TY - JOUR A1 - Grunz, Jan-Peter A1 - Wenig, Andreas Max A1 - Kunz, Andreas Steven A1 - Veyhl-Wichmann, Maike A1 - Schmitt, Rainer A1 - Gietzen, Carsten Herbert A1 - Pennig, Lenhard A1 - Herz, Stefan A1 - Ergün, Süleyman A1 - Bley, Thorsten Alexander A1 - Gassenmaier, Tobias T1 - 3D cone-beam CT with a twin robotic x-ray system in elbow imaging: comparison of image quality to high-resolution multidetector CT JF - European Radiology Experimental N2 - Background Elbow imaging is challenging with conventional multidetector computed tomography (MDCT), while cone-beam CT (CBCT) provides superior options. We compared intra-individually CBCT versus MDCT image quality in cadaveric elbows. Methods A twin robotic x-ray system with new CBCT mode and a high-resolution clinical MDCT were compared in 16 cadaveric elbows. Both systems were operated with a dedicated low-dose (LD) protocol (equivalent volume CT dose index [CTDI\(_{vol(16 cm)}\)] = 3.3 mGy) and a regular clinical scan dose (RD) protocol (CTDI\(_{vol(16 cm)}\) = 13.8 mGy). Image quality was evaluated by two radiologists (R1 and R2) on a seven-point Likert scale, and estimation of signal intensity in cancellous bone was conducted. Wilcoxon signed-rank tests and intraclass correlation coefficient (ICC) statistics were used. Results The CBCT prototype provided superior subjective image quality compared to MDCT scans (for RD, p ≤ 0.004; for LD, p ≤ 0.001). Image quality was rated very good or excellent in 100% of the cases by both readers for RD CBCT, 100% (R1) and 93.8% (R2) for LD CBCT, 62.6% and 43.8% for RD MDCT, and 0.0% and 0.0% for LD MDCT. Single-measure ICC was 0.95 (95% confidence interval 0.91–0.97; p < 0.001). Software-based assessment supported subjective findings with less “undecided” pixels in CBCT than dose-equivalent MDCT (p < 0.001). No significant difference was found between LD CBCT and RD MDCT. Conclusions In cadaveric elbow studies, the tested cone-beam CT prototype delivered superior image quality compared to high-end multidetector CT and showed a potential for considerable dose reduction. KW - Cancellous bone KW - Cone-beam computed tomography KW - Elbow KW - Elbow joint KW - Multidetector computed tomography Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-229877 VL - 4 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 - 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 - Grunz, Jan-Peter A1 - Kunz, Andreas Steven A1 - Baumann, Freerk T. A1 - Hasenclever, Dirk A1 - Sieren, Malte Maria A1 - Heldmann, Stefan A1 - Bley, Thorsten Alexander A1 - Einsele, Hermann A1 - Knop, Stefan A1 - Jundt, Franziska T1 - Assessing osteolytic lesion size on sequential CT scans is a reliable study endpoint for bone remineralization in newly diagnosed multiple myeloma JF - Cancers N2 - Multiple myeloma (MM) frequently induces persisting osteolytic manifestations despite hematologic treatment response. This study aimed to establish a biometrically valid study endpoint for bone remineralization through quantitative and qualitative analyses in sequential CT scans. Twenty patients (seven women, 58 ± 8 years) with newly diagnosed MM received standardized induction therapy comprising the anti-SLAMF7 antibody elotuzumab, carfilzomib, lenalidomide, and dexamethasone (E-KRd). All patients underwent whole-body low-dose CT scans before and after six cycles of E-KRd. Two radiologists independently recorded osteolytic lesion sizes, as well as the presence of cortical destruction, pathologic fractures, rim and trabecular sclerosis. Bland–Altman analyses and Krippendorff’s α were employed to assess inter-reader reliability, which was high for lesion size measurement (standard error 1.2 mm) and all qualitative criteria assessed (α ≥ 0.74). After six cycles of E-KRd induction, osteolytic lesion size decreased by 22% (p < 0.001). While lesion size response did not correlate with the initial lesion size at baseline imaging (Pearson’s r = 0.144), logistic regression analysis revealed that the majority of responding osteolyses exhibited trabecular sclerosis (p < 0.001). The sum of osteolytic lesion sizes on sequential CT scans defines a reliable study endpoint to characterize bone remineralization. Patient level response is strongly associated with the presence of trabecular sclerosis. KW - multiple myeloma KW - bone remineralization KW - computed tomography KW - whole-body imaging Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-362526 SN - 2072-6694 VL - 15 IS - 15 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 - 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 - 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 - JOUR A1 - Gilbert, Fabian A1 - Klein, Detlef A1 - Weng, Andreas Max A1 - Köstler, Herbert A1 - Schmitz, Benedikt A1 - Schmalzl, Jonas A1 - Böhm, Dirk T1 - Supraspinatus muscle elasticity measured with real time shear wave ultrasound elastography correlates with MRI spectroscopic measured amount of fatty degeneration JF - BMC Muscoskeletal Disorders N2 - Background: Fatty Degeneration (FD) of the rotator cuff muscles influences functional and anatomical outcome after rotator cuff repair. The MRI based estimation of fatty degeneration is the gold standard. There is some evidence that Ultrasound elastography (EUS) can detect local differences of tissue stiffness in muscles and tendons. Shear-wave elastography (SWE) was evaluated to determine the extent to which shear wave velocity was associated with measures of fatty degeneration. MRI-spectroscopic fat measurement was used as a reference to quantify the amount of fat in the muscle belly. Methods: Forty-two patients underwent SWE of the supraspinatus muscles at its thickest diameter. After ultrasound evaluation an MRI-spectroscopic fat measurement of the supraspinatus muscle was performed using the SPLASH-technique. A gel filled capsule was used to locate the measured area in the MRI. The values of shear wave velocity (SWV) measured with SWE and spectroscopic fat measurement were correlated statistically using Pearson’s correlation test. Results: Correlation of the fat amount measured with MRI-spectroscopy and the SWV measured with SWE was ρ =0.82. Spectroscopic measured fat ratio of the supraspinatus muscle ranged from 0% to 77.41% and SWV from 1.59 m/s to 5.32 m/s. In 4 patients no sufficient SWE could be performed, these individuals showed a larger diameter of the overlying soft tissue. SWV measured with SWE showed a good correlation with MRI spectroscopic fat amount of the supraspinatus muscle. Conclusion: These preliminary data suggest that SWE may be a sufficient tool in detecting and estimating the amount of fatty degeneration in the supraspinatus muscle in real time. Large overlying soft tissue may be a limitation in performing sufficient EUS. KW - shoulder surgery KW - rotator cuff KW - MRI KW - ultrasound KW - fatty degeneration Y1 - 2017 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-159378 VL - 18 IS - 549 ER - TY - JOUR A1 - Gilbert, Fabian A1 - Böhm, Dirk A1 - Eden, Lars A1 - Schmalzl, Jonas A1 - Meffert, Rainer H. A1 - Köstler, Herbert A1 - Weng, Andreas M. A1 - Ziegler, Dirk T1 - Comparing the MRI-based Goutallier Classification to an experimental quantitative MR spectroscopic fat measurement of the supraspinatus muscle JF - BMC Musculoskeletal Disorders N2 - Background The Goutallier Classification is a semi quantitative classification system to determine the amount of fatty degeneration in rotator cuff muscles. Although initially proposed for axial computer tomography scans it is currently applied to magnet-resonance-imaging-scans. The role for its clinical use is controversial, as the reliability of the classification has been shown to be inconsistent. The purpose of this study was to compare the semi quantitative MRI-based Goutallier Classification applied by 5 different raters to experimental MR spectroscopic quantitative fat measurement in order to determine the correlation between this classification system and the true extent of fatty degeneration shown by spectroscopy. Methods MRI-scans of 42 patients with rotator cuff tears were examined by 5 shoulder surgeons and were graduated according to the MRI-based Goutallier Classification proposed by Fuchs et al. Additionally the fat/water ratio was measured with MR spectroscopy using the experimental SPLASH technique. The semi quantitative grading according to the Goutallier Classification was statistically correlated with the quantitative measured fat/water ratio using Spearman’s rank correlation. Results Statistical analysis of the data revealed only fair correlation of the Goutallier Classification system and the quantitative fat/water ratio with R = 0.35 (p < 0.05). By dichotomizing the scale the correlation was 0.72. The interobserver and intraobserver reliabilities were substantial with R = 0.62 and R = 0.74 (p < 0.01). Conclusion The correlation between the semi quantitative MRI based Goutallier Classification system and MR spectroscopic fat measurement is weak. As an adequate estimation of fatty degeneration based on standard MRI may not be possible, quantitative methods need to be considered in order to increase diagnostic safety and thus provide patients with ideal care in regard to the amount of fatty degeneration. Spectroscopic MR measurement may increase the accuracy of the Goutallier classification and thus improve the prediction of clinical results after rotator cuff repair. However, these techniques are currently only available in an experimental setting. KW - rotator cuff KW - MRI KW - spectroscopy KW - goutallier KW - classification KW - shoulder surgery Y1 - 2016 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-147788 VL - 17 IS - 355 ER - TY - JOUR A1 - Gilbert, F. A1 - Schneemann, C. A1 - Scholz, C. J. A1 - Kickuth, R. A1 - Meffert, R. H. A1 - Wildenauer, R. A1 - Lorenz, U. A1 - Kellersmann, R. A1 - Busch, A. T1 - Clinical implications of fracture-associated vascular damage in extremity and pelvic trauma JF - BMC Muscuskeletal Disorders N2 - Background: Vascular damage in polytrauma patients is associated with high mortality and morbidity. Therefore, specific clinical implications of vascular damage with fractures in major trauma patients are reassessed. Methods: This comprehensive nine-year retrospective single center cohort study analyzed demography, laboratory, treatment and outcome data from 3689 patients, 64 patients with fracture-associated vascular injuries were identified and were compared to a control group. Results: Vascular damage occurred in 7% of patients with upper and lower limb and pelvic fractures admitted to the trauma room. Overall survival was 80% in pelvic fracture and 97% in extremity fracture patients and comparable to non-vascular trauma patients. Additional arterial damage required substantial fluid administration and was visible as significantly anemia and disturbed coagulation tests upon admission. Open procedures were done in over 80% of peripheral extremity vascular damage. Endovascular procedures were predominant (87%) in pelvic injury. Conclusion: Vascular damage is associated with high mortality rates especially in combination with pelvic fractures. Initial anemia, disturbed coagulation tests and the need for extensive pre-clinical fluid substitution were observed in the cohort with vascular damage. Therefore, fast diagnosis and early interventional and surgical procedures are necessary to optimize patient-specific outcome. KW - endovascular repair KW - extremity trauma KW - fracture-associated vascular damage KW - level of evidence: IV KW - surgical trauma room KW - pelvic trauma Y1 - 2018 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-176252 VL - 19 IS - 404 ER - TY - JOUR A1 - Gilbert, F. A1 - Meffert, R. H. A1 - Schmalzl, J. A1 - Weng, A. M. A1 - Köstler, H. A1 - Eden, L. T1 - Grade of retraction and tendon thickness correlates with MR-spectroscopically measured amount of fatty degeneration in full thickness supraspinatus tears JF - BMC Musculoskeletal Disorders N2 - Background: The amount of fatty degeneration (FD) has major impact on the clinical result and cuff integrity after rotator cuff repair. A quantitative analysis with magnet resonance imaging (MRI) spectroscopy was employed to analyze possible correlation of FD with tendon retraction, tendon thickness and patients’ characteristics in full thickness supraspinatus tears. Methods: Forty-two patients with full-thickness supraspinatus tears underwent shoulder MRI including an experimental spectroscopic sequence allowing quantification of the fat fraction in the supraspinatus muscle belly. The amount of fatty degeneration was correlated with tendon retraction, tendon thickness, patients’ age, gender, smoker status, symptom duration and body mass index (BMI). Patients were divided in to three groups of retraction (A) 0-10 mm (n=), (B) 11-20 mm (n=) and (C) < 21 mm (n=) and the means of FD for each group were calculated. Results: Tendon retraction (R = 0.6) and symptom duration (R = 0.6) correlated positively, whereas tendon thickness correlated negatively (R = − 0.6) with the amount of FD. The fat fraction increased significantly with tendon retraction: Group (A) showed a mean fat mount of 3.7% (±4%), group (B) of 16.7% (±8.2%) and group (C) of 37.5% (±19%). BMI, age and smoker-status only showed weak to moderate correlation with the amount of FD in this cohort. Conclusion: MRI spectroscopy revealed significantly higher amount of fat with increasing grade of retraction, symptom duration and decreased tendon thickness. Thus, these parameters may indirectly be associated with the severity of tendon disease. KW - rotator cuff KW - MRI KW - spectroscopy KW - muscle degeneration Y1 - 2018 