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Institute
- Institut für diagnostische und interventionelle Radiologie (Institut für Röntgendiagnostik) (244) (remove)
Sonstige beteiligte Institutionen
- Cheng Lab, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA (1)
- Datenintegrationszentrum Würzburg (DIZ) (1)
- Interdisziplinäre Biomaterial- und Datenbank Würzburg (ibdw) (1)
- Würzburg Fabry Center for Interdisciplinary Therapy (FAZIT), University of Würzburg, Würzburg, Germany (1)
Background
Children with different underlying malignant diseases require long-term central venous access. As for port systems in a pectoral position, peripherally implanted port systems in the forearm revealed high levels of technical and clinical success in adult cohorts.
Objective
To investigate the technical and clinical outcomes of percutaneous central venous port implantation in the forearm in adolescents.
Materials and methods
Between April 2010 and August 2020, 32 children ages 9 to 17 years with underlying malignancy received 35 totally implantable venous access ports (TIVAPs) in the forearm. All venous port systems were peripherally inserted under ultrasound guidance. Correct catheter placement was controlled by fluoroscopy. As primary endpoints, the technical success, rate of complications and catheter maintenance were analyzed. Secondary endpoints were the side of implantation, vein of catheter access, laboratory results on the day of the procedure, procedural radiation exposure, amount of contrast agent and reasons for port device removal.
Results
Percutaneous TIVAP placement under sonographic guidance was technically successful in 34 of 35 procedures (97.1%). Procedure-related complications did not occur. During the follow-up, 13,684 catheter days were analyzed, revealing 11 complications (0.8 per 1,000 catheter-duration days), Of these 11 complications, 7 were major and 10 occurred late. In seven cases, the port device had to be removed; removal-related complications did not occur.
Conclusion
Peripheral TIVAP placement in the forearms of children is a feasible, effective and safe technique with good midterm outcome. As results are comparable with standard access routes, this technique may be offered as an alternative when intermittent venous access is required.
Purpose
Artificial neural networks show promising performance in automatic segmentation of cardiac MRI. However, training requires large amounts of annotated data and generalization to different vendors, field strengths, sequence parameters, and pathologies is limited. Transfer learning addresses this challenge, but specific recommendations regarding type and amount of data required is lacking. In this study, we assess data requirements for transfer learning to experimental cardiac MRI at 7T where the segmentation task can be challenging. In addition, we provide guidelines, tools, and annotated data to enable transfer learning approaches by other researchers and clinicians.
Methods
A publicly available segmentation model was used to annotate a publicly available data set. This labeled data set was subsequently used to train a neural network for segmentation of left ventricle and myocardium in cardiac cine MRI. The network is used as starting point for transfer learning to 7T cine data of healthy volunteers (n = 22; 7873 images) by updating the pre-trained weights. Structured and random data subsets of different sizes were used to systematically assess data requirements for successful transfer learning.
Results
Inconsistencies in the publically available data set were corrected, labels created, and a neural network trained. On 7T cardiac cine images the model pre-trained on public imaging data, acquired at 1.5T and 3T, achieved DICE\(_{LV}\) = 0.835 and DICE\(_{MY}\) = 0.670. Transfer learning using 7T cine data and ImageNet weight initialization improved model performance to DICE\(_{LV}\) = 0.900 and DICE\(_{MY}\) = 0.791. Using only end-systolic and end-diastolic images reduced training data by 90%, with no negative impact on segmentation performance (DICE\(_{LV}\) = 0.908, DICE\(_{MY}\) = 0.805).
Conclusions
This work demonstrates and quantifies the benefits of transfer learning for cardiac cine image segmentation. We provide practical guidelines for researchers planning transfer learning projects in cardiac MRI and make data, models, and code publicly available.
