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Vollbrecht TM, Bissell MM, Kording F, Geipel A, Isaak A, Strizek BS, Hart C, Barker AJ, Luetkens JA. Fetal Cardiac MRI Using Doppler US Gating: Emerging Technology and Clinical Implications. Radiol Cardiothorac Imaging 2024; 6:e230182. [PMID: 38602469 PMCID: PMC11056758 DOI: 10.1148/ryct.230182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 02/13/2024] [Accepted: 02/27/2024] [Indexed: 04/12/2024]
Abstract
Fetal cardiac MRI using Doppler US gating is an emerging technique to support prenatal diagnosis of congenital heart disease and other cardiovascular abnormalities. Analogous to postnatal electrocardiographically gated cardiac MRI, this technique enables directly gated MRI of the fetal heart throughout the cardiac cycle, allowing for immediate data reconstruction and review of image quality. This review outlines the technical principles and challenges of cardiac MRI with Doppler US gating, such as loss of gating signal due to fetal movement. A practical workflow of patient preparation for the use of Doppler US-gated fetal cardiac MRI in clinical routine is provided. Currently applied MRI sequences (ie, cine or four-dimensional flow imaging), with special consideration of technical adaptations to the fetal heart, are summarized. The authors provide a literature review on the clinical benefits of Doppler US-gated fetal cardiac MRI for gaining additional diagnostic information on cardiovascular malformations and fetal hemodynamics. Finally, future perspectives of Doppler US-gated fetal cardiac MRI and further technical developments to reduce acquisition times and eliminate sources of artifacts are discussed. Keywords: MR Fetal, Ultrasound Doppler, Cardiac, Heart, Congenital, Obstetrics, Fetus Supplemental material is available for this article. © RSNA, 2024.
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Affiliation(s)
- Thomas M. Vollbrecht
- From the Department of Diagnostic and Interventional Radiology,
University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (T.M.V., A.I.,
C.H., J.A.L.); Quantitative Imaging Laboratory Bonn (QILaB), University Hospital
Bonn, Bonn, Germany (T.M.V., A.I., C.H., J.A.L.); Department of Biomedical
Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine,
University of Leeds, Leeds, United Kingdom (M.M.B.); Northh Medical, Hamburg,
Germany (F.K.); Departments of Obstetrics and Prenatal Medicine (A.G., B.S.S.)
and Pediatric Cardiology (C.H.), University Hospital Bonn, Bonn, Germany;
Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora,
Colo (A.J.B.); Department of Pediatric Radiology, Children’s Hospital
Colorado, Aurora, Colo (A.J.B.)
| | - Malenka M. Bissell
- From the Department of Diagnostic and Interventional Radiology,
University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (T.M.V., A.I.,
C.H., J.A.L.); Quantitative Imaging Laboratory Bonn (QILaB), University Hospital
Bonn, Bonn, Germany (T.M.V., A.I., C.H., J.A.L.); Department of Biomedical
Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine,
University of Leeds, Leeds, United Kingdom (M.M.B.); Northh Medical, Hamburg,
Germany (F.K.); Departments of Obstetrics and Prenatal Medicine (A.G., B.S.S.)
and Pediatric Cardiology (C.H.), University Hospital Bonn, Bonn, Germany;
Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora,
Colo (A.J.B.); Department of Pediatric Radiology, Children’s Hospital
Colorado, Aurora, Colo (A.J.B.)
| | - Fabian Kording
- From the Department of Diagnostic and Interventional Radiology,
University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (T.M.V., A.I.,
C.H., J.A.L.); Quantitative Imaging Laboratory Bonn (QILaB), University Hospital
Bonn, Bonn, Germany (T.M.V., A.I., C.H., J.A.L.); Department of Biomedical
Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine,
University of Leeds, Leeds, United Kingdom (M.M.B.); Northh Medical, Hamburg,
Germany (F.K.); Departments of Obstetrics and Prenatal Medicine (A.G., B.S.S.)
and Pediatric Cardiology (C.H.), University Hospital Bonn, Bonn, Germany;
Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora,
Colo (A.J.B.); Department of Pediatric Radiology, Children’s Hospital
Colorado, Aurora, Colo (A.J.B.)
| | - Annegret Geipel
- From the Department of Diagnostic and Interventional Radiology,
University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (T.M.V., A.I.,
C.H., J.A.L.); Quantitative Imaging Laboratory Bonn (QILaB), University Hospital
Bonn, Bonn, Germany (T.M.V., A.I., C.H., J.A.L.); Department of Biomedical
Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine,
University of Leeds, Leeds, United Kingdom (M.M.B.); Northh Medical, Hamburg,
Germany (F.K.); Departments of Obstetrics and Prenatal Medicine (A.G., B.S.S.)
and Pediatric Cardiology (C.H.), University Hospital Bonn, Bonn, Germany;
Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora,
Colo (A.J.B.); Department of Pediatric Radiology, Children’s Hospital
Colorado, Aurora, Colo (A.J.B.)
| | - Alexander Isaak
- From the Department of Diagnostic and Interventional Radiology,
University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (T.M.V., A.I.,
C.H., J.A.L.); Quantitative Imaging Laboratory Bonn (QILaB), University Hospital
Bonn, Bonn, Germany (T.M.V., A.I., C.H., J.A.L.); Department of Biomedical
Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine,
University of Leeds, Leeds, United Kingdom (M.M.B.); Northh Medical, Hamburg,
Germany (F.K.); Departments of Obstetrics and Prenatal Medicine (A.G., B.S.S.)
and Pediatric Cardiology (C.H.), University Hospital Bonn, Bonn, Germany;
Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora,
Colo (A.J.B.); Department of Pediatric Radiology, Children’s Hospital
Colorado, Aurora, Colo (A.J.B.)
| | - Brigitte S. Strizek
- From the Department of Diagnostic and Interventional Radiology,
University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (T.M.V., A.I.,
C.H., J.A.L.); Quantitative Imaging Laboratory Bonn (QILaB), University Hospital
Bonn, Bonn, Germany (T.M.V., A.I., C.H., J.A.L.); Department of Biomedical
Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine,
University of Leeds, Leeds, United Kingdom (M.M.B.); Northh Medical, Hamburg,
Germany (F.K.); Departments of Obstetrics and Prenatal Medicine (A.G., B.S.S.)
and Pediatric Cardiology (C.H.), University Hospital Bonn, Bonn, Germany;
Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora,
Colo (A.J.B.); Department of Pediatric Radiology, Children’s Hospital
Colorado, Aurora, Colo (A.J.B.)
| | - Christopher Hart
- From the Department of Diagnostic and Interventional Radiology,
University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (T.M.V., A.I.,
C.H., J.A.L.); Quantitative Imaging Laboratory Bonn (QILaB), University Hospital
Bonn, Bonn, Germany (T.M.V., A.I., C.H., J.A.L.); Department of Biomedical
Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine,
University of Leeds, Leeds, United Kingdom (M.M.B.); Northh Medical, Hamburg,
Germany (F.K.); Departments of Obstetrics and Prenatal Medicine (A.G., B.S.S.)
and Pediatric Cardiology (C.H.), University Hospital Bonn, Bonn, Germany;
Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora,
Colo (A.J.B.); Department of Pediatric Radiology, Children’s Hospital
Colorado, Aurora, Colo (A.J.B.)
| | - Alex J. Barker
- From the Department of Diagnostic and Interventional Radiology,
University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (T.M.V., A.I.,
C.H., J.A.L.); Quantitative Imaging Laboratory Bonn (QILaB), University Hospital
Bonn, Bonn, Germany (T.M.V., A.I., C.H., J.A.L.); Department of Biomedical
Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine,
University of Leeds, Leeds, United Kingdom (M.M.B.); Northh Medical, Hamburg,
Germany (F.K.); Departments of Obstetrics and Prenatal Medicine (A.G., B.S.S.)
and Pediatric Cardiology (C.H.), University Hospital Bonn, Bonn, Germany;
Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora,
Colo (A.J.B.); Department of Pediatric Radiology, Children’s Hospital
Colorado, Aurora, Colo (A.J.B.)
| | - Julian A. Luetkens
- From the Department of Diagnostic and Interventional Radiology,
University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (T.M.V., A.I.,
C.H., J.A.L.); Quantitative Imaging Laboratory Bonn (QILaB), University Hospital
Bonn, Bonn, Germany (T.M.V., A.I., C.H., J.A.L.); Department of Biomedical
Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine,
University of Leeds, Leeds, United Kingdom (M.M.B.); Northh Medical, Hamburg,
Germany (F.K.); Departments of Obstetrics and Prenatal Medicine (A.G., B.S.S.)
and Pediatric Cardiology (C.H.), University Hospital Bonn, Bonn, Germany;
Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora,
Colo (A.J.B.); Department of Pediatric Radiology, Children’s Hospital
Colorado, Aurora, Colo (A.J.B.)
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Layer YC, Isaak A, Mesropyan N, Kupczyk PA, Luetkens JA, Dell T, Attenberger UI, Kuetting D. Image quality of abdominal photon-counting CT with reduced contrast media dose: Evaluation of reduced contrast media protocols during the COVID19 pandemic supply shortage. Heliyon 2024; 10:e28142. [PMID: 38533048 PMCID: PMC10963370 DOI: 10.1016/j.heliyon.2024.e28142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 02/28/2024] [Accepted: 03/12/2024] [Indexed: 03/28/2024] Open
Abstract
Rationale and objectives Aim of this study was to assess the impact of contrast media dose (CMD) reduction on diagnostic quality of photon-counting detector CT (PCD-CT) and energy-integrating detector CT (EID-CT). Methods CT scans of the abdominal region with differing CMD acquired in portal venous phase on a PCD-CT were included and compared to EID-CT scans. Diagnostic quality and contrast intensity were rated. Additionally, readers had to assign the scans to reduced or regular CMD. Regions-of-interest (ROIs) were placed in defined segments of portal vein, inferior vena cava, liver, spleen, kidneys, abdominal aorta and muscular tissue. Signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were calculated. Results Overall 158 CT scans performed on a PCD-CT and 68 examinations on an EID-CT were analyzed. Overall diagnostic quality showed no significant differences for PCD-CT with standard CMD which scored a median 5 (IQR:5-5) and PCD-CT with 70% CMD scoring 5 (4-5). (For PCD-CT, 71.69% of the examinations with reduced CMD were assigned to regular CMD by the readers, for EID-CT 9.09%. Averaged for all measurements SNR for 50% CMD was reduced by 19% in PCD-CT (EID-CT 34%) and CNR by 48% (EID-CT 56%). Virtual monoenergetic images (VMI)50keV for PCD-CT images acquired with 50% CMD showed an increase in SNR by 72% and CNR by 153%. Conclusions Diagnostic interpretability of PCD-CT examinations with reduction of up to 50% CMD is maintained. PCD-CT deducted scans especially with 70% CMD were often not recognized as CMD reduced scans. Compared to EID-CT less decline in SNR and CNR is observed for CMD reduced PCD-CT images. Employing VMI50keV for CMD-reduced PCD-CT images compensated for the effects.
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Affiliation(s)
- Yannik C. Layer
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Alexander Isaak
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Narine Mesropyan
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Patrick A. Kupczyk
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Julian A. Luetkens
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Tatjana Dell
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Ulrike I. Attenberger
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Daniel Kuetting
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
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Salam B, Kravchenko D, Nowak S, Sprinkart AM, Weinhold L, Odenthal A, Mesropyan N, Bischoff LM, Attenberger U, Kuetting DL, Luetkens JA, Isaak A. Generative Pre-trained Transformer 4 makes cardiovascular magnetic resonance reports easy to understand. J Cardiovasc Magn Reson 2024; 26:101035. [PMID: 38460841 PMCID: PMC10981113 DOI: 10.1016/j.jocmr.2024.101035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 02/19/2024] [Accepted: 03/05/2024] [Indexed: 03/11/2024] Open
Abstract
BACKGROUND Patients are increasingly using Generative Pre-trained Transformer 4 (GPT-4) to better understand their own radiology findings. PURPOSE To evaluate the performance of GPT-4 in transforming cardiovascular magnetic resonance (CMR) reports into text that is comprehensible to medical laypersons. METHODS ChatGPT with GPT-4 architecture was used to generate three different explained versions of 20 various CMR reports (n = 60) using the same prompt: "Explain the radiology report in a language understandable to a medical layperson". Two cardiovascular radiologists evaluated understandability, factual correctness, completeness of relevant findings, and lack of potential harm, while 13 medical laypersons evaluated the understandability of the original and the GPT-4 reports on a Likert scale (1 "strongly disagree", 5 "strongly agree"). Readability was measured using the Automated Readability Index (ARI). Linear mixed-effects models (values given as median [interquartile range]) and intraclass correlation coefficient (ICC) were used for statistical analysis. RESULTS GPT-4 reports were generated on average in 52 s ± 13. GPT-4 reports achieved a lower ARI score (10 [9-12] vs 5 [4-6]; p < 0.001) and were subjectively easier to understand for laypersons than original reports (1 [1] vs 4 [4,5]; p < 0.001). Eighteen out of 20 (90%) standard CMR reports and 2/60 (3%) GPT-generated reports had an ARI score corresponding to the 8th grade level or higher. Radiologists' ratings of the GPT-4 reports reached high levels for correctness (5 [4, 5]), completeness (5 [5]), and lack of potential harm (5 [5]); with "strong agreement" for factual correctness in 94% (113/120) and completeness of relevant findings in 81% (97/120) of reports. Test-retest agreement for layperson understandability ratings between the three simplified reports generated from the same original report was substantial (ICC: 0.62; p < 0.001). Interrater agreement between radiologists was almost perfect for lack of potential harm (ICC: 0.93, p < 0.001) and moderate to substantial for completeness (ICC: 0.76, p < 0.001) and factual correctness (ICC: 0.55, p < 0.001). CONCLUSION GPT-4 can reliably transform complex CMR reports into more understandable, layperson-friendly language while largely maintaining factual correctness and completeness, and can thus help convey patient-relevant radiology information in an easy-to-understand manner.
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Affiliation(s)
- Babak Salam
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Dmitrij Kravchenko
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Sebastian Nowak
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Alois M Sprinkart
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Leonie Weinhold
- University Hospital Bonn, Department of Medical Biometry, Informatics, and Epidemiology, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Anna Odenthal
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Narine Mesropyan
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Leon M Bischoff
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Ulrike Attenberger
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Daniel L Kuetting
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Julian A Luetkens
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Alexander Isaak
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany.
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Reiter JT, Schulte F, Bauer T, David B, Endler C, Isaak A, Schuch F, Bitzer F, Witt JA, Hattingen E, Deichmann R, Attenberger U, Becker AJ, Helmstaedter C, Radbruch A, Surges R, Friedman A, Rüber T. Evidence for interictal blood-brain barrier dysfunction in people with epilepsy. Epilepsia 2024. [PMID: 38436479 DOI: 10.1111/epi.17929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 02/11/2024] [Accepted: 02/12/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVE Interictal blood-brain barrier dysfunction in chronic epilepsy has been demonstrated in animal models and pathological specimens. Ictal blood-brain barrier dysfunction has been shown in humans in vivo using an experimental quantitative magnetic resonance imaging (MRI) protocol. Here, we hypothesized that interictal blood-brain barrier dysfunction is also present in people with drug-resistant epilepsy. METHODS Thirty-nine people (21 females, mean age at MRI ± SD = 30 ± 8 years) with drug-resistant epilepsy were prospectively recruited and underwent interictal T1-relaxometry before and after administration of a paramagnetic contrast agent. Likewise, quantitative T1 was acquired in 29 people without epilepsy (12 females, age at MRI = 48 ± 18 years). Quantitative T1 difference maps were calculated and served as a surrogate imaging marker for blood-brain barrier dysfunction. Values of quantitative T1 difference maps inside hemispheres ipsilateral to the presumed seizure onset zone were then compared, on a voxelwise level and within presumed seizure onset zones, to the contralateral side of people with epilepsy and to people without epilepsy. RESULTS Compared to the contralateral side, ipsilateral T1 difference values were significantly higher in white matter (corrected p < .05), gray matter (uncorrected p < .05), and presumed seizure onset zones (p = .04) in people with epilepsy. Compared to people without epilepsy, significantly higher T1 difference values were found in the anatomical vicinity of presumed seizure onset zones (p = .004). A subgroup of people with hippocampal sclerosis demonstrated significantly higher T1 difference values in the ipsilateral hippocampus and in regions strongly interconnected with the hippocampus compared to people without epilepsy (corrected p < .01). Finally, z-scores reflecting the deviation of T1 difference values within the presumed seizure onset zone were associated with verbal memory performance (p = .02) in people with temporal lobe epilepsy. SIGNIFICANCE Our results indicate a blood-brain barrier dysfunction in drug-resistant epilepsy that is detectable interictally in vivo, anatomically related to the presumed seizure onset zone, and associated with cognitive deficits.
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Affiliation(s)
- Johannes T Reiter
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
- Department of Neuroradiology, University Hospital Bonn, Bonn, Germany
| | - Freya Schulte
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
- Department of Neuroradiology, University Hospital Bonn, Bonn, Germany
| | - Tobias Bauer
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
- Department of Neuroradiology, University Hospital Bonn, Bonn, Germany
| | - Bastian David
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Christoph Endler
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn, Germany
| | - Alexander Isaak
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn, Germany
| | - Fabiane Schuch
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Felix Bitzer
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
- Department of Neuroradiology, University Hospital Bonn, Bonn, Germany
| | | | - Elke Hattingen
- Institute of Neuroradiology, University Hospital and Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Ralf Deichmann
- Brain Imaging Center, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Ulrike Attenberger
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn, Germany
| | - Albert J Becker
- Department of Neuropathology, University Hospital Bonn, Bonn, Germany
| | | | | | - Rainer Surges
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Alon Friedman
- Department of Medical Neuroscience, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Departments of Cognitive and Brain Sciences, Physiology, and Cell Biology, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Theodor Rüber
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
- Department of Neuroradiology, University Hospital Bonn, Bonn, Germany
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Ortiz-Gonzalez A, Kobler E, Simon S, Bischoff L, Nowak S, Isaak A, Block W, Sprinkart AM, Attenberger U, Luetkens JA, Bayro-Corrochano E, Effland A. Optical Flow-Guided Cine MRI Segmentation With Learned Corrections. IEEE Trans Med Imaging 2024; 43:940-953. [PMID: 37856267 DOI: 10.1109/tmi.2023.3325766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
In cardiac cine magnetic resonance imaging (MRI), the heart is repeatedly imaged at numerous time points during the cardiac cycle. Frequently, the temporal evolution of a certain region of interest such as the ventricles or the atria is highly relevant for clinical diagnosis. In this paper, we devise a novel approach that allows for an automatized propagation of an arbitrary region of interest (ROI) along the cardiac cycle from respective annotated ROIs provided by medical experts at two different points in time, most frequently at the end-systolic (ES) and the end-diastolic (ED) cardiac phases. At its core, a 3D TV- L1 -based optical flow algorithm computes the apparent motion of consecutive MRI images in forward and backward directions. Subsequently, the given terminal annotated masks are propagated by this bidirectional optical flow in 3D, which results, however, in improper initial estimates of the segmentation masks due to numerical inaccuracies. These initially propagated segmentation masks are then refined by a 3D U-Net-based convolutional neural network (CNN), which was trained to enforce consistency with the forward and backward warped masks using a novel loss function. Moreover, a penalization term in the loss function controls large deviations from the initial segmentation masks. This method is benchmarked both on a new dataset with annotated single ventricles containing patients with severe heart diseases and on a publicly available dataset with different annotated ROIs. We emphasize that our novel loss function enables fine-tuning the CNN on a single patient, thereby yielding state-of-the-art results along the complete cardiac cycle.
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Wagenpfeil J, Kupczyk PA, Bruners P, Siepmann R, Guendel E, Luetkens JA, Isaak A, Meyer C, Kuetting F, Pieper CC, Attenberger UI, Kuetting D. Outcome of transarterial radioembolization in patients with hepatocellular carcinoma as a first-line interventional therapy and after a previous transarterial chemoembolization. Front Radiol 2024; 4:1346550. [PMID: 38445105 PMCID: PMC10912470 DOI: 10.3389/fradi.2024.1346550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 01/23/2024] [Indexed: 03/07/2024]
Abstract
Purpose Due to a lack of data, there is an ongoing debate regarding the optimal frontline interventional therapy for unresectable hepatocellular carcinoma (HCC). The aim of the study is to compare the results of transarterial radioembolization (TARE) as the first-line therapy and as a subsequent therapy following prior transarterial chemoembolization (TACE) in these patients. Methods A total of 83 patients were evaluated, with 38 patients having undergone at least one TACE session prior to TARE [27 male; mean age 67.2 years; 68.4% stage Barcelona clinic liver cancer (BCLC) B, 31.6% BCLC C]; 45 patients underwent primary TARE (33 male; mean age 69.9 years; 40% BCLC B, 58% BCLC C). Clinical [age, gender, BCLC stage, activity in gigabecquerel (GBq), Child-Pugh status, portal vein thrombosis, tumor volume] and procedural [overall survival (OS), local tumor control (LTC), and progression-free survival (PFS)] data were compared. A regression analysis was performed to evaluate OS, LTC, and PFS. Results No differences were found in OS (95% CI: 1.12, P = 0.289), LTC (95% CI: 0.003, P = 0.95), and PFS (95% CI: 0.4, P = 0.525). The regression analysis revealed a relationship between Child-Pugh score (P = 0.005), size of HCC lesions (>10 cm) (P = 0.022), and OS; neither prior TACE (Child-Pugh B patients; 95% CI: 0.120, P = 0.729) nor number of lesions (>10; 95% CI: 2.930, P = 0.087) correlated with OS. Conclusion Prior TACE does not affect the outcome of TARE in unresectable HCC.