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-176116 VL - 19 IS - 197 ER - TY - JOUR A1 - Gilbert, F. A1 - Heintel, T. M. A1 - Jakubietz, M. G. A1 - Köstler, H. A1 - Sebald, C. A1 - Meffert, R. H. A1 - Weng, A. M. T1 - Quantitative MRI comparison of multifidus muscle degeneration in thoracolumbar fractures treated with open and minimally invasive approach JF - BMC Musculoskeletal Disorders N2 - Background: Minimally invasive pedicle screw fixation has less approach-related morbidity than open screw placement and is allegedly less traumatizing on paravertebral muscles, as there is no requirement to mobilize and retract the adjacent muscle portion. The approach-related long-term effects to the morphology of the paravertebral muscles are unknown. The purpose of this study was to compare the long-term amount of fatty degeneration of the multifidus muscle in patients treated with a classical open or a minimally invasive approach. Methods: Fourteen Patients meeting inclusion criteria were selected. In all patients a singular fracture of the thoracolumbar spine with a two-level posterior instrumentation was treated, either using an open approach or a minimally invasive approach. All patients underwent quantitative MRI spectroscopy for quantification of the fatty degeneration in the multifidus muscle as a long-term proof for muscle loss after minimum 4-year follow-up. Clinical outcome was assessed using Oswestry Low Back Pain Disability Questionnaire, SF-36 and VA-scale for pain. Results: The minimally invasive approach group failed to show less muscle degeneration in comparison to the open group. Total amount of fatty degeneration was 14.22% in the MIS group and 12.60% in the open group (p = 0.64). In accordance to MRI quantitative results there was no difference in the clinical outcome after a mean follow up of 5.9 years (±1.8). Conclusion: As short-term advantages of minimal invasive screw placement have been widely demonstrated, no advantage of the MIS, displaying a significant difference in the amount of fatty degeneration and resulting in a better clinical outcome could be found. Besides the well-known short-term advantage of minimally invasive pedicle screw placement, a long-term advantage, such as less muscle degeneration and thus superior clinical results, compared to the open approach could not be shown. KW - dorsal instrumentation KW - minimal invasive surgery KW - muscle degeneration KW - spine trauma Y1 - 2018 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-175742 VL - 19 IS - 75 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 - 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 - THES A1 - Gemeinhardt, Katharina Christine T1 - Magnetresonanztomographie und -spektroskopie der Schulter nach Latissimus-dorsi-Transfer unter Berücksichtigung von Sehnenintegrität, Atrophie und fettiger Degeneration der Rotatorenmanschette T1 - Magnetic resonance tomography and spectroscopy of the shoulder N2 - Darstellung des Latissimus-dorsi-Transfers mit Hilfe des MRTs. Quantifizierung der fettigen Degeneration mit Hilfe der semiquantitativen Methode nach Goutailler und der 2D-SPLASH-Sequenz. N2 - Magnetic resonance tomography and spectroscopy of the shoulder, fatty degeneration and atrophy after rotator cuff tear KW - NMR-Tomographie KW - Breiter Rückenmuskel KW - Rotatorenmanschette KW - Atrophie KW - Fett KW - 2D-SPLASH KW - Spektroskopie KW - 2D-SPLASH Y1 - 2007 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-28035 ER - TY - JOUR A1 - Geiger, Julia A1 - Hirtler, Daniel A1 - Gottfried, Kristina A1 - Rahman, Ozair A1 - Bollache, Emilie A1 - Barker, Alex J. A1 - Markl, Michael A1 - Stiller, Brigitte T1 - Longitudinal Evaluation of Aortic Hemodynamics in Marfan Syndrome: New Insights from a 4D Flow Cardiovascular Magnetic Resonance Multi-Year Follow-Up Study JF - Journal of Cardiovascular Magnetic Resonance N2 - Background The aim of this 4D flow cardiovascular magnetic resonance (CMR) follow-up study was to investigate longitudinal changes in aortic hemodynamics in adolescent patients with Marfan syndrome (MFS). Methods 4D flow CMR for the assessment of in-vivo 3D blood flow with full coverage of the thoracic aorta was performed twice (baseline scan t1/follow-up scan t2) in 19 adolescent MFS patients (age at t1: 12.7 ± 3.6 years, t2: 16.2 ± 4.3 years) with a mean follow-up duration of 3.5 ± 1.2 years. Ten healthy volunteers (24 ± 3.8 years) served as a control group. Data analysis included aortic blood flow visualization by color-coded 3D pathlines, and grading of flow patterns (helices/vortices) on a 3-point scale (none, moderate, severe; blinded reading, 2 observers). Regional aortic peak systolic velocities and systolic 3D wall shear stress (WSS) along the entire aortic wall were quantified. Z-Scores of the aortic root and proximal descending aorta (DAo) were assessed. Results Regional systolic WSS was stable over the follow-up duration, except for a significant decrease in the proximal inner DAo segment (p = 0.02) between t1 and t2. MFS patients revealed significant lower mean systolic WSS in the proximal inner DAo compared with volunteers (0.78 ± 0.15 N/m\(^{2}\)) at baseline t1 (0.60 ± 0.18 N/m\(^{2}\); p = 0.01) and follow-up t2 (0.55 ± 0.16 N/m\(^{2}\); p = 0.001). There were significant relationships (p < 0.01) between the segmental WSS in the proximal inner DAo, DAo Z-scores (r = −0.64) and helix/vortex pattern grading (r = −0.55) at both t1 and t2. The interobserver agreement for secondary flow patterns assessment was excellent (Cohen’s k = 0.71). Conclusions MFS patients have lower segmental WSS in the inner proximal DAo segment which correlates with increased localized aberrant vortex/helix flow patterns and an enlarged diameter at one of the most critical sites for aortic dissection. General aortic hemodynamics are stable but these subtle localized DAo changes are already present at young age and tend to be more pronounced in the course of time. KW - Marfan syndrome KW - wall shear stress KW - hemodynamics KW - 4D flow cardiovascular magnetic resonance KW - follow-up KW - aorta Y1 - 2017 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-171119 VL - 19 IS - 33 ER - TY - JOUR A1 - Gassenmaier, Tobias A1 - Petritsch, Bernhard A1 - Kunz, Andreas S. A1 - Gkaniatsas, Spyridon A1 - Gaudron, Philipp D. A1 - Weidemann, Frank A1 - Nordbeck, Peter A1 - Beer, Meinrad T1 - Long term evolution of MRI characteristics in a case of atypical left lateral wall hypertrophic cardiomyopathy JF - World Journal of Cardiology N2 - We are reporting a long-time magnetic resonance imaging (MRI) follow-up in a rare case of cardiac left lateral wall hypertrophy. Hypertrophic cardiomyopathy (HCM) is the most common genetic cardiovascular disorder and a significant cause of sudden cardiac death. Cardiac magnetic resonance (CMR) imaging can be a valuable tool for assessment of detailed information on size, localization, and tissue characteristics of hypertrophied myocardium. However, there is still little knowledge of long-term evolution of HCM as visualized by magnetic resonance imaging. Recently, our group reported a case of left lateral wall HCM as a rare variant of the more common forms, such as septal HCM, or apical HCM. As we now retrieved an old cardiac MRI acquired in this patient more than 20 years ago, we are able to provide the thrilling experience of an ultra-long MRI follow-up presentation in this rare case of left lateral wall hypertrophy. Furthermore, this case outlines the tremendous improvements in imaging quality within the last two decades of CMR imaging. KW - cardiac magnetic resonance imaging KW - hypertrophic cardiomyopathy KW - follow-up KW - atypical KW - left lateral wall Y1 - 2015 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-124934 VL - 7 IS - 6 ER - TY - JOUR A1 - Gassenmaier, Tobias A1 - Gorski, Armin A1 - Aleksic, Ivan A1 - Deubner, Nikolas A1 - Weidemann, Frank A1 - Beer, Meinrad T1 - Impact of cardiac magnet resonance imaging on management of ventricular septal rupture after acute myocardial infarction JF - World Journal of Cardiology N2 - A 74-year-old man was admitted to the cardiac catheterization laboratory with acute myocardial infarction. After successful angioplasty and stent implantation into the right coronary artery, he developed cardiogenic shock the following day. Echocardiography showed ventricular septal rupture. Cardiac magnet resonance imaging (MRI) was performed on the critically ill patient and provided detailed information on size and localization of the ruptured septum by the use of fast MRI sequences. Moreover, the MRI revealed that the ventricular septal rupture was within the myocardial infarction area, which was substantially larger than the rupture. As the patient’s condition worsened, he was intubated and had intra-aortic balloon pump implanted, and extracorporeal membrane oxygenation was initiated. During the following days, the patient’s situation improved, and surgical correction of the ventricular septal defect could successfully be performed. To the best of our knowledge, this case report is the first description of postinfarction ventricular septal rupture by the use of cardiac MRI in an intensive care patient with cardiogenic shock and subsequent successful surgical repair. KW - Cardiac magnetic resonance imaging KW - Ventricular septal rupture KW - Myocardial infarction KW - surgical repair KW - Extracorporeal membrane oxygenation Y1 - 2013 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-96562 ER - TY - THES A1 - Gasparyan, Artur T1 - Quantifizierung pulmonaler Blutflussgeschwindigkeit durch SENCEFUL Magnetresonanztomographie mit bewegter Schichtselektion T1 - Quantification of pulmonary blood flow velocity through SENCEFUL magnetic resonance imaging using moving slice selection N2 - Patienten mit chronischen Lungenerkrankungen leiden unter schwerwiegender Symptomatik und bedürfen regelmäßiger Verlaufskontrollen der Therapie. Dabei sollte zum Schutz der Patienten sowohl auf kanzerogene, ionisierende Strahlung verzichtet als auch der Einsatz potenziell nebenwirkungsreicher Kontrastmittel vermieden werden. Die pulmonale Blutflussgeschwindigkeit im Parenchym stellt einen quantitativen, bildgebenden Biomarker dar, mit dessen Hilfe die Dynamik des Krankheitsgeschehens untersucht werden kann. In dieser Arbeit wurde eine neue Auswertungsmethode vorgestellt, die mit Hilfe kontrastmittelfreier Magnetresonanztomographie die Blutflussgeschwindigkeit im Lungenparenchym quantifizieren kann. Die auf diese Weise bestimmten Ergebnisse entsprechen den Angaben zur Lungenperfusion, wie sie in der Literatur zu finden sind. N2 - Patients with chronic respiratory diseases suffer from severe symptoms and require regular follow ups during treatment. It is important to avoid the use of cancerogenic ionising radiation as well as potentially harmful contrast agents. The pulmonary blood flow velocity within the parenchyma can serve as a quantitative imaging biomarker, which can help analyse the course of the disease. In this work a new method for the quantification of pulmonary blood flow velocity is shown. The results correspond to physiological values in the human lung. KW - Kernspintomografie KW - Lunge KW - Blutflussgeschwindigkeit KW - Quantitativ Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-215693 ER - TY - THES A1 - Fuchs, Kilian T1 - Absolutquantifizierung der myokardialen Perfusion mit hochauflösender MRT bei 3 Tesla T1 - Absolute Quantification of Myocardial Perfusion Using High-Resolution MRI at 3 T N2 - In den letzten Jahren hat die myokardiale MR-Perfusionsbildgebung als nichtinvasives Verfahren zur Darstellung von funktionellen Veränderungen des Myokards für die Diagnostik der KHK zunehmend an Bedeutung gewonnen. Während in den letzten 20 Jahren die kardiale MRT überwiegend bei einer Magnetfeldstärke von 1,5 T durchge-führt wurde und dies auch immer noch wird, findet aktuell eine rasante Verbreitung von MR-Systemen höherer Feldstärken statt. Von der neuen Hochfeldtechnik erhofft man sich vor allem, je nach Anwendung, eine deutliche Verbesserung der Bildqualität mit höherer räumlicher und zeitlicher Auflösung, wodurch der diagnostische Nutzen noch weiter gesteigert werden könnte. In der vorliegenden Arbeit wurden mittels First-Pass-MR-Bildgebung bei einer Magnet-feldstärke von 3 T quantitative Werte für die myokardiale Perfusion von 20 gesunden Probanden unter Ruhebedingungen bestimmt. Sowohl die erhobenen absoluten Perfusionswerte (0,859 ml/g/min im Mittel) als auch die Standardabweichung des mittleren MBF (0,298 ml/g/min) entsprechen den Messungen aus den früheren Publikationen dieser Arbeitsgruppe. In der Gesamtzusammenschau bisher veröffentlichter Perfusionsstudien zeigt sich eine relativ große Variabilität der publizierten Ruheflüsse. Dabei liegt der absolute MBF dieser Arbeit im mittleren Wertebereich dieser Streubreite. Er lässt sich auch mit den in PET-Studien ermittelten Ergebnissen in Einklang bringen, welche als Goldstandard zur Bestimmung der absoluten myokardialen Perfusion beim Menschen gelten. Die vorliegende Arbeit bestätigt die bereits in anderen 3 T-Studien untersuchten Vorteile der Hochfeld-MRT. Die höhere Magnetfeldstärke ermöglicht durch das größere SNR eine signifikant bessere räumliche Auflösung und besticht vor allem durch die hohe Bildqualität. Dies könnte bei der Erkennung kleiner, subendokardial gelegener Perfusionsdefekte sowie der Erstellung von transmuralen Perfusionsgradienten von Bedeutung sein und verspricht neben einer Reduktion von Partialvolumeneffekten auch eine Verminderung von „dark rim“-Artefakten. Um diese Vorteile entsprechend nutzen zu können, wird die Entwicklung von Methoden zur pixelweisen Bestimmung der absoluten