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Schoenbeck D, Sacha A, Niehoff JH, Moenninghoff C, Borggrefe J, Horstmeier S, Surov A, Shahzadi I, Knappe U, Kroeger JR, Michael AE. Imaging of intracranial hemorrhage in photon counting computed tomography using virtual monoenergetic images. Neuroradiology 2024; 66:729-736. [PMID: 38411902 PMCID: PMC11031477 DOI: 10.1007/s00234-024-03308-z] [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: 08/24/2023] [Accepted: 02/08/2024] [Indexed: 02/28/2024]
Abstract
PURPOSE To determine the optimal virtual monoenergetic image (VMI) for detecting and assessing intracranial hemorrhage in unenhanced photon counting CT of the head based on the evaluation of quantitative and qualitative image quality parameters. METHODS Sixty-three patients with acute intracranial hemorrhage and unenhanced CT of the head were retrospectively included. In these patients, 35 intraparenchymal, 39 intraventricular, 30 subarachnoidal, and 43 subdural hemorrhages were selected. VMIs were reconstructed using all available monoenergetic reconstruction levels (40-190 keV). Multiple regions of interest measurements were used for evaluation of the overall image quality, and signal, noise, signal-to-noise-ratio (SNR), and contrast-to-noise-ratio (CNR) of intracranial hemorrhage. Based on the results of the quantitative analysis, specific VMIs were rated by five radiologists on a 5-point Likert scale. RESULTS Signal, noise, SNR, and CNR differed significantly between different VMIs (p < 0.001). Maximum CNR for intracranial hemorrhage was reached in VMI with keV levels > 120 keV (intraparenchymal 143 keV, intraventricular 164 keV, subarachnoidal 124 keV, and subdural hemorrhage 133 keV). In reading, no relevant superiority in the detection of hemorrhage could be demonstrated using VMIs above 66 keV. CONCLUSION For the detection of hemorrhage in unenhanced CT of the head, the quantitative analysis of the present study on photon counting CT is generally consistent with the findings from dual-energy CT, suggesting keV levels just above 120 keV and higher depending on the location of the hemorrhage. However, on the basis of the qualitative analyses, no reliable statement can yet be made as to whether an additional VMI with higher keV is truly beneficial in everyday clinical practice.
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Affiliation(s)
- Denise Schoenbeck
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Bochum, Germany
- Johannes Wesling University Hospital By Muehlenkreiskliniken AöR, Hans-Nolte-Straße 1, 32429, Minden, Germany
| | - Alexander Sacha
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Bochum, Germany
- Johannes Wesling University Hospital By Muehlenkreiskliniken AöR, Hans-Nolte-Straße 1, 32429, Minden, Germany
| | - Julius Henning Niehoff
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Bochum, Germany
- Johannes Wesling University Hospital By Muehlenkreiskliniken AöR, Hans-Nolte-Straße 1, 32429, Minden, Germany
| | - Christoph Moenninghoff
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Bochum, Germany
- Johannes Wesling University Hospital By Muehlenkreiskliniken AöR, Hans-Nolte-Straße 1, 32429, Minden, Germany
| | - Jan Borggrefe
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Bochum, Germany
- Johannes Wesling University Hospital By Muehlenkreiskliniken AöR, Hans-Nolte-Straße 1, 32429, Minden, Germany
| | - Sebastian Horstmeier
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Bochum, Germany
- Johannes Wesling University Hospital By Muehlenkreiskliniken AöR, Hans-Nolte-Straße 1, 32429, Minden, Germany
| | - Alexey Surov
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Bochum, Germany
- Johannes Wesling University Hospital By Muehlenkreiskliniken AöR, Hans-Nolte-Straße 1, 32429, Minden, Germany
| | - Iram Shahzadi
- Siemens Healthineers GmbH, Henkestr. 127, 91052, Erlangen, Germany
| | - Ulrich Knappe
- Johannes Wesling University Hospital By Muehlenkreiskliniken AöR, Hans-Nolte-Straße 1, 32429, Minden, Germany
- Department of Neurosurgery, Johannes Wesling University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Jan Robert Kroeger
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Bochum, Germany
- Johannes Wesling University Hospital By Muehlenkreiskliniken AöR, Hans-Nolte-Straße 1, 32429, Minden, Germany
| | - Arwed Elias Michael
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Bochum, Germany.