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Affiliation(s)
- Julia Wagenpfeil
- Department of Diagnostic and Interventional Radiology, University Hospital of Bonn, Bonn, Germany
- Center for Integrated Oncology (CIO), Aachen-Bonn-Cologne-Duesseldorf, Germany
| | - Patrick Arthur Kupczyk
- Department of Diagnostic and Interventional Radiology, University Hospital of Bonn, Bonn, Germany
- Center for Integrated Oncology (CIO), Aachen-Bonn-Cologne-Duesseldorf, Germany
| | - Philipp Bruners
- Center for Integrated Oncology (CIO), Aachen-Bonn-Cologne-Duesseldorf, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital of Aachen, Aachen, Germany
| | - Robert Siepmann
- Center for Integrated Oncology (CIO), Aachen-Bonn-Cologne-Duesseldorf, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital of Aachen, Aachen, Germany
| | - Emelie Guendel
- Department of Diagnostic and Interventional Radiology, University Hospital of Bonn, Bonn, Germany
- Center for Integrated Oncology (CIO), Aachen-Bonn-Cologne-Duesseldorf, Germany
| | - Julian Alexander Luetkens
- Department of Diagnostic and Interventional Radiology, University Hospital of Bonn, Bonn, Germany
- Center for Integrated Oncology (CIO), Aachen-Bonn-Cologne-Duesseldorf, Germany
| | - Alexander Isaak
- Department of Diagnostic and Interventional Radiology, University Hospital of Bonn, Bonn, Germany
- Center for Integrated Oncology (CIO), Aachen-Bonn-Cologne-Duesseldorf, Germany
| | - Carsten Meyer
- Department of Diagnostic and Interventional Radiology, University Hospital of Bonn, Bonn, Germany
- Center for Integrated Oncology (CIO), Aachen-Bonn-Cologne-Duesseldorf, Germany
| | - Fabian Kuetting
- Center for Integrated Oncology (CIO), Aachen-Bonn-Cologne-Duesseldorf, Germany
| | - Claus Christian Pieper
- Department of Diagnostic and Interventional Radiology, University Hospital of Bonn, Bonn, Germany
- Center for Integrated Oncology (CIO), Aachen-Bonn-Cologne-Duesseldorf, Germany
| | - Ulrike Irmgard Attenberger
- Department of Diagnostic and Interventional Radiology, University Hospital of Bonn, Bonn, Germany
- Center for Integrated Oncology (CIO), Aachen-Bonn-Cologne-Duesseldorf, Germany
| | - Daniel Kuetting
- Department of Diagnostic and Interventional Radiology, University Hospital of Bonn, Bonn, Germany
- Center for Integrated Oncology (CIO), Aachen-Bonn-Cologne-Duesseldorf, Germany
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Vollbrecht TM, Hart C, Zhang S, Katemann C, Sprinkart AM, Isaak A, Attenberger U, Pieper CC, Kuetting D, Geipel A, Strizek B, Luetkens JA. Deep learning denoising reconstruction for improved image quality in fetal cardiac cine MRI. Front Cardiovasc Med 2024; 11:1323443. [PMID: 38410246 PMCID: PMC10894983 DOI: 10.3389/fcvm.2024.1323443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 01/10/2024] [Indexed: 02/28/2024] Open
Abstract
Purpose This study aims to evaluate deep learning (DL) denoising reconstructions for image quality improvement of Doppler ultrasound (DUS)-gated fetal cardiac MRI in congenital heart disease (CHD). Methods Twenty-five fetuses with CHD (mean gestational age: 35 ± 1 weeks) underwent fetal cardiac MRI at 3T. Cine imaging was acquired using a balanced steady-state free precession (bSSFP) sequence with Doppler ultrasound gating. Images were reconstructed using both compressed sensing (bSSFP CS) and a pre-trained convolutional neural network trained for DL denoising (bSSFP DL). Images were compared qualitatively based on a 5-point Likert scale (from 1 = non-diagnostic to 5 = excellent) and quantitatively by calculating the apparent signal-to-noise ratio (aSNR) and contrast-to-noise ratio (aCNR). Diagnostic confidence was assessed for the atria, ventricles, foramen ovale, valves, great vessels, aortic arch, and pulmonary veins. Results Fetal cardiac cine MRI was successful in 23 fetuses (92%), with two studies excluded due to extensive fetal motion. The image quality of bSSFP DL cine reconstructions was rated superior to standard bSSFP CS cine images in terms of contrast [3 (interquartile range: 2-4) vs. 5 (4-5), P < 0.001] and endocardial edge definition [3 (2-4) vs. 4 (4-5), P < 0.001], while the extent of artifacts was found to be comparable [4 (3-4.75) vs. 4 (3-4), P = 0.40]. bSSFP DL images had higher aSNR and aCNR compared with the bSSFP CS images (aSNR: 13.4 ± 6.9 vs. 8.3 ± 3.6, P < 0.001; aCNR: 26.6 ± 15.8 vs. 14.4 ± 6.8, P < 0.001). Diagnostic confidence of the bSSFP DL images was superior for the evaluation of cardiovascular structures (e.g., atria and ventricles: P = 0.003). Conclusion DL image denoising provides superior quality for DUS-gated fetal cardiac cine imaging of CHD compared to standard CS image reconstruction.
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Affiliation(s)
- Thomas M Vollbrecht
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn, Germany
- Quantitative Imaging Lab Bonn (QILaB), Bonn, Germany
| | - Christopher Hart
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn, Germany
- Quantitative Imaging Lab Bonn (QILaB), Bonn, Germany
- Department of Pediatric Cardiology, University Hospital Bonn, Bonn, Germany
| | - Shuo Zhang
- Philips GmbH Market DACH, PD Clinical Science, Hamburg, Germany
| | | | - Alois M Sprinkart
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn, Germany
- Quantitative Imaging Lab Bonn (QILaB), Bonn, Germany
| | - Alexander Isaak
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn, Germany
- Quantitative Imaging Lab Bonn (QILaB), Bonn, Germany
| | - Ulrike Attenberger
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn, Germany
| | - Claus C Pieper
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn, Germany
| | - Daniel Kuetting
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn, Germany
- Quantitative Imaging Lab Bonn (QILaB), Bonn, Germany
| | - Annegret Geipel
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
| | - Brigitte Strizek
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
| | - Julian A Luetkens
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn, Germany
- Quantitative Imaging Lab Bonn (QILaB), Bonn, Germany
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8
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Layer YC, Mesropyan N, Kupczyk PA, Luetkens JA, Isaak A, Dell T, Ernst BP, Attenberger UI, Kuetting D. Use of virtual monoenergetic images for reduction of extensive dental implant associated artifacts in photon-counting detector CT. Sci Rep 2024; 14:497. [PMID: 38177651 PMCID: PMC10766624 DOI: 10.1038/s41598-023-50926-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 12/28/2023] [Indexed: 01/06/2024] Open
Abstract
Aim of this study was to assess the impact of virtual monoenergetic images (VMI) on dental implant artifacts in photon-counting detector computed tomography (PCD-CT) compared to standard reconstructed polychromatic images (PI). 30 scans with extensive (≥ 5 dental implants) dental implant-associated artifacts were retrospectively analyzed. Scans were acquired during clinical routine on a PCD-CT. VMI were reconstructed for 100-190 keV (10 keV steps) and compared to PI. Artifact extent and assessment of adjacent soft tissue were rated using a 5-point Likert grading scale for qualitative assessment. Quantitative assessment was performed using ROIs in most pronounced hypodense and hyperdense artifacts, artifact-impaired soft tissue, artifact-free fat and muscle tissue. A corrected attenuation was calculated as difference between artifact-impaired tissue and tissue without artifacts. Qualitative assessment of soft palate and cheeks improved for all VMI compared to PI (Median PI: 1 (Range: 1-3) and 1 (1-3); e.g. VMI130 keV 2 (1-5); p < 0.0001 and 2 (1-4); p < 0.0001). In quantitative assessment, VMI130 keV showed best results with a corrected attenuation closest to 0 (PI: 30.48 ± 98.16; VMI130 keV: - 0.55 ± 73.38; p = 0.0026). Overall, photon-counting deducted VMI reduce the extent of dental implant-associated artifacts. VMI of 130 keV showed best results and are recommended to support head and neck CT scans.
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Affiliation(s)
- Yannik C Layer
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
| | - Narine Mesropyan
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Patrick A Kupczyk
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Julian A Luetkens
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Alexander Isaak
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Tatjana Dell
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Benjamin P Ernst
- Department of Otorhinolaryngology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Ulrike I Attenberger
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Daniel Kuetting
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
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9
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Bischoff LM, Peeters JM, Weinhold L, Krausewitz P, Ellinger J, Katemann C, Isaak A, Weber OM, Kuetting D, Attenberger U, Pieper CC, Sprinkart AM, Luetkens JA. Deep Learning Super-Resolution Reconstruction for Fast and Motion-Robust T2-weighted Prostate MRI. Radiology 2023; 308:e230427. [PMID: 37750774 DOI: 10.1148/radiol.230427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
Background Deep learning (DL) reconstructions can enhance image quality while decreasing MRI acquisition time. However, DL reconstruction methods combined with compressed sensing for prostate MRI have not been well studied. Purpose To use an industry-developed DL algorithm to reconstruct low-resolution T2-weighted turbo spin-echo (TSE) prostate MRI scans and compare these with standard sequences. Materials and Methods In this prospective study, participants with suspected prostate cancer underwent prostate MRI with a Cartesian standard-resolution T2-weighted TSE sequence (T2C) and non-Cartesian standard-resolution T2-weighted TSE sequence (T2NC) between August and November 2022. Additionally, a low-resolution Cartesian DL-reconstructed T2-weighted TSE sequence (T2DL) with compressed sensing DL denoising and resolution upscaling reconstruction was acquired. Image sharpness was assessed qualitatively by two readers using a five-point Likert scale (from 1 = nondiagnostic to 5 = excellent) and quantitatively by calculating edge rise distance. The Friedman test and one-way analysis of variance with post hoc Bonferroni and Tukey tests, respectively, were used for group comparisons. Prostate Imaging Reporting and Data System (PI-RADS) score agreement between sequences was compared by using Cohen κ. Results This study included 109 male participants (mean age, 68 years ± 8 [SD]). Acquisition time of T2DL was 36% and 29% lower compared with that of T2C and T2NC (mean duration, 164 seconds ± 20 vs 257 seconds ± 32 and 230 seconds ± 28; P < .001 for both). T2DL showed improved image sharpness compared with standard sequences using both qualitative (median score, 5 [IQR, 4-5] vs 4 [IQR, 3-4] for T2C and 4 [IQR, 3-4] for T2NC; P < .001 for both) and quantitative (mean edge rise distance, 0.75 mm ± 0.39 vs 1.15 mm ± 0.68 for T2C and 0.98 mm ± 0.65 for T2NC; P < .001 and P = .01) methods. PI-RADS score agreement between T2NC and T2DL was excellent (κ range, 0.92-0.94 [95% CI: 0.87, 0.98]). Conclusion DL reconstruction of low-resolution T2-weighted TSE sequences enabled accelerated acquisition times and improved image quality compared with standard acquisitions while showing excellent agreement with conventional sequences for PI-RADS ratings. Clinical trial registration no. NCT05820113 © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Turkbey in this issue.
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Affiliation(s)
- Leon M Bischoff
- From the Department of Diagnostic and Interventional Radiology (L.M.B., A.I., D.K., U.A., C.C.P., A.M.S., J.A.L.), Quantitative Imaging Laboratory Bonn (QILaB) (L.M.B., A.I., D.K., A.M.S., J.A.L.), Institute for Medical Biometry, Informatics and Epidemiology (L.W.), and Department of Urology (P.K., J.E.), University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; Philips MR Clinical Science, Best, the Netherlands (J.M.P.); and Philips Market DACH, Hamburg, Germany (C.K., O.M.W.)
| | - Johannes M Peeters
- From the Department of Diagnostic and Interventional Radiology (L.M.B., A.I., D.K., U.A., C.C.P., A.M.S., J.A.L.), Quantitative Imaging Laboratory Bonn (QILaB) (L.M.B., A.I., D.K., A.M.S., J.A.L.), Institute for Medical Biometry, Informatics and Epidemiology (L.W.), and Department of Urology (P.K., J.E.), University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; Philips MR Clinical Science, Best, the Netherlands (J.M.P.); and Philips Market DACH, Hamburg, Germany (C.K., O.M.W.)
| | - Leonie Weinhold
- From the Department of Diagnostic and Interventional Radiology (L.M.B., A.I., D.K., U.A., C.C.P., A.M.S., J.A.L.), Quantitative Imaging Laboratory Bonn (QILaB) (L.M.B., A.I., D.K., A.M.S., J.A.L.), Institute for Medical Biometry, Informatics and Epidemiology (L.W.), and Department of Urology (P.K., J.E.), University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; Philips MR Clinical Science, Best, the Netherlands (J.M.P.); and Philips Market DACH, Hamburg, Germany (C.K., O.M.W.)
| | - Philipp Krausewitz
- From the Department of Diagnostic and Interventional Radiology (L.M.B., A.I., D.K., U.A., C.C.P., A.M.S., J.A.L.), Quantitative Imaging Laboratory Bonn (QILaB) (L.M.B., A.I., D.K., A.M.S., J.A.L.), Institute for Medical Biometry, Informatics and Epidemiology (L.W.), and Department of Urology (P.K., J.E.), University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; Philips MR Clinical Science, Best, the Netherlands (J.M.P.); and Philips Market DACH, Hamburg, Germany (C.K., O.M.W.)
| | - Jörg Ellinger
- From the Department of Diagnostic and Interventional Radiology (L.M.B., A.I., D.K., U.A., C.C.P., A.M.S., J.A.L.), Quantitative Imaging Laboratory Bonn (QILaB) (L.M.B., A.I., D.K., A.M.S., J.A.L.), Institute for Medical Biometry, Informatics and Epidemiology (L.W.), and Department of Urology (P.K., J.E.), University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; Philips MR Clinical Science, Best, the Netherlands (J.M.P.); and Philips Market DACH, Hamburg, Germany (C.K., O.M.W.)
| | - Christoph Katemann
- From the Department of Diagnostic and Interventional Radiology (L.M.B., A.I., D.K., U.A., C.C.P., A.M.S., J.A.L.), Quantitative Imaging Laboratory Bonn (QILaB) (L.M.B., A.I., D.K., A.M.S., J.A.L.), Institute for Medical Biometry, Informatics and Epidemiology (L.W.), and Department of Urology (P.K., J.E.), University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; Philips MR Clinical Science, Best, the Netherlands (J.M.P.); and Philips Market DACH, Hamburg, Germany (C.K., O.M.W.)
| | - Alexander Isaak
- From the Department of Diagnostic and Interventional Radiology (L.M.B., A.I., D.K., U.A., C.C.P., A.M.S., J.A.L.), Quantitative Imaging Laboratory Bonn (QILaB) (L.M.B., A.I., D.K., A.M.S., J.A.L.), Institute for Medical Biometry, Informatics and Epidemiology (L.W.), and Department of Urology (P.K., J.E.), University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; Philips MR Clinical Science, Best, the Netherlands (J.M.P.); and Philips Market DACH, Hamburg, Germany (C.K., O.M.W.)
| | - Oliver M Weber
- From the Department of Diagnostic and Interventional Radiology (L.M.B., A.I., D.K., U.A., C.C.P., A.M.S., J.A.L.), Quantitative Imaging Laboratory Bonn (QILaB) (L.M.B., A.I., D.K., A.M.S., J.A.L.), Institute for Medical Biometry, Informatics and Epidemiology (L.W.), and Department of Urology (P.K., J.E.), University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; Philips MR Clinical Science, Best, the Netherlands (J.M.P.); and Philips Market DACH, Hamburg, Germany (C.K., O.M.W.)
| | - Daniel Kuetting
- From the Department of Diagnostic and Interventional Radiology (L.M.B., A.I., D.K., U.A., C.C.P., A.M.S., J.A.L.), Quantitative Imaging Laboratory Bonn (QILaB) (L.M.B., A.I., D.K., A.M.S., J.A.L.), Institute for Medical Biometry, Informatics and Epidemiology (L.W.), and Department of Urology (P.K., J.E.), University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; Philips MR Clinical Science, Best, the Netherlands (J.M.P.); and Philips Market DACH, Hamburg, Germany (C.K., O.M.W.)
| | - Ulrike Attenberger
- From the Department of Diagnostic and Interventional Radiology (L.M.B., A.I., D.K., U.A., C.C.P., A.M.S., J.A.L.), Quantitative Imaging Laboratory Bonn (QILaB) (L.M.B., A.I., D.K., A.M.S., J.A.L.), Institute for Medical Biometry, Informatics and Epidemiology (L.W.), and Department of Urology (P.K., J.E.), University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; Philips MR Clinical Science, Best, the Netherlands (J.M.P.); and Philips Market DACH, Hamburg, Germany (C.K., O.M.W.)
| | - Claus C Pieper
- From the Department of Diagnostic and Interventional Radiology (L.M.B., A.I., D.K., U.A., C.C.P., A.M.S., J.A.L.), Quantitative Imaging Laboratory Bonn (QILaB) (L.M.B., A.I., D.K., A.M.S., J.A.L.), Institute for Medical Biometry, Informatics and Epidemiology (L.W.), and Department of Urology (P.K., J.E.), University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; Philips MR Clinical Science, Best, the Netherlands (J.M.P.); and Philips Market DACH, Hamburg, Germany (C.K., O.M.W.)
| | - Alois M Sprinkart
- From the Department of Diagnostic and Interventional Radiology (L.M.B., A.I., D.K., U.A., C.C.P., A.M.S., J.A.L.), Quantitative Imaging Laboratory Bonn (QILaB) (L.M.B., A.I., D.K., A.M.S., J.A.L.), Institute for Medical Biometry, Informatics and Epidemiology (L.W.), and Department of Urology (P.K., J.E.), University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; Philips MR Clinical Science, Best, the Netherlands (J.M.P.); and Philips Market DACH, Hamburg, Germany (C.K., O.M.W.)
| | - Julian A Luetkens
- From the Department of Diagnostic and Interventional Radiology (L.M.B., A.I., D.K., U.A., C.C.P., A.M.S., J.A.L.), Quantitative Imaging Laboratory Bonn (QILaB) (L.M.B., A.I., D.K., A.M.S., J.A.L.), Institute for Medical Biometry, Informatics and Epidemiology (L.W.), and Department of Urology (P.K., J.E.), University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; Philips MR Clinical Science, Best, the Netherlands (J.M.P.); and Philips Market DACH, Hamburg, Germany (C.K., O.M.W.)
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10
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Isaak A, Bratz J, Kravchenko D, Mesropyan N, Eckardt I, Bischoff LM, Weinhold L, Kuetting D, Pieper CC, Attenberger U, Zimmer S, Luetkens JA. A novel and simple cardiac magnetic resonance score (PE 2RT) predicts outcome in takotsubo syndrome. Eur Radiol 2023; 33:5498-5508. [PMID: 36949253 PMCID: PMC10326093 DOI: 10.1007/s00330-023-09543-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 01/23/2023] [Accepted: 02/06/2023] [Indexed: 03/24/2023]
Abstract
OBJECTIVES To find simple imaging-based features on cardiac magnetic resonance (CMR) that are associated with major adverse cardiovascular events (MACE) in takotsubo syndrome (TTS). METHODS Patients with TTS referred for CMR between 2007 and 2021 were retrospectively evaluated. Besides standard CMR analysis, commonly known complications of TTS based on expert knowledge were assessed and summarised via a newly developed PE2RT score (one point each for pleural effusion, pericardial effusion, right ventricular involvement, and ventricular thrombus). Clinical follow-up data was reviewed up to three years after discharge. The relationship between PE2RT features and the occurrence of MACE (cardiovascular death or new hospitalisation due to acute myocardial injury, arrhythmia, or chronic heart failure) was examined using Cox regression analysis and Kaplan-Meier estimator. RESULTS Seventy-nine patients (mean age, 68 ± 14 years; 72 women) with TTS were included. CMR was performed in a median of 4 days (IQR, 2-6) after symptom onset. Over a median follow-up of 13.3 months (IQR, 0.4-36.0), MACE occurred in 14/79 (18%) patients: re-hospitalisation due to acute symptoms (9/79, 11%) or chronic heart failure symptoms (4/79, 5%), and cardiac death (1/79, 1%). Patients with MACE had a higher PE2RT score (median [IQR], 2 [2-3] vs 1 [0-1]; p < 0.001). PE2RT score was associated with MACE on Cox regression analysis (hazard ratio per PE2RT feature, 2.44; 95%CI: 1.62-3.68; p < 0.001). Two or more PE2RT complications were strongly associated with the occurrence of MACE (log-rank p < 0.001). CONCLUSIONS The introduced PE2RT complication score might enable an easy-to-assess outcome evaluation of TTS patients by CMR. KEY POINTS • Complications like pericardial effusion, pleural effusion, right ventricular involvement, and ventricular thrombus (summarised as PE2RT features) are relatively common in takotsubo syndrome. • The proposed PE2RT score (one point per complication) was associated with the occurrence of major adverse cardiac events on follow-up. • Complications easily detected by cardiac magnetic resonance imaging can help clinicians derive long-term prognostic information on patients with takotsubo syndrome.
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Affiliation(s)
- Alexander Isaak
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
- Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Bonn, Germany.
| | - Johanna Bratz
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Dmitrij Kravchenko
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
- Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Bonn, Germany
| | - Narine Mesropyan
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
- Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Bonn, Germany
| | - Irina Eckardt
- Department of Internal Medicine II - Cardiology, University Hospital Bonn, Bonn, Germany
| | - Leon M Bischoff
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
- Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Bonn, Germany
| | - Leonie Weinhold
- Institute of Medical Biometry, Informatics, and Epidemiology, University Hospital Bonn, Bonn, Germany
| | - Daniel Kuetting
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
- Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Bonn, Germany
| | - Claus Christian Pieper
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Ulrike Attenberger
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Sebastian Zimmer
- Department of Internal Medicine II - Cardiology, University Hospital Bonn, Bonn, Germany
| | - Julian A Luetkens
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
- Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Bonn, Germany.
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11
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Halfmann MC, Luetkens JA, Langenbach IL, Kravchenko D, Wenzel P, Emrich T, Isaak A. Cardiac MRI Findings in Patients Clinically Referred for Evaluation of Post-Acute Sequelae of SARS-CoV-2 Infection. Diagnostics (Basel) 2023; 13:2172. [PMID: 37443565 DOI: 10.3390/diagnostics13132172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 06/19/2023] [Accepted: 06/21/2023] [Indexed: 07/15/2023] Open
Abstract
Persistent or recurrent cardiovascular symptoms have been identified as one of the hallmarks of long-COVID or post-acute sequelae of SARS-CoV-2 infection (PASC). The purpose of this study was to determine the prevalence and extent of cardiac abnormalities in patients referred for cardiac MRI due to clinical evidence of PASC. To investigate this, two tertiary care hospitals identified all patients who were referred for cardiac MRI under the suspicion of PASC in a 2-year period and retrospectively included them in this study. Patients with previously known cardiac diseases were excluded. This resulted in a total cohort of 129 patients (63, 51% female; age 41 ± 16 years). The majority of patients (57%) showed normal cardiac results. No patient had active myocarditis or an acute myocardial infarction. However, 30% of patients had evidence of non-ischemic myocardial fibrosis, which exceeds the prevalence in the normal adult population and suggests that a possible history of myocarditis might explain persistent symptoms in the PASC setting.
