experimental cardiac MRI at 7T where the segmentation task can be challenging. In addition, we provide guidelines, tools, and annotated data to enable transfer learning approaches by other researchers and clinicians. Methods A publicly available segmentation model was used to annotate a publicly available data set. This labeled data set was subsequently used to train a neural network for segmentation of left ventricle and myocardium in cardiac cine MRI. The network is used as starting point for transfer learning to 7T cine data of healthy volunteers (n = 22; 7873 images) by updating the pre-trained weights. Structured and random data subsets of different sizes were used to systematically assess data requirements for successful transfer learning. Results Inconsistencies in the publically available data set were corrected, labels created, and a neural network trained. On 7T cardiac cine images the model pre-trained on public imaging data, acquired at 1.5T and 3T, achieved DICE\(_{LV}\) = 0.835 and DICE\(_{MY}\) = 0.670. Transfer learning using 7T cine data and ImageNet weight initialization improved model performance to DICE\(_{LV}\) = 0.900 and DICE\(_{MY}\) = 0.791. Using only end-systolic and end-diastolic images reduced training data by 90%, with no negative impact on segmentation performance (DICE\(_{LV}\) = 0.908, DICE\(_{MY}\) = 0.805). Conclusions This work demonstrates and quantifies the benefits of transfer learning for cardiac cine image segmentation. We provide practical guidelines for researchers planning transfer learning projects in cardiac MRI and make data, models, and code publicly available. KW - 7T KW - ultrahigh-field KW - transfer learning KW - segmentation KW - neural networks KW - deep learning KW - cardiac magnetic resonance KW - cardiac function Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-257604 VL - 86 IS - 4 ER - TY - JOUR A1 - Lenschow, Christina A1 - Fuss, Carmina Teresa A1 - Kircher, Stefan A1 - Buck, Andreas A1 - Kickuth, Ralph A1 - Reibetanz, Joachim A1 - Wiegering, Armin A1 - Stenzinger, Albrecht A1 - Hübschmann, Daniel A1 - Germer, Christoph Thomas A1 - Fassnacht, Martin A1 - Fröhling, Stefan A1 - Schlegel, Nicolas A1 - Kroiss, Matthias T1 - Case Report: Abdominal Lymph Node Metastases of Parathyroid Carcinoma: Diagnostic Workup, Molecular Diagnosis, and Clinical Management JF - Frontiers in Endocrinology N2 - Parathyroid carcinoma (PC) is an orphan malignancy accounting for only ~1% of all cases with primary hyperparathyroidism. The localization of recurrent PC is of critical importance and can be exceedingly difficult to diagnose and sometimes futile when common sites of recurrence in the neck and chest cannot be confirmed. Here, we present the diagnostic workup, molecular analysis and multimodal therapy of a 46-year old woman with the extraordinary manifestation of abdominal lymph node metastases 12 years after primary diagnosis of PC. The patient was referred to our endocrine tumor center in 2016 with the aim to localize the tumor causative of symptomatic biochemical recurrence. In view of the extensive previous workup we decided to perform [18F]FDG-PET-CT. A pathological lymph node in the liver hilus showed slightly increased FDG-uptake and hence was suspected as site of recurrence. Selective venous sampling confirmed increased parathyroid hormone concentration in liver veins. Abdominal lymph node metastasis was resected and histopathological examination confirmed PC. Within four months, the patient experienced biochemical recurrence and based on high tumor mutational burden detected in the surgical specimen by whole exome sequencing the patient received immunotherapy with pembrolizumab that led to a biochemical response. Subsequent to disease progression repeated abdominal lymph node resection was performed in 10/2018, 01/2019 and in 01/2020. Up to now (12/2020) the patient is biochemically free of disease. In conclusion, a multimodal diagnostic approach and therapy in an interdisciplinary setting is needed for patients with rare endocrine tumors. Molecular analyses may inform additional treatment options including checkpoint inhibitors such as pembrolizumab. KW - parathyroid carcinoma KW - abdominal lymph node metastases KW - molecular diagnostics KW - repeated surgery KW - [18F]FDG-PET-CT KW - immune check inhibitor KW - pembrolizumab Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-233362 SN - 1664-2392 VL - 12 ER - TY - JOUR A1 - Fröhlich, Matthias A1 - Serfling, Sebastian A1 - Higuchi, Takahiro A1 - Pomper, Martin G. A1 - Rowe, Steven P. A1 - Schmalzing, Marc A1 - Tony, Hans-Peter A1 - Gernert, Michael A1 - Strunz, Patrick-Pascal A1 - Portegys, Jan A1 - Schwaneck, Eva-Christina A1 - Gadeholt, Ottar A1 - Weich, Alexander A1 - Buck, Andreas K. A1 - Bley, Thorsten A. A1 - Guggenberger, Konstanze V. A1 - Werner, Rudolf A. T1 - Whole-Body [\(^{18}\)F]FDG PET/CT Can Alter Diagnosis in Patients with Suspected Rheumatic Disease JF - Diagnostics N2 - The 2-deoxy-d-[\(^{18}\)F]fluoro-D-glucose (FDG) positron emission tomography/computed tomography (PET/CT) is widely utilized to assess the vascular and articular inflammatory burden of patients with a suspected diagnosis of rheumatic disease. We aimed to elucidate the impact of [\(^{18}\)F]FDG PET/CT on change in initially suspected diagnosis in patients at the time of the scan. Thirty-four patients, who had undergone [\(^{18}\)F]FDG PET/CT, were enrolled and the initially suspected diagnosis prior to [18F]FDG PET/CT was compared to the final diagnosis. In addition, a semi-quantitative analysis including vessel wall-to-liver (VLR) and joint-to-liver (JLR) ratios was also conducted. Prior to [\(^{18}\)F]FDG PET/CT, 22/34 (64.7%) of patients did not have an established diagnosis, whereas in 7/34 (20.6%), polymyalgia rheumatica (PMR) was suspected, and in 5/34 (14.7%), giant cell arteritis (GCA) was suspected by the referring rheumatologists. After [\(^{18}\)F]FDG PET/CT, the diagnosis was GCA in 19/34 (55.9%), combined GCA and PMR (GCA + PMR) in 9/34 (26.5%) and PMR in the remaining 6/34 (17.6%). As such, [\(^{18}\)F]FDG PET/CT altered suspected diagnosis in 28/34 (82.4%), including in all unclear