Flüsse und farblich kodierten Darstellung derselben in Form von Perfusionskarten ein weiterer Schritt in Richtung klinisch einsetzbare Diagnostik sein. Eine Voraussetzung hierfür ist die Entwicklung einer exakten und sehr stabilen Bewegungskorrektur in weiterführenden Studien. Durch den Wechsel zu einer höheren Magnetfeldstärke von 3 T und den sich daraus ergebenden Vorteilen kann das Potential der MR-Perfusionsbildgebung, insbesondere der Bestimmung quantitativer Perfusionswerte, im Bereich der nichtinvasiven KHK-Diagnostik zukünftig weiter gesteigert werden. N2 - Absolute Quantification of Myocardial Perfusion Using High-Resolution MRI at 3 T KW - Kernspintomographie KW - Perfusion KW - Feldstärke KW - Quantifizierung KW - Absolutquantifizierung KW - myokardiale Perfusion KW - 3 Tesla KW - Hochfeld KW - Magnetresonanztomographie Y1 - 2014 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-107015 ER - TY - THES A1 - Fuchs, Jan Christopher T1 - Quantitative MR-Spektroskopie des menschlichen Herzens mittels CORRECT-SLIM T1 - Quantitative mr-spectroscopy of the human heart by CORRECT-SLIM N2 - Die 31P-MRS ermöglicht die nicht-invasive Untersuchung des kardialen Energiestoffwechsels sowie die Absolutquantifizierung der Metaboliten des kardialen Energiestoffwechsels. Mit dem schnellen Siegeszug der MR-Bildgebung in der klinischen Routine im Bereich kardiologischer Fragestellungen konnte die MRS bis in die heutige Zeit hinein jedoch nicht Schritt halten. Bedingt durch technische Limitationen konnte der Einsatz der MR-Spektroskopie des menschlichen Herzens hier bisher noch nicht Fuß fassen. Eine Weiterentwicklung mit dem Ziel der Etablierung der MRS in der klinischen Routine würde der Medizin neue Wege in Diagnostik und Patientenmonitoring ermöglichen. So wäre die Entwicklung eines kombinierten MRI/MRS-Protokolles für ein kardiales Langzeitmonitoring bei Kindern/Jugendlichen sowie bei erwachsenen Patienten mit unterschiedlichen Herzerkrankungen eine lohnende Aufgabe. Nur sehr wenige Arbeiten konnten bisher Ergebnisse zum Energiestoffwechsel und den Verhältnissen und Konzentration im rechten Ventrikel liefern. Durch die Entwicklung eines verbesserten Auswertealgorithmus (CORRECT-SLIM) am Institut für Röntgendiagnostik der Universität Würzburg könnten nun erstmals neue Aussagen hierzu möglich werden. Mit CORRECT-SLIM stellen wir erstmals ein Verfahren zur Absolutquantifizierung vor, das die Kontamination des Myokards des linken und rechten Ventrikel aus Brustwandarealen reduziert. Das Ziel der vorliegenden Arbeit war es, das neue Auswerteverfahren CORRECT-SLIM (Contamination Reduction in the Reconstruction with Spectral Localization by Imaging) systematisch sowohl am linken als auch am rechten Ventrikel des Herzens anzuwenden um hierdurch neue Aussagen zum Energiestoffwechsel des gesamten Herzens zu erhalten bzw. die Entwicklung und Verbesserung der bisherigen Auswerteverfahren (SLOOP) im Bereich der 31P-MRS Untersuchungen voranzutreiben. Hierzu wurden spektroskopische Untersuchungen am Myokard gesunder und kardial erkrankter Probanden durchgeführt. Die kardial erkrankten Patienten wiesen alle eine Hypertrophie des linken und/oder rechten Ventrikels auf, womit ein für die spektroskopische Auswertung erhöhtes Volumen zur Verfügung stand, was gerade im Hinblick auf die geringe physiologische Wandstärke des rechten Ventrikels erwünscht war und die Festlegung der Segmentationsgrenzen erleichterte. N2 - 31P-MRS allows the non-invasive examination of the cardiac high-energy phosphate metabolism and furthermore the absolute quantification of the high-energy phosphor metabolites. Due to the rapid progress of the MR imaging techniques and applications in the field of cardiology it is now used as a common instrument in the all-day clinical routine. Despite of it’s rapid progress in the field of the cardiac imaging techniques the 31P-MRS couldn’t be integrated into the clinical routine until today, due to technical limitations. Integration and development of the 31P-MRS technique in the clinical routine could offer new possibilities in diagnostic approaches and patient monitoring. The development of a combined MRI/31P-MRS-protocol for a cardiovascular long-time monitoring of cardiac diseases could be of great benefit. Only few publications concerning the energy metabolism of the right human cardiac ventricle have been made until today. By the development of a new evaluation- and quantification-algorithm (CORRECT-SLIM) new findings could be possible. With CORRECT-SLIM we introduce a new method for the absolute quantification of cardiac high-energy phosphates. It reduces the contamination of the left and right ventricle signal by the skeletal-muscle of the chest wall. The aim of the following study was to evaluate the CORRECT-SLIM algorithm (Contamination Reduction in the Reconstruction with Spectral Localization by Imaging) systematically for the cardiac high-energy metabolism of the left as well as for the right ventricle of the human heart and compare it to other evaluation/quantification-methods (SLOOP). The spectroscopic analysis involved the left and right ventricle of healthy volunteers and patients with hypertrophic heart disease as well as severe aortic stenosis. KW - Phosphor-31-NMR-Spektroskopie KW - Herzstoffwechsel KW - Quantifizierung KW - 31P-MRS KW - MR-Spektroskopie KW - Absolutquantifizierung KW - Phosphormetaboliten KW - mrs KW - cardiac spectroscopy KW - high-energy-phosphate metabolism Y1 - 2010 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-49005 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 - THES A1 - Fritz, Dorothée Ulrike T1 - Retrospektive Analyse der computertomographisch gesteuerten Punktionen an einem Kollektiv von 951 Patienten T1 - Retrospective review of CT-guided biopsies performed on 951 patients N2 - Ziel dieser Arbeit war es, den Stellenwert der CT-gesteuerten Punktion hinsichtlich Komplikationsrate, nicht auswertbaren Biopsien, deren statistische Kenngrößen in der Gesamtheit und deren Zusammenhang bezüglich Nadelgröße, Punktionsweg und Läsionsgröße zu ermitteln. Insgesamt konnte retrospektiv ein Kollektiv von 1019 Punktionen an 951 Patienten im Institut für Röntgendiagnostik der Universität Würzburg mit einem Follow-up von 2 Jahren untersucht werden. Es konnten in 96 % der Fälle vom Pathologen auswertbare Proben gewonnen werden. Bei 951 Patienten konnten 38 Biopsien nicht histologisch ausgewertet werden. Es bestand ein signifikanter Zusammenhang bezüglich der Dicke der Biopsienadel und der histologischen Auswertbarkeit. 19/20 G Nadeln führten in 20 % der Fälle zu nicht beurteilbaren Proben, 15/16 G und 17/18 G Nadeln hingegen nur bei 1,8 % und 3,6 % der Punktionen. Bei komplikationslosen Punktionen ergaben sich seltener histologisch nicht auswertbare Proben (3,5 %) als bei Biopsien, die eine Komplikation verursachten bzw. nach sich zogen (6,3 %). Die Biopsien fanden in 57 % der Fälle mit 17/18 G Nadeln statt. Bei 40 % der Punktionen wurden 15/16 G Nadeln verwendet. In lediglich 4,3 % und 6,7 % der Fälle kamen 19/20 G Nadeln und Knochenstanzen zum Einsatz. In der Gesamtheit des Kollektivs ergab sich eine Sensitivität von 92 % bei einer Spezifität von 100 %. Die Kenngrößen variierten in den anatomischen Subgruppen. Von 951 Punktionen erwiesen sich 6,8 % als falsch negativ, 73,2 % als richtig positiv und 16,7 % als richtig negativ. 58 Bei Pankreas-Punktionen lag die falsch negativ Rate mit 23,1 % am höchsten. Niedrige falsch negativ Raten zeigten sich bei Pleura- (2,9 %), Lungen- (5,3 %) und Muskel-/Weichteilpunktionen (1,5 %). Als signifikant erwies sich der Zusammenhang zwischen Biopsienadelgröße und histologischem Ergebnis. Falsch negative Ergebnisse waren besonders bei Anwendungen von 19/20 G Nadeln zu verzeichnen (17,5 %). Bei 17/18 G Nadeln und Knochenstanzen traten insgesamt nur in 7,5 % und 7,9 % falsch negative Ergebnisse auf. Der Durchmesser der Läsion beeinflusste signifikant das histologische Ergebnis. Bei falsch negativen Ergebnissen betrug der Durchmesser im Mittelwert 3,4 cm. Bei richtig positiven Punktionen lag der Läsionsdurchmesser bei 4,1 cm. In 18,4 % der Fälle führte eine Probeentnahme zu einer Komplikation. Davon erwiesen sich 14,8 % als Minor- und 3,6 % als Majorkomplikation, wie zum Beispiel ein Pneumothorax mit Notwendigkeit einer Drainagelegung. Die meisten Komplikationen traten bei Punktionen der Lunge (14 %) auf. Dabei zeigten die Nadeln 19/20 G mit 40 % die höchste Komplikationsrate. Dies ist nicht der Tatsache geschuldet, dass die dünneren Nadeln vorwiegend bei tiefen Läsionen zum Einsatz kamen. Auch bei tieferen Punktionen ist die Komplikationsrate der dickeren Nadeln geringer, als die der dünnen. 15/16 G Nadeln kamen bei einer durchschnittlichen Tiefe von 5,6 cm zum Einsatz, 17/18 G Nadeln bei 6,6 cm und 19/20 G Nadeln bei 7,2 cm. Betrachtet man jedoch die Nadelgruppen 17/18 G und 19/20 G für sich, zeigte sich, dass der Abstand zur Haut bei Komplikationen nicht größer war, als ohne Komplikation. Bei 15/16 G Nadeln war der Punktionsweg bei Komplikationen signifikant größer als bei Punktionen ohne Komplikation. Bei Lungenpunktionen im Speziellen war der Punktionsweg ebenfalls für 15/16 G länger, wenn ein Pneumothorax aufgetreten ist, als bei komplikationslosen Biopsien. 59 Es zeigte sich, dass bei Wiederholungspunktionen die Läsionen tiefer lagen, als bei einmaligen Punktionen. Die Läsionsgröße lag durchschnittlich bei 4 cm. Beim Auftreten einer Komplikation erwies sich der Durchmesser der Läsion, besonders für Lungenbiopsien, als signifikant kleiner (MV = 3,5), als bei komplikationslosen Biopsien. Ein wichtiger Faktor für die Treffsicherheit, den positiven Vorhersagewert und die Komplikationsrate spielte die Erfahrung des jeweiligen Punkteurs. Diese Arbeit konnte belegen, dass der Radiologe mit 20 Jahren Erfahrung die niedrigste Komplikationsrate (15 %) und gleichzeitig die geringste falsch negativ Rate (12 %) hatte. N2 - Purpose: The CT-guided biopsy is a well-established technique for the diagnosis of unknown lesions. The objective of this study was to evaluate the diagnostic accuracy of CT-guided biopsies, in the context of needle size, complication rate, lesion size and the radiologists experience in a representative number of patients. Method: The results of 1019 CT-guided biopsies in 951 patients were evaluated with regard to sensitivity, specificity and complication rate of the chosen needle sizes. A 17/18 g needle was used in 544 cases, a 19/20 g needle in 40 cases and a 15/16 g needle was used in 351 cases. Lesion size, depth and location were included as variables. Results: The biopsies yielded sufficient histology material in 913 of 951 (96%) cases. The rate of insufficient histology material increased significantly when a smaller needle size was used (20% when a 19/20 g needle was used). The false negative rate (6,8%) was influenced by needle size (17,5% at 19/29 g) and lesion size. Overall the sensitivity, specificity and diagnostic accuracy were 92%, 100% and 93%. Complications were noted in 18,4% of all cases. The most major-complication was pneumothorax (3%), which required chest tube drainages. Conclusion: With 15/16 g and 17/18 G needle sizes, diagnostic accuracy can be drastically increased without an increase in the complication rate. KW - Computertomograph KW - Punktion KW - Diagnostik KW - Komplikation KW - CT-gesteuerte Punktion KW - Maligne Tumoren KW - Raumforderung KW - Stanzbiopsie KW - Pneumothorax Y1 - 2014 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-126347 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 - THES A1 - Fischer, Monika T1 - Nicht operierte Sagittalnahtsynostosen im Verlauf T1 - Radiographic Changes in Non-Operated Sagittal Suture Synostosis N2 - Zur Darstellung des Verlaufs bei nicht operierten Kindern mit Sagittalsynostose wurden 155 Röntgenbilder von 52 Patienten im Alter zwischen 15 Tagen und 9 Jahren untersucht. Die Schädelnähte wurden hinsichtlich der Darstellbarkeit, Begrenzung, Zähnelung und Aktivität beurteilt. Weiterhin wurden acht Strecken und vier Winkel gemessen, daraus zwei Indizes berechnet. Die Sagittalnaht war bei mehr als der Hälfte der Aufnahmen im ersten Lebensjahr partiell bzw. vollständig darstellbar. Die Lambdanaht war ab dem zweiten Lebensmonat immer, die Coronarnaht bis auf wenige Ausnahmen darstellbar. Die Zähnelung der Nähte entwickelte sich altersentsprechend. Der Anteil der Nähte, die keine erhöhte Aktivität aufwiesen, sank im Verlauf von 94% auf 38%. Bei den Messstrecken und Winkeln wurden die Ergebnisse aus der Literatur weitgehend bestätigt. Der Basiswinkel war im untersuchten Patientenkollektiv signifikant erhöht. Der Höhenindex näherte sich im Verlauf der Altersnorm an, wohingegen sich die Parameter innere Schädelbreite und Breiten-Längen-Index signifikant von der Altersnorm entfernten. Der Skaphozephalus wächst sich nicht aus, aber einzelne Merkmale, wie die parietale Wölbung,nähern sich wieder etwas der Norm an. Sichere Hinweise für ein Übergreifen der Synostose auf andere Nähte wurden nicht gefunden. Im weiteren wurden digitale und konventionelle Röntgenaufnahmen von 33 Patienten mit Kraniostenosen verglichen. Untersucht wurde die Beurteilbarkeit hinsichtlich Schärfe und Kontrast. Der Zeitabstand zwischen konventioneller und digitaler Röntgenaufnahme lag im Mittel bei 24 Monaten. Die Vorteile des digitalen Röntgens hinsichtlich der Beurteilbarkeit konnten deutlich gezeigt werden. Somit ist das optimierte digitale Röntgensystem dem konventionellen vorzuziehen. N2 - Purpose: To characterize the spontaneous clinical course of isolated sagittal synostosis based on planar skull radiography. Materials and Methods: In this retrospective analysis we evaluated a total