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Affiliation(s)
- Moritz C Halfmann
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University Mainz, 55116 Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, 55116 Mainz, Germany
- Researchers for the Future (Forschende für die Zukunft), German Society of Radiology (DRG), 10587 Berlin, Germany
| | - Julian A Luetkens
- Department of Radiology, University Hospital Bonn, 53127 Bonn, Germany
| | - Isabel L Langenbach
- Researchers for the Future (Forschende für die Zukunft), German Society of Radiology (DRG), 10587 Berlin, Germany
- Department of Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany
| | | | - Philip Wenzel
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, 55116 Mainz, Germany
- Department of Cardiology, University Medical Center Mainz-Center of Cardiology, Johannes Gutenberg University, 55116 Mainz, Germany
| | - Tilman Emrich
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University Mainz, 55116 Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, 55116 Mainz, Germany
| | - Alexander Isaak
- Researchers for the Future (Forschende für die Zukunft), German Society of Radiology (DRG), 10587 Berlin, Germany
- Department of Radiology, University Hospital Bonn, 53127 Bonn, Germany
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Isaak A, Chang J, Mesropyan N, Kravchenko D, Endler C, Bischoff L, Böhling N, Pieper CC, Kuetting D, Strassburg CP, Attenberger U, Jansen C, Praktiknjo M, Luetkens JA. Cardiac involvement in non-cirrhotic portal hypertension: MRI detects myocardial fibrosis and oedema similar to compensated cirrhosis. Eur Heart J Cardiovasc Imaging 2023; 24:949-960. [PMID: 36423215 DOI: 10.1093/ehjci/jeac235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 11/04/2022] [Indexed: 08/03/2023] Open
Abstract
AIMS The exact role of portal hypertension in cirrhotic cardiomyopathy remains unclear, and it is uncertain whether cardiac abnormalities also occur in non-cirrhotic portal hypertension (NCPH). This magnetic resonance imaging (MRI) study aimed to evaluate the presence of subclinical myocardial dysfunction, oedema, and fibrosis in NCPH. METHODS AND RESULTS In this prospective study (2018-2022), participants underwent multiparametric abdominal and cardiac MRI including assessment of cardiac function, myocardial oedema, late gadolinium enhancement (LGE), and abdominal and cardiac mapping [T1 and T2 relaxation times, extracellular volume fraction (ECV)]. A total of 111 participants were included [44 participants with NCPH (48 ± 15 years; 23 women), 47 cirrhotic controls, and 20 healthy controls]. The cirrhotic group was dichotomized (Child A vs. Child B/C). NCPH participants demonstrated a more hyperdynamic circulation compared with healthy controls (cardiac index: 3.7 ± 0.6 vs. 3.2 ± 0.8 L/min/m², P = 0.004; global longitudinal strain: -27.3 ± 4.6 vs. -24.6 ± 3.5%, P = 0.022). The extent of abnormalities indicating myocardial fibrosis and oedema in NCPH was comparable with Child A cirrhosis (e.g. LGE presence: 32 vs. 33 vs. 69%, P = 0.004; combined T1 and T2 elevations: 46 vs. 27 vs. 69%, P = 0.017; NCPH vs. Child A vs. Child B/C). Correlations between splenic T1 and myocardial T1 values were found (r = 0.41; P = 0.007). Splenic T1 values were associated with the presence of LGE (odds ratio, 1.010; 95% CI: 1.002, 1.019; P = 0.013). CONCLUSION MRI parameters of myocardial fibrosis and oedema were altered in participants with NCPH to a similar extent as in compensated cirrhosis and were associated with splenic markers of portal hypertension, indicating specific portal hypertensive cardiomyopathy.
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Affiliation(s)
- Alexander Isaak
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
- Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Johannes Chang
- Department of Internal Medicine I, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
- Center for Cirrhosis and Portal Hypertension Bonn (CCB), University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Narine Mesropyan
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
- Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Dmitrij Kravchenko
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
- Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Christoph Endler
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
- Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Leon Bischoff
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
- Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Nina Böhling
- Department of Internal Medicine I, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
- Center for Cirrhosis and Portal Hypertension Bonn (CCB), University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Claus C Pieper
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Daniel Kuetting
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
- Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Christian P Strassburg
- Department of Internal Medicine I, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
- Center for Cirrhosis and Portal Hypertension Bonn (CCB), University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Ulrike Attenberger
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Christian Jansen
- Department of Internal Medicine I, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
- Center for Cirrhosis and Portal Hypertension Bonn (CCB), University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Michael Praktiknjo
- Department of Internal Medicine I, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
- Center for Cirrhosis and Portal Hypertension Bonn (CCB), University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Julian A Luetkens
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
- Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
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Layer YC, Mesropyan N, Kupczyk PA, Luetkens JA, Isaak A, Dell T, Attenberger UI, Kuetting D. Combining iterative metal artifact reduction and virtual monoenergetic images severely reduces hip prosthesis-associated artifacts in photon-counting detector CT. Sci Rep 2023; 13:8955. [PMID: 37268675 DOI: 10.1038/s41598-023-35989-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 05/26/2023] [Indexed: 06/04/2023] Open
Abstract
Aim of this study was to assess the impact of virtual monoenergetic images (VMI) in combination and comparison with iterative metal artifact reduction (IMAR) on hip prosthesis-associated artifacts in photon-counting detector CT (PCD-CT). Retrospectively, 33 scans with hip prosthesis-associated artifacts acquired during clinical routine on a PCD-CT between 08/2022 and 09/2022 were analyzed. VMI were reconstructed for 100-190 keV with and without IMAR, and compared to polychromatic images. Qualitatively, artifact extent and assessment of adjacent soft tissue were rated by two radiologists using 5-point Likert items. Quantitative assessment was performed measuring attenuation and standard deviation in most pronounced hypodense and hyperdense artifacts, artifact-impaired bone, muscle, vessels, bladder and artifact-free corresponding tissue. To quantify artifacts, an adjusted attenuation was calculated as the difference between artifact-impaired tissue and corresponding tissue without artifacts. Qualitative assessment improved for all investigated image reconstructions compared to polychromatic images (PI). VMI100keV in combination with IMAR achieved best results (e.g. diagnostic quality of the bladder: median PI: 1.5 (range 1-4); VMI100keV+IMAR: 5 (3-5); p < 0.0001). In quantitative assessment VMI100keV with IMAR provided best artifact reduction with an adjusted attenuation closest to 0 (e.g. bone: PI: 302.78; VMI100keV+IMAR: 51.18; p < 0.0001). The combination of VMI and IMAR significantly reduces hip prosthesis-associated artifacts in PCD-CT and improves the diagnostic quality of surrounding tissue.
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Affiliation(s)
- Yannik C Layer
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
| | - Narine Mesropyan
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Patrick A Kupczyk
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Julian A Luetkens
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Alexander Isaak
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Tatjana Dell
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Ulrike I Attenberger
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Daniel Kuetting
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
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14
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Isaak A, Pomareda I, Mesropyan N, Kravchenko D, Endler C, Bischoff L, Pieper CC, Kuetting D, Attenberger U, Zimmer S, Putensen C, Schewe J, Kreyer S, Luetkens JA. Cardiovascular Magnetic Resonance in Survivors of Critical Illness: Cardiac Abnormalities Are Associated With Acute Kidney Injury. J Am Heart Assoc 2023; 12:e029492. [PMID: 37119085 PMCID: PMC10227222 DOI: 10.1161/jaha.123.029492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 03/28/2023] [Indexed: 04/30/2023]
Abstract
Background The objective of this study was to investigate cardiac abnormalities in intensive care unit (ICU) survivors of critical illness and to determine whether temporary acute kidney injury (AKI) is associated with more pronounced findings on cardiovascular magnetic resonance. Methods and Results There were 2175 patients treated in the ICU (from 2015 until 2021) due to critical illness who were screened for study eligibility. Post-ICU patients without known cardiac disease were prospectively recruited from March 2021 to May 2022. Participants underwent cardiovascular magnetic resonance including assessment of cardiac function, myocardial edema, late gadolinium enhancement, and mapping including extracellular volume fraction. Student t test, Mann-Whitney U test, and χ2 tests were used. There were 48 ICU survivors (46±15 years of age, 28 men, 29 with AKI and continuous kidney replacement therapy, and 19 without AKI) and 20 healthy controls who were included. ICU survivors had elevated markers of myocardial fibrosis (T1: 995±31 ms versus 957±21 ms, P<0.001; extracellular volume fraction: 24.9±2.5% versus 22.8±1.2%, P<0.001; late gadolinium enhancement: 1% [0%-3%] versus 0% [0%-0%], P<0.001), more frequent focal late gadolinium enhancement lesions (21% versus 0%, P=0.03), and an impaired left ventricular function (eg, ejection fraction: 57±6% versus 60±5%, P=0.03; systolic longitudinal strain: 20.3±3.7% versus 23.1±3.5%, P=0.004) compared with healthy controls. ICU survivors with AKI had higher myocardial T1 (1002±33 ms versus 983±21 ms; P=0.046) and extracellular volume fraction values (25.6±2.6% versus 23.9±1.9%; P=0.02) compared with participants without AKI. Conclusions ICU survivors of critical illness without previously diagnosed cardiac disease had distinct abnormalities on cardiovascular magnetic resonance including signs of myocardial fibrosis and systolic dysfunction. Findings were more abnormal in participants who experienced AKI with necessity of continuous kidney replacement therapy during their ICU stay. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT05034588.
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Affiliation(s)
- Alexander Isaak
- Department of Diagnostic and Interventional RadiologyUniversity Hospital BonnBonnGermany
- Quantitative Imaging Lab Bonn (QILaB)University Hospital BonnBonnGermany
| | - Isabel Pomareda
- Department of Diagnostic and Interventional RadiologyUniversity Hospital BonnBonnGermany
| | - Narine Mesropyan
- Department of Diagnostic and Interventional RadiologyUniversity Hospital BonnBonnGermany
- Quantitative Imaging Lab Bonn (QILaB)University Hospital BonnBonnGermany
| | - Dmitrij Kravchenko
- Department of Diagnostic and Interventional RadiologyUniversity Hospital BonnBonnGermany
- Quantitative Imaging Lab Bonn (QILaB)University Hospital BonnBonnGermany
| | - Christoph Endler
- Department of Diagnostic and Interventional RadiologyUniversity Hospital BonnBonnGermany
- Quantitative Imaging Lab Bonn (QILaB)University Hospital BonnBonnGermany
| | - Leon Bischoff
- Department of Diagnostic and Interventional RadiologyUniversity Hospital BonnBonnGermany
- Quantitative Imaging Lab Bonn (QILaB)University Hospital BonnBonnGermany
| | - Claus C. Pieper
- Department of Diagnostic and Interventional RadiologyUniversity Hospital BonnBonnGermany
| | - Daniel Kuetting
- Department of Diagnostic and Interventional RadiologyUniversity Hospital BonnBonnGermany
- Quantitative Imaging Lab Bonn (QILaB)University Hospital BonnBonnGermany
| | - Ulrike Attenberger
- Department of Diagnostic and Interventional RadiologyUniversity Hospital BonnBonnGermany
| | - Sebastian Zimmer
- Clinic for Internal Medicine II, Heart Center BonnUniversity Hospital BonnBonnGermany
| | - Christian Putensen
- Department of Anesthesiology and Intensive Care MedicineUniversity Hospital BonnBonnGermany
| | - Jens‐Christian Schewe
- Department of Anesthesiology and Intensive Care MedicineUniversity Hospital BonnBonnGermany
- Department of Anesthesiology, Intensive Care Medicine and Pain TherapyUniversity Medical Centre RostockRostockGermany
| | - Stefan Kreyer
- Department of Anesthesiology and Intensive Care MedicineUniversity Hospital BonnBonnGermany
| | - Julian A. Luetkens
- Department of Diagnostic and Interventional RadiologyUniversity Hospital BonnBonnGermany
- Quantitative Imaging Lab Bonn (QILaB)University Hospital BonnBonnGermany
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15
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Kravchenko D, Isaak A, Zhang S, Katemann C, Mesropyan N, Bischoff LM, Pieper CC, Kuetting D, Attenberger U, Weber O, Hart C, Luetkens JA. Free-breathing pseudo-golden-angle bSSFP cine cardiac MRI for biventricular functional assessment in congenital heart disease. Eur J Radiol 2023; 163:110831. [PMID: 37059004 DOI: 10.1016/j.ejrad.2023.110831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/23/2023] [Accepted: 04/07/2023] [Indexed: 04/16/2023]
Abstract
PURPOSE To compare standard breath-hold (BH) cine imaging to a radial pseudo-golden-angle free-breathing (FB) technique in congenital heart disease (CHD). METHODS In this prospective study, short-axis and 4-chamber BH and FB cardiac MRI sequences of 25 participants with CHD acquired at 1.5 Tesla, were quantitatively compared regarding ventricular volumes, function, interventricular septum thickness (IVSD), apparent signal to noise ratio (aSNR), and estimated contrast to noise ratio (eCNR). For qualitative comparison, three image quality criteria (contrast, endocardial edge definition, and artefacts) were rated on a 5-point Likert scale (5: excellent, 1: non-diagnostic). Paired t-Test was used for group comparisons, Bland-Altman analysis for agreement between techniques. Inter-reader agreement was compared using intraclass correlation coefficient. RESULTS IVSD (BH 7.4 ± 2.1 mm vs FB 7.4 ± 1.9 mm, p =.71), biventricular ejection fraction (left ventricle [LV]: 56.4 ± 10.8% vs 56.1 ± 9.3%, p =.83; right ventricle [RV]: 49.5 ± 8.6% vs 49.7 ± 10.1%, p =.83), and biventricular end diastolic volume (LV: 176.3 ± 63.9 ml vs 173.9 ± 64.9 ml, p =.90; RV: 185.4 ± 63.8 ml vs 189.6 ± 66.6 ml, p =.34) were comparable. Mean measurement time for FB short-axis sequences was 8.1 ± 1.3 compared to 4.4 ± 1.3 min for BH (p <.001). Subjective image quality between sequences was deemed comparable, (4.6 ± 0.6 vs 4.5 ± 0.6, p =.26, for 4-chamber views) with a significant difference regarding short-axis views (4.9 ± 0.3 vs 4.5 ± 0.6, p =.008). aSNR was similar (BH 25.8 ± 11.2 vs FB 22.2 ± 9.5, p =.24), while eCNR was higher for BH (89.1 ± 36.1 vs 68.5 ± 32.1, p =.03). CONCLUSION FB sequences yielded comparable results to BH regarding image quality, biventricular volumetry, and function, though measurement times were longer. The FB sequence described might be clinically valuable when BHs are insufficiently performed.
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Affiliation(s)
- Dmitrij Kravchenko
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn, Germany; Quantitative Imaging Lab Bonn (QILaB), Germany
| | - Alexander Isaak
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn, Germany; Quantitative Imaging Lab Bonn (QILaB), Germany
| | - Shuo Zhang
- Philips GmbH Market DACH, Hamburg, Germany
| | | | - Narine Mesropyan
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn, Germany; Quantitative Imaging Lab Bonn (QILaB), Germany
| | - Leon M Bischoff
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn, Germany; Quantitative Imaging Lab Bonn (QILaB), Germany
| | - Claus C Pieper
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn, Germany
| | - Daniel Kuetting
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn, Germany; Quantitative Imaging Lab Bonn (QILaB), Germany
| | - Ulrike Attenberger
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn, Germany
| | | | - Christopher Hart
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn, Germany; Department of Pediatric Cardiology, University Hospital Bonn, Bonn, Germany
| | - Julian A Luetkens
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn, Germany; Quantitative Imaging Lab Bonn (QILaB), Germany.
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Bischoff LM, Katemann C, Isaak A, Mesropyan N, Wichtmann B, Kravchenko D, Endler C, Kuetting D, Pieper CC, Ellinger J, Weber O, Attenberger U, Luetkens JA. T2 Turbo Spin Echo With Compressed Sensing and Propeller Acquisition (Sampling k-Space by Utilizing Rotating Blades) for Fast and Motion Robust Prostate MRI: Comparison With Conventional Acquisition. Invest Radiol 2023; 58:209-215. [PMID: 36070533 DOI: 10.1097/rli.0000000000000923] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The aim of this study was to compare a new compressed sensing (CS) method for T2-weighted propeller acquisitions (T2 CS ) with conventional T2-weighted propeller sequences (T2 conv ) in terms of achieving a higher image quality, while reducing the acquisition time. MATERIALS AND METHODS Male participants with a clinical suspicion of prostate cancer were prospectively enrolled and underwent prostate magnetic resonance imaging at 3 T. Axial and sagittal images of the T2 conv sequence and the T2 CS sequence were acquired. Sequences were qualitatively assessed by 2 blinded radiologists concerning artifacts, image-sharpness, lesion conspicuity, capsule delineation, and overall image quality using 5-point Likert items ranging from 1 (nondiagnostic) to 5 (excellent). The apparent signal-to-noise ratio and apparent contrast-to-noise ratio were evaluated. PI-RADS scores were assessed for both sequences. Statistical analysis was performed by using Wilcoxon signed rank test and paired samples t test. Intrarater and interrater reliability of qualitative image evaluation was assessed using intraclass correlation coefficient (ICC) estimates. RESULTS A total of 29 male participants were included (mean age, 66 ± 8 years). The acquisition time of the T2 CS sequence was respectively 26% (axial plane) and 24% (sagittal plane) shorter compared with the T2 conv sequence (eg, axial: 171 vs 232 seconds; P < 0.001). In the axial plane, the T2 CS sequence had fewer artifacts (4 [4-4.5] vs 4 [3-4]; P < 0.001), better image-sharpness (4 [4-4.5] vs 3 [3-3.5]; P < 0.001), better capsule delineation (4 [3-4] vs 3 [3-3.5]; P < 0.001), and better overall image quality (4 [4-4] vs 4 [3-4]; P < 0.001) compared with the T2 conv sequence. The ratings of lesion conspicuity were similar (4 [4-4] vs 4 [3-4]; P = 0.166). In the sagittal plane, the T2 CS sequence outperformed the T2 conv sequence in the categories artifacts (4 [4-4] vs 3 [3-4]; P < 0.001), image sharpness (4 [4-5] vs 4 [3-4]; P < 0.001), lesion conspicuity (4 [4-4] vs 4 [3-4]; P = 0.002), and overall image quality (4 [4-4] vs 4 [3-4]; P = 0.002). Capsule delineation was similar between both sequences (3 [3-4] vs 3 [3-3]; P = 0.07). Intraobserver and interobserver reliability for qualitative scoring were good (ICC intra: 0.92; ICC inter: 0.86). Quantitative analysis revealed a higher apparent signal-to-noise ratio (eg, axial: 52.2 ± 9.7 vs 22.8 ± 3.6; P < 0.001) and a higher apparent contrast-to-noise ratio (eg, axial: 44.0 ± 9.6 vs 18.6 ± 3.7; P ≤ 0.001) of the T2 CS sequence. PI-RADS scores were the same for both sequences in all participants. CONCLUSIONS CS-accelerated T2-weighted propeller acquisition had a superior image quality compared with conventional T2-weighted propeller sequences while significantly reducing the acquisition time.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Claus C Pieper
- From the Department of Diagnostic and Interventional Radiology
| | - Jörg Ellinger
- Department of Urology, University Hospital Bonn, Bonn, Germany
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Mesropyan N, Khorsandian L, Faron A, Sprinkart AM, Dorn F, Paech D, Isaak A, Kuetting D, Pieper CC, Radbruch A, Attenberger UI, Reimann J, Bode FJ, Kornblum C, Luetkens JA. Computed tomography derived cervical fat-free muscle fraction as an imaging-based outcome marker in patients with acute ischemic stroke: a pilot study. BMC Neurol 2023; 23:86. [PMID: 36855093 PMCID: PMC9971678 DOI: 10.1186/s12883-023-03132-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 02/19/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND Outcome assessment in stroke patients is essential for evidence-based stroke care planning. Computed tomography (CT) is the mainstay of diagnosis in acute stroke. This study aimed to investigate whether CT-derived cervical fat-free muscle fraction (FFMF) as a biomarker of muscle quality is associated with outcome parameters after acute ischemic stroke. METHODS In this retrospective study, 66 patients (mean age: 76 ± 13 years, 30 female) with acute ischemic stroke in the anterior circulation who underwent CT, including CT-angiography, and endovascular mechanical thrombectomy of the middle cerebral artery between August 2016 and January 2020 were identified. Based on densitometric thresholds, cervical paraspinal muscles covered on CT-angiography were separated into areas of fatty and lean muscle and FFMF was calculated. The study cohort was binarized based on median FFMF (cutoff value: < 71.6%) to compare clinical variables and outcome data between two groups. Unpaired t test and Mann-Whitney U test were used for statistical analysis. RESULTS National Institute of Health Stroke Scale (NIHSS) (12.2 ± 4.4 vs. 13.6 ± 4.5, P = 0.297) and modified Rankin scale (mRS) (4.3 ± 0.9 vs. 4.4 ± 0.9, P = 0.475) at admission, and pre-stroke mRS (1 ± 1.3 vs. 0.9 ± 1.4, P = 0.489) were similar between groups with high and low FFMF. NIHSS and mRS at discharge were significantly better in patients with high FFMF compared to patients with low FFMF (NIHSS: 4.5 ± 4.4 vs. 9.5 ± 6.7; P = 0.004 and mRS: 2.9 ± 2.1 vs.3.9 ± 1.8; P = 0.049). 90-day mRS was significantly better in patients with high FFMF compared to patients with low FFMF (3.3 ± 2.2 vs. 4.3 ± 1.9, P = 0.045). CONCLUSION Cervical FFMF obtained from routine clinical CT might be a new imaging-based muscle quality biomarker for outcome prediction in stroke patients.