cases. VLR of patients whose final diagnosis was GCA tended to be significantly higher when compared to VLR in PMR (GCA, 1.01 ± 0.08 (95%CI, 0.95–1.1) vs. PMR, 0.92 ± 0.1 (95%CI, 0.85–0.99), p = 0.07), but not when compared to PMR + GCA (1.04 ± 0.14 (95%CI, 0.95–1.13), p = 1). JLR of individuals finally diagnosed with PMR (0.94 ± 0.16, (95%CI, 0.83–1.06)), however, was significantly increased relative to JLR in GCA (0.58 ± 0.04 (95%CI, 0.55–0.61)) and GCA + PMR (0.64 ± 0.09 (95%CI, 0.57–0.71); p < 0.0001, respectively). In individuals with a suspected diagnosis of rheumatic disease, an inflammatory-directed [\(^{18}\)F]FDG PET/CT can alter diagnosis in the majority of the cases, particularly in subjects who were referred because of diagnostic uncertainty. Semi-quantitative assessment may be helpful in establishing a final diagnosis of PMR, supporting the notion that a quantitative whole-body read-out may be useful in unclear cases. KW - giant cell arteritis KW - GCA KW - [18F]FDG PET/CT KW - vasculature KW - inflammation KW - polymyalgia rheumatica KW - PMR KW - vasculitis Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-250227 SN - 2075-4418 VL - 11 IS - 11 ER - TY - JOUR A1 - Detomas, Mario A1 - Altieri, Barbara A1 - Schlötelburg, Wiebke A1 - Appenzeller, Silke A1 - Schlaffer, Sven A1 - Coras, Roland A1 - Schirbel, Andreas A1 - Wild, Vanessa A1 - Kroiss, Matthias A1 - Sbiera, Silviu A1 - Fassnacht, Martin A1 - Deutschbein, Timo T1 - Case Report: Consecutive Adrenal Cushing’s Syndrome and Cushing’s Disease in a Patient With Somatic CTNNB1, USP8, and NR3C1 Mutations JF - Frontiers in Endocrinology N2 - The occurrence of different subtypes of endogenous Cushing’s syndrome (CS) in single individuals is extremely rare. We here present the case of a female patient who was successfully cured from adrenal CS 4 years before being diagnosed with Cushing’s disease (CD). The patient was diagnosed at the age of 50 with ACTH-independent CS and a left-sided adrenal adenoma, in January 2015. After adrenalectomy and histopathological confirmation of a cortisol-producing adrenocortical adenoma, biochemical hypercortisolism and clinical symptoms significantly improved. However, starting from 2018, the patient again developed signs and symptoms of recurrent CS. Subsequent biochemical and radiological workup suggested the presence of ACTH-dependent CS along with a pituitary microadenoma. The patient underwent successful transsphenoidal adenomectomy, and both postoperative adrenal insufficiency and histopathological workup confirmed the diagnosis of CD. Exome sequencing excluded a causative germline mutation but showed somatic mutations of the β-catenin protein gene (CTNNB1) in the adrenal adenoma, and of both the ubiquitin specific peptidase 8 (USP8) and the glucocorticoid receptor (NR3C1) genes in the pituitary adenoma. In conclusion, our case illustrates that both ACTH-independent and ACTH-dependent CS may develop in a single individual even without evidence for a common genetic background. KW - Cushing’s syndrome KW - Cushing’s disease KW - hypercortisolism KW - glucocorticoid excess KW - USP8 KW - CTNNB1 KW - NR3C1 Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-244596 SN - 1664-2392 VL - 12 ER - TY - THES A1 - Grathwohl, Daniela T1 - Quantitative Sonoelastographie der Leber bei Kindern und Jugedlichen mit Cystischer Fibrose T1 - Quantitative ultrasound imaging of the liver in children and adolescents with cystic fibrosis N2 - Morbidität und Mortalität der Lebererkrankung im Rahmen der Cystischen Fiborse (Cystic fibrosis liver disease, CFLD) sind vornehmlich von Ausmaß und Progredienz der Leberfibrose abhängig. Aufgrund der fehlenden Genauigkeit der bisherigen diagnostischen Verfahren werden viele der an CF erkrankten Menschen erst in fortgeschrittenen Stadien diagnostiziert. Schwere Komplikationen einer Leberzirrhose treten häufig bereits im Kindesalter auf. Die Quantitative Sonoelastographie, hier die Acoustic Radiation Force Impulse (ARFI)-Elastographie, ist ein vielversprechendes, nicht-invasives und strahlenfreies Verfahren zur Messung der Gewebesteifigkeit. Anhand dieser retrospektiven, monozentrischen Studie soll die ARFI-Elastographie im Hinblick auf den klinischen Einsatz bei der CFLD-Diagnostik untersucht werden. Es wurde eruiert, ob sich mittels ARFI-Elastographie Rückschlüsse auf eine CFLD und deren Schweregrade ziehen lassen. Hierfür wurden die ARFI-Messungen verschiedener Lebersegmente von 62 an CF erkrankten und 19 lebergesunden Kindern und Jugendlichen verglichen. Zudem erfolgte die Korrelation der Ergebnisse mit zwei etablierten klinischen Leberfibrose-Scores (APRI, Williams-Score). Im Patientenkollektiv konnten tendenziell erhöhte Scherwellengeschwindigkeiten, entsprechend einer fibrotischen Aktivität, gemessen werden. Die transkostale Messposition in Segment VII/VIII (TC VII/VIII) erwies sich als zuverlässigste Position zur Differenzierung zwischen einer CF-Hepatopathie und einem gesunden Leberparenchym. Hingegen war das Errechnen von Cut-off Werten zur Graduierung von Fibrosestadien nicht möglich. Auch war keine Korrelation zu Leberfiborsescores feststellbar. Insgesamt zeigt sich, dass die Diagnosestellung einer CFLD aktuell nur in Kombination mit bisherigen Messmethoden wie der klinischen Untersuchung, der Laboranalytik und der Sonographie möglich ist. Die Interpretation der ARFI-cut-off Werte bleibt aufgrund mangelnder Sensitivität und Spezifität und vor dem Hintergrund der CF-typischen heterogenen Leberpathologie erschwert. Die ARFI-Elastographie kann als zusätzlicher Baustein in der Diagnostik der CFLD, bei unklaren Befundkonstellationen oder zum Therapie-Monitoring herangezogen werden. Um einen klaren klinischen Einsatz in der Routinediagnostik zu definieren bedarf es weiterer großer, multizentrischer und prospektiver Studien. N2 - The liver-associated morbidity and mortality of the patients with cystic fibrosis (CF) depends on the progression of liver fibrosis. The lack of sensitive diagnostics in the early stages of fibrosis is a key reason for delayed diagnosis, often when complications from liver cirrhosis have already developed in childhood. Quantitative ultrasound (US) imaging, such as Acoustic Radiation Force Imaging (ARFI)-Elastography, is a modern and non-invasive technique for the measurement of tissue stiffness. ARFI-Elastography could improve the detection of Liver Disease (LD) in CF over today‘s routine diagnostics. The aim of this single centre, retrospective study was to analyse the diagnostic performance and the clinical use of the ARFI-method with regard to the early detection of parenchymal changes in Cystic Fibrosis Liver Disease (CFLD). ARFI-data of 62 patients with CF were compared to 19 healthy controls. Results have been related to common and previously established scores (APRI, Williams-Score) for fibrosis in CF. ARFI measurements were higher in the patient group. In particular, the transcostal imaging of segments VII/VIII (TC CII/VIII) of the right liver lobe showed a statistically significant difference between patients with CF and healthy controls. However, because of the wide range of the measurements it was not possible to establish cutoff-values to differentiate stages of liver stiffness and there was no correlation to clinical scores of fibrosis. Due to the lack of sensitivity and specificity of the ARFI cutoff-value and the knowledge of the heterogeneous pathology of cirrhosis in CF, interpretation of ARFI measurements remains challenging. On the basis of our findings, we conclude that ARFI may have a useful role in combination with routine assessments including physical examination, screening laboratory values and US-imaging, to detect, diagnose and monitor CFLD. Larger prospective validation studies are required to establish how ARFI can best be incorporated into routine clinical practice. KW - Ultraschall-Elastographie KW - Cystische Fibrose KW - Quantitative Sonoelastographie KW - Acoustic radiation force imaging (ARFI) KW - Leberfibrose KW - Cystic fibrosis liver disease (CFLD) Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-250621 ER - TY - THES A1 - Schmid, Andrea T1 - Diagnostische Genauigkeit der Dual-Energy Computertomographie Angiographie bei Patienten mit peripherer arterieller Verschlusskrankheit T1 - Diagnostic Accuracy of Dual-Energy Computertomography Angiography in Patients with Peripheral Arterial Occlusive Disease N2 - Es wurde die diagnostische Genauigkeit fünf verschiedener Rekonstruktionsalgorithmen der DE-CTA der Becken-Bein-Gefäße von Patienten mit pAVK an einem Dual-Source CT mit dem diagnostischen Goldstandard der DSA verglichen. Die DE-CTA zeigte eine exzellente Sensitivität an Becken- und Beingefäßen hinsichtlich einer korrekten Stenosegraduierung, unabhängig von der Rekonstruktion. Die Standard MPR zeigte insgesamt die besten Ergebnisse und ist deshalb vor allem in nicht eindeutigen Fällen die Methode der Wahl. Die Auswertung von DE-CS MPRs, DE-CS MIPs, gekrümmten MPRs oder die semi-automatische quantitative Stenosegradauswertung bringt keinen Zugewinn an diagnostischer Performance im Vergleich zur visuellen Auswertung der Standard MPR. Das Ausmaß der Gefäßwandverkalkungen und die intraluminale Kontrastierung hatten keinen signifikanten Effekt auf die Sensitivität zur Erkennung signifikanter Stenosen an den Becken- und Beingefäßen. Jedoch verschlechterten sich die Spezifität und die Genauigkeit der Rekonstruktionen, welche auf der DE-Knochen- und DE-Plaqueentfernung basieren, signifikant in stark verkalkten oder nur schwach kontrastierten Gefäßsegmenten. Beim Auswerten von DE-CS Rekonstruktionen ist infolgedessen vor allem in schlecht kontrastierten oder stark verkalkten Gefäßen eine weitere Verifizierung des Befundes nötig, um unnötige invasive DSAs als Folge von falsch positiven CTA-Befunden zu reduzieren. N2 - The diagnostic accuracy of five different DE-CTA recontruction approaches of a dual-source CT in patients with peripheral artery disease were compared, using digital subtraction angiography as reference standard. DE-CTA shows an excellent sensitivity for the detection of lower extremity arterial stenosis, regardless of image reconstruction approach. The standard MPR showed the best results overall and is therefore the method of choice in unclear cases. Thus DE-CS MPRs, DE-CS MIPs, curved MPRs and semi-automatic stenosis grading don’t bring additional value regarding the diagnostic performance in comparison to the standard MPR. The amount of vessel wall calcification and the intraluminal contrast had no significant effect on the sensitivity for the detection of lower extremity arterial stenosis. Specifity and accuracy decreased in reconstructions that relied on DE-bone- and DE-plaque-subtraction significantly in vessels with strong calcification or poor contrasting. When analyzing DE-CS reconstructions for poorly contrasted or strongly calcified vessels a further evaluation is necessary, to avoid invasive DSAs as a result of false positive findings. KW - Dual-Source-Computertomographie KW - Periphere arterielle Verschlusskrankheit KW - Computertomographie Angiographie KW - Dual-Source Computertomography KW - Peripheral Artery Disease KW - Computertomography Angiography Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-251137 ER - TY - JOUR A1 - Hock, Michael A1 - Terekhov, Maxim A1 - Stefanescu, Maria Roxana A1 - Lohr, David A1 - Herz, Stefan A1 - Reiter, Theresa A1 - Ankenbrand, Markus A1 - Kosmala, Aleksander A1 - Gassenmaier, Tobias A1 - Juchem, Christoph A1 - Schreiber, Laura Maria T1 - B\(_{0}\) shimming of the human heart at 7T JF - Magnetic Resonance in Medicine N2 - Purpose Inhomogeneities of the static magnetic B\(_{0}\) field are a major limiting factor in cardiac MRI at ultrahigh field (≥ 7T), as they result in signal loss and image distortions. Different magnetic susceptibilities of the myocardium and surrounding tissue in combination with cardiac motion lead to strong spatio‐temporal B\(_{0}\)‐field inhomogeneities, and their homogenization (B0 shimming) is a prerequisite. Limitations of state‐of‐the‐art shimming are described, regional B\(_{0}\) variations are measured, and a methodology for spherical harmonics shimming of the B\(_{0}\) field within the human myocardium is proposed. Methods The spatial B\(_{0}\)‐field distribution in the heart was analyzed as well