of 155 radiographs of 55 children 2 weeks to 9 years old. The sagittal, coronal and lambdoid sutures were evaluated on the basis of pairs of ap and lateral radiographs. The sutures were examined with respect to their boundary, activity, and conspicuity to be visualized (based on a 3-grade score system). Six selected points on the skull X-ray defined eight measured distances, three angles, and a width-length index. To document changes over time, the measurements were correlated to normal values. In addition, a correlation between suture activity and selected parameters was evaluated. Results: The sagittal suture could be continuously or partially depicted in more then half of all radiographs taken during the first year of life. The measured distances and angles were concordant with results from the literature. With increasing age, the width-length index deviated from standard values while other parameters approximated the norm. Conclusion: In the case of children younger than twelve months, the sagittal suture appears radiologically open in many cases despite clear-cut scaphocephaly. Definite signs of progressive plurisutural fusion were not found in this series. The dolichocephalic deformity remained unchanged while some signs of scaphocephalic appearance actually improved. Key words KW - Kraniostenose KW - Konservative Therapie KW - Radiologie KW - Vergleich konservative digitale Röntgentechnik KW - pathology KW - skull KW - radiography Y1 - 2007 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-24310 ER - TY - THES A1 - Feldner, Natascha Christina Maria T1 - Die interventionelle Therapie von Lebertumoren - Würzburger Ergebnisse und Verträglichkeit der transarteriellen Chemoembolisation (TACE) T1 - Interventional therapy of livertumours - A study from the university of Würzburg on tolerability of TACE N2 - Zusammenfassung Einleitung: Die Therapie der Lebertumore stellt nach wie vor eine Herausforderung für alle beteiligten Disziplinen dar. Die Universitätskliniken Würzburg verfügen über ein interdisziplinäres Therapiekonzept. Diese Studie aus der Abteilung für Röntgendiagnostik der Universität Würzburg ist ein Vergleich der eigenen Ergebnisse nach interventionellen Therapien von Lebertumoren, im Speziellen nach TACE, mit Daten der Literatur. Besonders berücksichtigt wurden die Auswirkungen auf die Lebensqualität und mögliche Komplikationen. Material und Methode: Von September 1994 bis April 2003 wurden die Lebertumore von 54 Patienten mit insgesamt 135 transarteriellen Chemoembolisationen (TACE) behandelt. Berücksichtigt wurden das Verhalten des Tumors, die Entwicklung des Karnofsky-Index, die Dauer des stationären Aufenthalts, die Kombination mit weiteren Therapieoptionen, die Überlebenszeit für die Monotherapie mit TACE und die Kombinationstherapie aus TACE und PEI / RFA, die Entwicklung ausgewählter Laborparameter, das Auftreten von Nebenwirkungen und Beschwerden nach TACE, die Ausprägung des Postembolisationssyndroms sowie aufgetretene Komplikationen und Embolisatverschleppungen. Ergebnisse: Die TACE hat sich unter Beachtung ihrer Kontraindikationen und der jeweiligen Situation des einzelnen Patienten als sichere und effektive Methode für die palliative Therapie von Lebertumoren erwiesen. Sie führt zu einer Verlängerung der Überlebenszeit, wobei sich die Kombination aus TACE und PEI / RFA der Monotherapie mit TACE überlegen darstellte. Auftretende Nebenwirkungen sind in der Regel vorübergehend, schwere Komplikationen und wesentliche Einschränkungen der Lebensqualität traten nur in Einzelfällen auf. Schlussfolgerung: Die Ergebnisse aus unserer Abteilung weisen eine gute Verträglichkeit der TACE für die Patienten nach und unterstreichen ihren Stellenwert in der Therapie primär inoperabler Lebertumore. N2 - Abstract Background and aims: The therapy of livertumours is still a challenge for all involved disciplines. The clinics of the university of Würzburg are using an interdisciplinary therapy concept. The following study from the department for x-ray diagnostics of the university of Würzburg is a comparison between our results of the interventional therapies of the livertumours especially using the TACE, with data from the literature. A special focus was made on the effects on the quality of life and possible complications. Materials and methods: From September 1994 to April 2003 54 patients with livertumours were treated with in all 135 transarterial chemoembolizations (TACE). Certain aspects were evaluated, such as the reaction of the tumours, the development of the Karnofsky-index, the duration of the stationary treatments, the combination with additional therapies, the survival rate with a single therapy with TACE alone and with a combination therapy consisting of TACE and PEI / RFA, the development of chosen laboratory parameters, the occurrence of side effects and complaints after the use of the TACE therapy, the development of the postembolisations syndromes as well as accruing complications and embolisations protractions. Results: The TACE has proven itself to be a safe and effective method for the palliative therapy of livertumours while considering the contraindications and the individual situations of the patients. The therapy leads a lengthening of the survival, whereas the combination of TACE and PEI / RFA has shown to be superior to the therapy consisting of TACE alone. Occurring side effects are usually only temporary, heavy complications and essential restrictions in the quality of life occurred only in isolated cases. Conclusion: The results form our department prove a good tolerability of the TACE for patients and underline its place value in the therapy of primarily inoperable livertumour. KW - Lebensqualität KW - interventionelle Therapie KW - Lebertumore KW - hepatozelluläres Karzinom (HCC) KW - transarterielle Chemomebolisation (TACE) KW - interventional therapy KW - livertumour KW - transarterial chemoembolization (TACE) KW - quality of life KW - hepatocellular carcinoma (HCC) Y1 - 2008 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-36504 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 - Ewald, Andrea A1 - Fuchs, Andreas A1 - Boegelein, Lasse A1 - Grunz, Jan-Peter A1 - Kneist, Karl A1 - Gbureck, Uwe A1 - Hoelscher-Doht, Stefanie T1 - Degradation and bone-contact biocompatibility of two drillable magnesium phosphate bone cements in an in vivo rabbit bone defect model JF - Materials N2 - The use of bone-cement-enforced osteosynthesis is a growing topic in trauma surgery. In this context, drillability is a desirable feature for cements that can improve fracture stability, which most of the available cement systems lack. Therefore, in this study, we evaluated a resorbable and drillable magnesium-phosphate (MgP)-based cement paste considering degradation behavior and biocompatibility in vivo. Two different magnesium-phosphate-based cement (MPC) pastes with different amounts of phytic acid (IP 6) as setting retarder (MPC 22.5 and MPC 25) were implanted in an orthotopic defect model of the lateral femoral condyle of New Zealand white rabbits for 6 weeks. After explantation, their resorption behavior and material characteristics were evaluated by means of X-ray diffraction (XRD), porosimetry measurement, histological staining, peripheral quantitative computed tomography (pQCT), cone-beam computed tomography (CBCT) and biomechanical load-to-failure tests. Both cement pastes displayed comparable results in mechanical strength and resorption kinetics. Bone-contact biocompatibility was excellent without any signs of inflammation. Initial resorption and bone remodeling could be observed. MPC pastes with IP 6 as setting retardant have the potential to be a valuable alternative in distinct fracture patterns. Drillability, promising resorption potential and high mechanical strength confirm their suitability for use in clinical routine. KW - magnesium phosphate cement KW - phytic acid KW - drillability KW - bone replacement material Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-362824 SN - 1996-1944 VL - 16 IS - 13 ER - TY - THES A1 - Evangelista, Laura T1 - Innovative Anwendungen der diffusionsgewichteten MRT in der pädiatrischen muskuloskelettalen Bildgebung T1 - Innovative applications of diffusion-weighted MRI in pediatric musculoskeletal imaging analisys N2 - Die vorliegende Arbeit untesucht die Darstellung tumoröser und entzündlicher muskuloskelettaler Läsionen mit der diffusionsgewichteten MRT-Bildgebung bei Kindern und Jugendlichen. Es sollten die Machbarkeit und die Zuverlässigkeit der Methode in der klinischen Routinebildgebung überprüft werden. Zusätzlich untersuchten wir den Einsatz von ADC-Werten zur Differenzierung von malignen und benignen Tumoren sowie bei inflammatorischen Knochen- und Weichteilbefunden. Wie die klassische MRT, ist die diffusionsgewichtete Bildgebung nicht-invasiv: da der Bildkontrast allein mittels magnetischer Feldgradienten erzielt wird, erfordert sie weder eine Injektion von Kontrastmitteln, noch den Einsatz von ionisierender Strahlung. Sie garantiert eine schnelle Aquisitionstechink um Artefakte zu begrenzen und die Untersuchungen kindergerechter zu gestalten. Die von uns erfassten Daten wurden in zwei unterschiedlichen Studien aufgeteilt. Die Erste Studie erfasst Ergebnisse bzgl. der Detektion und Dignitätsabschätzung kinderlicher muskuloskelettaler Tumoren mittels diffusionsgewichteten MRT Bilder. Das zweite Forschungsprojekt, befasst sich mit dem erstmaligen Einsatz der diffusionsgewichteten MRT zur Identifikation und Differenzierung von Knochenmarködem, Weichteilödem und Synovitis bei pädiatrischen Patienten. N2 - This study investigates the presentation of tumorous and inflammatory musculoskeletal lesions by diffusion-weighted MRI imaging in children and adolescents. The feasibility and reliability of the method should be tested in clinical routine imaging. In addition, we investigated the use of ADC values ​​for the differentiation of malignant and benign tumors as well as for inflammatory bone and soft tissue findings. Like the classical MRI, diffusion-weighted imaging is non-invasive: since the image contrast is achieved solely by means of magnetic field gradients, it does not require either the injection of contrast agents or the use of ionizing radiations. This technique allows a quick aquisition to limit artefacts and to shape the investigations in a more child-friendly way. The data we collected were divided into two different studies. The first study records results concerning the detection and dignity-assessment of childhood musculoskeletal tumors using diffusion-weighted MRI images. The second research project deals with the initial use of diffusion-weighted MRI for the identification and differentiation of bone marrow edema, soft tissue edema and synovitis in Pediatric patients. KW - Diffusionsgewichtete Magnetresonanztomographie KW - Diffusions-MRT KW - DW-MRI KW - Pädiatrie KW - muskuloskelettalen Bildgebung KW - pädiatrischen Tumoren Y1 - 2016 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-145065 ER - TY - JOUR A1 - Elsner, Clara A1 - Kunz, Andreas Steven A1 - Wagner, Nicole A1 - Huflage, Henner A1 - Hübner, Stefan A1 - Luetkens, Karsten Sebastian A1 - Bley, Thorsten Alexander A1 - Schmitt, Rainer A1 - Ergün, Süleyman A1 - Grunz, Jan-Peter T1 - MRI-based evaluation of the flexor digitorum superficialis anatomy: investigating the prevalence and morphometry of the “chiasma antebrachii” JF - Diagnostics N2 - Recent dissection studies resulted in the introduction of the term “chiasma antebrachii”, which represents an intersection of the flexor digitorum superficialis (FDS) tendons for digits 2 and 3 in the distal third of the forearm. This retrospective investigation aimed to provide an MRI-based morphologic analysis of the chiasma antebrachii. In 89 patients (41 women, 39.3 ± 21.3 years), MRI examinations of the forearm (2010–2021) were reviewed by two radiologists, who evaluated all studies for the presence and length of the chiasma as well as its distance from the distal radioulnar and elbow joint. The chiasma antebrachii was identified in the distal third of the forearm in 88 patients (98.9%), while one intersection was located more proximally in the middle part. The chiasma had a median length of 28 mm (interquartile range: 24–35 mm). Its distances to the distal radioulnar and elbow joint were 16 mm (8–25 mm) and 215 mm (187–227 mm), respectively. T1-weighted post-contrast sequences were found to be superior to T2- or proton-density-weighted sequences in 71 cases (79.8%). To conclude, the chiasma antebrachii is part of the standard FDS anatomy. Knowledge of its morphology is important, e.g., in targeted injections of therapeutics or reconstructive surgery. KW - flexor digitorum superficialis KW - flexor tendon KW - chiasma antebrachii KW - magnetic resonance imaging Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-362631 SN - 2075-4418 VL - 13 IS - 14 ER - TY - JOUR A1 - Duhr, Carolin D. A1 - Kenn, Werner A1 - Kickuth, Ralph A1 - Kerscher, Alexander G. A1 - Germer, Christoph-Thomas A1 - Hahn, Dietbert A1 - Pelz, Joerg O. W. T1 - Optimizing of preoperative computed tomography for diagnosis in patients with peritoneal carcinomatosis JF - World Journal of Surgical Oncology N2 - Background and Objective This study evaluates whether Computer Tomography is an effective procedure for preoperative staging of patients with Peritoneal Carcinomatosis. Method A sample of 37 patients was analyzed with contrast enhanced abdominal Computer Tomography, followed by surgical staging. All Computer Tomography scans were evaluated 3 times by 2 radiologists with one radiologist reviewing 2 times. The efficacy of Computer Tomography