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Affiliation(s)
- Narine Mesropyan
- grid.15090.3d0000 0000 8786 803XDepartment of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany ,Quantitative Imaging Lab Bonn (QILaB), Venusberg-Campus 1, 53127 Bonn, Germany
| | - Louisa Khorsandian
- grid.15090.3d0000 0000 8786 803XDepartment of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany ,grid.15090.3d0000 0000 8786 803XDepartment of Neurology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Anton Faron
- grid.15090.3d0000 0000 8786 803XDepartment of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany ,Quantitative Imaging Lab Bonn (QILaB), Venusberg-Campus 1, 53127 Bonn, Germany ,Radiologische Allianz, Andreas-Knack-Ring 16, 22307 Hamburg, Germany
| | - Alois M. Sprinkart
- grid.15090.3d0000 0000 8786 803XDepartment of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany ,Quantitative Imaging Lab Bonn (QILaB), Venusberg-Campus 1, 53127 Bonn, Germany
| | - Franziska Dorn
- grid.15090.3d0000 0000 8786 803XDepartment of Neuroradiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Daniel Paech
- grid.15090.3d0000 0000 8786 803XDepartment of Neuroradiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Alexander Isaak
- grid.15090.3d0000 0000 8786 803XDepartment of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany ,Quantitative Imaging Lab Bonn (QILaB), Venusberg-Campus 1, 53127 Bonn, Germany
| | - Daniel Kuetting
- grid.15090.3d0000 0000 8786 803XDepartment of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany ,Quantitative Imaging Lab Bonn (QILaB), Venusberg-Campus 1, 53127 Bonn, Germany
| | - Claus C. Pieper
- grid.15090.3d0000 0000 8786 803XDepartment of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Alexander Radbruch
- grid.15090.3d0000 0000 8786 803XDepartment of Neuroradiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Ulrike I. Attenberger
- grid.15090.3d0000 0000 8786 803XDepartment of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Jens Reimann
- grid.15090.3d0000 0000 8786 803XDepartment of Neurology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Felix J. Bode
- grid.15090.3d0000 0000 8786 803XDepartment of Neurology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Cornelia Kornblum
- grid.15090.3d0000 0000 8786 803XDepartment of Neurology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Julian A. Luetkens
- grid.15090.3d0000 0000 8786 803XDepartment of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany ,Quantitative Imaging Lab Bonn (QILaB), Venusberg-Campus 1, 53127 Bonn, Germany
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Dell T, Menne M, Wagenpfeil J, Praktiknjo M, Jansen C, Isaak A, Mesropyan N, Steinseifer U, Attenberger U, Luetkens J, Meyer C, Kuetting D. How Controlled is the Expansion of VIATORR CX? Cardiovasc Intervent Radiol 2023; 46:658-663. [PMID: 36826490 PMCID: PMC10156797 DOI: 10.1007/s00270-023-03383-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 01/30/2023] [Indexed: 02/25/2023]
Abstract
PURPOSE To investigate and compare the physical properties of the new generation Gore VIATORR-Controlled Expansion Endoprosthesis (VCX) to those of the predecessor VIATORR stent in an in vitro experimental setup. MATERIALS AND METHODS A total of 12 stents (8 VCX; 4 VIATORR; GORE, USA) were examined. Radial resistive force (RRF) and chronic outward force (COF) were assessed using a radial force testing machine (RX-650, Machine Solutions Inc., USA). To assess the radial forces of the VCX above 8 mm, balloon expansion was performed between cycles. RESULTS All VCX stents show an abrupt decrease in COF at an external diameter of 8.3 mm; RRF decreases likewise at an external diameter of 8.5 mm. The predecessor VIATORR stent without the "controlled expansion" feature shows linear radial force reduction until full expansion at a diameter of 10 mm. The physical properties of the VCX can be altered by balloon modulation. Point of COF (RRF) reduction shifts to 8.5 mm (8.6 mm), 8.6 mm (8.8 mm) and 9.3 mm (9.6 mm) following modulation with a 8 mm, 9 mm and 10 mm balloon. CONCLUSIONS The VCX shows an abrupt and disproportionate decrease in COF and RRF at an external diameter of 8.3 mm, thus passive expansion to its nominal diameter of 10 mm is not to be expected. By means of balloon dilatation the physical properties of the stent can be altered, enabling customized TIPS creation. The previous VIATORR stent shows continuous COF and RRF until total expansion.
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Affiliation(s)
- Tatjana Dell
- Department of Diagnostic and Interventional Radiology and Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
| | - Matthias Menne
- Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Helmholtz Institute Aachen, RWTH Aachen University, Pauwelsstraße 20, 52074, Aachen, Germany
| | - Julia Wagenpfeil
- Department of Diagnostic and Interventional Radiology and Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Michael Praktiknjo
- Department of Internal Medicine I, Center for Cirrhosis and Portal Hypertension Bonn (CCB), University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Christian Jansen
- Department of Internal Medicine I, Center for Cirrhosis and Portal Hypertension Bonn (CCB), University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Alexander Isaak
- Department of Diagnostic and Interventional Radiology and Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Narine Mesropyan
- Department of Diagnostic and Interventional Radiology and Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Ulrich Steinseifer
- Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Helmholtz Institute Aachen, RWTH Aachen University, Pauwelsstraße 20, 52074, Aachen, Germany
| | - Ulrike Attenberger
- Department of Diagnostic and Interventional Radiology and Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Julian Luetkens
- Department of Diagnostic and Interventional Radiology and Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Carsten Meyer
- Department of Diagnostic and Interventional Radiology and Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Daniel Kuetting
- Department of Diagnostic and Interventional Radiology and Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
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Vollbrecht TM, Hart C, Zhang S, Katemann C, Isaak A, Pieper CC, Kuetting D, Faridi B, Strizek B, Attenberger U, Kipfmueller F, Herberg U, Geipel A, Luetkens JA. Fetal Cardiac Cine MRI with Doppler US Gating in Complex Congenital Heart Disease. Radiol Cardiothorac Imaging 2023; 5:e220129. [PMID: 36860838 PMCID: PMC9969216 DOI: 10.1148/ryct.220129] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 11/23/2022] [Accepted: 12/16/2022] [Indexed: 02/25/2023]
Abstract
Purpose To apply Doppler US (DUS)-gated fetal cardiac cine MRI in clinical routine and investigate diagnostic performance in complex congenital heart disease (CHD) compared with that of fetal echocardiography. Materials and Methods In this prospective study (May 2021 to March 2022), women with fetuses with CHD underwent fetal echocardiography and DUS-gated fetal cardiac MRI on the same day. For MRI, balanced steady-state free precession cine images were acquired in the axial and optional sagittal and/or coronal orientations. Overall image quality was assessed on a four-point Likert scale (from 1 = nondiagnostic to 4 = good image quality). The presence of abnormalities in 20 fetal cardiovascular features was independently assessed by using both modalities. The reference standard was postnatal examination results. Differences in sensitivities and specificities were determined by using a random-effects model. Results The study included 23 participants (mean age, 32 years ± 5 [SD]; mean gestational age, 36 weeks ± 1). Fetal cardiac MRI was completed in all participants. The median overall image quality of DUS-gated cine images was 3 (IQR, 2.5-4). In 21 of 23 participants (91%), underlying CHD was correctly assessed by using fetal cardiac MRI. In one case, the correct diagnosis was made by using MRI only (situs inversus and congenitally corrected transposition of the great arteries). Sensitivities (91.8% [95% CI: 85.7, 95.1] vs 93.6% [95% CI: 88.8, 96.2]; P = .53) and specificities (99.9% [95% CI: 99.2, 100] vs 99.9% [95% CI: 99.5, 100]; P > .99) for the detection of abnormal cardiovascular features were comparable between MRI and echocardiography, respectively. Conclusion Using DUS-gated fetal cine cardiac MRI resulted in performance comparable with that of using fetal echocardiography for diagnosing complex fetal CHD.Keywords: Pediatrics, MR-Fetal (Fetal MRI), Cardiac, Heart, Congenital, Fetal Imaging, Cardiac MRI, Prenatal, Congenital Heart DiseaseClinical trial registration no. NCT05066399 Supplemental material is available for this article. © RSNA, 2023See also the commentary by Biko and Fogel in this issue.
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Isaak A, Mesropyan N, Hart C, Zhang S, Kravchenko D, Endler C, Katemann C, Weber O, Pieper CC, Kuetting D, Attenberger U, Dabir D, Luetkens JA. Non-contrast free-breathing 3D cardiovascular magnetic resonance angiography using REACT (relaxation-enhanced angiography without contrast) compared to contrast-enhanced steady-state magnetic resonance angiography in complex pediatric congenital heart disease at 3T. J Cardiovasc Magn Reson 2022; 24:55. [PMID: 36384752 PMCID: PMC9670549 DOI: 10.1186/s12968-022-00895-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 10/14/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND To evaluate the great vessels in young children with complex congenital heart disease (CHD) using non-contrast cardiovascular magnetic resonance angiography (CMRA) based on three-dimensional relaxation-enhanced angiography without contrast (REACT) in comparison to contrast-enhanced steady-state CMRA. METHODS In this retrospective study from April to July 2021, respiratory- and electrocardiogram-gated native REACT CMRA was compared to contrast-enhanced single-phase steady-state CMRA in children with CHD who underwent CMRA at 3T under deep sedation. Vascular assessment included image quality (1 = non-diagnostic, 5 = excellent), vessel diameter, and diagnostic findings. For statistical analysis, paired t-test, Pearson correlation, Bland-Altman analysis, Wilcoxon test, and intraclass correlation coefficients (ICC) were applied. RESULTS Thirty-six young children with complex CHD (median 4 years, interquartile range, 2-5; 20 males) were included. Native REACT CMRA was obtained successfully in all patients (mean scan time: 4:22 ± 1:44 min). For all vessels assessed, diameters correlated strongly between both methods (Pearson r = 0.99; bias = 0.04 ± 0.61 mm) with high interobserver reproducibility (ICC: 0.99 for both CMRAs). Native REACT CMRA demonstrated comparable overall image quality to contrast-enhanced CMRA (3.9 ± 1.0 vs. 3.8 ± 0.9, P = 0.018). With REACT CMRA, better image quality was obtained at the ascending aorta (4.8 ± 0.5 vs. 4.3 ± 0.8, P < 0.001), coronary roots (e.g., left: 4.1 ± 1.0 vs. 3.3 ± 1.1, P = 0.001), and inferior vena cava (4.6 ± 0.5 vs. 3.2 ± 0.8, P < 0.001). In all patients, additional vascular findings were assessed equally with native REACT CMRA and the contrast-enhanced reference standard (n = 6). CONCLUSION In young children with complex CHD, REACT CMRA can provide gadolinium-free high image quality, accurate vascular measurements, and equivalent diagnostic quality compared to standard contrast-enhanced CMRA.
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Affiliation(s)
- Alexander Isaak
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
- Quantitative Imaging Lab Bonn (QILaB), Bonn, Germany.
| | - Narine Mesropyan
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
- Quantitative Imaging Lab Bonn (QILaB), Bonn, Germany
| | - Christopher Hart
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
- Department of Pediatric Cardiology, University Hospital Bonn, Bonn, Germany
| | - Shuo Zhang
- Philips GmbH Market DACH, Hamburg, Germany
| | - Dmitrij Kravchenko
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
- Quantitative Imaging Lab Bonn (QILaB), Bonn, Germany
| | - Christoph Endler
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
- Quantitative Imaging Lab Bonn (QILaB), Bonn, Germany
| | | | | | - Claus C Pieper
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Daniel Kuetting
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
- Quantitative Imaging Lab Bonn (QILaB), Bonn, Germany
| | - Ulrike Attenberger
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Darius Dabir
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
- Quantitative Imaging Lab Bonn (QILaB), Bonn, Germany
| | - Julian A Luetkens
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
- Quantitative Imaging Lab Bonn (QILaB), Bonn, Germany
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Kravchenko D, Isaak A, Mesropyan N, Bischoff LM, Pieper CC, Attenberger U, Kuetting D, Zimmer S, Hart C, Luetkens JA. Cardiac magnetic resonance follow-up of COVID-19 vaccine associated acute myocarditis. Front Cardiovasc Med 2022; 9:1049256. [PMID: 36440045 PMCID: PMC9682292 DOI: 10.3389/fcvm.2022.1049256] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 10/24/2022] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Mass COVID-19 vaccination campaigns have helped impede the COVID-19 pandemic. In rare cases, some vaccines have led to vaccine associated myocarditis in a specific subset of the population, usually young males. Cardiac magnetic resonance (CMR) can reliably diagnose vaccine associated myocarditis, but follow-up data of CMR proven acute myocarditis is scarce. MATERIALS AND METHODS Nine patients with acute vaccine associated myocarditis underwent baseline and follow-up CMR examinations and were compared to baseline parameters at initial presentation and to a group of 20 healthy controls. CMR protocol included functional assessment, T1 and T2 mapping, T2 signal intensity ratio, strain feature tracking, and late gadolinium enhancement (LGE). RESULTS Myocarditis patients (n = 9, aged 24 ± 6 years, 8 males) underwent CMR follow-up after an average of 5.8 ± 4.3 months. All patients showed a complete resolution of visual myocardial edema while also demonstrating a reduction in overall LGE extent from baseline to follow-up (4.2 ± 2.1 vs. 0.9 ± 0.8%, p < 0.001), although visual LGE was still noted in all patients. Left ventricular ejection fraction was normal at baseline and at follow-up (58 ± 6 vs. 62 ± 4%, p = 0.10) as well as compared to a healthy control group (60 ± 4%, p = 0.24). T1 (1024 ± 77 vs. 971 ± 34 ms, p = 0.05) and T2 relaxations times (57 ± 6 vs. 51 ± 3 ms, p = 0.03) normalized at follow-up. Most patients reported a resolution of clinical symptoms, while two (22%) reported new onset of exertional dyspnea. CONCLUSION Patients with COVID-19 vaccine associated acute myocarditis showed a complete, uncomplicated resolution of myocardial inflammation on follow-up CMR, which was associated with a near complete resolution of symptoms. Minor, residual myocardial scarring was present on follow-up LGE imaging. The long-term implications of the remaining myocardial scar-tissue after vaccine associated myocarditis remain unknown warranting further studies.
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Affiliation(s)
- Dmitrij Kravchenko
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn, Germany
- Quantitative Imaging Lab Bonn, University Hospital Bonn, Bonn, Germany
| | - Alexander Isaak
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn, Germany
- Quantitative Imaging Lab Bonn, University Hospital Bonn, Bonn, Germany
| | - Narine Mesropyan
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn, Germany
- Quantitative Imaging Lab Bonn, University Hospital Bonn, Bonn, Germany
| | - Leon M. Bischoff
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn, Germany
- Quantitative Imaging Lab Bonn, University Hospital Bonn, Bonn, Germany
| | - Claus C. Pieper
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn, Germany
| | - Ulrike Attenberger
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn, Germany
| | - Daniel Kuetting
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn, Germany
- Quantitative Imaging Lab Bonn, University Hospital Bonn, Bonn, Germany
| | - Sebastian Zimmer
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn, Germany
- Department of Internal Medicine II–Cardiology, University Hospital Bonn, Bonn, Germany
| | - Christopher Hart
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn, Germany
- Department of Pediatric Cardiology, University Hospital Bonn, Bonn, Germany
| | - Julian A. Luetkens
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn, Germany
- Quantitative Imaging Lab Bonn, University Hospital Bonn, Bonn, Germany
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22
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Kravchenko D, Isaak A, Mesropyan N, Endler C, Bischoff L, Vollbrecht T, Pieper C, Sedaghat A, Kütting D, Hart C, Feißt A, Attenberger U, Luetkens J. Kardio MRT bei Verdacht auf akute Myokarditis nach mRNA COVID-19 Impfung. ROFO-FORTSCHR RONTG 2022. [DOI: 10.1055/s-0042-1749810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
| | - A Isaak
- Uniklinik Bonn, Klinik für diagnostische und interventionelle Radiologie, Bonn
| | - N Mesropyan
- Uniklinik Bonn, Klinik für diagnostische und interventionelle Radiologie, Bonn
| | - C Endler
- Uniklinik Bonn, Klinik für diagnostische und interventionelle Radiologie, Bonn
| | - L Bischoff
- Uniklinik Bonn, Klinik für diagnostische und interventionelle Radiologie, Bonn
| | - T Vollbrecht
- Uniklinik Bonn, Klinik für diagnostische und interventionelle Radiologie, Bonn
| | - C Pieper
- Uniklinik Bonn, Klinik für diagnostische und interventionelle Radiologie, Bonn
| | - A Sedaghat
- Uniklinik Bonn, Klinik für innere Medizin II – Kardiologie, Bonn
| | - D Kütting
- Uniklinik Bonn, Klinik für diagnostische und interventionelle Radiologie, Bonn
| | - C Hart
- Uniklinik Bonn, Kinderkardiologie, Bonn
| | - A Feißt
- Uniklinik Bonn, Klinik für diagnostische und interventionelle Radiologie, Bonn
| | - U Attenberger
- Uniklinik Bonn, Klinik für diagnostische und interventionelle Radiologie, Bonn
| | - J Luetkens
- Uniklinik Bonn, Klinik für diagnostische und interventionelle Radiologie, Bonn
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23
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Isaak A, Kravchenko D, Mesropyan N, Endler C, Bischoff L, Vollbrecht T, Dabir D, Zimmer S, Attenberger U, Kuetting D, Luetkens J. Kardio-MRT-basierte schichtspezifische Strainanalyse bei Patienten mit akuter Myokarditis. ROFO-FORTSCHR RONTG 2022. [DOI: 10.1055/s-0042-1749809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- A Isaak
- Universitätsklinikum Bonn, Klinik für Diagnostische und Interventionelle Radiologie, Bonn
| | - D Kravchenko
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Bonn, Bonn
| | - N Mesropyan
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Bonn, Bonn
| | - C Endler
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Bonn, Bonn
| | - L Bischoff
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Bonn, Bonn
| | - T Vollbrecht
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Bonn, Bonn
| | - D Dabir
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Bonn, Bonn
| | - S Zimmer
- Medizinische Klinik und Poliklinik II, Universitätsklinikum Bonn, Bonn
| | - U Attenberger
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Bonn, Bonn
| | - D Kuetting
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Bonn, Bonn
| | - J Luetkens
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Bonn, Bonn
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24
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Vollbrecht T, Hart C, Herberg U, Katemann C, Zhang S, Isaak A, Mesropyan N, Kravchenko D, Bischoff ML, Pieper CC, Kütting D, Faridi B, Attenberger U, Geipel A, Luetkens AJ. Doppler-Ultraschall (DUS)-getriggerte fetale Herz-MRT zur Diagnose komplexer Herzfehler bei 3 Tesla: Klinische Etablierung und diagnostische Wertigkeit. ROFO-FORTSCHR RONTG 2022. [DOI: 10.1055/s-0042-1749889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- T Vollbrecht
- Universitätsklinikum Bonn, Klinik für Diagnostische und Interventionelle Radiologie, Bonn
| | - C Hart
- Universitätsklinikum Bonn, Klinik für Diagnostische und Interventionelle Radiologie, Bonn
| | - U Herberg
- Uniklinikum Bonn, Abteilung für Kinderkardiologie, Bonn
| | | | - S Zhang
- Philips GmbH Market DACH, Hamburg
| | - A Isaak
- Uniklinikum Bonn, Klinik für Diagnostische und Interventionelle Radiologie, Bonn
| | - N Mesropyan
- Uniklinikum Bonn, Klinik für Diagnostische und Interventionelle Radiologie, Bonn
| | - D Kravchenko
- Uniklinikum Bonn, Klinik für Diagnostische und Interventionelle Radiologie, Bonn
| | - M L Bischoff
- Uniklinikum Bonn, Klinik für Diagnostische und Interventionelle Radiologie, Bonn
| | - C C Pieper
- Uniklinikum Bonn, Klinik für Diagnostische und Interventionelle Radiologie, Bonn
| | - D Kütting
- Uniklinikum Bonn, Klinik für Diagnostische und Interventionelle Radiologie, Bonn
| | - B Faridi
- Uniklinikum Bonn, Abteilung für Geburtshilfe und Pränatalmedizin, Bonn
| | - U Attenberger
- Uniklinikum Bonn, Klinik für Diagnostische und Interventionelle Radiologie, Bonn
| | - A Geipel
- Uniklinikum Bonn, Abteilung für Geburtshilfe und Pränatalmedizin, Bonn
| | - A J Luetkens
- Uniklinikum Bonn, Klinik für Diagnostische und Interventionelle Radiologie, Bonn
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Goody PR, Zimmer S, Öztürk C, Zimmer A, Kreuz J, Becher MU, Isaak A, Luetkens J, Sugiura A, Jansen F, Nickenig G, Hammerstingl C, Tiyerili V. 3D-speckle-tracking echocardiography correlates with cardiovascular magnetic resonance imaging diagnosis of acute myocarditis – An observational study. IJC Heart & Vasculature 2022; 41:101081. [PMID: 35855974 PMCID: PMC9287637 DOI: 10.1016/j.ijcha.2022.101081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 06/29/2022] [Accepted: 07/04/2022] [Indexed: 01/09/2023]
Abstract
Regional changes in myocardial texture (as diagnosed by CMR) were significantly associated with regional impairment of circumferential, longitudinal, and radial strain, as well as regional 3D displacement and total 3D strain. 3D and 2D global longitudinal strain (GLS) showed higher diagnostic performance than well-known parameters associated with myocarditis, such as LVEF and LVEDV in our patient collective. 3D-speckle-tracking echocardiography offers a promising diagnostic tool in the diagnosis of myocarditis.
Background The diagnostic importance of three-dimensional (3D) speckle-tracking strain-imaging echocardiography in patients with acute myocarditis remains unclear. The aim of this study was to test the diagnostic performance of 3D-speckle-tracking echocardiography compared to CMR (cardiovascular magnetic resonance imaging) for the diagnosis of acute myocarditis. Methods and results 45 patients with clinically suspected myocarditis were enrolled in our study (29% female, mean age: 43.9 ± 16.3 years, peak troponin I level: 1.38 ± 3.51 ng/ml). 3D full-volume echocardiographic images were obtained and offline 2D as well as 3D speckle-tracking analysis of regional and global LV deformation was performed. All patients received CMR scans and myocarditis was diagnosed in 29 subjects based on original Lake-Louise criteria. The 16 patients, in whom myocarditis was excluded by CMR, served as controls. Regional changes in myocardial texture (diagnosed by CMR) were significantly associated with regional impairment of circumferential, longitudinal, and radial strain, as well as regional 3D displacement and total 3D strain. Interestingly, the 2D and 3D global longitudinal strain (GLS) showed higher diagnostic performance than well-known parameters associated with myocarditis, such as LVEF (as obtained by echocardiography and CMR) and LVEDV (as obtained by CMR). Conclusions In this study, we examined the use of 3D-speckle-tracking echocardiography in patients with acute myocarditis. Global longitudinal strain was significantly impaired in patients with acute myocarditis and correlated with CMR findings. Therefore, 3D echocardiography could become a useful diagnostic tool in the primary diagnosis of myocarditis.