as temporal B\(_{0}\)‐field variations in the myocardium over the cardiac cycle. Different shim region‐of‐interest selections were compared, and hardware limitations of spherical harmonics B\(_{0}\) shimming were evaluated by calibration‐based B0‐field modeling. The role of third‐order spherical harmonics terms was analyzed as well as potential benefits from cardiac phase–specific shimming. Results The strongest B\(_{0}\)‐field inhomogeneities were observed in localized spots within the left‐ventricular and right‐ventricular myocardium and varied between systolic and diastolic cardiac phases. An anatomy‐driven shim region‐of‐interest selection allowed for improved B\(_{0}\)‐field homogeneity compared with a standard shim region‐of‐interest cuboid. Third‐order spherical harmonics terms were demonstrated to be beneficial for shimming of these myocardial B\(_{0}\)‐field inhomogeneities. Initial results from the in vivo implementation of a potential shim strategy were obtained. Simulated cardiac phase–specific shimming was performed, and a shim term‐by‐term analysis revealed periodic variations of required currents. Conclusion Challenges in state‐of‐the‐art B\(_{0}\) shimming of the human heart at 7 T were described. Cardiac phase–specific shimming strategies were found to be superior to vendor‐supplied shimming. KW - 7 T KW - B KW - cardiac MRI KW - shimming KW - ultrahigh field Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-218096 VL - 85 IS - 1 SP - 182 EP - 196 ER - TY - JOUR A1 - Richter, Julian A. J. A1 - Wech, Tobias A1 - Weng, Andreas M. A1 - Stich, Manuel A1 - Weick, Stefan A1 - Breuer, Kathrin A1 - Bley, Thorsten A. A1 - Köstler, Herbert T1 - Free‐breathing self‐gated 4D lung MRI using wave‐CAIPI JF - Magnetic Resonance in Medicine N2 - Purpose The aim of this study was to compare the wave‐CAIPI (controlled aliasing in parallel imaging) trajectory to the Cartesian sampling for accelerated free‐breathing 4D lung MRI. Methods The wave‐CAIPI k‐space trajectory was implemented in a respiratory self‐gated 3D spoiled gradient echo pulse sequence. Trajectory correction applying the gradient system transfer function was used, and images were reconstructed using an iterative conjugate gradient SENSE (CG SENSE) algorithm. Five healthy volunteers and one patient with squamous cell carcinoma in the lung were examined on a clinical 3T scanner, using both sampling schemes. For quantitative comparison of wave‐CAIPI and standard Cartesian imaging, the normalized mutual information and the RMS error between retrospectively accelerated acquisitions and their respective references were calculated. The SNR ratios were investigated in a phantom study. Results The obtained normalized mutual information values indicate a lower information loss due to acceleration for the wave‐CAIPI approach. Average normalized mutual information values of the wave‐CAIPI acquisitions were 10% higher, compared with Cartesian sampling. Furthermore, the RMS error of the wave‐CAIPI technique was lower by 19% and the SNR was higher by 14%. Especially for short acquisition times (down to 1 minute), the undersampled Cartesian images showed an increased artifact level, compared with wave‐CAIPI. Conclusion The application of the wave‐CAIPI technique to 4D lung MRI reduces undersampling artifacts, in comparison to a Cartesian acquisition of the same scan time. The benefit of wave‐CAIPI sampling can therefore be traded for shorter examinations, or enhancing image quality of undersampled 4D lung acquisitions, keeping the scan time constant. KW - free‐breathing KW - lung KW - self‐gated KW - wave‐CAIPI Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-218075 VL - 84 IS - 6 SP - 3223 EP - 3233 ER - TY - THES A1 - Thein, Irina T1 - Monochromatische DSA versus farbkodierte DSA in der Entscheidungsfindung zur Stentimplantation bei pAVK T1 - Evaluation of superficial femoral artery lesions after percutaneous transluminal angioplasty: color-coded summation vs. monochromatic digital subtraction angiography N2 - In der vorliegenden Arbeit wurde untersucht, ob die farbige DSA-Darstellungsweise besser als die monochromatische dazu geeignet ist, eine Entscheidung über eine mögliche Stentimplantation bei pAVK zu treffen. Hierfür wurden DSA-Daten des Universitätsklinikums Würzburg im Zeitraum 04/2014 - 10/2015 retrospektiv ausgewertet. Drei Ärzte bewerteten die Bilder in zwei getrennten Durchgängen bezüglich ihrer Entscheidung zur Stentimplantation. Diese Entscheidungen wurden mit einem Konsensus aus 2 Ärzten verglichen. Anhand von ROC-Analysen konnte so die Treffsicherheit der Entscheidungen evaluiert werden. In der Studie stellte sich die farbkodierte Darstellung im Vergleich zur monochromatischen Darstellung nicht als überlegen heraus. N2 - The present paper analyses if color-coded DSA is more suitable than conventional monochromatitic DSA to decide on a possible stent implantation for a pAVK-lesion. Therefor DSA-Data of the University Hospital of Würzburg was evaluated retrospectively of the period from 04/2014 – 10/2015. Three doctors assessed the pictures in two separate cycles in terms of their decision concerning stenting. These decisions were compared with a consensus of two doctors. The accuracy of the decisions were evaluated based on ROC-analyses. In this study, color coded DSA did not prove to be superior to conventional DSA. KW - Digitale Subtraktionsangiographie KW - Periphere arterielle Verschlusskrankheit KW - ROC-Kurve KW - farbkodierte DSA Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-240562 ER - TY - JOUR A1 - Hartrampf, Philipp E. A1 - Petritsch, Bernhard A1 - Buck, Andreas K. A1 - Serfling, Sebastian E. T1 - Pitfalls in PSMA-PET/CT: Intensive bone-marrow uptake in a case with polycythaemia vera JF - European Journal of Nuclear Medicine and Molecular Imaging N2 - No abstract available. KW - bone-marrow Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-235608 SN - 1619-7070 VL - 48 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 - JOUR A1 - Guggenberger, Konstanze Viktoria A1 - Bley, Thorsten Alexander T1 - Imaging in Vasculitis JF - Current Rheumatology Reports N2 - Purpose of Review: Vasculitides are