was evaluated using the Spearman correlation coefficient. Correlations were analyzed by abdominopelvic region to assess results of the Peritoneal Carcinomatosis Index (PCI) aggregating the 13 regions. Surgical findings were compared to radiological findings. Results Results indicate high correlations between the surgical and radiological Peritoneal Carcinomatosis Indices. Analyses of the intra-class correlation between the first and second reading of one radiologist suggest high intra-observer reliability. Correlations by abdominopelvic region show higher values in the upper and middle regions and relatively lower values in the lower regions and the small bowel (correlation coefficients range between 0.418 and 0.726, p < 0.010; sensitivities range between 50% and 96%; and specificities range between 62% and 100%). Conclusion Computer Tomography represents an effective procedure in the preoperative staging of patients with PC. However, results by abdominopelvic region show lower correlation, therefore suggest lower efficacy. These results are supported by analyses of sensitivity and accuracy by lesion size. This suggests that Computer Tomography is an effective procedure for pre-operative staging but less for determining a tumor's accurate extent. KW - Carcinomatosis KW - diagnosis KW - PCI Y1 - 2011 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-138024 VL - 9 IS - 171 ER - TY - THES A1 - Dragolea, Darius T1 - Ergebnisqualität von klinischen und Vorsorgemammographien im Vergleich zu internationalen Leitlinien für Brustkrebsscreening T1 - The quality of the results of diagnostic and screening mammographic examinations in comparison with international breast cancer screening guidelines N2 - Durch den mehrfachen Führungswechsel in der Radiologischen Abteilung der Frauenklinik der Universität Würzburg seit 1995, ergab sich die Frage, ob die verantwortlichen Radiologen sich in der Mammographiebeurteilung unterscheiden. Ausgehend von 8033 Mammographien von asymptomatischen- und Patientinnen mit einem klinischen Befund, wurde die Sensitivität, Spezifität, die Biopsierate, die Tumorentdeckung- und Recallrate für die einzelnen Untersucher ermittelt. Die wesentlichen Ergebnisse dieser Arbeit sind: 1. Die Sensitivität liegt bei durchschnittlich 97,14%, die Spezifität 98,62%. Die Tumorentdeckungsrate liegt zwischen 6,59‰ und 8,99‰, die Biopsierate beträgt 1,34% und die Recallrate 3,79%. 2. Für alle Behandler liegen diese Werte innerhalb der vom American College of Radiology und den European Guidelines for Quality Assurance in Mammography Screening vorgegebenen Richtlinien. 3. Es gibt keine signifikanten Unterschiede in der Mammographiebefundung durch die verschiedenen Untersucher. 4. Durch die Einführung der standardisierten Klassifikation der Befunde wird in Zukunft eine Qualitätssicherung der Mammographieuntersuchungen und eine Kontrolle der Ergebnisse gewährleistet. N2 - The frequent changes of management in the Radiological Department of the Gynaecological Clinic of the University of Würzburg since 1995 gave rise to the question of whether the radiologists responsible differed in their assessments of mammographical examinations. The sensitivity, specifity, biopsy rate, cancer detection rate and recall rate were calculated for each inidividual examining physician on the basis of 8033 mammographies of asymptomatic patients and patients with clinical symptoms. The primary results of this study were as follows: 5. The average sensitivity came to 97.14% and the average specifity came to 98.62%. The cancer detection rate was between 6.59‰ and 8.99‰, the biopsy rate was 1.34% and the recall rate was 3.79%. 6. These values fell within the guidelines specified by the American College of Radiology and the European Guidelines for Quality Assurance in Mammography Screening for all examining physicians. 7. There were no significant differences between the individual examining physicians with respect to their mammographical assessments. 8. The introduction of the standardised classification of the assessments will in future guarantee quality assurance in mammographical examinations and ensure that the results can be monitored. KW - Mammographie KW - Sensitivität KW - Spezifität KW - Tumorentdeckungsrate KW - mammography KW - sensitivity KW - specifity KW - cancer detection rate Y1 - 2005 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-12306 ER - TY - JOUR A1 - Dorn, Franziska A1 - Herzberg, Moriz T1 - Response to Letter to the Editor “Keeping Late Thrombectomy Imaging Protocols Simple to Avoid Analysis Paralysis” JF - Clinical Neuroradiology KW - neuroradiology KW - neurosurgery KW - neurology Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-307023 SN - 1869-1439 SN - 1869-1447 VL - 31 IS - 3 ER - TY - THES A1 - Dietrich, Philipp T1 - Traveling Wave Magnetic Particle Imaging: Visuelle Stenosequantifizierung und Perkutane Transluminale Angioplastie im Gefäßmodell T1 - Traveling Wave Magnetic Particle Imaging: visual stenosis quantification and percutaneous transluminal angioplasty in a phantom model N2 - Magnetic Particle Imaging (MPI) ist ein innovatives tomographisches Bildgebungs­verfahren, mit dem Tracerpartikel äußerst sensitiv und schnell mehrdimensional abgebildet werden können. Die Methode basiert auf der nichtlinearen Magnetisierungs­antwort superparamagnetischer Eisenoxidnanopartikel (SPION) in einem Messpunkt, welcher ein Messvolumen rastert. In vorliegender Arbeit wurde das sog. Traveling Wave MPI (TWMPI) Verfahren eingesetzt, wodurch im Vergleich zu konventionellen MPI-Scannern ein größeres Field of View (FOV) und eine geringere Latenz bis zur Bildanzeige erreicht werden konnte. TWMPI weist einige für medizinische Zwecke vielversprechende Eigenschaften auf: Es liefert zwei- und dreidimensionale Bildrekonstruktionen in Echtzeit mit hoher zeitlicher und räumlicher Auflösung. Dabei ist die Bildgebung von Grund auf hintergrundfrei und erfordert keinerlei ionisierende Strahlung. Zudem ist die Technik äußerst sensitiv und kann SPION-Tracer noch in mikromolaren Konzentrationen detektieren. Ziel dieser Arbeit war es daher zu untersuchen, inwiefern es mittels TWMPI möglich ist, künstliche Stenosen im Gefäßmodell visuell in Echtzeit darzustellen und quantitativ zu beurteilen sowie überdies eine perkutane transluminale Angioplastie (PTA) im Gefäßmodell unter TWMPI-Echtzeit-Bildgebung durchzuführen. Alle Experimente wurden in einem speziell angefertigten TWMPI-Scanner durchgeführt (JMU Würzburg, Experimentelle Physik V (Biophysik), FOV: 65 x 29 x 29 mm³, Auflösung: ca. 1.5 - 2 mm). Die Lumen-Darstellungen erfolgten mittels des SPION-Tracers Ferucarbotran in einer Verdünnung von 1 : 50 (entspr. 10 mmol [Fe]/l). Das PTA-Instrumentarium wurde mit eigens hergestelltem ferucarbotran­haltigem Lack (100 mmol [Fe]/l) markiert. Für die verschiedenen Teilexperimente wurden den jeweiligen speziellen Anforderungen entsprechend mehrere Gefäßmodelle handgefertigt. Für die visuelle Stenosequantifizierung wurden fünf starre Stenosephantome unterschiedlicher Stenosierung (0%, 25%, 50%, 75%, 100%) aus Polyoxymethylen her­gestellt (l: 40 mm, ID: 8 mm). Die Gefäßmodelle wurden mehrfach zentral im FOV platz­iert und das stenosierte Lumen mittels sog. Slice-Scanning Modus (SSM, Einzel­aufnahme inkl. 10 Mittelungen: 200 ms, Bildfrequenz: 5 Bilder pro Sekunde, Latenz: ca. 100 ms) als zweidimensionale Quasi-Projektionen abgebildet. Diese Aufnahmen (n = 80, 16 je Phantom) wurden mit einer ein­heitlichen Grauskalierung versehen und anschließend entsprechend den NASCET-Kriterien visuell ausgewertet. Alle achtzig Aufnahmen waren unabhängig vom Stenosegrad aufgrund einheitlicher Fensterung sowie konstanter Scannerparameter untereinander gut vergleichbar. Niedrig­gradige Stenosen konnten insgesamt genauer abgebildet werden als höhergradige, was sich neben der subjektiven Bildqualität auch in geringeren Standardabweichungen zeigte (0%: 3.70 % ± 2.71, 25%: 18.64 % ± 1.84, 50%: 52.82 % ± 3.66, 75%: 77.84 % ± 14.77, 100%: 100 % ± 0). Mit zunehmendem Stenosegrad kam es vermehrt zu geometrischen Ver­zerrungen im Zentrum, sodass bei den 75%-Stenosen eine breitere Streuung der Messwerte mit einer höheren Standardabweichung von 14.77% einherging. Leichte, randständige Artefakte konnten bei allen Datensätzen beobachtet werden. Für die PTA wurden drei interaktive Gefäßmodelle aus Polyvinylchlorid (l: 100 mm, ID: 8 mm) mit zu- und abführendem Schlauchsystem entwickelt, welche mittels Kabelband von außen hochgradig eingeengt werden konnten. Analog zu einer konventionellen PTA mittels röntgenbasierter digitaler Subtraktionsangiographie (DSA), wurden alle erforder­lichen Arbeitsschritte (Gefäßdarstellung, Drahtpassage, Ballonplatzierung, Angioplastie, Erfolgskontrolle) unter (TW)MPI-Echtzeit-Bildgebung (Framerate: 2 - 4 FPS, Latenz: ca. 100 ms) abgebildet bzw. durchgeführt. Im Rahmen der PTA war eine Echtzeit-Visualisierung der Stenose im Gefäßmodell durch Tracer-Bolusgabe sowie die Führung des markierten Instrumentariums zum Zielort möglich. Die Markierung der Instrumente hielt der Beanspruchung während der Prozedur stand und ermöglichte eine genaue Platzierung des Ballonkatheters. Die Stenose konnte mittels Angioplastie-Ballons unter Echtzeit-Darstellung gesprengt werden und der Interventionserfolg im Anschluss durch erneute Visualisierung des Lumens validiert werden. Insgesamt zeigt sich MPI somit als adäquate Bildgebungstechnik für die beiden in der Fragestellung bzw. Zielsetzung definierten experimentellen Anwendungen. Stenosen im Gefäßmodell konnten erfolgreich in Echtzeit visualisiert und bildmorphologisch nach NASCET-Kriterien quantifiziert werden. Ebenso war eine PTA im Gefäßmodell unter TWMPI-Echtzeit-Bildgebung machbar. Diese Ergebnisse unter­streichen das grundlegende Potenzial von MPI für medizinische Zwecke. Um zu den bereits etablierten Bildgebungsmethoden aufzuschließen, ist jedoch weitere Forschung im Bereich der Scanner-Hard- und -Software sowie bezüglich SPION-Tracern nötig. N2 - Magnetic Particle Imaging (MPI) is an innovative tomographic imaging method with which tracer particles can be depicted multidimensionally quickly and extremely sensitively. The method is based on the nonlinear magnetization response of superparamagnetic iron oxide nanoparticles (SPION) in a measuring point that runs through a measurement volume. In the present work, the so-called Traveling Wave MPI (TWMPI) method was used, whereby a larger Field of View (FOV) and a lower latency from measurement to image display could be achieved compared to conventional MPI scanners. TWMPI has some promising properties for medical purposes: it delivers two- and three-dimensional image reconstructions in real time with high temporal and spatial resolution. The imaging is background-free by default and does not require any ionizing radiation. In addition, the technology is extremely sensitive and can detect SPION tracers in micromolar concentrations. The aim of this work was therefore to investigate to what extent it is possible to use TWMPI to graphically visualize and quantitatively assess artificial stenoses in a phantom model in real time and furthermore to perform a percutaneous transluminal angioplasty (PTA) in a phantom model under TWMPI real-time imaging. All experiments were carried out in a specially manufactured TWMPI scanner (JMU Würzburg, Experimental Physics V (Biophysics), FOV: 65 x 29 x 29 mm³, resolution: approx. 1.5 - 2 mm). Lumen visualization was achieved by use of the SPION tracer Ferucarbotran in a dilution of 1 : 50 (corresponding to 10 mmol [Fe] / l). The PTA instruments were marked with specially produced ferucarbotran-containing lacquer (100 mmol [Fe]/l). For the different sub-experiments, several vessel phantoms were custom-made according to the respective specific requirements. For visual stenosis quantification, five rigid stenosis phantoms of different grade of stenosis (0%, 25%, 50%, 75%, 100%) were built from polyoxymethylene (l: 40 mm, ID: 8 mm). The vessel phantoms were placed centrally in the FOV several times and the stenotic lumen was depicted as two-dimensional quasi-projections using a so-called slice scanning mode (SSM, single recording incl. averaging 10‑fold: 200 ms, frame rate: 5 frames per second, latency: approx. 100 ms). A uniform gray scaling was applied to these images (n = 80, 16 per phantom) before they were visually evaluated according to the NASCET criteria. Due to the uniform gray scaling, display settings and constant scanner parameters, all eighty images were well comparable with each other, regardless of the degree of stenosis. Overall, low-grade stenoses could be depicted more accurately than higher-grade ones, which, in addition to the subjective image quality, was also reflected in lower standard deviations (0%: 3.70 % ± 2.71, 25%: 18.64 % ± 1.84, 50%: 52.82 % ± 3.66, 75%: 77.84 % ± 14.77, 100%: 100 % ± 0). With increasing­ degree of stenosis, geometric distortions in the center increased, so that within the 75% stenoses a wider spread of the measured values led to a higher standard deviation of 14.77%. Faint, marginal artifacts could be observed over all data sets. For PTA, three interactive vessel phantoms made of polyvinyl chloride (l: 100 mm, ID: 8 mm) were developed with additional tubing to and from the phantom. These vessel phantoms could be highly constricted from the outside by use of cable ties. Analogous to a conventional PTA using X-ray-based digital subtraction angiography (DSA), all necessary steps (vascular visualization, wire passage, balloon placement, angioplasty, control imaging) were depicted by resp. carried out under (TW)MPI real-time imaging (frame rate: 2 – 4 FPS, latency: approx. 