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Affiliation(s)
- Philip Roger Goody
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Sebastian Zimmer
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Can Öztürk
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Angela Zimmer
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Jens Kreuz
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Marc Ulrich Becher
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Alexander Isaak
- Department of Radiology, University Hospital Bonn, Venusberg-Campus 1, 53125 Bonn, Germany
| | - Julian Luetkens
- Department of Radiology, University Hospital Bonn, Venusberg-Campus 1, 53125 Bonn, Germany
| | - Atsushi Sugiura
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Felix Jansen
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Georg Nickenig
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Christoph Hammerstingl
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Vedat Tiyerili
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
- Department of Internal Medicine I, St.-Johannes-Hospital Dortmund, Dortmund, Germany
- Corresponding author at: Medizinische Klinik und Poliklinik II, Universitätsklinikum Bonn, Venusberg-Campus 1, 53125 Bonn, Germany.
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26
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Mesropyan N, Kupczyk P, Dold L, Praktiknjo M, Chang J, Isaak A, Endler C, Kravchenko D, Sprinkart MA, Pieper CC, Kuetting D, Jansen C, Attenberger U, Luetkens AJ. Bestimmung des Schweregrads der Leberzirrhose in der Leber-MRT mittels Mapping des extrazellulären Volumens. ROFO-FORTSCHR RONTG 2022. [DOI: 10.1055/s-0042-1749789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- N Mesropyan
- Universitätsklinikum Bonn, Klinik für Diagnostische und Interventionelle Radiologie, Bonn
| | - P Kupczyk
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Bonn, Bonn
| | - L Dold
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Bonn, Bonn
| | - M Praktiknjo
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Bonn, Bonn
| | - J Chang
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Bonn, Bonn
| | - A Isaak
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Bonn, Bonn
| | - C Endler
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Bonn, Bonn
| | - D Kravchenko
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Bonn, Bonn
| | - M A Sprinkart
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Bonn, Bonn
| | - C C Pieper
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Bonn, Bonn
| | - D Kuetting
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Bonn, Bonn
| | - C Jansen
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Bonn, Bonn
| | - U Attenberger
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Bonn, Bonn
| | - A J Luetkens
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Bonn, Bonn
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Isaak A, Mesropyan N, Hart C, Kravchenko D, Endler C, Bischoff L, Zhang S, Katemann C, Weber O, Kuetting D, Attenberger U, Dabir D, Luetkens J. Kontrastmittelfreie REACT MRA unter freier Atmung zur Beurteilung der thorakalen Gefäße bei Kleinkindern mit angeborenen Herzfehlern. ROFO-FORTSCHR RONTG 2022. [DOI: 10.1055/s-0042-1749795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- A Isaak
- Universitätsklinikum Bonn, Klinik für Diagnostische und Interventionelle Radiologie, Bonn
| | - N Mesropyan
- Universitätsklinikum Bonn, Klinik für Diagnostische und Interventionelle Radiologie, Bonn
| | - C Hart
- Universitätsklinikum Bonn, Klinik für Diagnostische und Interventionelle Radiologie, Zentrum für Kinderheilkunde/Abteilung für Kinderkardiologie, Bonn
| | - D Kravchenko
- Universitätsklinikum Bonn, Klinik für Diagnostische und Interventionelle Radiologie, Bonn
| | - C Endler
- Universitätsklinikum Bonn, Klinik für Diagnostische und Interventionelle Radiologie, Bonn
| | - L Bischoff
- Universitätsklinikum Bonn, Klinik für Diagnostische und Interventionelle Radiologie, Bonn
| | - S Zhang
- Philips GmbH Market DACH, Hamburg
| | | | - O Weber
- Philips GmbH Market DACH, Hamburg
| | - D Kuetting
- Universitätsklinikum Bonn, Klinik für Diagnostische und Interventionelle Radiologie, Bonn
| | - U Attenberger
- Universitätsklinikum Bonn, Klinik für Diagnostische und Interventionelle Radiologie, Bonn
| | - D Dabir
- Universitätsklinikum Bonn, Klinik für Diagnostische und Interventionelle Radiologie, Bonn
| | - J Luetkens
- Universitätsklinikum Bonn, Klinik für Diagnostische und Interventionelle Radiologie, Bonn
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Endler C, Peeters J, Kukuk G, Isaak A, Mesropyan N, Luetkens J, Attenberger U, Kupczyk P. Dynamische Leber-MRT bei freier Atmung – eine Machbarkeitsstudie mit einer bewegungskompensierten radialen k-Raum Auslesung und einer KWIC-Rekonstruktion. ROFO-FORTSCHR RONTG 2022. [DOI: 10.1055/s-0042-1749794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- C Endler
- Universitätsklinikum Bonn, Klinik für Radiologie, Bonn
| | - J Peeters
- Philips Healthcare, Best, Niederlande
| | - G Kukuk
- Kantonsspital Graubünden, Institut für Radiologie, Chur, Schweiz
| | - A Isaak
- Universitätsklinikum Bonn, Klinik für Diagnostische und Interventionelle Radiologie, Bonn
| | - N Mesropyan
- Universitätsklinikum Bonn, Klinik für Diagnostische und Interventionelle Radiologie, Bonn
| | - J Luetkens
- Universitätsklinikum Bonn, Klinik für Diagnostische und Interventionelle Radiologie, Bonn
| | - U Attenberger
- Universitätsklinikum Bonn, Klinik für Diagnostische und Interventionelle Radiologie, Bonn
| | - P Kupczyk
- Universitätsklinikum Bonn, Klinik für Diagnostische und Interventionelle Radiologie, Bonn
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29
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Bischoff L, Katemann C, Weber O, Isaak A, Kravchenko D, Mesropyan N, Endler C, Vollbrecht T, Pieper CC, Attenberger U, Luetkens J. Schnelle und robuste 2D T2 TSE Propeller Akquisition der Prostata mit Compressed SENSE: Vergleich mit der konventionellen, SENSE-beschleunigten Propeller Akquisition. ROFO-FORTSCHR RONTG 2022. [DOI: 10.1055/s-0042-1749901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
| | | | - O Weber
- Philips GmbH Market DACH, Hamburg
| | - A Isaak
- Diagnostische und Interventionelle Radiologie, Uniklinikum Bonn, Bonn
| | - D Kravchenko
- Diagnostische und Interventionelle Radiologie, Uniklinikum Bonn, Bonn
| | - N Mesropyan
- Diagnostische und Interventionelle Radiologie, Uniklinikum Bonn, Bonn
| | - C Endler
- Diagnostische und Interventionelle Radiologie, Uniklinikum Bonn, Bonn
| | - T Vollbrecht
- Diagnostische und Interventionelle Radiologie, Uniklinikum Bonn, Bonn
| | - C C Pieper
- Diagnostische und Interventionelle Radiologie, Uniklinikum Bonn, Bonn
| | - U Attenberger
- Diagnostische und Interventionelle Radiologie, Uniklinikum Bonn, Bonn
| | - J Luetkens
- Diagnostische und Interventionelle Radiologie, Uniklinikum Bonn, Bonn
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30
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Kravchenko D, Hart C, Garbe S, Luetkens JA, Isaak A, Mesropyan N, Vergnat M, Leyens J, Attenberger U, Kuetting D. Image quality and radiation dose of dual source high pitch computed tomography in pediatric congenital heart disease. Sci Rep 2022; 12:9934. [PMID: 35705551 PMCID: PMC9200716 DOI: 10.1038/s41598-022-13404-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 05/24/2022] [Indexed: 11/10/2022] Open
Abstract
To explore the image quality and radiation dose of dual source high-pitch cardiac computed tomography with tailored contrast injection protocols for pediatric congenital heart disease patients (CHD). In total, 27 infants with CHD (median age 109 days [IQR 6-199]) were retrospectively analyzed regarding dose length product (DLP) and effective dose (ED) after undergoing cardiothoracic CT imaging. Scan parameters were adjusted on a dual source/detector CT (DSCT) to minimize radiation dose while maintaining adequate quality. Image acquisition was performed at 70% of the R-R interval. Dose reducing measures included prospective electrocardiogram gating, utilizing slow injection velocities and foregoing bolus tracking during contrast injection. Image quality was assessed for artefacts, vessel definition, and noise on a 5-point scale (1 non-diagnostic, 5 excellent). Series were scored on a 0-to-3-point scale regarding answered clinical questions (0 non-diagnostic, 3 all clinical questions could be answered). The median DLP was 5.2 mGy*cm (IQR 3.5-7.8) leading to a median ED of 0.20 mSv (IQR 0.14-0.30). On average the acquired images scored 13.3 ± 2.1 (SD) out of a maximum 15 points with an intraclass correlation coefficient (ICC) of 0.94. All acquired series were able to fully answer all clinical questions scoring maximum points (ICC 1.0). Dual source high pitch CT protocols combined with custom contrast agent injection protocols in pediatric patients with CHD delivered sufficiently high diagnostic imaging quality combined with low submilisievert radiation doses. Prospective high pitch imaging is a reliable method for depiction of cardiac anatomy even in very young pediatric CHD patients with elevated heart rates.
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Affiliation(s)
- Dmitrij Kravchenko
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany. .,Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Bonn, Germany.
| | - Christopher Hart
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.,Department for Pediatric Cardiology, Children's Hospital, University of Bonn, Bonn, Germany
| | - Stephan Garbe
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Julian A Luetkens
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.,Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Bonn, Germany
| | - Alexander Isaak
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.,Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Bonn, Germany
| | - Narine Mesropyan
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.,Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Bonn, Germany
| | - Mathieu Vergnat
- Department of Pediatric Cardiothoracic Surgery, Children's Hospital, University of Bonn, Bonn, Germany
| | - Judith Leyens
- Department of Neonatology and Pediatric Intensive Care, Children's Hospital, University of Bonn, Bonn, Germany
| | - Ulrike Attenberger
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Daniel Kuetting
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.,Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Bonn, Germany
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31
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Mesropyan N, Kupczyk PA, Dold L, Praktiknjo M, Chang J, Isaak A, Endler C, Kravchenko D, Bischoff LM, Sprinkart AM, Pieper CC, Kuetting D, Jansen C, Attenberger UI, Luetkens JA. Assessment of liver cirrhosis severity with extracellular volume fraction MRI. Sci Rep 2022; 12:9422. [PMID: 35676399 PMCID: PMC9177655 DOI: 10.1038/s41598-022-13340-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 05/23/2022] [Indexed: 11/23/2022] Open
Abstract
We aimed to investigate the diagnostic utility of MRI extracellular volume fraction (ECV) for the assessment of liver cirrhosis severity as defined by Child–Pugh class. In this retrospective study, 90 patients (68 cirrhotic patients and 22 controls), who underwent multiparametric liver MRI, were identified. Hepatic T1 relaxation times and ECV were assessed. Clinical scores of liver disease severity were calculated. One-way analysis of variance (ANOVA) followed by Tukey’s multiple comparison test, Spearman’s correlation coefficient, and receiver operating characteristic (ROC) analysis were used for statistical analysis. In cirrhotic patients, hepatic native T1 increased depending on Child–Pugh class (620.5 ± 78.9 ms (Child A) vs. 666.6 ± 73.4 ms (Child B) vs. 828.4 ± 91.2 ms (Child C), P < 0.001). ECV was higher in cirrhotic patients compared to the controls (40.1 ± 11.9% vs. 25.9 ± 4.5%, P < 0.001) and increased depending of Child–Pugh class (33.3 ± 6.0% (Child A) vs. 39.6 ± 4.9% (Child B) vs. 52.8 ± 1.2% (Child C), P < 0.001). ECV correlated with Child–Pugh score (r = 0.64, P < 0.001). ECV allowed differentiating between Child–Pugh classes A and B, and B and C with an AUC of 0.785 and 0.944 (P < 0.001, respectively). The diagnostic performance of ECV for differentiating between Child–Pugh classes A and B, and B and C was higher compared to hepatic native T1 (AUC: 0.651 and 0.910) and MELD score (AUC: 0.740 and 0.795) (P < 0.05, respectively). MRI-derived ECV correlated with Child–Pugh score and had a high diagnostic performance for the discrimination of different Child–Pugh classes. ECV might become a valuable non-invasive biomarker for the assessment of liver cirrhosis severity.
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Isaak A, Kravchenko D, Mesropyan N, Endler C, Bischoff LM, Vollbrecht T, Thomas D, Dabir D, Zimmer S, Attenberger U, Kuetting D, Luetkens JA. Layer-specific Strain Analysis with Cardiac MRI Feature Tracking in Acute Myocarditis. Radiol Cardiothorac Imaging 2022; 4:e210318. [PMID: 35833169 PMCID: PMC9274313 DOI: 10.1148/ryct.210318] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 04/20/2022] [Accepted: 05/10/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE To evaluate the diagnostic performance of layer-specific cardiac MRI feature-tracking (FT) strain analysis in patients with acute myocarditis. MATERIALS AND METHODS Seventy patients (mean age, 43 years ± 19 [SD]; 46 men) with clinically defined acute myocarditis and 42 healthy controls who underwent cardiac MRI from March 2014 to November 2018 were retrospectively analyzed. FT-based left ventricular peak systolic global longitudinal strain (GLS) and global circumferential strain (GCS) were assessed at subendocardial, midmyocardial, and subepicardial layers. The 2018 Lake Louise criteria (LLC) were assessed. Patients with myocarditis were dichotomized into two groups: those with preserved and those with reduced ejection fraction. For statistical analysis, unpaired t test, one-way analysis of variance, Pearson correlation, and receiver operating characteristic analysis were used. RESULTS GLS and GCS values of all layers (eg, midmyocardial GCS: -21.3% ± 5.5 vs -28.0% ± 4.3; P < .001) were impaired in patients with myocarditis compared with controls. Only subepicardial GLS (-20.0% ± 3.3 vs -17.5% ± 3.3; P < .001) and midmyocardial GCS values (-28.0% ± 4.3 vs -23.1% ± 4.3; P < .001) could differentiate between controls and patients with preserved ejection fraction. Midmyocardial GCS correlated with inflammatory myocardial parameters (eg, late gadolinium enhancement percentage, r = 0.48, P < .001). Midmyocardial GCS (area under the receiver operating characteristic curve [AUC], 0.82) and subepicardial GLS (AUC, 0.77) had the highest diagnostic performance for acute myocarditis diagnosis (P < .05 against all other strain parameters). The diagnostic performance of the 2018 LLC was significantly improved by inclusion of these two strain parameters (AUC, 0.92 vs 0.97; P = .04). CONCLUSION Diagnostic performance of cardiac MRI FT strain was different between myocardial layers in acute myocarditis, with midmyocardial GCS and subepicardial GLS providing the highest diagnostic performance.Keywords: MRI, Cardiac, Heart, Left Ventricle, Inflammation, Tissue Characterization, MR-Functional Imaging, Feature-Tracking Strain, Acute Myocarditis Supplemental material is available for this article. © RSNA, 2022.
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Kravchenko D, Isaak A, Mesropyan N, Endler C, Bischoff L, Vollbrecht T, Pieper CC, Sedaghat A, Kuetting D, Hart C, Feisst A, Attenberger U, Luetkens JA. Cardiac MRI in Suspected Acute Myocarditis After COVID-19 mRNA Vaccination. ROFO-FORTSCHR RONTG 2022; 194:1003-1011. [PMID: 35272355 DOI: 10.1055/a-1752-0951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To evaluate cardiac MRI characteristics in patients with suspected hypersensitivity myocarditis following mRNA COVID-19 vaccination. MATERIALS AND METHODS Patients clinically suspected of acute myocarditis after COVID-19 vaccination were retrospectively analyzed and compared against a healthy control group. Cardiac MRI protocol included parameters such as T1 and T2 relaxation times, extracellular volume (ECV), T2 signal intensity ratio, and late gadolinium enhancement (LGE). Lymph node size was assessed in the patient group on the injection side. Student t-test, analyses of variance (ANOVA) with Tukey post-hoc test, and χ2 test were used for statistical analysis. RESULTS 20 patients with clinically suspected post-vaccine myocarditis (28 ± 12 years; 12 men) and 40 controls (31 ± 11 years; 25 men) were evaluated. According to the 2018 Lake Louise criteria (LLC), patients with clinically suspected myocarditis were further subdivided into an LLC-positive group (n = 9) and an LLC-negative group (n = 11). The mean time of symptom onset after vaccination was 1.1 ± 1.2 days (LLC-positive) and 6.5 ± 9.2 days (LLC-negative). Group differences in inflammatory variables between myocarditis patients and control subjects were more pronounced in the LLC-positive group (e. g., T1 relaxation time: 1041 ± 61 ms [LLC positive] vs. 1008 ± 79 ms [LLC-negative] vs. 970 ± 25 ms [control]; p <.001; or T2 signal intensity ratio 2.0 ± 0.3 vs. 1.6 ± 0.3 [LLC-negative] and vs. 1.6 ± 0.3 [control], p = .012). LLC-positive patients were significantly faster in receiving an MRI after initial symptom onset (8.8 ± 6.1 days vs. 52.7 ± 33.4 days; p = .001) and had higher troponin T levels (3938 ± 5850 ng/l vs. 9 ± 11 ng/l; p <.001). LGE lesions were predominantly located at the subepicardium of the lateral wall. Axillary lymphadenopathy was more frequent in the LLC-positive group compared to the LLC-negative group (8/9 [89 %] vs. 0/11 [0 %], p < 0.001). CONCLUSION Vaccine-induced myocarditis should be considered in patients with acute symptom onset after mRNA vaccination, especially if elevated serum troponin T is observed. Imaging findings of vaccine-induced myocarditis are similar to virus-induced myocarditis, allowing for the use of the Lake Louise Criteria for diagnostic purposes. KEY POINTS · Vaccine-induced hypersensitivity myocarditis can be confirmed with cardiac MRI. · Especially patients with sudden onset of symptoms and elevated serum troponin T had positive cardiac MRI findings. · Cardiac MRI characteristics of vaccine-induced myocarditis are similar to those in virus-induced myocarditis. CITATION FORMAT · Kravchenko D, Isaak A, Mesropyan N et al. Cardiac MRI in Suspected Acute Myocarditis After COVID-19 mRNA Vaccination. Fortschr Röntgenstr 2022; DOI: 10.1055/a-1752-0951.
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Affiliation(s)
- Dmitrij Kravchenko
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Germany
| | - Alexander Isaak
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Germany
| | - Narine Mesropyan
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Germany
| | - Christoph Endler
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Germany
| | - Leon Bischoff
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Germany
| | - Thomas Vollbrecht
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Germany
| | - Claus Christian Pieper
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Germany
| | - Alexander Sedaghat
- Cardiology, University Hospital Bonn Clinic II of Cardiology Angiology and Pulmonology, Bonn, Germany
| | - Daniel Kuetting
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Germany
| | - Christopher Hart
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Germany.,Department of Pediatric Cardiology, Paediatric Heart Center, University Hospital Bonn, Germany
| | - Andreas Feisst
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Germany
| | - Ulrike Attenberger
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Germany
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34
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Faron A, Opheys NS, Nowak S, Sprinkart AM, Isaak A, Theis M, Mesropyan N, Endler C, Sirokay J, Pieper CC, Kuetting D, Attenberger U, Landsberg J, Luetkens JA. Deep Learning-Based Body Composition Analysis Predicts Outcome in Melanoma Patients Treated with Immune Checkpoint Inhibitors. Diagnostics (Basel) 2021; 11:diagnostics11122314. [PMID: 34943551 PMCID: PMC8700660 DOI: 10.3390/diagnostics11122314] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 11/19/2021] [Accepted: 12/05/2021] [Indexed: 01/11/2023] Open
Abstract
Previous studies suggest an impact of body composition on outcome in melanoma patients. We aimed to determine the prognostic value of CT-based body composition assessment in patients receiving immune checkpoint inhibitor therapy for treatment of metastatic disease using a deep learning approach. One hundred seven patients with staging CT examinations prior to initiation of checkpoint inhibition between January 2013 and August 2019 were retrospectively evaluated. Using an automated deep learning-based body composition analysis pipeline, parameters for estimation of skeletal muscle mass (skeletal muscle index, SMI) and adipose tissue compartments (visceral adipose tissue index, VAI; subcutaneous adipose tissue index, SAI) were derived from staging CT. The cohort was binarized according to gender-specific median cut-off values. Patients below the median were defined as having low SMI, VAI, or SAI, respectively. The impact on outcome was assessed using the Kaplan-Meier method with log-rank tests. A multivariable logistic regression model was built to test the impact of body composition parameters on 3-year mortality. Patients with low SMI displayed significantly increased 1-year (25% versus 9%, p = 0.035), 2-year (32% versus 13%, p = 0.017), and 3-year mortality (38% versus 19%, p = 0.016). No significant differences with regard to adipose tissue compartments were observed (3-year mortality: VAI, p = 0.448; SAI, p = 0.731). On multivariable analysis, low SMI (hazard ratio (HR), 2.245; 95% confidence interval (CI), 1.005-5.017; p = 0.049), neutrophil-to-lymphocyte ratio (HR, 1.170; 95% CI, 1.076-1.273; p < 0.001), and Karnofsky index (HR, 0.965; 95% CI, 0.945-0.985; p = 0.001) remained as significant predictors of 3-year mortality. Lowered skeletal muscle index as an indicator of sarcopenia was associated with worse outcome in patients with metastatic melanoma receiving immune checkpoint inhibitor therapy.
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Affiliation(s)
- Anton Faron
- Department of Diagnostics and Interventional Radiology, Venusberg Campus 1, University Hospital Bonn, 53127 Bonn, Germany; (A.F.); (N.S.O.); (S.N.); (A.M.S.); (A.I.); (M.T.); (N.M.); (C.E.); (C.C.P.); (D.K.); (U.A.)
- Quantitative Imaging Lab Bonn (QLaB), Venusberg Campus 1, University Hospital Bonn, 53127 Bonn, Germany
| | - Nikola S. Opheys
- Department of Diagnostics and Interventional Radiology, Venusberg Campus 1, University Hospital Bonn, 53127 Bonn, Germany; (A.F.); (N.S.O.); (S.N.); (A.M.S.); (A.I.); (M.T.); (N.M.); (C.E.); (C.C.P.); (D.K.); (U.A.)
- Quantitative Imaging Lab Bonn (QLaB), Venusberg Campus 1, University Hospital Bonn, 53127 Bonn, Germany
| | - Sebastian Nowak
- Department of Diagnostics and Interventional Radiology, Venusberg Campus 1, University Hospital Bonn, 53127 Bonn, Germany; (A.F.); (N.S.O.); (S.N.); (A.M.S.); (A.I.); (M.T.); (N.M.); (C.E.); (C.C.P.); (D.K.); (U.A.)
- Quantitative Imaging Lab Bonn (QLaB), Venusberg Campus 1, University Hospital Bonn, 53127 Bonn, Germany
| | - Alois M. Sprinkart
- Department of Diagnostics and Interventional Radiology, Venusberg Campus 1, University Hospital Bonn, 53127 Bonn, Germany; (A.F.); (N.S.O.); (S.N.); (A.M.S.); (A.I.); (M.T.); (N.M.); (C.E.); (C.C.P.); (D.K.); (U.A.)