- Johannes Wesling University Hospital By Muehlenkreiskliniken AöR, Hans-Nolte-Straße 1, 32429, Minden, Germany.
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Zimmermann S, Mathew A, Schöppe R, Mangova G, Biemann R, Surov A, Meyer HJ, Isermann B. Fat tissue quantity, waist circumference or waist-to-hip ratio in patients with chronic kidney disease: A systematic review and meta-analysis. Obes Res Clin Pract 2024:S1871-403X(24)00034-6. [PMID: 38582736 DOI: 10.1016/j.orcp.2024.03.007] [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: 01/03/2024] [Revised: 01/13/2024] [Accepted: 03/23/2024] [Indexed: 04/08/2024]
Abstract
The BMI predicts mortality and cardiovascular disease (CVD) in the general population, while in patients with end-stage chronic kidney disease (CKD) a high BMI is associated with improved survival, a phenomenon referred to as the "obesity paradox". While BMI is easy to determine and helps to categorize patients, it does not differentiate between fat tissue, lean tissue and bone mass. As the BMI may be altered in CKD, e.g. by muscle wasting, we determined in this meta-analysis (i) the association of mortality with fat tissue quantity in CKD and (ii) the association of mortality with abdominal obesity (as measured by waist circumference (WC) or waist-to-hip ratio (WHR)) in CKD. We systematically reviewed databases for prospective or retrospective cohort studies. In eleven studies with 23,523 patients the association between mortality and high fat tissue quantity in CKD was calculated. The pooled hazard ratio (HR) for this association in the CKD group in the dialysis group 0.91 (CI 0.84- 0.98, p = 0.01) which is comparable to the HR for the association with BMI. The HR in patients without dialysis was 0.7 (95% CI 0.53- 0.93, p = 0.01), suggesting a better risk prediction of high fat tissue content with mortality as compared to higher BMI with mortality in patients with CKD without dialysis. Importantly, both BMI and fat tissue quantity in CKD are described by the "obesity paradox": the higher the fat tissue content or BMI, the lower the mortality risk. In thirteen studies with 55,175 patients the association between mortality and high WC or WHR in CKD (with or without dialysis) was calculated. We observed, that the HR in the WHR group was 1.31 (CI 1.08-1.58, p = 0.007), whereas the overall hazard ratio of both groups was 1.09 (CI 1.01-1.18, p = 0.03), indicating that a higher abdominal obesity as measured by WHR is associated with higher mortality in CKD. Our analysis suggests gender-specific differences, which need larger study numbers for validation. This meta-analysis confirms the obesity paradox in CKD using fat tissue quantity as measure and further shows that using abdominal obesity measurements in the routine in obese CKD patients might allow better risk assessment than using BMI or fat tissue quantity. Comparable to the overall population, here, the higher the WHR, the higher the mortality risk.
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Affiliation(s)
- Silke Zimmermann
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University of Leipzig, Leipzig, Germany.