In einem Zeitraum von Oktober 1997 bis Mai 1998 werden an 19 Patienten 22 Untersuchungen der Becken- und Bein-Arterien sowohl in MRA-Technik als auch als i.a. DSA durchgeführt. Hierbei finden im Rahmen der MRA-Untersuchung in allen Fällen die zeitaufgelöste, Kontrastmittel-unterstützte 3d-Flash-Sequenz und die EKG-getriggerte 2d-Flash-Multivenc-Pha-senkontrast-Sequenz Anwendung. Beide Methoden werden in der Diagnostik der pAVK von der Aortenbifurkation bis zum distalen Unterschenkel getestet und in 3 Fällen im Rahmen einer periinterventionellen Kontrolle vor und nach PTA eingesetzt. Das Patientenkollektiv setzt sich ausnahmslos aus Patienten mit pAVK zusammen, die häufig Nebenbefunde wie zum Beispiel einen Diabetes mellitus oder eine Niereninsuffizienz aufweisen. Die Auswertung der Angiographien erfolgt durch die Zuordnung der verschiedenen arte-riellen Abschnitte zu verschiedenen Stenosegraden und dem anschließenden statistischen Ver-gleich der Befunde der MRA und der i.a.DSA. Als Ergebnisse erhalten wir für die Kontrastmittel-unterstützte MRA eine Übereinstim-mungsrate mit der i.a. DSA von 79% sowie eine Sensitivität von 96,7% und eine Spezifität von 97% für die Abbildung hämodynamisch relevanter Stenosen. Die Sensitivität für die Detektion von Verschlüssen beträgt 97,8% und die entsprechende Spezifität 99,2%. Die Phasenkontrast-MRA zeigt im Vergleich mit der i.a.DSA eine schwächere Überein-stimmungsrate von 65,4% sowie eine Sensitivität von 88,3% und eine Spezifität von 85,6% für die Darstellung hämodynamisch relevanter Stenosen. Für die Diagnose eines Gefäßverschlus-ses ist die Sensitivität 89% und die Spezifität 91,8%. Als Schlußfolgerung wird festgestellt, daß die MRA eine nichtinvasive, zur i.a.DSA äqui-valente Untersuchungsmethode darstellt, die bei Kontraindikationen gegen die i.a.DSA einge-setzt werden kann. Im Vergleich zur Phasenkontrast-MRA ist die Kontrastmittel-unterstützte MRA sowohl ein schnelleres als auch ein präziseres Verfahren zur Diagnostik von Gefäßläsio-nen der Becken-Bein-Arterien und bietet den Vorteil der 3-dimensionalen Darstellung. Die Phasenkontrast-MRA ist insbesondere durch die einfache Durchführbarkeit und die fehlende Invasivität ebenfalls als Verfahren zur Diagnostik der peripheren AVK denkbar, jedoch ist zur exakten Stenosegraduierung im Bereich der Läsion eine nachgeschaltete Untersuchung mit weiteren Methoden nötig. Die MRA kann in der postinterventionellen, angiographischen Kontrolle eingesetzt werden. Für die Empfehlung zum routinemäßigen Einsatz in diesem Bereich sind jedoch Studien mit größeren Fallzahlen nötig. In naher Zukunft läßt sich die MRA-Technik durch die Entwicklung von leistungsfähi-geren Gradientenspulensystemen, neuen Prototypen von Oberflächenspulen, intelligenteren Nachverarbeitungs-Algorhytmen und Blutpool-Kontrastmitteln noch weiter optimieren. Die Evolution der MRA-Technik wird ihre Integration in die Routinediagnostik vereinfachen und ihr Indikationsspektrum erweitern.
Der Atypische teratoid/rhabdoide Tumor (ATRT) und der primitive neuroektodermale Tumor (PNET) sind hochmaligne Tumorentitäten (WHO-Grad IV) des zentralen Nervensystems, die überwiegend im Kleinkindalter auftreten. Beide zeigen eine sehr heterogene morphologische Struktur und sind bisher nur mittels Histopathologie und Immunhistochemie voneinander zu differenzieren. Bisherige Untersuchungen ließen noch keine neuroradiologische Unterscheidbarkeit zwischen beiden Tumorentitäten erkennen. Die vorliegende Arbeit befasst sich anhand eines diesbezüglich einmalig großen Patientenkollektives (23 ATRT, 36 PNET) mit den spezifisichen morphologischen Kriterien des supratentoriellen (st) ATRT und PNET in der Magnetresonanztomographie (MRT). Die Patienten rekrutierten sich aus der multizentrischen Hirntumorstudie HIT 2000 (Teil des Kompetenznetzes der Hirntumorstudien der „Gesellschaft für pädiatrische Onkologie und Hämatologie“). Retrospektiv wurden MRT-Bilder aus einem Zeitraum von 5 Jahren ausgewertet. Untersucht wurden T1- und T2-Wichtung, nativ und unter Kontrastmittelapplikation. Zur Abgrenzung beider Entitäten voneinander wurden verschiedene Kriterien herausgearbeitet. Dazu zählten zunächst die Darstellung in der nativen T1-Wichtung, die Schärfe der Tumorbegrenzung, das zeitgleiche Vorliegen von Zysten, Ödemen und Blutungen sowie die Ausprägung des Kontrastmittel-Enhancements. Als zentrales Ergebnis der Arbeit konnte ein markantes strukturelles Muster des Kontrastmittel-Enhancements herausgearbeitet werden, welches sich als charakteristisch für den stATRT erwies, während es nur bei einem sehr geringen Prozentsatz der stPNETs anzutreffen war. Hierbei handelt es sich um ein girlandenförmiges Band, welches den Tumor randständig um eine zentrale Nekrose herum auskleidet. Dieses als „ATRT-typisch“ bezeichnete Muster wiesen zehn der stATRTs (43,5%) und drei der stPNETs (8,3%) auf. Darüber hinaus konnte man bei fünf stATRTs (21,7%) Areale mit wie in der Girlande anzutreffenden vesikulären Strukturen aber ohne begleitende zentrale Tumornekrose beobachten. Nur ein stPNET (2,8%) wies ebenfalls vesikuläre Anteile ohne zentrale Nekrose auf. Es konnten somit charakteristische Muster identifiziert werden, welche auffällig häufig in Kontrastmittel-verstärkten T1-gewichteten MRT-Bildern des stATRT in Erscheinung treten, während sie bei stPNETs nur ausgesprochen selten vorzufinden sind.