characterized by mostly autoimmunologically induced inflammatory processes of vascularstructures. They have various clinical and radiologic appearances. Early diagnosis and reliable monitoring are indispensable foradequate therapy to prevent potentially serious complications. Imaging, in addition to laboratory tests and physical examination,constitutes a key component in assessing disease extent and activity. This review presents current standards and some typicalfindings in the context of imaging in vasculitis with particular attention to large vessel vasculitides. Recent Findings: Recently, imaging has gained importance in the management of vasculitis, especially regarding large vesselvasculitides (LVV). Recently, EULAR (European League Against Rheumatism) has launched its recommendations concerningthe diagnosis of LVVs. Imaging is recommended as the preferred complement to clinical examination. Color-coded duplexsonography is considered the first choice imaging test in suspected giant cell arteritis, and magnetic resonance imaging isconsidered the first choice in suspected Takayasu’sarteritis. Summary: Due to diversity of clinical and radiologic presentations, diagnosis and therapy monitoring of vasculitides mayconstitute a challenge. As a result of ongoing technological progress, a variety of non-invasive imaging modalities now playan elemental role in the interdisciplinary management of vasculitic diseases. KW - Vasculitis KW - Large vessel vasculitides (LVV) KW - Giant cell arteritis (GCA KW - Imaging KW - Magnetic resonance imaging(MRI) KW - EULAR guidelines Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-232762 SN - 1523-3774 VL - 22 IS - 34 ER - TY - JOUR A1 - Jordan, Martin C. A1 - Jovic, Sebastian A1 - Gilbert, Fabian A1 - Kunz, Andreas A1 - Ertl, Maximilian A1 - Strobl, Ute A1 - Jakubietz, Rafael G. A1 - Jakubietz, Michael G. A1 - Meffert, Rainer H. A1 - Fuchs, Konrad F. T1 - Qualitätssteigerung der Abrechnungsprüfung durch Smartphone-basierte Fotodokumentation in der Unfall-, Hand-, und Plastischen Chirurgie JF - Der Unfallchirurg N2 - Hintergrund Die Fotodokumentation von offenen Frakturen, Wunden, Dekubitalulzera, Tumoren oder Infektionen ist ein wichtiger Bestandteil der digitalen Patientenakte. Bisher ist unklar, welchen Stellenwert diese Fotodokumentation bei der Abrechnungsprüfung durch den Medizinischen Dienst der Krankenkassen (MDK) hat. Fragestellung Kann eine Smartphone-basierte Fotodokumentation die Verteidigung von erlösrelevanten Diagnosen und Prozeduren sowie der Verweildauer verbessern? Material und Methoden Ausstattung der Mitarbeiter mit digitalen Endgeräten (Smartphone/Tablet) in den Bereichen Notaufnahme, Schockraum, OP, Sprechstunden sowie auf den Stationen. Retrospektive Auswertung der Abrechnungsprüfung im Jahr 2019 und Identifikation aller Fallbesprechungen, in denen die Fotodokumentation eine Erlösveränderung bewirkt hat. Ergebnisse Von insgesamt 372 Fallbesprechungen half die Fotodokumentation in 27 Fällen (7,2 %) zur Bestätigung eines Operationen- und Prozedurenschlüssels (OPS) (n = 5; 1,3 %), einer Hauptdiagnose (n = 10; 2,7 %), einer Nebendiagnose (n = 3; 0,8 %) oder der Krankenhausverweildauer (n = 9; 2,4 %). Pro oben genanntem Fall mit Fotodokumentation ergab sich eine durchschnittliche Erlössteigerung von 2119 €. Inklusive Aufwandpauschale für die Verhandlungen wurde somit ein Gesamtbetrag von 65.328 € verteidigt. Diskussion Der Einsatz einer Smartphone-basierten Fotodokumentation kann die Qualität der Dokumentation verbessern und Erlöseinbußen bei der Abrechnungsprüfung verhindern. Die Implementierung digitaler Endgeräte mit entsprechender Software ist ein wichtiger Teil des digitalen Strukturwandels in Kliniken. N2 - Background Photographic documentation of wounds, decubitus ulcers, tumors, open fractures and infections is an important part of digital patient files. It is unclear whether the photographic documentation has an effect on medical accounting with health insurance companies. Objective It was hypothesized that Smartphone-based systematic photographic documentation can improve the confirmation of proceeds-relevant diagnoses and procedures as well as the duration. Material and methods Staff in the emergency room, operating theater, outpatient clinic and on the wards were equipped with digital devices (Smartphone, tablet) including a photo-app. Medical accounting with the health insurance companies and identification of all case conferences in which the photographic documentation had effected a change in proceeds were analyzed for 2019 in a retrospective manner. Results Overall, 372 cases were discussed of which 27 cases were affected by the digital photographic documentation. Photographic documentation was used for clarification of the operative procedure (n = 5), primary diagnosis (n = 10), secondary diagnosis (n = 3), and length of hospitalization (n = 9). An average of 2119 € was negotiated and added per case affected by photographic documentation. Hereby, a level 1 trauma center gained an estimated 65,328 € in revenue. Discussion The use of Smartphone based photographic documentation can improve the overall quality of patient files and thus avoid loss of revenue. The implementation of digital devices with corresponding software is an important component of the digital structural change in hospitals. KW - Digitalisierung KW - Gesundheits-App KW - Künstliche Intelligenz KW - Plattform KW - Strukturwandel KW - artificial intelligence KW - database KW - digital transformation KW - photo app KW - surgery Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-232415 SN - 0177-5537 VL - 124 ER - TY - JOUR A1 - Kippnich, Maximilian A1 - Schorscher, Nora A1 - Kredel, Markus A1 - Markus, Christian A1 - Eden, Lars A1 - Gassenmaier, Tobias A1 - Lock, Johann A1 - Wurmb, Thomas T1 - Dual‑room twin‑CT scanner in multiple trauma care: first results after implementation in a level one trauma centre JF - European Journal of Trauma and Emergency Surgery N2 - Purpose The trauma centre of the Wuerzburg University Hospital has integrated a pioneering dual-room twin-CT scanner in a multiple trauma pathway. For concurrent treatment of two trauma patients, two