- Quantitative Imaging Lab Bonn (QLaB), Venusberg Campus 1, University Hospital Bonn, 53127 Bonn, Germany
| | - Alexander Isaak
- Department of Diagnostics and Interventional Radiology, Venusberg Campus 1, University Hospital Bonn, 53127 Bonn, Germany; (A.F.); (N.S.O.); (S.N.); (A.M.S.); (A.I.); (M.T.); (N.M.); (C.E.); (C.C.P.); (D.K.); (U.A.)
- Quantitative Imaging Lab Bonn (QLaB), Venusberg Campus 1, University Hospital Bonn, 53127 Bonn, Germany
| | - Maike Theis
- Department of Diagnostics and Interventional Radiology, Venusberg Campus 1, University Hospital Bonn, 53127 Bonn, Germany; (A.F.); (N.S.O.); (S.N.); (A.M.S.); (A.I.); (M.T.); (N.M.); (C.E.); (C.C.P.); (D.K.); (U.A.)
- Quantitative Imaging Lab Bonn (QLaB), Venusberg Campus 1, University Hospital Bonn, 53127 Bonn, Germany
| | - Narine Mesropyan
- Department of Diagnostics and Interventional Radiology, Venusberg Campus 1, University Hospital Bonn, 53127 Bonn, Germany; (A.F.); (N.S.O.); (S.N.); (A.M.S.); (A.I.); (M.T.); (N.M.); (C.E.); (C.C.P.); (D.K.); (U.A.)
- Quantitative Imaging Lab Bonn (QLaB), Venusberg Campus 1, University Hospital Bonn, 53127 Bonn, Germany
| | - Christoph Endler
- Department of Diagnostics and Interventional Radiology, Venusberg Campus 1, University Hospital Bonn, 53127 Bonn, Germany; (A.F.); (N.S.O.); (S.N.); (A.M.S.); (A.I.); (M.T.); (N.M.); (C.E.); (C.C.P.); (D.K.); (U.A.)
- Quantitative Imaging Lab Bonn (QLaB), Venusberg Campus 1, University Hospital Bonn, 53127 Bonn, Germany
| | - Judith Sirokay
- Center of Integrated Oncology (CIO) Bonn, Department of Dermatology and Allergy, Venusberg Campus 1, University Hospital Bonn, 53127 Bonn, Germany; (J.S.); (J.L.)
| | - Claus C. Pieper
- Department of Diagnostics and Interventional Radiology, Venusberg Campus 1, University Hospital Bonn, 53127 Bonn, Germany; (A.F.); (N.S.O.); (S.N.); (A.M.S.); (A.I.); (M.T.); (N.M.); (C.E.); (C.C.P.); (D.K.); (U.A.)
| | - Daniel Kuetting
- Department of Diagnostics and Interventional Radiology, Venusberg Campus 1, University Hospital Bonn, 53127 Bonn, Germany; (A.F.); (N.S.O.); (S.N.); (A.M.S.); (A.I.); (M.T.); (N.M.); (C.E.); (C.C.P.); (D.K.); (U.A.)
- Quantitative Imaging Lab Bonn (QLaB), Venusberg Campus 1, University Hospital Bonn, 53127 Bonn, Germany
| | - Ulrike Attenberger
- Department of Diagnostics and Interventional Radiology, Venusberg Campus 1, University Hospital Bonn, 53127 Bonn, Germany; (A.F.); (N.S.O.); (S.N.); (A.M.S.); (A.I.); (M.T.); (N.M.); (C.E.); (C.C.P.); (D.K.); (U.A.)
| | - Jennifer Landsberg
- Center of Integrated Oncology (CIO) Bonn, Department of Dermatology and Allergy, Venusberg Campus 1, University Hospital Bonn, 53127 Bonn, Germany; (J.S.); (J.L.)
| | - Julian A. Luetkens
- Department of Diagnostics and Interventional Radiology, Venusberg Campus 1, University Hospital Bonn, 53127 Bonn, Germany; (A.F.); (N.S.O.); (S.N.); (A.M.S.); (A.I.); (M.T.); (N.M.); (C.E.); (C.C.P.); (D.K.); (U.A.)
- Quantitative Imaging Lab Bonn (QLaB), Venusberg Campus 1, University Hospital Bonn, 53127 Bonn, Germany
- Correspondence:
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Vach M, Luetkens JA, Faron A, Isaak A, Salam B, Thomas D, Attenberger UI, Sprinkart AM. Association between single-slice and whole heart measurements of epicardial and pericardial fat in cardiac MRI. Acta Radiol 2021:2841851211054192. [PMID: 34747661 DOI: 10.1177/02841851211054192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Epicardial (ECF) and pericardial fat (PCF) are important prognostic markers for various cardiac diseases. However, volumetry of the fat compartments is time-consuming. PURPOSE To investigate whether total volume of ECF and PCF can be estimated by axial single-slice measurements and in a four-chamber view. MATERIAL AND METHODS A total of 113 individuals (79 patients and 34 healthy) were included in this retrospective magnetic resonance imaging (MRI) study. The total volume of ECF and PCF was determined using a 3D-Dixon sequence. Additionally, the area of ECF and PCF was obtained in single axial layers at five anatomical landmarks (left coronary artery, right coronary artery, right pulmonary artery, mitral valve, coronary sinus) of the Dixon sequence and in a four-chamber view of a standard cine sequence. Pearson's correlation coefficient was calculated between the total volume and each single-slice measurement. RESULTS Axial single-slice measurements of ECF and PCF correlated strongly with the total fat volumes at all landmarks (ECF: r = 0.85-0.94, P < 0.001; PCF: r = 0.89-0.94, P < 0.001). The best correlation was found at the level of the left coronary artery for ECF and PCF (r = 0.94, P < 0.001). Correlation between single-slice measurement in the four-chamber view and the total ECF and PCF volume was lower (r = 0.75 and r = 0.8, respectively, P < 0.001). CONCLUSION Single-slice measurements allow an estimation of ECF and PCF volume. This time-efficient analysis allows studies of larger patient cohorts and the opportunistic determination of ECF/PCF from routine examinations.
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Affiliation(s)
- Marius Vach
- Department of Diagnostic and Interventional Radiology, Quantitative Imaging Lab Bonn (QILaB), University of Bonn, Bonn, Germany
| | - Julian A Luetkens
- Department of Diagnostic and Interventional Radiology, Quantitative Imaging Lab Bonn (QILaB), University of Bonn, Bonn, Germany
| | - Anton Faron
- Department of Diagnostic and Interventional Radiology, Quantitative Imaging Lab Bonn (QILaB), University of Bonn, Bonn, Germany
| | - Alexander Isaak
- Department of Diagnostic and Interventional Radiology, Quantitative Imaging Lab Bonn (QILaB), University of Bonn, Bonn, Germany
| | - Babak Salam
- Department of Diagnostic and Interventional Radiology, Quantitative Imaging Lab Bonn (QILaB), University of Bonn, Bonn, Germany
| | - Daniel Thomas
- Department of Diagnostic and Interventional Radiology, Quantitative Imaging Lab Bonn (QILaB), University of Bonn, Bonn, Germany
| | - Ulrike I Attenberger
- Department of Diagnostic and Interventional Radiology, Quantitative Imaging Lab Bonn (QILaB), University of Bonn, Bonn, Germany
| | - Alois M Sprinkart
- Department of Diagnostic and Interventional Radiology, Quantitative Imaging Lab Bonn (QILaB), University of Bonn, Bonn, Germany
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Radbruch A, Paech D, Gassenmaier S, Luetkens J, Isaak A, Herrmann J, Othman A, Schäfer J, Nikolaou K. 1.5 vs 3 Tesla Magnetic Resonance Imaging: A Review of Favorite Clinical Applications for Both Field Strengths-Part 2. Invest Radiol 2021; 56:692-704. [PMID: 34417406 DOI: 10.1097/rli.0000000000000818] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
ABSTRACT The second part of this review deals with experiences in neuroradiological and pediatric examinations using modern magnetic resonance imaging systems with 1.5 T and 3 T, with special attention paid to experiences in pediatric cardiac imaging. In addition, whole-body examinations, which are widely used for diagnostic purposes in systemic diseases, are compared with respect to the image quality obtained in different body parts at both field strengths. A systematic overview of the technical differences at 1.5 T and 3 T has been presented in part 1 of this review, as well as several organ-based magnetic resonance imaging applications including musculoskeletal imaging, abdominal imaging, and prostate diagnostics.
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Affiliation(s)
- Alexander Radbruch
- From the Clinic for Diagnostic and Interventional Neuroradiology, University Hospital Bonn, Bonn
| | - Daniel Paech
- From the Clinic for Diagnostic and Interventional Neuroradiology, University Hospital Bonn, Bonn
| | - Sebastian Gassenmaier
- Department of Radiology, Diagnostic and Interventional Radiology, University of Tübingen, Tübingen
| | - Julian Luetkens
- Clinic for Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn
| | - Alexander Isaak
- Clinic for Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn
| | - Judith Herrmann
- Department of Radiology, Diagnostic and Interventional Radiology, University of Tübingen, Tübingen
| | | | - Jürgen Schäfer
- Department of Radiology, Diagnostic and Interventional Radiology, University of Tübingen, Tübingen
| | - Konstantin Nikolaou
- Department of Radiology, Diagnostic and Interventional Radiology, University of Tübingen, Tübingen
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Mesropyan N, Isaak A, Dabir D, Hart C, Faron A, Endler C, Kravchenko D, Katemann C, Pieper CC, Kuetting D, Attenberger UI, Luetkens JA. Free-breathing high resolution modified Dixon steady-state angiography with compressed sensing for the assessment of the thoracic vasculature in pediatric patients with congenital heart disease. J Cardiovasc Magn Reson 2021; 23:117. [PMID: 34689811 PMCID: PMC8543883 DOI: 10.1186/s12968-021-00810-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 08/30/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cardiovascular magnetic resonance angiography (CMRA) is a non-invasive imaging modality of choice in pediatric patients with congenital heart disease (CHD). This study was aimed to evaluate the diagnostic utility of a respiratory- and electrocardiogram-gated steady-state CMRA with modified Dixon (mDixon) fat suppression technique and compressed sensing in comparison to standard first-pass CMRA in pediatric patients with CHD at 3 T. METHODS In this retrospective single center study, pediatric CHD patients who underwent CMR with first-pass CMRA followed by mDixon steady-state CMRA at 3 T were analyzed. Image quality using a Likert scale from 5 (excellent) to 1 (non-diagnostic) and quality of fat suppression were assessed in consensus by two readers. Blood-to-tissue contrast and quantitative measurements of the thoracic vasculature were assessed separately by two readers. CMRA images were reevaluated by two readers for additional findings, which could be identified only on either one of the CMRA types. Paired Student t test, Wilcoxon test, and intraclass correlation coefficients (ICCs) were used for statistical analysis. RESULTS 32 patients with CHD (3.3 ± 1.7 years, 13 female) were included. Overall image quality of steady-state mDixon CMRA was higher compared to first-pass CMRA (4.5 ± 0.5 vs. 3.3 ± 0.5; P < 0.001). Blood-to-tissue contrast ratio of steady-state mDixon CMRA was comparable to first-pass CMRA (7.85 ± 4.75 vs. 6.35 ± 2.23; P = 0.133). Fat suppression of steady-state mDixon CMRA was perfect in 30/32 (94%) cases. Vessel diameters were greater in first-pass CMRA compared to steady-state mDixon CMRA with the greatest differences at the level of pulmonary arteries and veins (e.g., right pulmonary artery for reader 1: 10.4 ± 2.4 vs. 9.9 ± 2.3 mm, P < 0.001). Interobserver agreement was higher for steady-state mDixon CMRA for all measurements compared to first-pass CMRA (ICCs > 0.92). In 9/32 (28%) patients, 10 additional findings were identified on mDixon steady-state CMRA (e.g., partial anomalous venous return, abnormalities of coronary arteries, subclavian artery stenosis), which were not depicted using first-pass CMRA. CONCLUSIONS Steady-state mDixon CMRA offers a robust fat suppression, a high image quality, and diagnostic utility for the assessment of the thoracic vasculature in pediatric CHD patients.
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Affiliation(s)
- Narine Mesropyan
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg- Campus 1, 53127, Bonn, Germany
- Quantitative Imaging Lab Bonn (QILaB), Venusberg-Campus 1, 53127, Bonn, Germany
| | - Alexander Isaak
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg- Campus 1, 53127, Bonn, Germany
- Quantitative Imaging Lab Bonn (QILaB), Venusberg-Campus 1, 53127, Bonn, Germany
| | - Darius Dabir
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg- Campus 1, 53127, Bonn, Germany
- Quantitative Imaging Lab Bonn (QILaB), Venusberg-Campus 1, 53127, Bonn, Germany
| | - Christopher Hart
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg- Campus 1, 53127, Bonn, Germany
- Department of Pediatric Cardiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Anton Faron
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg- Campus 1, 53127, Bonn, Germany
- Quantitative Imaging Lab Bonn (QILaB), Venusberg-Campus 1, 53127, Bonn, Germany
| | - Christoph Endler
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg- Campus 1, 53127, Bonn, Germany
- Quantitative Imaging Lab Bonn (QILaB), Venusberg-Campus 1, 53127, Bonn, Germany
| | - Dmitrij Kravchenko
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg- Campus 1, 53127, Bonn, Germany
- Quantitative Imaging Lab Bonn (QILaB), Venusberg-Campus 1, 53127, Bonn, Germany
| | | | - Claus C Pieper
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg- Campus 1, 53127, Bonn, Germany
| | - Daniel Kuetting
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg- Campus 1, 53127, Bonn, Germany
- Quantitative Imaging Lab Bonn (QILaB), Venusberg-Campus 1, 53127, Bonn, Germany
| | - Ulrike I Attenberger
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg- Campus 1, 53127, Bonn, Germany
| | - Julian A Luetkens
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg- Campus 1, 53127, Bonn, Germany.
- Quantitative Imaging Lab Bonn (QILaB), Venusberg-Campus 1, 53127, Bonn, Germany.
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Faron A, Isaak A, Mesropyan N, Reinert M, Schwab K, Sirokay J, Sprinkart AM, Bauernfeind FG, Dabir D, Pieper CC, Heine A, Kuetting D, Attenberger U, Landsberg J, Luetkens JA. Cardiac MRI Depicts Immune Checkpoint Inhibitor-induced Myocarditis: A Prospective Study. Radiology 2021; 301:602-609. [PMID: 34581628 DOI: 10.1148/radiol.2021210814] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Immune checkpoint inhibitors (ICIs) for cancer treatment are associated with a spectrum of immune-related adverse events, including ICI-induced myocarditis; however, the extent of subclinical acute cardiac effects related to ICI treatment is unclear. Purpose To explore the extent of cardiac injury and inflammation related to ICI therapy that can be detected with use of cardiac MRI. Materials and Methods In this prospective study from November 2019 to April 2021, oncologic participants, without known underlying structural heart disease or cardiac symptoms, underwent multiparametric cardiac MRI before planned ICI therapy (baseline) and 3 months after starting ICI therapy (follow-up). The cardiac MRI protocol incorporated assessment of cardiac function, including systolic myocardial strain, myocardial edema, late gadolinium enhancement (LGE), T1 and T2 relaxation times, and extracellular volume fraction. The paired t test, Wilcoxon signed-rank test, and McNemar test were used for intraindividual comparisons. Results Twenty-two participants (mean age ± standard deviation, 65 years ± 14; 13 men) were evaluated, receiving a median of four infusions of ICI therapy (interquartile range, four to six infusions). Compared with baseline MRI, participants displayed increased markers of diffuse myocardial edema at follow-up (T1 relaxation time, 972 msec ± 26 vs 1006 msec ± 36 [P < .001]; T2 relaxation time, 54 msec ± 3 vs 58 msec ± 4 [P < .001]; T2 signal intensity ratio, 1.5 ± 0.3 vs 1.7 ± 0.3 [P = .03]). Left ventricular average systolic longitudinal strain had decreased at follow-up MRI (-23.4% ± 4.8 vs -19.6% ± 5.1, respectively; P = .005). New nonischemic LGE lesions were prevalent in two of 22 participants (9%). Compared with baseline, small pericardial effusions were more evident at follow-up (one of 22 participants [5%] vs 10 of 22 [45%]; P = .004). Conclusion In participants who received immune checkpoint inhibitor therapy for cancer treatment, follow-up cardiac MRI scans showed signs of systolic dysfunction and increased parameters of myocardial edema and inflammation. © RSNA, 2021 Online supplemental material is available for this article.
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Affiliation(s)
- Anton Faron
- From the Department of Diagnostic and Interventional Radiology (A.F., A.I., N.M., M.R., A.M.S., D.D., C.C.P., D.K., U.A., J.A.L.), Quantitative Imaging Laboratory Bonn (QILaB) (A.F., A.I., N.M., A.M.S., D.K., J.A.L.), Department of Oncology, Hematology, and Rheumatology (K.S., F.G.B., A.H.), and Department of Dermatology and Allergology (J.S., J.L.), University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Alexander Isaak
- From the Department of Diagnostic and Interventional Radiology (A.F., A.I., N.M., M.R., A.M.S., D.D., C.C.P., D.K., U.A., J.A.L.), Quantitative Imaging Laboratory Bonn (QILaB) (A.F., A.I., N.M., A.M.S., D.K., J.A.L.), Department of Oncology, Hematology, and Rheumatology (K.S., F.G.B., A.H.), and Department of Dermatology and Allergology (J.S., J.L.), University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Narine Mesropyan
- From the Department of Diagnostic and Interventional Radiology (A.F., A.I., N.M., M.R., A.M.S., D.D., C.C.P., D.K., U.A., J.A.L.), Quantitative Imaging Laboratory Bonn (QILaB) (A.F., A.I., N.M., A.M.S., D.K., J.A.L.), Department of Oncology, Hematology, and Rheumatology (K.S., F.G.B., A.H.), and Department of Dermatology and Allergology (J.S., J.L.), University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Matthäus Reinert
- From the Department of Diagnostic and Interventional Radiology (A.F., A.I., N.M., M.R., A.M.S., D.D., C.C.P., D.K., U.A., J.A.L.), Quantitative Imaging Laboratory Bonn (QILaB) (A.F., A.I., N.M., A.M.S., D.K., J.A.L.), Department of Oncology, Hematology, and Rheumatology (K.S., F.G.B., A.H.), and Department of Dermatology and Allergology (J.S., J.L.), University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Katjana Schwab
- From the Department of Diagnostic and Interventional Radiology (A.F., A.I., N.M., M.R., A.M.S., D.D., C.C.P., D.K., U.A., J.A.L.), Quantitative Imaging Laboratory Bonn (QILaB) (A.F., A.I., N.M., A.M.S., D.K., J.A.L.), Department of Oncology, Hematology, and Rheumatology (K.S., F.G.B., A.H.), and Department of Dermatology and Allergology (J.S., J.L.), University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Judith Sirokay
- From the Department of Diagnostic and Interventional Radiology (A.F., A.I., N.M., M.R., A.M.S., D.D., C.C.P., D.K., U.A., J.A.L.), Quantitative Imaging Laboratory Bonn (QILaB) (A.F., A.I., N.M., A.M.S., D.K., J.A.L.), Department of Oncology, Hematology, and Rheumatology (K.S., F.G.B., A.H.), and Department of Dermatology and Allergology (J.S., J.L.), University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Alois M Sprinkart
- From the Department of Diagnostic and Interventional Radiology (A.F., A.I., N.M., M.R., A.M.S., D.D., C.C.P., D.K., U.A., J.A.L.), Quantitative Imaging Laboratory Bonn (QILaB) (A.F., A.I., N.M., A.M.S., D.K., J.A.L.), Department of Oncology, Hematology, and Rheumatology (K.S., F.G.B., A.H.), and Department of Dermatology and Allergology (J.S., J.L.), University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Franz-Georg Bauernfeind
- From the Department of Diagnostic and Interventional Radiology (A.F., A.I., N.M., M.R., A.M.S., D.D., C.C.P., D.K., U.A., J.A.L.), Quantitative Imaging Laboratory Bonn (QILaB) (A.F., A.I., N.M., A.M.S., D.K., J.A.L.), Department of Oncology, Hematology, and Rheumatology (K.S., F.G.B., A.H.), and Department of Dermatology and Allergology (J.S., J.L.), University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Darius Dabir
- From the Department of Diagnostic and Interventional Radiology (A.F., A.I., N.M., M.R., A.M.S., D.D., C.C.P., D.K., U.A., J.A.L.), Quantitative Imaging Laboratory Bonn (QILaB) (A.F., A.I., N.M., A.M.S., D.K., J.A.L.), Department of Oncology, Hematology, and Rheumatology (K.S., F.G.B., A.H.), and Department of Dermatology and Allergology (J.S., J.L.), University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Claus C Pieper
- From the Department of Diagnostic and Interventional Radiology (A.F., A.I., N.M., M.R., A.M.S., D.D., C.C.P., D.K., U.A., J.A.L.), Quantitative Imaging Laboratory Bonn (QILaB) (A.F., A.I., N.M., A.M.S., D.K., J.A.L.), Department of Oncology, Hematology, and Rheumatology (K.S., F.G.B., A.H.), and Department of Dermatology and Allergology (J.S., J.L.), University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Annkristin Heine
- From the Department of Diagnostic and Interventional Radiology (A.F., A.I., N.M., M.R., A.M.S., D.D., C.C.P., D.K., U.A., J.A.L.), Quantitative Imaging Laboratory Bonn (QILaB) (A.F., A.I., N.M., A.M.S., D.K., J.A.L.), Department of Oncology, Hematology, and Rheumatology (K.S., F.G.B., A.H.), and Department of Dermatology and Allergology (J.S., J.L.), University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Daniel Kuetting
- From the Department of Diagnostic and Interventional Radiology (A.F., A.I., N.M., M.R., A.M.S., D.D., C.C.P., D.K., U.A., J.A.L.), Quantitative Imaging Laboratory Bonn (QILaB) (A.F., A.I., N.M., A.M.S., D.K., J.A.L.), Department of Oncology, Hematology, and Rheumatology (K.S., F.G.B., A.H.), and Department of Dermatology and Allergology (J.S., J.L.), University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Ulrike Attenberger
- From the Department of Diagnostic and Interventional Radiology (A.F., A.I., N.M., M.R., A.M.S., D.D., C.C.P., D.K., U.A., J.A.L.), Quantitative Imaging Laboratory Bonn (QILaB) (A.F., A.I., N.M., A.M.S., D.K., J.A.L.), Department of Oncology, Hematology, and Rheumatology (K.S., F.G.B., A.H.), and Department of Dermatology and Allergology (J.S., J.L.), University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Jennifer Landsberg
- From the Department of Diagnostic and Interventional Radiology (A.F., A.I., N.M., M.R., A.M.S., D.D., C.C.P., D.K., U.A., J.A.L.), Quantitative Imaging Laboratory Bonn (QILaB) (A.F., A.I., N.M., A.M.S., D.K., J.A.L.), Department of Oncology, Hematology, and Rheumatology (K.S., F.G.B., A.H.), and Department of Dermatology and Allergology (J.S., J.L.), University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Julian A Luetkens
- From the Department of Diagnostic and Interventional Radiology (A.F., A.I., N.M., M.R., A.M.S., D.D., C.C.P., D.K., U.A., J.A.L.), Quantitative Imaging Laboratory Bonn (QILaB) (A.F., A.I., N.M., A.M.S., D.K., J.A.L.), Department of Oncology, Hematology, and Rheumatology (K.S., F.G.B., A.H.), and Department of Dermatology and Allergology (J.S., J.L.), University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
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Kravchenko D, Isaak A, Zimmer S, Mesropyan N, Reinert M, Faron A, Pieper CC, Heine A, Velten M, Nattermann J, Kuetting D, Duerr GD, Attenberger UI, Luetkens JA. Cardiac MRI in Patients with Prolonged Cardiorespiratory Symptoms after Mild to Moderate COVID-19 Infection. Radiology 2021; 301:E419-E425. [PMID: 34374593 PMCID: PMC8369880 DOI: 10.1148/radiol.2021211162] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background Myocardial injury and inflammation at cardiac MRI in patients with COVID-19 have been described in recent publications. Concurrently, a chronic COVID-19 syndrome (CCS) after SARS-CoV-2 infection has been observed and manifests with symptoms such as fatigue and exertional dyspnea. Purpose To explore the relationship between CCS and myocardial injury and inflammation as an underlying cause of the persistent complaints in previously healthy individuals. Materials and Methods In this prospective study from January 2021 to April 2021, study participants without known cardiac or pulmonary diseases prior to SARS-CoV-2 infection who had persistent CCS symptoms such as fatigue or exertional dyspnea after convalescence and healthy control participants underwent cardiac MRI. The cardiac MRI protocol included evaluating the T1 and T2 relaxation times, extracellular volume, T2 signal intensity ratio, and late gadolinium enhancement (LGE). Student t tests, Mann-Whitney U tests, and χ2 tests were used for statistical analysis. Results Forty-one participants with CCS (mean age, 39 years ± 13 [standard deviation]; 18 men) and 42 control participants (mean age, 39 years ± 16; 26 men) were evaluated. The median time between the initial incidence of mild to moderate COVID-19 not requiring hospitalization and undergoing cardiac MRI was 103 days (interquartile range, 88–158 days). Troponin T levels were normal. Parameters indicating myocardial inflammation and edema were comparable between participants with CCS and control participants (T1 relaxation times: 978 msec ± 23 vs 971 msec ± 25 [P = .17]; T2 relaxation times: 53 msec ± 2 vs 52 msec ± 2 [P = .47]; T2 signal intensity ratios: 1.6 ± 0.2 vs 1.6 ± 0.3 [P = .10]). Visible myocardial edema was present in none of the participants. Three of 41 (7%) participants with CCS demonstrated nonischemic LGE, whereas no participants in the control group demonstrated nonischemic LGE (0 of 42 [0%]; P = .07). None of the participants fulfilled the 2018 Lake Louise criteria for the diagnosis of myocarditis. Conclusion Individuals with chronic COVID-19 syndrome who did not undergo hospitalization for COVID-19 did not demonstrate signs of active myocardial injury or inflammation at cardiac MRI. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Lima and Bluemke in this issue.