100 ms). During the PTA, real-time visualization of the stenosis in the vascular phantom by tracer bolus administration as well as guidance of the marked instruments to the destination was possible. The marking of the instruments withstood the stress during the procedure and allowed an accurate placement of the balloon catheter. The stenosis could be dilated with an angioplasty balloon under real-time imaging and the intervention success could then be validated by re-visualization of the lumen. Overall, MPI thus proves to be an adequate imaging technique in regard of the two experimental applications defined in the questions and aims of this study. Stenoses in a vascular phantom could be successfully visualized in real time and quantified visually according to NASCET criteria. Furthermore, a PTA in a vascular phantom guided by TWMPI real-time imaging was feasible. These findings underscore the fundamental potential of MPI for medical purposes. In order to catch up with the already established imaging methods, however, further research is needed in the field of scanner hard- and software as well as regarding SPION tracers. KW - Medizinische Radiologie KW - Magnetpartikelbildgebung KW - Interventionsradiologie KW - Experimentelle Bildgebung KW - Magnetic Particle Imaging KW - Traveling Wave Magnetic Particle Imaging KW - Interventionelle Radiologie KW - MPI KW - experimental imaging KW - magnetic particle imaging KW - traveling wave magnetic particle imaging KW - interventional radiology KW - Transluminale Angioplastie KW - MPI Y1 - 2024 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-352517 ER - TY - JOUR A1 - Diessner, Joachim A1 - Anders, Laura A1 - Herbert, Saskia A1 - Kiesel, Matthias A1 - Bley, Thorsten A1 - Schlaiss, Tanja A1 - Sauer, Stephanie A1 - Wöckel, Achim A1 - Bartmann, Catharina T1 - Evaluation of different imaging modalities for axillary lymph node staging in breast cancer patients to provide a personalized and optimized therapy algorithm JF - Journal of Cancer Research and Clinical Oncology N2 - Purpose The reliable detection of tumor-infiltrated axillary lymph nodes for breast cancer [BC] patients plays a decisive role in further therapy. We aimed to find out whether cross-sectional imaging techniques could improve sensitivity for pretherapeutic axillary staging in nodal-positive BC patients compared to conventional imaging such as mammography and sonography. Methods Data for breast cancer patients with tumor-infiltrated axillary lymph nodes having received surgery between 2014 and 2020 were included in this study. All examinations (sonography, mammography, computed tomography [CT] and magnetic resonance imaging [MRI]) were interpreted by board-certified specialists in radiology. The sensitivity of different imaging modalities was calculated, and binary logistic regression analyses were performed to detect variables influencing the detection of positive lymph nodes. Results All included 382 breast cancer patients had received conventional imaging, while 52.61% of the patients had received cross-sectional imaging. The sensitivity of the combination of all imaging modalities was 68.89%. The combination of MRI and CT showed 63.83% and the combination of sonography and mammography showed 36.11% sensitivity. Conclusion We could demonstrate that cross-sectional imaging can improve the sensitivity of the detection of tumor-infiltrated axillary lymph nodes in breast cancer patients. Only the safe detection of these lymph nodes at the time of diagnosis enables the evaluation of the response to neoadjuvant therapy, thereby allowing access to prognosis and improving new post-neoadjuvant therapies. KW - breast cancer imaging KW - positive nodal status KW - cross-sectional imaging KW - conventional imaging KW - post-neoadjuvant therapies KW - neoadjuvant therapies Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-324047 VL - 149 IS - 7 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 - JOUR A1 - Conrads, Nora A1 - Grunz, Jan-Peter A1 - Huflage, Henner A1 - Luetkens, Karsten Sebastian A1 - Feldle, Philipp A1 - Grunz, Katharina A1 - Köhler, Stefan A1 - Westermaier, Thomas T1 - Accuracy of pedicle screw placement using neuronavigation based on intraoperative 3D rotational fluoroscopy in the thoracic and lumbar spine JF - Archives of Orthopaedic and Trauma Surgery N2 - Introduction In spinal surgery, precise instrumentation is essential. This study aims to evaluate the accuracy of navigated, O-arm-controlled screw positioning in thoracic and lumbar spine instabilities. Materials and methods Posterior instrumentation procedures between 2010 and 2015 were retrospectively analyzed. Pedicle screws were placed using 3D rotational fluoroscopy and neuronavigation. Accuracy of screw placement was assessed using a 6-grade scoring system. In addition, screw length was analyzed in relation to the vertebral body diameter. Intra- and postoperative revision rates were recorded. Results Thoracic and lumbar spine surgery was performed in 285 patients. Of 1704 pedicle screws, 1621 (95.1%) showed excellent positioning in 3D rotational fluoroscopy imaging. The lateral rim of either pedicle or vertebral body was protruded in 25 (1.5%) and 28 screws (1.6%), while the midline of the vertebral body was crossed in 8 screws (0.5%). Furthermore, 11 screws each (0.6%) fulfilled the criteria of full lateral and medial displacement. The median relative screw length was 92.6%. Intraoperative revision resulted in excellent positioning in 58 of 71 screws. Follow-up surgery due to missed primary malposition had to be performed for two screws in the same patient. Postsurgical symptom relief was reported in 82.1% of patients, whereas neurological deterioration occurred in 8.9% of cases with neurological follow-up. Conclusions Combination of neuronavigation and 3D rotational fluoroscopy control ensures excellent accuracy in pedicle screw positioning. As misplaced screws can be detected reliably and revised intraoperatively, repeated surgery for screw malposition is rarely required. KW - pedicle screws KW - vertebral pedicles KW - fluoroscopy KW - neuronavigation KW - spine Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-324966 VL - 143 IS - 6 ER - TY - THES A1 - Cao, Victoria Xinghui T1 - Stichkanalembolisation nach perkutaner transhepatischer Cholangiodrainage mittels Gelatineschwamm: Eine retrospektive Analyse T1 - Catheter tract embolization after percutaneous biliary drainage using gelatin sponge: a retrospective analysis N2 - Durch die Anlage einer perkutanen transhepatischen Cholangiodrainage (PTCD), im Rahmen benigner und maligner biliärer Obstruktionen, wird eine Kommunikation zwischen Hautoberfläche, Peritoneum und dem biliären System geschaffen. Insbesondere nach Entfernung der PTCD besteht das Risiko einer Galleleckage, einer Blutung, einer biliokutanen Fistel oder einer lokalen Peritonitis, mit durchaus schwerwiegenden Konsequenzen. Die Embolisation dieses Stichkanals nach Entfernung der Drainage mittels Gelatineschwamm (Gelfoam) stellt eine einfache und effektive Lösung dar diese Komplikationen zu reduzieren und zu verhindern. Ziel dieser Studie war es, die Effektivität der Stichkanalembolisation mittels Gelatineschwamm nach PTCD retrospektiv zu evaluieren. N2 - Applying percutaneous biliary drainage (PTBD) in the context of benign and malignant biliary obstructions, communication between the skin surface, peritoneum and the biliary system is created. Particularly after removal of the PTBD, there is a risk of bile leakage, bleeding, a bilio-cutaneous fistula or local peritonitis, with serious consequences. Transhepatic catheter tract embolization after removal of the drainage using gelatin sponge (Gelfoam) is a simple and effective method to reduce and prevent these complications. The aim of this study was to retrospectively evaluate the feasibility and safety of tract embolization after PTBD using gelatin sponge. KW - Embolisation KW - Stichkanalembolisation KW - Perkutane transhepatische Cholangiodrainage KW - Interventionelle Radiologie KW - Galle KW - Gelatineschwamm KW - tract embolization KW - percutaneous biliary drainage KW - Interventional radiology KW - Biliary KW - gelatin sponge Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-210855 ER - TY - THES A1 - Bürckstümmer, Ruth T1 - Quantitative 31P-MR-spektroskopische Untersuchung globaler Herzerkrankungen unterschiedlicher Genese - Verlaufsbeobachtung nach Aortenklappenersatz und unter Therapie bei Dilatativer Kardiomyopathie T1 - Quantitative 31P-NMR Spectroscopy in Global Heart Diseases of different genesis - Observations after Aortic Valve Replacement and during Therapy in Dilated Cardiomyopathy N2 - Die Arbeit zeigt bei verschiedenen Patientengruppen, dass mit Hilfe der quantitativen 31P-MR-Spektroskopie der Energiemetabolismus des Myokards beurteilt werden kann. Mit der gewählten Methode SLOOP ist nun auch eine Bestimmung der absoluten Konzentration der energiereichen Phosphate PCr und ATP möglich; im Gegensatz dazu wurde bisher nur das Verhältnis von PCr/ATP bestimmt. Die Beobachtungen bei Patienten mit Aortenklappenfehlern zeigten vor und nach Aortenklappenersatz Veränderungen, ebenso wurden bei Patienten mit Dilatativer Kardiomyopathie nach Einsatz von ß-Blockern bzw. nach Beginn regelmäßiger körperlicher Aktivität Verbessserungen des Energiestoffwechsels beobachet. N2 - The Study shows in different patient groups, that the high energy metabolism of myocardial tissue can be judged by 31P-NMR spectroscopy. With the chosen method SLOOP it is possible to do a quantitative determination of the high energy phosphates PCrand ATP unlike determining the ratio of PCr/ATP. The observations in patients with aortic valve diseases showed changes before and after valve replacement, in patients with dilated cardiomyopathy improvements of the energy metabolism could be observed as well after beginning of a ß-blocker therapy and after exercise. KW - Quantitative 31P-MR- Spektroskopie KW - Herzerkrankung KW - Aortenklappenersatz KW - DCM KW - 31P-MR-Spectroscopy KW - Heartdisease KW - Aortic Valve Replacement KW - DCM Y1 - 2003 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-8976 ER - TY - THES A1 - Böck, Lena T1 - Evaluation der präoperativen Ausdehnungsbestimmung ductaler Carcinomata in situ mittels hochauflösender 3-Tesla MR-Mammographie T1 - Evaluation of the Extension of ductal Carcinoma in situ with high resolution 3-Tesla MR mammography N2 - Zusammenfassend lässt sich sagen, dass auch in dieser Studie die MRT bewiesen hat, dass sie eine Diagnostik ist, die aufgrund ihrer vielen Vorteile (röntgenstrahlenfrei, schmerzfrei, hochauflösende Diagnostik) der konventionellen Mammographie überlegen ist. Im Vergleich mit anderen diagnostischen Möglichkeiten, weist die MRT die höchsten Sensitivitäten auf. Viele falsch positive Befunde könnten so vermieden werden und unnötige Biopsien umgangen werden. Die MRT zeigte in dieser Studie eine Sensitivität von 78%, für reine DCIS 76%. Die in der präoperativen MR-Diagnostik gemessenen Größen korrelierten statistisch signifikant mit der histologisch bestimmten Größe für alle Gruppen (reines DCIS, begleitendes DCIS, mikroinvasives DCIS) zusammen genommen (c=0,378; p<0,01) sowie für reine DCIS (c=0,403; p<0,05). Desweiteren korrelierten die Größen statistisch signifikant für high-grade DCIS (c=0,493; p<0,05) und für Nekrosen positive DCIS (c=0,556; p<0,01). Hier ließen sich die Tumorgrößen verlässlich vorhersagen. In der Auswertung der Signalintensitäts-Zeit-Kurven zeigten sich signifikante Unterschiede zwischen den Gruppen hinsichtlich der initialen (p<0,05) und postinitialen Phase (p<0,01). So lässt sich anhand der KM-Kinetik eine Aussage über die Malignität treffen. Ein reines DCIS zeigte typischerweise eine initiale Phase mit einem KM-Anstieg von 50-100% oder >100%, gefolgt von einer Plateau-Phase. Ein invasives Carcinom begleitendes DCIS zeichnete sich durch einen raschen Anstieg >100% gefolgt von einem „wash-out“ und einem inhomogenen, unbegrenzten Anreicherungsverhalten aus. Mikrovinvasive DCIS zeigten ähnlich den reinen DCIS einen initialen Anstieg von 50-100% sowie eine folgende Plateau-Phase. Keinen statistisch signifikanten Einfluss hatte die präoperative Größenbestimmung auf das operativen Verfahren (BET vs. Ablatio). Trotz der präoperativen MRT waren zu 29,6 % Nachresektionen - davon ca. die Hälfte (14,1%) als sekundäre Ablatio - nötig. Mit der MRT ließen sich grundsätzlich verlässliche präoperative Vorhersagen hinsichtlich Größe und Malignität treffen. Signalintensitäts-Zeit-Kurven und höhere Feldstärken, wie die 3T-MRT, könnten sehr hilfreich sein und die Sensitivität und Spezifität verbessern. Warum trotz allem noch so viele Nachresektionen nötig sind, gilt es in folgenden Studien zu untersuchen. N2 - Evaluation of the Extension of ductal Carcinoma in situ with high resolution 3-Tesla MR mammography KW - DCIS KW - MRT KW - duktal KW - Tesla KW - evaluation Y1 - 2018 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-169153 ER - TY - THES A1 - Bärwolff, Jennifer T1 - Prognostische Marker im MRT bei diffus intrinsischen Ponsgliomen im Kindesalter T1 - Diffuse intrinsic brainstem glioma in children – prognostic marker on MRI N2 - Das DIPG ist eine für die Kindheit recht spezifische Neoplasie und geht aufgrund seiner Lage im Hirnstamm mit diffusen Ausbreitungsmuster, sowie fehlendem Therapieansprechen mit einer sehr schlechten Prognose einher. 