carbon CT examination and intervention tables are positioned head to head with one sliding CT-Gantry in the middle. The focus of this study is the process of trauma care with the time to CT (tCT) and the time to operation (tOR) as quality indicator. Methods All patients with suspected multiple trauma, who required emergency surgery and who were initially diagnosed by the CT trauma protocol between 05/2018 and 12/2018 were included. Data relating to time spans (tCT and tOR), severity of injury and outcome was obtained. Results 110 of the 589 screened trauma patients had surgery immediately after finishing primary assessment in the ER. The ISS was 17 (9–34) (median and interquartile range, IQR). tCT was 15 (11–19) minutes (median and IQR) and tOR was 96.5 (75–119) minutes (median and IQR). In the first 30 days, seven patients died (6.4%) including two within the first 24 h (2%). There were two ICU days (1–6) (median and IQR) and one (0–1) (median and IQR) ventilator day. Conclusion The twin-CT technology is a fascinating tool to organize high-quality trauma care for two multiple trauma patients simultaneously KW - trauma centre KW - trauma management KW - resuscitation time KW - dual-room whole-body CT Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-232390 SN - 1863-9933 ER - TY - JOUR A1 - Kollmann, Cathérine T. A1 - Pretzsch, Elise B. A1 - Kunz, Andreas A1 - Isbert, Christoph A1 - Krajinovic, Katica A1 - Reibetanz, Joachim A1 - Kim, Mia T1 - Anorectal angle at rest predicting successful sacral nerve stimulation in idiopathic fecal incontinence—a cohort analysis JF - International Journal of Colorectal Disease N2 - Purpose Sacral nerve stimulation is an effective treatment for patients suffering from fecal incontinence. However, less is knownabout predictors of success before stimulation. The purpose of this study was to identify predictors of successful sacral nervestimulation in patients with idiopathic fecal incontinence. Methods Consecutive female patients, receiving peripheral nerve evaluation and sacral nerve stimulation between September2008 and October 2014, suffering from idiopathic fecal incontinence were included in this study. Preoperative patient’scharac-teristics, anal manometry, and defecography results were collected prospectively and investigated by retrospective analysis. Mainoutcome measures were independent predictors of treatment success after sacral nerve stimulation. Results From, all in all, 54 patients suffering from idiopathic fecal incontinence receiving peripheral nerve evaluation, favorableoutcome was achieved in 23 of 30 patients after sacral nerve stimulation (per protocol 76.7%; intention to treat 42.6%). From allanalyzed characteristics, wide anorectal angle at rest in preoperative defecography was the only independent predictor offavorable outcome in multivariate analysis (favorable 134.1 ± 13.9° versus unfavorable 118.6 ± 17.1°). Conclusions Anorectal angle at rest in preoperative defecography might present a predictor of outcome after sacral nervestimulation in patients with idiopathic fecal incontinence. KW - sacral nerve stimulation KW - idiopathic fecal incontinence KW - sacral neuromodulation KW - anorectal angl Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-232379 SN - 0179-1958 VL - 35 ER - TY - THES A1 - Klabouch [geb. Kleinbach], Stefanie T1 - Prädiktoren für die postinterventionelle Leberfunktion nach transarterieller Chemotherapie bei Patienten und Patientinnen mit hepatozellulärem Karzinom T1 - Predictors of postinterventional liver function after transarterial chemoembolization in patients with hepatocellular carcinoma N2 - Hintergrund: Die transarterielle Chemoembolisation (TACE) stellt eine Erstlinientherapie bei nicht resezierbarem HCC im intermediären Stadium (BCLC B) dar. TACE induziert einen zytotoxischen und ischämischen Gewebeeffekt, der möglicherweise zu einer Leberfunktionsstörung führt. Der 13C-Methacetin-Atemtest (MBT) ist ein nichtinvasiver CYP1A2-Funktionstest zur Beurteilung der funktionellen Leberzellmasse. Ziel dieser prospektiven Studie war es, die Auswirkung der konventionellen TACE auf die hepatozelluläre Reserve, gemessen mittels 13C-MBT, statischen Leberfunktionstests und entzündlichen Parametern bewerten zu können. Methoden & Ergebnisse: 27 Patient*innen mit nicht resezierbarem HCC (BCLC B, Child Pugh A) erhielten vor (d0), 24 Stunden (d1) und 72 Stunden (d3) nach 41 cTACE-Verfahren einen MBT. Das hepatische Lipiodol®-Verteilungsvolumen wurde aus CT-Daten berechnet. Statische Leberfunktionstests, entzündliche Parameter und klinische Ereignisse wurden an d0-3 analysiert. Es zeigte sich eine deutliche Verringerung der CYP1A2-Funktion nach cTACE an d1 und d3, was hauptsächlich durch die Entzündungsreaktion (CRP) und hepatozelluläre Schadensmarker (AST) und nur in geringem Maße durch das embolisierte Lebervolumen zu erklären ist. Schlussfolgerung: Der MBT kann die kurzfristige Verringerung der Leberfunktionsreserve sensitiv abbilden und korreliert mit klinischen Komplikationen nach cTACE. Der MBT kann Anwendung in der frühen Identifizierung einer hepatischen Dysfunktion finden. N2 - Background: Transarterial Chemoembolization (TACE) is a standard therapy for unresectable HCC and is suggested as first line-therapy for intermediate stages (BCLC B). TACE induces a cytotoxic and ischemic tissue effect potentially leading to hepatic dysfunction. 