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Affiliation(s)
- Dmitrij Kravchenko
- Department for Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn, Germany.,Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Germany
| | - Alexander Isaak
- Department for Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn, Germany.,Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Germany
| | - Sebastian Zimmer
- Department of Internal Medicine II - Cardiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Narine Mesropyan
- Department for Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn, Germany.,Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Germany
| | - Matthäus Reinert
- Department for Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn, Germany.,Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Germany
| | - Anton Faron
- Department for Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn, Germany.,Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Germany
| | - Claus C Pieper
- Department for Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn, Germany
| | - Annkristin Heine
- Department of Internal Medicine III-Oncology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Markus Velten
- Department of Anesthesiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Jacob Nattermann
- Department of Internal Medicine I, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Daniel Kuetting
- Department for Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn, Germany.,Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Germany
| | - Georg D Duerr
- Department of Cardiothoracic and Vascular Surgery, University Hospital Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
| | - Ulrike I Attenberger
- Department for Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn, Germany
| | - Julian A Luetkens
- Department for Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn, Germany.,Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Germany
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40
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Affiliation(s)
- Alexander Isaak
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany.,Quantitative Imaging Lab Bonn (QILaB)
| | - Andreas Feisst
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany.,Quantitative Imaging Lab Bonn (QILaB)
| | - Julian A Luetkens
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany.,Quantitative Imaging Lab Bonn (QILaB)
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Isaak A, Luetkens JA, Faron A, Endler C, Mesropyan N, Katemann C, Zhang S, Kupczyk P, Kuetting D, Attenberger U, Dabir D. Free-breathing non-contrast flow-independent cardiovascular magnetic resonance angiography using cardiac gated, magnetization-prepared 3D Dixon method: assessment of thoracic vasculature in congenital heart disease. J Cardiovasc Magn Reson 2021; 23:91. [PMID: 34275486 PMCID: PMC8287681 DOI: 10.1186/s12968-021-00788-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 06/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To evaluate a non-contrast respiratory- and electrocardiogram-gated 3D cardiovascular magnetic resonance angiography (CMRA) based on magnetization-prepared Dixon method (relaxation-enhanced angiography without contrast and triggering, REACT) for the assessment of the thoracic vasculature in congenital heart disease (CHD) patients. METHODS 70 patients with CHD (mean 28 years, range: 10-65 years) were retrospectively identified in this single-center study. REACT-CMRA was applied with respiratory- and cardiac-gating. Image quality (IQ) of REACT-CMRA was compared to standard non-gated multi-phase first-pass-CMRA and respiratory- and electrocardiogram-gated steady-state-CMRA. IQ of different vessels of interest (ascending aorta, left pulmonary artery, left superior pulmonary vein, right coronary ostium, coronary sinus) was independently assessed by two readers on a five-point Likert scale. Measurements of vessel diameters were performed in predefined anatomic landmarks (ascending aorta, left pulmonary artery, left superior pulmonary vein). Both readers assessed artifacts and vascular abnormalities. Friedman test, chi-squared test, and Bland-Altman method were used for statistical analysis. RESULTS Overall IQ score of REACT-CMRA was higher compared to first-pass-CMRA (3.5 ± 0.4 vs. 2.7 ± 0.4, P < 0.001) and did not differ from steady-state-CMRA (3.5 ± 0.4 vs. 3.5 ± 0.6, P = 0.99). Non-diagnostic IQ of the defined vessels of interest was observed less frequently on REACT-CMRA (1.7 %) compared to steady-state- (4.3 %, P = 0.046) or first-pass-CMRA (20.9 %, P < 0.001). Close agreements in vessel diameter measurements were observed between REACT-CMRA and steady-state-CMRA (e.g. ascending aorta, bias: 0.38 ± 1.0 mm, 95 % limits of agreement (LOA): - 1.62-2.38 mm). REACT-CMRA showed high intra- (bias: 0.04 ± 1.0 mm, 95 % LOA: - 1.9-2.0 mm) and interobserver (bias: 0.20 ± 1.1 mm, 95 % LOA: - 2.0-2.4 mm) agreements regarding vessel diameter measurements. Fat-water separation artifacts were observed in 11/70 (16 %) patients on REACT-CMRA but did not limit diagnostic utility. Six vascular abnormalities were detected on REACT-CMRA that were not seen on standard contrast-enhanced CMRA. CONCLUSIONS Non-contrast-enhanced cardiac-gated REACT-CMRA offers a high diagnostic quality for assessment of the thoracic vasculature in CHD patients.
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Affiliation(s)
- Alexander Isaak
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
- Quantitative Imaging Lab Bonn (QILaB), Bonn, Germany.
| | - Julian A Luetkens
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
- Quantitative Imaging Lab Bonn (QILaB), Bonn, Germany
| | - Anton Faron
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
- Quantitative Imaging Lab Bonn (QILaB), Bonn, Germany
| | - Christoph Endler
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
- Quantitative Imaging Lab Bonn (QILaB), Bonn, Germany
| | - Narine Mesropyan
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
- Quantitative Imaging Lab Bonn (QILaB), Bonn, Germany
| | | | | | - Patrick Kupczyk
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
- Quantitative Imaging Lab Bonn (QILaB), Bonn, Germany
| | - Daniel Kuetting
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
- Quantitative Imaging Lab Bonn (QILaB), Bonn, Germany
| | - Ulrike Attenberger
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Darius Dabir
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
- Quantitative Imaging Lab Bonn (QILaB), Bonn, Germany
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Endler CH, Ginzburg D, Isaak A, Faron A, Mesropyan N, Kuetting D, Pieper CC, Kupczyk PA, Attenberger UI, Luetkens JA. Diagnostic Benefit of MRI for Exclusion of Ligamentous Injury in Patients with Lateral Atlantodental Interval Asymmetry at Initial Trauma CT. Radiology 2021; 300:633-640. [PMID: 34184931 DOI: 10.1148/radiol.2021204187] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Cervical spine CT is regularly performed to exclude cervical spine injury during the initial evaluation of trauma patients. Patients with asymmetry of the lateral atlantodental interval (LADI) often undergo subsequent MRI to rule out ligamentous injuries. The clinical relevance of an asymmetric LADI and the benefit of additional MRI remain unclear. Purpose To evaluate the diagnostic benefit of additional MRI in patients with blunt trauma who have asymmetry of the LADI and no other cervical injuries. Materials and Methods Patients who underwent cervical spine CT during initial trauma evaluation between March 2017 and August 2019 were retrospectively evaluated. Those who underwent subsequent MRI because of LADI asymmetry of 1 mm or greater with no other signs of cervical injury were identified and reevaluated by two readers blinded to clinical data and initial study reports regarding possible ligamentous injuries. Results Among 1553 patients, 146 (9%) had LADI asymmetry of 1 mm or greater. Of these, 46 patients (mean age ± standard deviation, 39 years ± 22; 28 men; median LADI asymmetry, 2.4 mm [interquartile range, 1.8-3.1 mm]) underwent supplementary MRI with no other signs of cervical injury at initial CT. Ten of the 46 patients (22%) showed cervical tenderness at clinical examination, and 36 patients (78%) were asymptomatic. In two of the 46 patients (4%), MRI revealed alar ligament injury; both of these patients showed LADI asymmetry greater than 3 mm, along with cervical tenderness at clinical examination, and underwent treatment for ligamentous injury. In 13 of the 46 patients (28%), signal intensity alterations of alar ligaments without signs of rupture were observed. Four of these 13 patients (31%) were subsequently treated for ligamentous injury despite being asymptomatic. Conclusion Subsequent MRI following CT of the cervical spine in trauma patients with lateral atlantodental interval asymmetry may have diagnostic benefit only in symptomatic patients. In asymptomatic patients without proven cervical injuries, subsequent MRI showed no diagnostic benefit and may even lead to overtreatment. © RSNA, 2021 Online supplemental material is available for this article.
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Affiliation(s)
- Christoph H Endler
- From the Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (C.H.E., D.G., A.I., A.F., N.M., D.K., C.C.P., P.A.K., U.I.A., J.A.L.); and Quantitative Imaging Laboratory Bonn (QILaB), Bonn, Germany (C.H.E., A.I., A.F., N.M., D.K., P.A.K., J.A.L.)
| | - Daniel Ginzburg
- From the Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (C.H.E., D.G., A.I., A.F., N.M., D.K., C.C.P., P.A.K., U.I.A., J.A.L.); and Quantitative Imaging Laboratory Bonn (QILaB), Bonn, Germany (C.H.E., A.I., A.F., N.M., D.K., P.A.K., J.A.L.)
| | - Alexander Isaak
- From the Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (C.H.E., D.G., A.I., A.F., N.M., D.K., C.C.P., P.A.K., U.I.A., J.A.L.); and Quantitative Imaging Laboratory Bonn (QILaB), Bonn, Germany (C.H.E., A.I., A.F., N.M., D.K., P.A.K., J.A.L.)
| | - Anton Faron
- From the Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (C.H.E., D.G., A.I., A.F., N.M., D.K., C.C.P., P.A.K., U.I.A., J.A.L.); and Quantitative Imaging Laboratory Bonn (QILaB), Bonn, Germany (C.H.E., A.I., A.F., N.M., D.K., P.A.K., J.A.L.)
| | - Narine Mesropyan
- From the Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (C.H.E., D.G., A.I., A.F., N.M., D.K., C.C.P., P.A.K., U.I.A., J.A.L.); and Quantitative Imaging Laboratory Bonn (QILaB), Bonn, Germany (C.H.E., A.I., A.F., N.M., D.K., P.A.K., J.A.L.)
| | - Daniel Kuetting
- From the Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (C.H.E., D.G., A.I., A.F., N.M., D.K., C.C.P., P.A.K., U.I.A., J.A.L.); and Quantitative Imaging Laboratory Bonn (QILaB), Bonn, Germany (C.H.E., A.I., A.F., N.M., D.K., P.A.K., J.A.L.)
| | - Claus C Pieper
- From the Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (C.H.E., D.G., A.I., A.F., N.M., D.K., C.C.P., P.A.K., U.I.A., J.A.L.); and Quantitative Imaging Laboratory Bonn (QILaB), Bonn, Germany (C.H.E., A.I., A.F., N.M., D.K., P.A.K., J.A.L.)
| | - Patrick A Kupczyk
- From the Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (C.H.E., D.G., A.I., A.F., N.M., D.K., C.C.P., P.A.K., U.I.A., J.A.L.); and Quantitative Imaging Laboratory Bonn (QILaB), Bonn, Germany (C.H.E., A.I., A.F., N.M., D.K., P.A.K., J.A.L.)
| | - Ulrike I Attenberger
- From the Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (C.H.E., D.G., A.I., A.F., N.M., D.K., C.C.P., P.A.K., U.I.A., J.A.L.); and Quantitative Imaging Laboratory Bonn (QILaB), Bonn, Germany (C.H.E., A.I., A.F., N.M., D.K., P.A.K., J.A.L.)
| | - Julian A Luetkens
- From the Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (C.H.E., D.G., A.I., A.F., N.M., D.K., C.C.P., P.A.K., U.I.A., J.A.L.); and Quantitative Imaging Laboratory Bonn (QILaB), Bonn, Germany (C.H.E., A.I., A.F., N.M., D.K., P.A.K., J.A.L.)
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Roesti A, Isaak A, Gemayel G, Mujagic E, Briner L, Wolff T, Deslarzes-Dubuis C, Corpataux JM, Déglise S. Multicenter observational study of the gore excluder conformable endograft for endovascular abdominal aortic repair: Initial results. Br J Surg 2021. [DOI: 10.1093/bjs/znab202.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Objective
Endovascular repair (EVAR) has become the standard of care for treatment of abdominal aortic aneurysms. However, a significant number of EVAR remains outside the IFU, especially in cases of severe proximal angulation (>60 degrees), resulting in failure. The new device GORE EXCLUDER Conformable AAA Endoprosthesis (W. L. Gore & Associates, Flagstaff, Ariz) has been designed to accommodate neck angulation, due to conformability and angulation control. The aim of this multicenter study is to report the initial results of this device.
Methods
From March 2019 to January 2021, the data of all consecutive patients with AAA treated with the Gore Excluder Conformable endograft at 4 vascular centers were reviewed. Patients were followed using a standardized protocol, with CT-scan at 1, 6 and 12 months, and then yearly. The primary endpoint was technical success and secondary outcomes were postoperative morbidity, rate of endoleak (EL) and any aneurysm-related re-interventions during follow-up.
Results
Among the 32 patients included, most were men with a mean age of 77 years old (range 60-92). Half of patients were smokers and 72% had hypertension. The mean diameter of AAA was 62 mm (47-90). The mean length of aortic neck was 26 mm (10-69), the mean diameter 23 mm (16-31) and the median neck angulation was 81 degrees (range 40-110). The mean procedural duration was 102 min (54-153) with a mean time of scopy of 24 min (8-47) and a total volume of contrast of 101 ml (40-165). Thirteen iliac branch device have been used in 7 patients. The technical success was 97% with 1 type Ia EL (3%). In the post-operative period, 4 medical and 3 surgical complications were observed. Two reinterventions were needed with an iliac stenting for a stenosis and a correction of a femoral false aneurysm. During the mean follow-up of 7 months, 2 type Ia ELs were observed. One spontaneously resolved and the other one was followed. One distal limb extension was succesfully implanted at 3 months for a type Ib EL for a total rate of reintervention of 9%. No migration was observed. No death occured.
Conclusion
The use of the Gore Excluder Conformable endograft seems to be safe and effective in difficult anatomies and especially high angulation. It allows for precise deployment without the need for additional contrast or operation time. Longer follow-up and more patients are required to confirm these excellent initials results.
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Affiliation(s)
- A Roesti
- Department of Vascular Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - A Isaak
- Department of Vascular Surgery, Cantonal Hospital Aarau, Aarau, Switzerland
| | - G Gemayel
- Department of Vascular Surgery, Hôpital de la Tour, Geneva, Switzerland
| | - E Mujagic
- Department of Vascular Surgery, Universitätspital Basel, Basel, Switzerland
| | - L Briner
- Department of Vascular Surgery, Réseau Hospitalier Neuchâtelois, Neuchâtel, Switzerland
| | - T Wolff
- Department of Vascular Surgery, Universitätspital Basel, Basel, Switzerland
| | - C Deslarzes-Dubuis
- Department of Vascular Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - J -M Corpataux
- Department of Vascular Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - S Déglise
- Department of Vascular Surgery, Lausanne University Hospital, Lausanne, Switzerland
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Isaak A, Mallios A, Gürke L, Wolff T. Tele-proctoring in vascular surgery implementing percutaneous creation of arteriovenous fistula. Br J Surg 2021. [PMCID: PMC8194804 DOI: 10.1093/bjs/znab202.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Objective Percutaneous ultrasound-guided creation of an arteriovenous fistula (pAVF) for hemodialysis access is a relatively novel procedure with promising technical success and patency rates. The vascular surgery departments of two collaborating Swiss hospitals had decided to introduce the technique to their services. A surgeon experienced in the technique (AM) was supposed to come to Switzerland and proctor the first four procedures. Due to the SARS-CoV-2 pandemic and travel restrictions, this was not possible and we decided to perform the first four pAVF procedures tele-proctored via a video conference system. We present the setup and our experience with tele-proctoring. Methods The setup relied on an all-in-one live video production device, video encoder, video streamer and video recorder (Pearl-2, Epiphan), which made it possible to simultaneously transmit the live image from the ultrasound device (GE Logiq S8, linear probe 9L-D) and a live image from a video camera (JVC Camcorder G/-HM440E, Japan), both connected via HDMI (Figure). The live stream was shared with the proctor in France and the device support team in the US, using an encrypted Swiss video client (www.vitimway.ch). The setup was tested with all parties three days in advance. Results All 4 procedures started with a verbal briefing and a live ultrasound scan. All steps of the procedures were taken under the proctor’s instruction and supervision. The proctor gave on average 21 instructions per procedure. An average 4 were device-related but these became less frequent as we proceeded. The operators consulted the proctor on average 5 times per procedure. The average duration of the procedure was 34 min. The pAVF creation was successful in all 4 patients, with an average fistula flow measured at the end of the procedure of 600 ml/min. Conclusion Our experience showed us that pAVF creation, which is a procedure performed entirely under sonographic guidance lends itself particularly well to tele-proctoring. The simultaneous transmission of the live sonographic image and the live image of the operators' hands allowed the proctor to supervise and correct the key steps of the procedures. The simplicity of the set-up and the quality of proctor-operator interaction was such a positive experience that we can well envisage a much wider use of tele-proctoring in the future.
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Affiliation(s)
- A Isaak
- Department of Vascular and Endovascular Surgery, Cantonal Hospital Aarau, Aarau, Switzerland
| | - A Mallios
- Vascular Access Center, Hospital Saint-Joseph, Paris, France
| | - L Gürke
- Vascular and Endovascular Surgery, University Hospital Basel, Basel, Switzerland
| | - T Wolff
- Vascular and Endovascular Surgery, University Hospital Basel, Basel, Switzerland
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Richarz S, Stevenson K, White B, Thomson P, Jackson A, Isaak A, Kingsmore D. Early-cannulation arteriovenous grafts are safe and effective in avoiding recurrent tunneled central catheter infection. Br J Surg 2021. [DOI: 10.1093/bjs/znab202.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Objective
Tunneled central venous catheter infection (TCVCi) is a common complication that often necessitates removal of the TCVC and a further TCVC. Theoeretically, insertion of an early-cannualtion graft (ecAVG) early after TCVC infection is possible but not widely practiced with concerns over safety and infection in the ecAVG. With 8 years of ecAVG experience, the aim of this study was to compare the outcomes following TCVC infection, comparing replacement with TCVC (TCVCr) versus immediate ecAVG (ecAVGr).
Methods
Retrospective comparison of two cohorts, who underwent replacement of an infected TCVC either by an early cannulation graft (n = 18) or by a further central catheter (n = 39).
Data were abstracted from a prospectively completed electronic patient record and collected on patient demographics, TCVC insertion, duration and infection, including culture proven bacteriaemia and subsequent access interventions.
Results
18/299 patients identified from 2012-2020 had an ecAVG implanted as treatment for a TCVCi. In a one-year time-period (1/1/2015 -31/12/2015) out of 222 TCVC inserted, 39 were as a replacement following a TCVCi. No patient with an ecAVGr developed an immediate infection, nor complication from the procedure. The rate of subsequent vascular access infection was significantly more frequent for those with TCVCr than with an ecAVGr (0.6 vs. 0.1/patient/ 1000 HD days, p < 0.000). The number of further TCVC required was significantly higher in the TCVCr group (7.1 vs. 0.4/patient/ 1000 HD days, p = 0.000).
Conclusion
An ecAVG early following a TCVC infection is safe, reduces the incidence of subsequent infectious complications and reduces the number of TCVC required, with a better functional patency.