90% der betroffenen Kinder versterben innerhalb der ersten beiden Jahre nach Diagnosestellung. Ziel dieser Arbeit war es herauszufinden ob es bildgebende oder epidemiologische Merkmale gibt, die einen Einfluss auf die Überlebenszeiten zeigen und somit als prognostische Marker genutzt werden können. Die Daten der 253 Studienteilnehmer mit neudiagnostizierten DIPG stammen aus der HIT-HGG-2007-Studie, sowie den 4 Vorgängerstudien HIT-GBM-A-D über einen Untersuchungszeitraum von 1998 - 2012. Alle Erst-MRTs und alle 3-monatige follow-up-Untersuchungen wurden statistisch ausgewertet und mit Hilfe von Kaplan-Meier-Kurven Überlebenswahrscheinlichkeiten für das OS und EFS bestimmt, sowie anschließendem Gruppenvergleich im Log- Rank-Test. Als prognostisch günstig erwiesen sich ein Erkrankungsalter bei Diagnosestellung unter 3 Jahren, sowie eine Therapie nach SKK-Schema. Auch eine fehlende Kontrastmittelaufnahme bei Diagnosestellung und eine große Tumorfläche zeigten bessere Überlebenszeiten. Dagegen hatten weder das Geschlecht, noch die Histologie, noch eine max. Flächen- oder Volumenreduktion Einfluss auf die Überlebenszeiten der betroffenen Kinder. N2 - Brainstem tumors are the most common solid neoplasm in childhood. Especially diffuse intrinsic brainstem gliomas occure diffusely in the pons. Subsequently they are difficult to treat and characterized by a dismal prognosis. More than 90% of children die within 2 years of diagnosis. The aim of this retrospective study was to find any predictive imaging or epidemiological features of overall and progression free survival, which could be used as prognostic markers. Data were analyzed from 253 children with newly diagnosed pontine glioma registered in HIT-GBM database, including the prospective multi-center studies HIT- GBM A-D and HIT-HGG 2007, from 1998-2012. To evaluate prognostic values, we performed a Kaplan-Meier survival analysis (log- rank test) that incorporated all initial MRIs and 3 month-follow-up MRIs. Favorable prognostic factors seemed to be an age younger than 3 years, as well as a therapy according to SKK, a large tumor area and absence of enhancement at baseline. But there was no survival difference between males and females. Neither histological grade, nor a maximum reduced tumor area or volume have shown a prognostic relevance. KW - DIPG KW - diffus intrinsisches Ponsgliom KW - prognostische Marker KW - MRT KW - brainstem glioma KW - prognostic marker on MRI Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-185505 ER - TY - JOUR A1 - Busch, Albert A1 - Tschernitz, Sebastian A1 - Thurner, Anette A1 - Kellersmann, Richard A1 - Lorenz, Udo T1 - Fatal Paraneoplastic Embolisms in Both Circulations in a Patient with Poorly Differentiated Neuroendocrine Tumour JF - Case Reports in Vascular Medicine N2 - Arterial embolism with lower limb ischemia is a rare manifestation of paraneoplastic hypercoagulability in cancer patients. We report a unique case of fatal thromboembolism involving both circulations associated with a poorly differentiated neuroendocrine tumor of the lung with rapid progress despite high doses of unfractioned heparin and review the current literature on anticoagulative regimen in tumour patients. KW - Medizin Y1 - 2013 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-97335 ER - TY - JOUR A1 - Buder, Kristina A1 - Lapa, Constantin A1 - Kreissl, Michael C. A1 - Schirbel, Andreas A1 - Herrmann, Ken A1 - Schnack, Alexander A1 - Bröcker, Eva-Bettina A1 - Goebeler, Matthias A1 - Buck, Andreas K. A1 - Becker, Jürgen C. T1 - "Somatostatin receptor expression in Merkel cell carcinoma as target for molecular imaging" N2 - Background Merkel cell carcinoma (MCC) is a rare cutaneous neoplasm with increasing incidence, aggressive behavior and poor prognosis. Somatostatin receptors (SSTR) are expressed in MCC and represent a potential target for both imaging and treatment. Methods To non-invasively assess SSTR expression in MCC using PET and the radiotracers [68Ga]DOTA-D-Phe1-Tyr3-octreotide (DOTATOC) or -octreotate (DOTATATE) as surrogate for tumor burden. In 24 patients with histologically proven MCC SSTR-PET was performed and compared to results of computed tomography (CT). Results SSTR-PET detected primary and metastatic MCC lesions. On a patient-based analysis, sensitivity of SSTR-PET was 73% for nodal metastases, 100% for bone, and 67% for soft-tissue metastases, respectively. Notably, brain metastases were initially detected by SSTR-PET in 2 patients, whereas liver and lung metastases were diagnosed exclusively by CT. SSTR-PET showed concordance to CT results in 20 out of 24 patients. Four patients (17%) were up-staged due to SSTR-PET and patient management was changed in 3 patients (13%). Conclusion SSTR-PET showed high sensitivity for imaging bone, soft tissue and brain metastases, and particularly in combination with CT had a significant impact on clinical stage and patient management. KW - Merkel cell carcinoma KW - Molecular imaging KW - Somatostatin receptor expression KW - Positron emission tomography Y1 - 2014 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-110326 ER - TY - THES A1 - Buchner, Stefan T1 - Quantitative 31P-MR-Spektroskopie am menschlichen Herzen und Etablierung von SLOOP am Skelettmuskel T1 - Quantitative 31P-MR-Spectroscopy of the human myocardium and establishment of SLOOP on skeletal muscle N2 - Die vorliegende Arbeit setzt sich mit dem Einsatz der 31P-Magnetresonanzspektroskopie (MRS) zur Untersuchung des menschlichen Herz- und Skelettmuskelstoffwechsels auseinander: [1] Mit der Anwendung und Implementierung der akquisitionsgewichteten CSI (AW-CSI) am menschlichen Herzen konnten wir den Einsatz dieser neuen Methode zur 31P-MR-Bildgebung am klinischen MR-Gerät etablieren. [2] Mit dem erstmaligen Einsatz von SLOOP am Skelettmuskel zur nicht-invasiven Quantifizierung des Energiestoffwechsels mit 31P-MRS erarbeiteten wir neue Untersuchungsprotokolle und konnten sie erfolgreich bei Probanden anwenden. [3] Mit der 31P-MRs konnten wir durch Bestimmung des PCr/ATP Verhältnisses Einflüsse und Veränderungen im Energiestoffwechsel sowohl im infarzierten als auch im nicht-infarzierten Myokard bei Patienten mit vitalem und avitalem anterioren Infarkt nachweisen (FAST). [4] Mit der klinischen Anwendung von SLOOP wurden subklinische Stoffwechselveränderungen bei Patienten mit multipler Sklerose (MS) und bei mit Mitoxantron (MX) therapierten MS-Patienten eruiert. [5] Mit dem erstmalig kombinierten Einsatz von SLOOP bei neuromuskulären Erkrankungen wie myotoner Dystrophie (DM1) und proximaler myotoner Myopathie (PROMM/DM2) wurden Zusammenhänge zwischen Krankheitsdauer, Krankheitsverlauf, Muskelschwäche und dem kardialen und skelettmuskulären Energiestoffwechsel untersucht, um zusätzliche Informationen zum Verständnis der Pathogenese und Entwicklung von DM1 und PROMM/DM2 zu gewinnen. N2 - The purpose of the study was KW - SLOOP KW - PROMM KW - DM KW - MS KW - Mitoxantron KW - AW-CSI KW - 31P KW - MR KW - Spektroskopie KW - PCr KW - ATP KW - Myokardinfarkt KW - SLOOP KW - PROMM KW - DM KW - MS KW - Mitoxantrone KW - AW-CSI KW - 31P KW - MR KW - spectroscopy KW - PCr KW - ATP KW - myocardial infarction Y1 - 2003 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-9071 ER - TY - THES A1 - Buchberger, Miriam T1 - Stellenwert der Computertomographie im Staging der Sigmadivertikulitis T1 - CT staging in sigmoid diverticulitis N2 - Zielsetzung: Wie genau kann die Computertomographie die einzelnen Stadien der Sigmadivertikulitis abbilden? Inwieweit ist eine Übereinstimmung befunderabhängig? Material und Methoden: Grundlage dieser Arbeit waren die Daten von 91 Patienten (43 Männer und 48 Frauen, Durchschnittalter: 60,4 Jahre), die im Zeitraum August 2008 bis Mai 2010 aufgrund einer Sigmadivertikulitis operiert wurden. Das prätherapeutisch mittels Computertomographie (Hansen und Stock-Klassifikation)diagnostizierte Stadium wurde mit dem histopathologisch bestimmten Stadium auf eine Übereinstimmung hin verglichen. Zudem wurden alle CT-Bilder von einem zweiten Radiologen nachbefundet und auf eine Übereinstimmung mit dem Befund des Erstbefunders verglichen. Ergebnisse: Die Sensitivität für das phlegmonöse Stadium (H&S IIA) lag bei 83,3%, für das Stadium der gedeckten Perforation (H&S IIB) bei 71,4% und 72,7% für das chronisch-rezidivierende Stadium (H&S III). Die Spezifität lag bei 83,5% für Stadium IIA, 81,0% für Stadium IIB und 92,7% für Stadium III. Die Sensitivität und Spezifität für Stadium IIC (freie Perforation) lag bei 100%. Bei zehn Patienten kam es seitens der Computertomographie zu einer Unterschätzung des Entzündungsausmaßes: hier wurde anhand der CT ein histopathologisch verifiziertes Stadium IIB als Stadium IIA klassifiziert. Der Kappa-Wert der Zwischenbeobachter-Korrelation lag bei 0,598. Zusammenfassung: Die Computertomographie ist insgesamt ein zuverlässiges radiologisches Verfahren in der Diagnostik der einzelnen Divertikulitis-Stadien, zeigt aber, insbesondere in der Diagnostik des Stadiums IIB Defizite im Sinne einer Unterschätzung des Entzündungsausmaßes. Auch die moderate Zwischenbeobachter-Übereinstimmung hebt mögliche Defizite der CT im Staging der Sigmadivertikulitis hervor. N2 - Purpose To assess accuracy of CT in the diagnosis of sigmoid diverticulitis and to evaluate interobserver correlation Methods and Materials This study included 91 patients (43 men and 48 women; median age 60.4 years) who underwent resection for sigmoid diverticulitis from August 2008 to May 2010. The preoperative stage was compared with intraoperative and histological reports utilizing the Hansen and Stock-classification (HS). All CT scans were interpreted by two radiologists, and we compared their reports in regard of agreement. Results The sensitivity in detecting the phlegmonous type (HS IIA) was 83.3%, for the covered perforation (HS IIB) 71.4% and 72.7% for the chronically recurrent diverticulitis (HS type III). The calculated specifity was 83.5% for type IIA, 81.0% for type IIB and 92.7% for type III. In the presence of free perforation (HS type IIC) we found a sensitivity and specifity of 100%. In the covered perforation type CT often leads to an underestimation of the findings. In ten cases the CT was not able to show a histopathologically verified covered perforation. Kappa statistics showed that radiologists only agreed moderately in their diagnosis (kappa=0.598). Conclusion CT is an accurate tool for staging in sigmoid diverticulitis, but shows especially in diagnosing type IIB a deficit in terms of an understaging. Moderate interobserver agreement also highlights potential difficulties in staging sigmoid diverticulitis by CT. KW - Divertikulitis KW - Sigmadivertikulitis KW - Computertomographie Y1 - 2018 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-162486 ER - TY - THES A1 - Brenner, Sophie Anna T1 - Optimierte Lungenbildgebung an einem offenen MRT bei Patienten mit Mukoviszidose - Darstellung der Morphologie und Funktion T1 - Optimized lung imaging at an open-design 0.2 T MR system in Cystic fibrosis: morphological and functional imaging N2 - Das Ziel dieser Arbeit war die Evaluierung von morphologischen und funktionellen Techniken zur Untersuchung der Lunge am Niederfeld MRT bei Patienten mit Mukoviszidose. Patienten mit Mukoviszidose und lungengesunde Probanden wurden an einem Niederfeld-MRT (0,2 Tesla) mittels coronaren TrueFISP, FLASH 2D und FLASH 3D Sequenzen untersucht. T1 und T2*-Messungen wurden während Atmung von Raumluft und Atmung von 100 % Sauerstoff durchgeführt und die Parameterkarten pixelweise berechnet. Die für die Lungenbildgebung am Niederfeld-MRT optimierten 2D und 3D FLASH Sequenzen zeigten ein signifikant besseres Signalverhalten als die Standardsequenz TrueFISP. Zur Beurteilung der Parenchymveränderungen wurde ein MR-Score in Anlehnung an den Chrispin-Norman-Score angewandt. Es zeigte sich eine gute Korrelation zwischen dem MR-Score der FLASH-Sequenzen und dem etablierten CN-Score der konventionellen Bildgebung mit einer geringen Interobservariabiliät für die 2D und 3D FLASH Sequenzen. Schließlich konnte eine O2-gestütze funktionelle Bildgebung der Lunge bei Patienten mit Mukoviszidose am offenen Niederfeld-MRT etabliert werden. Es zeigten sich gute Korrelationen zwischen der relativen Änderung der T1 Relaxationszeit und der spirometrisch bestimmten Lungenfunktion. Ein solcher Zusammenhang konnte für die T2*-Messungen nicht hergestellt werden. Aufgrund der Patientenfreundlichkeit ist diese Technik insbesondere für die Untersuchung von Kindern geeignet. N2 - The purpose of the present thesis was to evaluate the clinical relevance of morpholocical and functional MRI of the human lung using an open-designed magnet system for patients with cystic fibrosis. Such patients and healthy volunteers were investigated in a low-field (0,2 Tesla) MR-scanner by TrueFISP, FLASH 2D und FLASH 3D sequences (Magnetom Open 0,2 Tesla, Siemens Medical Solutions, Erlangen, Germany). For functional lung imaging the patients and volunteers alternately breathed room air and 100 % oxygen. All images were fitted pixel by pixel and T1 and T2* parameter maps were generated. The optimized FLASH 2D and 3D sequences demonstrated a significantly higher signal-to-noise ratio in comparison to TrueFISP sequence. The here proposed modified CN-Score for low-field MRI correlated well with the established score of Chrispin and Norman in CXR and showed a low interobserver variability for FLASH 2D und FLASH 3D sequences. Oxygen-enhanced T1 und T2* mapping of the human lung was successfully etablished at an open low field scanner in patients with cystic fibrosis. Observed relative changes of the average pulmonary relaxation times T1 and T2* were related to pulmonary function tests. The measured T1 values were in good agreement with the severity of disease in CF defined by the pulmonary function test. This was not the case for navigated T2* mapping. The open design provides superior patient comfort and relieves the examination of