13C-methacetin breath test (MBT) is a noninvasive CYP1A2 function test for the assessment of hepatic functional reserve. We aimed to assess by MBT the effect of conventional TACE on hepatic functional reserve, static functional and inflammatory parameters. Methods & Results: 27 patients with unresectable HCC (BCLC B, Child Pugh A) underwent MBT before (d0), 24h (d1) and 72h (d3) after 41 cTACE procedures. Hepatic Lipiodol® distribution volumes were calculated from CT data. Static liver function, inflammatory markers and clinical events were assessed at d0-3. A rapid and marked reduction of CYP1A2 function occurred on d1 and d3, mainly explained by the inflammatory response (CRP) and hepatocellular damage markers (AST) but to a minor extent by hepatic embolization volumes. Conclusion: MBT can sensitively monitor short-term reduction in hepatic functional reserve and correlates with clinical complications after cTACE. MBT might be useful in the early identification of patients with hepatic dysfunction. KW - Leberfunktion KW - Leberzellkrebs KW - Kohlenstoff-13-Exhalationstest KW - Leberzirrhose KW - Leberversagen KW - Transarterielle Chemoembolisation KW - 13C-Methacetin-Atemtest KW - Hepatozelluläres Karzinom KW - Mikrosomale Leberfunktion Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-237070 ER - TY - JOUR A1 - Steinhardt, Maximilian Johannes A1 - Zhou, Xiang A1 - Krummenast, Franziska A1 - Meckel, Katharina A1 - Nickel, Katharina A1 - Böckle, David A1 - Messerschmidt, Janin A1 - Knorz, Sebastian A1 - Dierks, Alexander A1 - Heidemeier, Anke A1 - Lapa, Constantin A1 - Einsele, Hermann A1 - Rasche, Leo A1 - Kortüm, Klaus Martin T1 - Sequential CD38 monoclonal antibody retreatment leads to deep remission in a patient with relapsed/refractory multiple myeloma JF - International Journal of Immunopathology and Pharmacology N2 - We report on a currently 76-year-old female patient with relapsed/refractory (RR) multiple myeloma (MM) treated at our institution. This patient had received six lines of therapy including tandem autologous stem cell transplant, proteasome inhibitor, immunomodulatory drugs and CD38 antibody MOR202. At the last relapse, she progressed during treatment with pomalidomide and MOR202. In an individualized therapy concept, we started a multi-agent salvage therapy with pomalidomide, bortezomib, doxorubicin, dexamethasone, and CD38 antibody daratumumab (“Pom-PAD-Dara”), which resulted in a stringent complete remission with minimal residual disease (MRD) negativity after nine cycles. So far, our patient shows a progression free survival of more than 12 months. Our case demonstrates the feasibility of successful CD38 antibody retreatment in a patient with heavily pretreated CD38 antibody resistant MM. KW - CD38 KW - MOR202 KW - daratumumab KW - multiple myeloma KW - refractory KW - relapse Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-236235 VL - 34 ER - TY - JOUR A1 - Grunz, Jan-Peter A1 - Gietzen, Carsten Herbert A1 - Luetkens, Karsten A1 - Wagner, Matthias A1 - Kalb, Karlheinz A1 - Bley, Thorsten Alexander A1 - Lehmkul, Luka A1 - van Schoonhoven, Jörg A1 - Gassenmaier, Tobias A1 - Schmitt, Rainer T1 - The importance of radial multiplanar reconstructions for assessment of triangular fibrocartilage complex injury in CT arthrography of the wrist JF - BMC Musculoskeletal Disorders N2 - Background: Triangular fibrocartilage complex (TFCC) lesions commonly cause ulnar-sided wrist pain and instability of the distal radioulnar joint. Due to its triangular shape, discontinuity of the TFCC is oftentimes difficult to visualize in radiological standard planes. Radial multiplanar reconstructions (MPR) may have the potential to simplify diagnosis in CT wrist arthrography. The objective of this study was to assess diagnostic advantages provided by radial MPR over standard planes for TFCC lesions in CT arthrography. Methods: One hundred six patients (49 women, 57 men; mean age 44.2 ± 15.8 years) underwent CT imaging after wrist arthrography. Two radiologists (R1, R2) retrospectively analyzed three randomized datasets for each CT arthrography. One set contained axial, coronal and sagittal planes (MPR\(_{Standard}\)), while the other two included an additional radial reconstruction with the rotating center either atop the ulnar styloid (MPR\(_{Styloid}\)) or in the ulnar fovea (MPR\(_{Fovea}\)). Readers evaluated TFCC differentiability and condition. Suspected lesions were categorized using Palmer’s and Atzei’s classification and diagnostic confidence was stated on a fivepoint Likert scale. Results: Compared to standard planes, differentiability of the superficial and deep TFCC layer was superior in radial reconstructions (R1/R2; MPR\(_{Fovea}\): p < 0.001; MPRStyloid: p ≤ 0.007). Palmer and Atzei lesions were present in 86.8% (92/106) and 52.8% (56/106) of patients, respectively. Specificity, sensitivity and accuracy for central Palmer lesions did not differ in radial and standard MPR. For peripheral Atzei lesions, sensitivity (MPR\(_{Standard}\) 78.6%/80.4%, MPR\(_{Styloid}\) 94.6%/94.6%, MPR\(_{Fovea}\) 91.1%/89.3%) and accuracy (MPR\(_{Standard}\) 86.8%/86.8%, MPR\(_{Styloid}\) 96.2%/96.2%, MPR\(_{Fovea}\) 94.3%/93.4%) improved with additional styloid-centered (p = 0.004/0.008) and foveacentered (p = 0.039/0.125) reconstructions. No substantial difference was observed between both radial MPR (p = 0.688/0.250). Interrater agreement was almost perfect for each dataset (κ\(_{Standard}\) = 0.876, κ\(_{Styloid}\) = 0.894, κ\(_{Fovea}\) = 0.949). Diagnostic confidence increased with addition of either radial MPR (p < 0.001). Conclusions: Ancillary radial planes improve accuracy and diagnostic confidence for detection of peripheral TFCC lesions in CT arthrography of the wrist. KW - Triangular fibrocartilage KW - Wrist KW - Arthrography KW - Tomography KW - X-ray computed Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-236075 VL - 21 ER - TY - JOUR A1 - Frey, Anna A1 - Gassenmaier, Tobias A1 - Hofmann, Ulrich A1 - Schmitt, Dominik A1 - Fette, Georg A1 - Marx, Almuth A1 - Heterich, Sabine A1 - Boivin-Jahns, Valérie A1 - Ertl, Georg A1 - Bley, Thorsten A1 - Frantz, Stefan A1 - Jahns, Roland A1 - Störk, Stefan T1 - Coagulation factor XIII activity predicts left ventricular remodelling after acute myocardial infarction JF - ESC Heart Failure N2 - Aims Acute myocardial infarction (MI) is the major cause of chronic heart failure. The activity of blood coagulation factor XIII (FXIIIa) plays an important role in rodents as a healing factor after MI, whereas its role in healing and remodelling processes in humans remains unclear. We prospectively evaluated the relevance of FXIIIa after acute MI as a potential early prognostic marker for adequate healing. Methods and results This monocentric prospective cohort study investigated cardiac remodelling in patients with ST-elevation MI and followed them up for 1 year. Serum FXIIIa was serially assessed during the first 