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Affiliation(s)
- S Richarz
- Department of Vascular Surgery, University Hospital Basel, Basel, Switzerland
- Department of Renal and Transplant Surgery, Queen Elizabeth University Hospital Glasgow, Glasgow, United Kingdom
| | - K Stevenson
- Department of Renal and Transplant Surgery, Queen Elizabeth University Hospital Glasgow, Glasgow, United Kingdom
| | - B White
- Department of Infectious Diseases and Microbiology, Queen Elizabeth University Hospital Glasgow, Glasgow, United Kingdom
| | - P Thomson
- Department of Nephrology, Queen Elizabeth University Hospital Glasgow, Glasgow, United Kingdom
| | - A Jackson
- Department of Renal and Transplant Surgery, Queen Elizabeth University Hospital Glasgow, Glasgow, United Kingdom
| | - A Isaak
- Department of Vascular Surgery, Cantonal Hospital Aarau, Aarau, Switzerland
| | - D Kingsmore
- Department of Vascular and Endovascular Surgery, Queen Elizabeth University Hospital Glasgow, Glasgow, United Kingdom
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Isaak A, Mallios A, Gürke L, Wolff T. First experience with percutaneous arteriovenous fistula creation using the Ellipsys® vascular access system. Br J Surg 2021. [DOI: 10.1093/bjs/znab202.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Objective
Percutaneous creation of arteriovenous fistulae (pAVF) has been developed as an alternative to the creation of an upper arm cephalic or basilic vein fistula. Several studies have shown high technical success rates and comparable time of maturation. To our knowledge, the technique has not been used in Switzerland before.
Methods
Prospective data collection of the first consecutive patients undergoing the creation of pAVF between April and July 2020 at two vascular surgery centres.
Results
Seven patients underwent pAVF creation with the Ellipsys® vascular access system under regional anaesthesia for maximum vasodilation. The procedures were performed entirely under sonographic control without the use of fluoroscopy. The cephalic or basilic vein was punctured and the puncture needle advanced under sonographic control through the cubital perforator vein into the proximal radial artery. The Ellipsys® catheter was advanced over a guidewire and activated to create the fistula between the proximal radial artery and the perforator vein. The fistula was further dilated with a 5mm PTA balloon. We achieved technical success in 6 patients. In one patient with small and spastic vessels, the needle could not be advanced into the radial artery. A conventional upper arm cephalic fistula was created during the same procedure. In three patients primary maturation was achieved and the cephalic vein or distal basilic vein could be punctured for dialysis without any adjunct procedures. One patient required three additional procedures before the fistula could be used successfully (additional angioplasty of the fistula, superficialisation of the basilic vein and correction of a cubital vein stenosis by excision and end-to-end anastomosis). One patient required superficialisation of the basilic vein and one patient transposition of the arterialised brachial vein. Maturation was achieved in six pAVF after a mean of 158 days with a mean fistula flow of 920 ml/ min.
Conclusion
We achieved high technical success and maturation rates in our first patients undergoing pAVF creation with the Ellipsys® system. Prerequisites are suitable anatomy of the cubital perforator vein and good skills in sonography and endovascular techniques. We believe that pAVF is a promising alternative to the creation of a conventional upper arm fistula in patients unsuitable for a distal radio-cephalic fistula.
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Affiliation(s)
- A Isaak
- Department of Vascular and Endovascular Surgery, Cantonal Hospital Aarau, Aarau, Switzerland
| | - A Mallios
- Vascular Access Center, Hospital Saint-Joseph, Paris, France
| | - L Gürke
- Department of Vascular and Endovascular Surgery, University Hospital Basel, Basel, Switzerland
| | - T Wolff
- Department of Vascular and Endovascular Surgery, University Hospital Basel, Basel, Switzerland
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Mesropyan N, Kupczyk P, Kukuk GM, Dold L, Weismueller T, Endler C, Isaak A, Faron A, Sprinkart AM, Pieper CC, Kuetting D, Strassburg CP, Attenberger UI, Luetkens JA. Diagnostic value of magnetic resonance parametric mapping for non-invasive assessment of liver fibrosis in patients with primary sclerosing cholangitis. BMC Med Imaging 2021; 21:65. [PMID: 33827475 PMCID: PMC8028226 DOI: 10.1186/s12880-021-00598-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 03/24/2021] [Indexed: 12/12/2022] Open
Abstract
Background Primary sclerosing cholangitis (PSC) is a chronic cholestatic liver disease, characterized by bile duct inflammation and destruction, leading to biliary fibrosis and cirrhosis. The purpose of this study was to investigate the utility of T1 and T2 mapping parameters, including extracellular volume fraction (ECV) for non-invasive assessment of fibrosis severity in patients with PSC. Methods In this prospective study, patients with PSC diagnosis were consecutively enrolled from January 2019 to July 2020 and underwent liver MRI. Besides morphological sequences, MR elastography (MRE), and T1 and T2 mapping were performed. ECV was calculated from T1 relaxation times. The presence of significant fibrosis (≥ F2) was defined as MRE-derived liver stiffness ≥ 3.66 kPa and used as the reference standard, against which the diagnostic performance of MRI mapping parameters was tested. Student t test, ROC analysis and Pearson correlation were used for statistical analysis. Results 32 patients with PSC (age range 19–77 years) were analyzed. Both, hepatic native T1 (r = 0.66; P < 0.001) and ECV (r = 0.69; P < 0.001) correlated with MRE-derived liver stiffness. To diagnose significant fibrosis (≥ F2), ECV revealed a sensitivity of 84.2% (95% confidence interval (CI) 62.4–94.5%) and a specificity of 84.6% (CI 57.8–95.7%); hepatic native T1 revealed a sensitivity of 52.6% (CI 31.7–72.7%) and a specificity of 100.0% (CI 77.2–100.0%). Hepatic ECV (area under the curve (AUC) 0.858) and native T1 (AUC 0.711) had an equal or higher diagnostic performance for the assessment of significant fibrosis compared to serologic fibrosis scores (APRI (AUC 0.787), FIB-4 (AUC 0.588), AAR (0.570)). Conclusions Hepatic T1 and ECV can diagnose significant fibrosis in patients with PSC. Quantitative mapping has the potential to be a new non-invasive biomarker for liver fibrosis assessment and quantification in PSC patients.
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Affiliation(s)
- Narine Mesropyan
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Patrick Kupczyk
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Guido M Kukuk
- Department of Radiology, Kantonsspital Graubünden, Chur, Switzerland
| | - Leona Dold
- Department of Internal Medicine I, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Tobias Weismueller
- Department of Internal Medicine I, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Christoph Endler
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Alexander Isaak
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Anton Faron
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Alois M Sprinkart
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Claus C Pieper
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Daniel Kuetting
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Christian P Strassburg
- Department of Internal Medicine I, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Ulrike I Attenberger
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Julian A Luetkens
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
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Richarz S, Stevenson K, White B, Thomson PC, Jackson A, Isaak A, Kingsmore DB. Early-Cannulation Arteriovenous Grafts Are Safe and Effective in Avoiding Recurrent Tunneled Central Catheter Infection. Ann Vasc Surg 2021; 75:287-293. [PMID: 33819582 DOI: 10.1016/j.avsg.2021.01.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 01/23/2021] [Accepted: 01/26/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Tunneled central venous catheter infection (TCVCi) is a common complication that often necessitates removal of the TCVC and replacement by a further TCVC. Theoretically, insertion of an early - cannulation graft (ecAVG) early after TCVC infection is possible but not widely practiced with concerns over safety and infection in the ecAVG. With 8 years of ecAVG experience, the aim of this study was to compare the outcomes following TCVC infection, comparing replacement with TCVC (TCVCr) versus immediate ecAVG (ecAVGr). DESIGN Retrospective comparison of 2 cohorts, who underwent replacement of an infected TCVC either by an early cannulation graft (n = 18) or by a further central catheter (n = 39). METHODS Data were abstracted from a prospectively completed electronic patient record and collected on patient demographics, TCVC insertion, duration and infection, including culture proven bacteriaemia and subsequent access interventions. RESULTS Eighteen of 299 patients identified from 2012 to 2020 had an ecAVG implanted as treatment for a TCVCi. In a 1-year time-period (January 1, 2015-December 31, 2015) out of 222 TCVC inserted, 39 were as a replacement following a TCVCi. No patient with an ecAVGr developed an immediate infection, nor complication from the procedure. The rate of subsequent vascular access infection was significantly more frequent for those with a TCVCr than with an ecAVGr (0.6 vs. 0.1/patient/1000 HD days, P< 0.000). The number of further TCVC required was significantly higher in the TCVCr group (7.1 vs. 0.4/patient/1000 HD days, P= 0.000). CONCLUSIONS An ecAVG early following a TCVC infection is safe, reduces the incidence of subsequent infectious complications and reduces the number of TCVC required, with a better functional patency.
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Affiliation(s)
- S Richarz
- Renal and Transplant Surgery, Queen Elisabeth University Hospital, Glasgow, UK; Department of Vascular and Endovascular Surgery, University Hospital Basel, Basel, Switzerland.
| | - K Stevenson
- Renal and Transplant Surgery, Queen Elisabeth University Hospital, Glasgow, UK
| | - B White
- Department of Infectious Diseases and Microbiology, Queen Elisabeth University Hospital, Glasgow, UK
| | - P C Thomson
- Department of Nephrology, Queen Elisabeth University Hospital, Glasgow, UK
| | - A Jackson
- Renal and Transplant Surgery, Queen Elisabeth University Hospital, Glasgow, UK
| | - A Isaak
- Department of Vascular and Endovascular Surgery, Kantonsspital Aarau, Aarau, Switzerland
| | - D B Kingsmore
- Renal and Transplant Surgery, Queen Elisabeth University Hospital, Glasgow, UK; Department of Vascular Surgery, Queen Elizabeth University Hospital, Glasgow, UK
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Kuetting D, Luetkens J, Faron A, Isaak A, Attenberger U, Pieper CC, Meffert L, Jansen C, Sprinkart A, Kütting F. Evaluation of malignant effusions using MR-based T1 mapping. Sci Rep 2021; 11:7116. [PMID: 33782528 PMCID: PMC8007641 DOI: 10.1038/s41598-021-86632-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 03/12/2021] [Indexed: 11/22/2022] Open
Abstract
Our aim was to investigate the diagnostic yield of rapid T1-mapping for the differentiation of malignant and non-malignant effusions in an ex-vivo set up. T1-mapping was performed with a fast modified Look-Locker inversion-recovery (MOLLI) acquisition and a combined turbo spin-echo and inversion-recovery sequence (TMIX) as reference. A total of 13 titrated albumin-solutions as well as 48 samples (29 ascites/pleural effusions from patients with malignancy; 19 from patients without malignancy) were examined. Samples were classified as malignant-positive histology, malignant-negative histology and non-malignant negative histology. In phantom analysis both mapping techniques correlated with albumin-content (MOLLI: r = − 0.97, TMIX: r = − 0.98). MOLLI T1 relaxation times were shorter in malignancy-positive histology fluids (2237 ± 137 ms) than in malignancy-negative histology fluids (2423 ± 357 ms) as well as than in non-malignant-negative histology fluids (2651 ± 139 ms); post hoc test for all intergroup comparisons: < 0.05. ROC analysis for differentiation between malignant and non-malignant effusions (malignant positive histology vs. all other) showed an (AUC) of 0.89 (95% CI 0.77–0.96). T1 mapping allows for non-invasive differentiation of malignant and non-malignant effusions in an ex-vivo set up.
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Affiliation(s)
- D Kuetting
- Department of Diagnostic and Interventional Radiology, University of Bonn, Venusberg Campus 1, 53105, Bonn, Germany.
| | - J Luetkens
- Department of Diagnostic and Interventional Radiology, University of Bonn, Venusberg Campus 1, 53105, Bonn, Germany
| | - A Faron
- Department of Diagnostic and Interventional Radiology, University of Bonn, Venusberg Campus 1, 53105, Bonn, Germany
| | - A Isaak
- Department of Diagnostic and Interventional Radiology, University of Bonn, Venusberg Campus 1, 53105, Bonn, Germany
| | - U Attenberger
- Department of Diagnostic and Interventional Radiology, University of Bonn, Venusberg Campus 1, 53105, Bonn, Germany
| | - C C Pieper
- Department of Diagnostic and Interventional Radiology, University of Bonn, Venusberg Campus 1, 53105, Bonn, Germany
| | - L Meffert
- Department of Internal Medicine III; Center of Integrated Oncology (CIO) Cologne-Bonn, University of Bonn, Bonn, Germany
| | - C Jansen
- Department of Internal Medicine I, University of Bonn, Bonn, Germany
| | - A Sprinkart
- Department of Diagnostic and Interventional Radiology, University of Bonn, Venusberg Campus 1, 53105, Bonn, Germany
| | - F Kütting
- Clinic for Gastroenterology and Hepatology, University of Cologne, Cologne, Germany
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50
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Luetkens JA, Isaak A, Öztürk C, Mesropyan N, Monin M, Schlabe S, Reinert M, Faron A, Heine A, Velten M, Dabir D, Boesecke C, Strassburg CP, Attenberger U, Zimmer S, Duerr GD, Nattermann J. Cardiac MRI in Suspected Acute COVID-19 Myocarditis. Radiol Cardiothorac Imaging 2021; 3:e200628. [PMID: 33969316 PMCID: PMC8098091 DOI: 10.1148/ryct.2021200628] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Keywords: COVID-19; coronavirus; myocarditis; cardiac MRI; T1 mapping; T2 mapping
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Affiliation(s)
- Julian A Luetkens
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (J.A.L., A.I., N.M., M.R., A.F., D.D., U.A.); Quantitative Imaging Lab Bonn (QILaB) (J.A.L., A.I., N.M., M.R., A.F., D.D.); Department of Internal Medicine II - Cardiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (C.O., S.Z.); Department of Internal Medicine I, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (M.M., S.S., C.B., C.P.S., J.N.); Department of Internal Medicine III-Oncology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (A.H.); Department of Anesthesiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (M.V.); Department of Cardiac Surgery, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (G.D.D.)
| | - Alexander Isaak
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (J.A.L., A.I., N.M., M.R., A.F., D.D., U.A.); Quantitative Imaging Lab Bonn (QILaB) (J.A.L., A.I., N.M., M.R., A.F., D.D.); Department of Internal Medicine II - Cardiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (C.O., S.Z.); Department of Internal Medicine I, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (M.M., S.S., C.B., C.P.S., J.N.); Department of Internal Medicine III-Oncology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (A.H.); Department of Anesthesiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (M.V.); Department of Cardiac Surgery, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (G.D.D.)
| | - Can Öztürk
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (J.A.L., A.I., N.M., M.R., A.F., D.D., U.A.); Quantitative Imaging Lab Bonn (QILaB) (J.A.L., A.I., N.M., M.R., A.F., D.D.); Department of Internal Medicine II - Cardiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (C.O., S.Z.); Department of Internal Medicine I, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (M.M., S.S., C.B., C.P.S., J.N.); Department of Internal Medicine III-Oncology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (A.H.); Department of Anesthesiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (M.V.); Department of Cardiac Surgery, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (G.D.D.)
| | - Narine Mesropyan
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (J.A.L., A.I., N.M., M.R., A.F., D.D., U.A.); Quantitative Imaging Lab Bonn (QILaB) (J.A.L., A.I., N.M., M.R., A.F., D.D.); Department of Internal Medicine II - Cardiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (C.O., S.Z.); Department of Internal Medicine I, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (M.M., S.S., C.B., C.P.S., J.N.); Department of Internal Medicine III-Oncology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (A.H.); Department of Anesthesiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (M.V.); Department of Cardiac Surgery, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (G.D.D.)
| | - Malte Monin
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (J.A.L., A.I., N.M., M.R., A.F., D.D., U.A.); Quantitative Imaging Lab Bonn (QILaB) (J.A.L., A.I., N.M., M.R., A.F., D.D.); Department of Internal Medicine II - Cardiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (C.O., S.Z.); Department of Internal Medicine I, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (M.M., S.S., C.B., C.P.S., J.N.); Department of Internal Medicine III-Oncology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (A.H.); Department of Anesthesiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (M.V.); Department of Cardiac Surgery, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (G.D.D.)
| | - Sefan Schlabe
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (J.A.L., A.I., N.M., M.R., A.F., D.D., U.A.); Quantitative Imaging Lab Bonn (QILaB) (J.A.L., A.I., N.M., M.R., A.F., D.D.); Department of Internal Medicine II - Cardiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (C.O., S.Z.); Department of Internal Medicine I, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (M.M., S.S., C.B., C.P.S., J.N.); Department of Internal Medicine III-Oncology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (A.H.); Department of Anesthesiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (M.V.); Department of Cardiac Surgery, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (G.D.D.)
| | - Matthäus Reinert
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (J.A.L., A.I., N.M., M.R., A.F., D.D., U.A.); Quantitative Imaging Lab Bonn (QILaB) (J.A.L., A.I., N.M., M.R., A.F., D.D.); Department of Internal Medicine II - Cardiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (C.O., S.Z.); Department of Internal Medicine I, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (M.M., S.S., C.B., C.P.S., J.N.); Department of Internal Medicine III-Oncology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (A.H.); Department of Anesthesiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (M.V.); Department of Cardiac Surgery, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (G.D.D.)
| | - Anton Faron
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (J.A.L., A.I., N.M., M.R., A.F., D.D., U.A.); Quantitative Imaging Lab Bonn (QILaB) (J.A.L., A.I., N.M., M.R., A.F., D.D.); Department of Internal Medicine II - Cardiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (C.O., S.Z.); Department of Internal Medicine I, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (M.M., S.S., C.B., C.P.S., J.N.); Department of Internal Medicine III-Oncology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (A.H.); Department of Anesthesiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (M.V.); Department of Cardiac Surgery, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (G.D.D.)
| | - Annkristin Heine
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (J.A.L., A.I., N.M., M.R., A.F., D.D., U.A.); Quantitative Imaging Lab Bonn (QILaB) (J.A.L., A.I., N.M., M.R., A.F., D.D.); Department of Internal Medicine II - Cardiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (C.O., S.Z.); Department of Internal Medicine I, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (M.M., S.S., C.B., C.P.S., J.N.); Department of Internal Medicine III-Oncology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (A.H.); Department of Anesthesiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (M.V.); Department of Cardiac Surgery, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (G.D.D.)
| | - Markus Velten
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (J.A.L., A.I., N.M., M.R., A.F., D.D., U.A.); Quantitative Imaging Lab Bonn (QILaB) (J.A.L., A.I., N.M., M.R., A.F., D.D.); Department of Internal Medicine II - Cardiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (C.O., S.Z.); Department of Internal Medicine I, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (M.M., S.S., C.B., C.P.S., J.N.); Department of Internal Medicine III-Oncology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (A.H.); Department of Anesthesiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (M.V.); Department of Cardiac Surgery, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (G.D.D.)
| | - Darius Dabir
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (J.A.L., A.I., N.M., M.R., A.F., D.D., U.A.); Quantitative Imaging Lab Bonn (QILaB) (J.A.L., A.I., N.M., M.R., A.F., D.D.); Department of Internal Medicine II - Cardiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (C.O., S.Z.); Department of Internal Medicine I, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (M.M., S.S., C.B., C.P.S., J.N.); Department of Internal Medicine III-Oncology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (A.H.); Department of Anesthesiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (M.V.); Department of Cardiac Surgery, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (G.D.D.)
| | - Christoph Boesecke
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (J.A.L., A.I., N.M., M.R., A.F., D.D., U.A.); Quantitative Imaging Lab Bonn (QILaB) (J.A.L., A.I., N.M., M.R., A.F., D.D.); Department of Internal Medicine II - Cardiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (C.O., S.Z.); Department of Internal Medicine I, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (M.M., S.S., C.B., C.P.S., J.N.); Department of Internal Medicine III-Oncology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (A.H.); Department of Anesthesiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (M.V.); Department of Cardiac Surgery, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (G.D.D.)
| | - Christian P Strassburg
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (J.A.L., A.I., N.M., M.R., A.F., D.D., U.A.); Quantitative Imaging Lab Bonn (QILaB) (J.A.L., A.I., N.M., M.R., A.F., D.D.); Department of Internal Medicine II - Cardiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (C.O., S.Z.); Department of Internal Medicine I, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (M.M., S.S., C.B., C.P.S., J.N.); Department of Internal Medicine III-Oncology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (A.H.); Department of Anesthesiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (M.V.); Department of Cardiac Surgery, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (G.D.D.)
| | - Ulrike Attenberger
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (J.A.L., A.I., N.M., M.R., A.F., D.D., U.A.); Quantitative Imaging Lab Bonn (QILaB) (J.A.L., A.I., N.M., M.R., A.F., D.D.); Department of Internal Medicine II - Cardiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (C.O., S.Z.); Department of Internal Medicine I, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (M.M., S.S., C.B., C.P.S., J.N.); Department of Internal Medicine III-Oncology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (A.H.); Department of Anesthesiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (M.V.); Department of Cardiac Surgery, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (G.D.D.)
| | - Sebastian Zimmer
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (J.A.L., A.I., N.M., M.R., A.F., D.D., U.A.); Quantitative Imaging Lab Bonn (QILaB) (J.A.L., A.I., N.M., M.R., A.F., D.D.); Department of Internal Medicine II - Cardiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (C.O., S.Z.); Department of Internal Medicine I, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (M.M., S.S., C.B., C.P.S., J.N.); Department of Internal Medicine III-Oncology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (A.H.); Department of Anesthesiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (M.V.); Department of Cardiac Surgery, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (G.D.D.)
| | - Georg D Duerr
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (J.A.L., A.I., N.M., M.R., A.F., D.D., U.A.); Quantitative Imaging Lab Bonn (QILaB) (J.A.L., A.I., N.M., M.R., A.F., D.D.); Department of Internal Medicine II - Cardiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (C.O., S.Z.); Department of Internal Medicine I, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (M.M., S.S., C.B., C.P.S., J.N.); Department of Internal Medicine III-Oncology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (A.H.); Department of Anesthesiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (M.V.); Department of Cardiac Surgery, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (G.D.D.)
| | - Jacob Nattermann
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (J.A.L., A.I., N.M., M.R., A.F., D.D., U.A.); Quantitative Imaging Lab Bonn (QILaB) (J.A.L., A.I., N.M., M.R., A.F., D.D.); Department of Internal Medicine II - Cardiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (C.O., S.Z.); Department of Internal Medicine I, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (M.M., S.S., C.B., C.P.S., J.N.); Department of Internal Medicine III-Oncology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (A.H.); Department of Anesthesiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (M.V.); Department of Cardiac Surgery, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (G.D.D.)
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