children. KW - MRT KW - Lunge KW - Mukoviszidose KW - Morphologie KW - Ventilation KW - Sauerstoff KW - 0 KW - 2 Tesla KW - mri KW - lung KW - cystic fibrosis KW - oxygen-enhanced Y1 - 2011 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-71805 ER - TY - THES A1 - Brackertz, Anita T1 - Absolutquantifizierung der myokardialen Perfusion in Ruhe und unter Adenosin-induziertem Stress mittels First-Pass MR-Bildgebung T1 - Absolute quantification of myocardial perfusion at rest and under adenosine stress by means of first-pass MR-Imaging N2 - In der Diagnostik und Therapie der KHK sind das frühzeitige Erkennen und die Beurteilung funktioneller Folgen atherosklerotischer Veränderungen von großer Bedeutung. Die First-Pass MR-Bildgebung ermöglicht Aussagen über die myokardiale Perfusion und damit die hämodynamische Relevanz einer Koronarstenose. In der vorliegenden Arbeit wurden quantitative Werte für die myokardiale Durchblutung gesunder Probanden unter Adenosin-induziertem Stress und in Ruhe unter Einsatz der Präbolustechnik bestimmt. Eine exakte Darstellung der arteriellen Inputfunktion wurde durch einen Kontrastmittelbolus in niedriger Dosierung erreicht, die Verwendung höherer Kontrastmitteldosen führte dagegen zu einem verbesserten Signal-zu-Rausch-Verhältnis im Myokard. Die Absolutwerte der myokardialen Perfusion unter Stressbedingungen und in Ruhe wie auch die myokardiale Perfusionsreserve zeigten vergleichbare Mittelwerte, wiesen aber eine geringere Streubreite im Vergleich zu früheren MR Studien auf und waren vergleichbar mit in PET-Studien erzielten Ergebnissen. Weiterhin wurden unter Verwendung dieser Methode Werte für das myokardiale Verteilungsvolumen des Kontrastmittels als wichtiger Parameter in der Differenzierung von gesundem und infarziertem Herzmuskelgewebe ermittelt und die Laufzeit der Boluspassage nach Injektion in Ruhe und unter Stress bestimmt, die zur Unterscheidung von antegrad perfundiertem und von über Kollateralen versorgtem Myokard dienen kann. Mit Hilfe der MRT war es auch möglich, Unterschiede zwischen subendo- und subepimyokardialer Perfusion zu quantifizieren. Die erzielten Ergebnisse entsprechen bisher publizierten Werten, die mit anderen Modalitäten gewonnen wurden. Der Vergleich der absoluten Perfusion bei verminderter zeitlicher Auflösung mit den bei hoher zeitlicher Auflösung gemessenen Werten ergab nur geringfügige Abweichungen der Ergebnisse voneinander. Dadurch eröffnet sich die Möglichkeit, durch die Zeitersparnis mehrere Schichten abwechselnd bei verschiedenen Herzschlägen zu messen und damit eine erweiterte Abdeckung des linksventrikulären Myokards zu erreichen. Durch die quantitative Auswertung der First-Pass MR-Perfusionsmessung stellt die beschriebene Methode eine vielversprechende Option im Bereich der nichtinvasiven Diagnostik verschiedener myokardialer Erkrankungen dar. N2 - The detection and the assessment of the functional significance of atherosclerosis are of great importance in diagnosis and therapy of coronary artery disease. First-Pass MR-Imaging provides information about myocardial perfusion and the hemodynamic relevance of coronary artery stenoses. The aim of this work was to establish quantitative values of myocardial perfusion in healthy volunteers under adenosine induced stress and at rest using the prebolus technique. An exact determination of the arterial input function was achieved by injection of a low-dose bolus of contrast agent. High-dose bolus administration lead to an improved signal-to-noise ratio in the myocardium. Absolute values of myocardial perfusion under stress and at rest as well as the myocardial perfusion reserve showed comparable mean values as previous MR studies. However, the standard deviation was decreased compared to previous MR studies but similar to those of PET studies. Furthermore, values of the myocardial distribution volume of the contrast agent could be determined, which is an important parameter for differentiating between healthy and infarcted myocardium. Additionally, the duration of the bolus passage from the left ventricular lumen to the arrival in the myocardium was determined. By establishing the regional delay of contrast agent arrival, it is possible to differentiate between antegradely perfused and collateral-dependent myocardium. MRT also allowed the quantification of differences between subendocardial und subepicardial perfusion. The achieved results matches well previously published values obtained with other modalities. The comparison of perfusion values using only the images acquired at every 2nd, 3rd or 4th heartbeat and those measured at every heartbeat resulted in only minor changes. Consequently, it may become possible to scan several slices at alternating heartbeats, thereby achieving an increased coverage of the left ventricular myocardium. The absolute quantification of myocardial perfusion by means of MR-First-Pass-Imaging presents a promising non-invasive option in the diagnosis of myocardial diseases. KW - NMR-Tomographie KW - Perfusion KW - Herzmuskel KW - Quantifizierung KW - Stress KW - MRI KW - perfusion KW - myocardium KW - quantification KW - stress Y1 - 2008 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-34921 ER - TY - THES A1 - Boldt, Cornelia Klara T1 - Diffusionsgewichtete MRT Bildgebung bei Erkrankungen im Zahn-Mund-Kiefer/Hals-Nasen-Ohren Bereich T1 - Diffusion weighted magnetic resonance imaging of lesions in the head and neck region N2 - Zielsetzung: Die Zielsetzung dieser Arbeit war es zu beurteilen, inwieweit die Diffusionsgewichtete MRT Bildgebung bei der Differenzierung zwischen malignen und benignen Erkrankungen im Kopf-Hals Bereich nützlich sein kann. Außerdem ging es um die Sammlung der mittleren ADC-Werte von verschiedenen Diagnosen. Material und Methoden: Es wurden diffusionsgewichtete Bilder mit einer SE-EPI-Sequenz (b-Wert Paarung von 50 und 800 s/mm2, 1,5T) verglichen. 53 Plattenepithelcarzinome (PeCa), 21 benigne Befunde, 6 Lymphome, 6 Hämangiome, 6 Zysten Ergebnis: Die mittlere ADC- Wert (MW x10-3mm²/s +/-SD) der PeCa betrug 0.967 (0.118), der benignen Läsionen 1.458 (0.371), der Lymphome 0.649 (0.167), der Hämangiome 1.654 (0.254), der Zysten 2.310 (0.655) Der mittlere ADC-Wert der PeCa war signifikant kleiner als der der benignen Läsionen. Ein ADC- Wert von 1.202x10-3mm²/s kann als Grenzwert für die Differenzierung zwischen benignen und malignen Läsionen im Kopf-Hals Bereich angesehen werden. Schlussfolgerung: Die ADC-Werte können für die Charakterisierung von Läsionen im Kopf-Hals Bereich genutzt werden. N2 - Objective: The objective of this study was to evaluate the utility of diffusion weighted MR imaging (DWI) in the differentiation between malignant and benign lesions in the head and neck region. Furthermore get values for the apparent diffusion coefficient (ADC) for different diagnoses. Material and methods: We compared diffusion weighted images using SE-EPI sequences (b values of 50 and 800 s/mm2, 1,5T). 53 squamosa cell carcinomas (SSC), 21 benigne lesions, 6 malignant lymphomas, 6 hämangiomas, 6 cysts Results: The ADC values (mean x10-3mm²/s +/- SD) were 0.967 (0.118) in squamosal cell carcinomas (SSC), 1.458 (0.371) in benign lesions, 0.649 (0.167) in malignant lymphomas, 1.654 (0.254) in hämangiomas, 2.310 (0.655) in cysts. The mean ADC of SSC was significantly lower than of benign lesions. An ADC value of 1.202x10-3mm²/s may be the threshold value for differentiation between benign and malignant head and neck lesions. Conclusion: Measurement of ADCs may be used to characterize head and neck lesions. KW - DWI KW - ADC KW - DWI KW - head and neck KW - ADC Y1 - 2012 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-84303 ER - TY - THES A1 - Blättner, Katrin Ayara T1 - Quantifizierung myokardialer Fibrose in der Late Enhancement- MRT- manuell (Viewing) versus semiautomatisch (VPT3.0) T1 - Quantification of myocardial fibrosis in late enhancement mri- manual (Viewing) versus semi-automatic (VPT3.0) N2 - Die kontrastmittel- gestützte Late Enhancement- MRT ermöglicht die Darstellung myokardialer Veränderungen wie z.B. Ödem, Nekrose oder Fibrose. Ziel dieser Arbeit war es die semiautomatische Late Enhancement- Quantifizierung im Programm VPT 3.0 mit der manuellen Late Enhancement- Quantifizierung im Viewing- Programm zu vergleichen. Es wurden Late Enhancement- MRT- Datensätze von Patienten mit ischämischen (Myokardinfarkt) bzw. nicht- ischämischen Kardiomyopathien (Morbus Fabry, Morbus Hodgkin, Aortenklappenstenose) analysiert. Die Quantifizierung des Late Enhancement- Signals erfolgte manuell im Viewing- Programm und semiautomatisch unter Anwendung von VPT 3.0. Der Vergleich der Ergebnisse aus der manuellen Analyse und der semiautomatischen Analyse der Daten von Patienten nach Myokardinfarkt, mit kardialer Beteiligung bei Morbus Fabry und bei Z.n. anteriorer Mantelfeldbestrahlung bei Morbus Hodgkin, zeigte eine hohe Übereinstimmung sowie eine gute Korrelation der Werte beider Methoden. Eine valide Late Enhancement- Quantifizierung bei Patienten mit Aortenklappenstenose war sowohl in der manuellen, wie auch in der semiautomatischen Methode nicht möglich. Dies ist unter anderem auf das kleinfleckige, diffus flächige Verteilungsmuster im Rahmen der hier auftretenden konzentrischen Hypertrophie zurückzuführen. Des Weiteren konnte eine geringe Intraobservervariabilität aufgezeigt werden. Das semiautomatische Programm VPT3.0 ermöglicht eine genaue, mit der manuellen Methode gut korrelierende, Quantifizierung von Late Enhancement bei ischämischen und nicht- ischämischen Kardiomyopathien. Davon ausgenommen ist die Aortenstenose. N2 - Contrast agent-based late enhancement mri allows the depiction of myocardial changes e.g. edema, fibrosis or necrosis. The purpose of this thesis was to compare semi- automatic quantification of late enhancement using VPT3.0 with manual quantification using viewing- program. Late enhancement mri data of patients with ischemic (myocardial infarction) and non-ischemic cardiomyopathy (fabry's disease, hodgkin's lymphoma and aortic stenosis) were analyzed. The quantification of late enhancement signal was accomplished manually using viewing program and semi-automatically using VPT 3.0. The comparison of the results from the analysis of patients‘ data suffering from myocardial infarction, cardiac involvement in fabry’s disease and after anterior mantle field irradiation for hodgkin’s lymphoma, showed high correlation for both methods. A valid quantification of late enhancement in patients with aortic stenosis was not possible in most cases. This can, in part, be attributed to the blotchy and patchy pattern of the fibrotic changes appearing due to concentric hypertrophy. Additionally, a low intraobserver variability was demonstrated. The semi- automatic program VPT 3.0 provides an accurate, with the manual technique well- correlated method of quantifying late enhancement in ischemic and nonischemic cardiomyopathies, excluding aortic stenosis. KW - NMR-Tomographie KW - Kontrastmittel KW - Quantifizierung KW - Herzinfarkt KW - Fabry-Krankheit KW - Lymphogranulomatose KW - Aortenstenose KW - Late Enhancement KW - mri KW - contrast agent KW - late enhancement KW - quantification KW - myocardial infarction KW - fabry's disease KW - hodgkin's lymphoma KW - aortic stenosis Y1 - 2011 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-72465 ER - TY - JOUR A1 - Bluemel, Christina A1 - Linke, Fraenze A1 - Herrmann, Ken A1 - Simunovic, Iva A1 - Eiber, Matthias A1 - Kestler, Christian A1 - Buck, Andreas K. A1 - Schirbel, Andreas A1 - Bley, Thorsten A. A1 - Wester, Hans-Juergen A1 - Vergho, Daniel A1 - Becker, Axel T1 - Impact of \(^{68}\)Ga-PSMA PET/CT on salvage radiotherapy planning in patients with prostate cancer and persisting PSA values or biochemical relapse after prostatectomy JF - EJNMMI Research N2 - Background Salvage radiotherapy (SRT) is clinically established in prostate cancer (PC) patients with PSA persistence or biochemical relapse (BCR) after prior radical surgery. PET/CT imaging prior to SRT may be performed to localize disease recurrence. The recently introduced \(^{68}\)Ga-PSMA outperforms other PET tracers for detection of recurrence and is therefore expected also to impact radiation planning. Forty-five patients with PSA persistence (16 pts) or BCR (29 pts) after prior prostatectomy, scheduled to undergo SRT of the prostate bed, underwent \(^{68}\)Ga-PSMA PET/CT. The median PSA level was 0.67 ng/ml. The impact of \(^{68}\)Ga-PSMA PET/CT on the treatment decision was assessed. Patients with oligometastatic (≤5 lesions) PC underwent radiotherapy (RT), with the extent of the RT area and dose escalation being based on PET positivity. Results Suspicious lesions were detected in 24/45 (53.3 %) patients. In 62.5 % of patients, lesions were only detected by 68Ga-PSMA PET. Treatment was changed in 19/45 (42.2 %) patients, e.g., extending SRT to metastases (9/19), administering dose escalation in patients with morphological local recurrence (6/19), or replacing SRT by systemic therapy (2/19). 38/45 (84.4 %) followed the treatment recommendation, with data on clinical follow-up being available in 21 patients treated with SRT. All but one showed biochemical response (mean PSA decline 78 ± 19 %) within a mean follow-up of 8.12 ± 5.23 months. Conclusions \(^{68}\)Ga-PSMA PET/CT impacts treatment planning in more than 40 % of patients scheduled to undergo SRT. Future prospective studies are needed to confirm this significant therapeutic impact on patients prior to SRT. KW - prostate cancer KW - salvage radiotherapy KW - PSMA KW - PET/CT KW - recurrence Y1 - 2016 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-147798 VL - 6 IS - 78 ER -