9 days after MI and after 2, 6, and 12 months. Cardiac magnetic resonance imaging was performed within 4 days after MI (Scan 1), after 7 to 9 days (Scan 2), and after 12 months (Scan 3). The FXIII valine-to-leucine (V34L) single-nucleotide polymorphism rs5985 was genotyped. One hundred forty-six patients were investigated (mean age 58 ± 11 years, 13% women). Median FXIIIa was 118 % (quartiles, 102–132%) and dropped to a trough on the second day after MI: 109%(98–109%; P < 0.001). FXIIIa recovered slowly over time, reaching the baseline level after 2 to 6 months and surpassed baseline levels only after 12 months: 124 % (110–142%). The development of FXIIIa after MI was independent of the genotype. FXIIIa on Day 2 was strongly and inversely associated with the relative size of MI in Scan 1 (Spearman’s ρ = –0.31; P = 0.01) and Scan 3 (ρ = –0.39; P < 0.01) and positively associated with left ventricular ejection fraction: ρ = 0.32 (P < 0.01) and ρ = 0.24 (P = 0.04), respectively. Conclusions FXIII activity after MI is highly dynamic, exhibiting a significant decline in the early healing period, with reconstitution 6 months later. Depressed FXIIIa early after MI predicted a greater size of MI and lower left ventricular ejection fraction after 1 year. The clinical relevance of these findings awaits to be tested in a randomized trial. KW - blood coagulation factor XIII KW - ST-elevation myocardial infarction KW - healing and remodelling processes KW - cardiac magnetic resonance imaging Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-236013 VL - 7 IS - 5 ER - TY - JOUR A1 - Zhou, Xiang A1 - Dierks, Alexander A1 - Kertels, Olivia A1 - Samnick, Samuel A1 - Kircher, Malte A1 - Buck, Andreas K. A1 - Haertle, Larissa A1 - Knorz, Sebastian A1 - Böckle, David A1 - Scheller, Lukas A1 - Messerschmidt, Janin A1 - Barakat, Mohammad A1 - Truger, Marietta A1 - Haferlach, Claudia A1 - Einsele, Hermann A1 - Rasche, Leo A1 - Kortüm, K. Martin A1 - Lapa, Constantin T1 - The link between cytogenetics/genomics and imaging patterns of relapse and progression in patients with relapsed/refractory multiple myeloma: a pilot study utilizing 18F-FDG PET/CT JF - Cancers N2 - Utilizing 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET)/computed tomography (CT), we performed this pilot study to evaluate the link between cytogenetic/genomic markers and imaging patterns in relapsed/refractory (RR) multiple myeloma (MM). We retrospectively analyzed data of 24 patients with RRMM who were treated at our institution between November 2018 and February 2020. At the last relapse/progression, patients had been treated with a median of three (range 1–10) lines of therapy. Six (25%) patients showed FDG avid extramedullary disease without adjacency to bone. We observed significantly higher maximum standardized uptake values (SUV\(_{max}\)) in patients harboring del(17p) compared with those without del(17p) (p = 0.025). Moreover, a high SUV\(_{max}\) of >15 indicated significantly shortened progression-free survival (PFS) (p = 0.01) and overall survival (OS) (p = 0.0002). One female patient exhibited biallelic TP53 alteration, i.e., deletion and mutation, in whom an extremely high SUV\(_{max}\) of 37.88 was observed. In summary, this pilot study suggested a link between del(17p)/TP53 alteration and high SUV\(_{max}\) on 18F-FDG PET/CT in RRMM patients. Further investigations are highly warranted at this point. KW - radiogenomics KW - 18F-FDG PET/CT KW - multiple myeloma KW - relapse KW - progression KW - pattern Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-211157 SN - 2072-6694 VL - 12 IS - 9 ER - TY - JOUR A1 - Grebe, Sören Jendrik A1 - Malzahn, Uwe A1 - Donhauser, Julian A1 - Liu, Dan A1 - Wanner, Christoph A1 - Krane, Vera A1 - Hammer, Fabian T1 - Quantification of left ventricular mass by echocardiography compared to cardiac magnet resonance imaging in hemodialysis patients JF - Cardiovascular Ultrasound N2 - Background: Left ventricular hypertrophy (LVH), defined by the left ventricular mass index (LVMI), is highly prevalent in hemodialysis patients and a strong independent predictor of cardiovascular events. Compared to cardiac magnetic resonance imaging (CMR), echocardiography tends to overestimate the LVMI. Here, we evaluate the diagnostic performance of transthoracic echocardiography (TTE) compared to CMR regarding the assessment of LVMI in hemodialysis patients. Methods: TTR and CMR data for 95 hemodialysis patients who participated in the MiREnDa trial were analyzed. The LVMI was calculated by two-dimensional (2D) TTE-guided M-mode measurements employing the American Society of Echocardiography (ASE) and Teichholz (Th) formulas, which were compared to the reference method, CMR. Results: LVH was present in 44% of patients based on LVMI measured by CMR. LVMI measured by echocardiography correlated moderately with CMR, ASE: r = 0.44 (0.34-0.62); Th: r = 0.44 (0.32-0.62). Compared to CMR, both echocardiographic formulas overestimated LVMI (mean increment LVMI (ASE-CMR): 19.5 +/- 19.48 g/m(2),p < 0.001; mean increment LVMI (Th-CMR): 15.9 +/- 15.89 g/m(2),p < 0.001). We found greater LVMI overestimation in patients with LVH using the ASE formula compared to the Th formula. Stratification of patients into CMR LVMI quartiles showed a continuous decrease in increment LVMI with increasing CMR LVMI quartiles for the Th formula (p < 0.001) but not for the ASE formula (p = 0.772). Bland-Altman analysis showed that the Th formula had a constant bias independent of LVMI. Both methods had good discrimination ability for the detection of LVH (ROC-AUC: 0.819 (0.737-0.901) and 0.808 (0.723-0.892) for Th and ASE, respectively). Conclusions: The ASE and Th formulas overestimate LVMI in hemodialysis patients. However, the overestimation is less with the Th formula, particularly with increasing LVMI. The results suggest that the Th formula should be preferred for measurement of LVMI in chronic hemodialysis patients. KW - Teichholz formula KW - ASE formula KW - echocardiography KW - left ventricular hypertrophy KW - left ventricular mass index KW - hemodialysis Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-229282 VL - 18 ER -