| | - Akash Mathew
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University of Leipzig, Leipzig, Germany
| | - Robert Schöppe
- Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Gyulten Mangova
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University of Leipzig, Leipzig, Germany
| | - Ronald Biemann
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University of Leipzig, Leipzig, Germany
| | - Alexey Surov
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University, Bochum, Germany
| | - Hans-Jonas Meyer
- Department of Diagnostic and Interventional Radiology, University of Leipzig, Leipzig, Germany
| | - Berend Isermann
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University of Leipzig, Leipzig, Germany
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Stojkova M, Behme D, Barajas Ordonez F, Christ SM, March C, Surov A, Thormann M. Evaluation of brain metastasis edema in breast cancer patients as a marker for Ki-67 and cell count-A single center analysis. Neuroradiol J 2024; 37:178-183. [PMID: 38131219 DOI: 10.1177/19714009231224443] [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] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Peritumoral edema is an important cause of morbidity and mortality in patients with breast cancer brain metastases (BCBM). The relationship between vasogenic edema and proliferation indices or cell density in BCBM remains poorly understood. PURPOSE To assess the association between tumor volume and peritumoral edema volume and histopathological and immunohistochemical parameters in BCBM. MATERIALS AND METHODS Patients with confirmed BCBM were retrospectively identified. The tumor volume and peritumoral edema volume of each brain metastasis (BM) were semi-automatically calculated in axial T2w and axial T2-fluid attenuated inversion recovery (FLAIR) sequences using the software MIM (Cleveland, Ohio, USA). Edema volume was correlated with histological parameters, including cell count and Ki-67. Sub-analyses were conducted for luminal B, Her2-positive, and tripe negative subgroups. RESULTS Thirty-eight patients were included in the study. There were 24 patients with a single BM. Mean metastasis volume was 31.40 ± 32.52 mL and mean perifocal edema volume was 72.75 ± 58.85 mL. In the overall cohort, no correlation was found between tumor volume and Ki-67 (r = 0.046, p = .782) or cellularity (r = 0.028, p = .877). Correlation between edema volume and Ki-67 was r = 0.002 (p = .989), correlation with cellularity was r = 0.137 (p = .453). No relevant correlation was identified in any subgroup analysis. There was no relevant correlation between BM volume and edema volume. CONCLUSION In patients with breast cancer brain metastases, we did not find linear associations between edema volumes and immunohistochemical features reflecting proliferation potential. Furthermore, there was no relevant correlation between metastasis volume and edema volume.
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Affiliation(s)
- Marija Stojkova
- Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
| | - Daniel Behme
- Clinic for Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany
| | - Felix Barajas Ordonez
- Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
| | - Sebastian M Christ
- Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland
| | - Christine March
- Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
| | - Alexey Surov
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Maximilian Thormann
- Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
- Clinic for Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany
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Surov A, Meyer HJ, Ehrengut C, Zimmermann S, Schramm D, Hinnerichs M, Bär C, Borggrefe J. Myosteatosis predicts short-term mortality in patients with COVID-19: A multicenter analysis. Nutrition 2024; 120:112327. [PMID: 38341908 DOI: 10.1016/j.nut.2023.112327] [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: 06/20/2023] [Revised: 10/29/2023] [Accepted: 12/06/2023] [Indexed: 02/13/2024]
Abstract
OBJECTIVES Body composition on computed tomography can predict prognosis in patients with COVID-19. The reported data are based on small retrospective studies. The aim of the present study was to analyze the prognostic relevance of skeletal muscle parameter derived from chest computed tomography for prediction of 30-d mortality in patients with COVID-19 in a multicenter setting. METHODS The clinical databases of three centers were screened for patients with COVID-19 between 2020 and 2022. Overall, 447 patients (142 female; 31.7%) were included into the study. The mean age at the time of computed tomography acquisition was 63.8 ± 14.7 y and median age was 65 y. Skeletal muscle area and skeletal muscle density were defined on level T12 of the chest. RESULTS Overall, 118 patients (26.3%) died within the 30-d observation period. Of the patient sample, 255 patients (57.0%) were admitted to an intensive care unit and 122 patients needed mechanical ventilation (27.3%). The mean skeletal muscle area of all patients was 96.1 ± 27.2 cm² (range = 23.2-200.7 cm²). For skeletal muscle density, the mean was 24.3 ± 11.1 Hounsfield units (range = -5.6 to 55.8 Hounsfield units). In survivors, the mean skeletal muscle density was higher compared with the lethal cases (mean 25.8 ± 11.2 versus 20.1 ± 9.6; P < 0.0001). Presence of myosteatosis was independently associated with 30-d mortality: odds ratio = 2.72 (95% CI, 1.71-4.32); P = 0.0001. CONCLUSIONS Myosteatosis is strongly associated with 30-d mortality in patients COVID-19. Patients with COVID-19 with myosteatosis should be considered a risk group.
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Affiliation(s)
- Alexey Surov
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling Medical Center, Ruhr University Bochum, Germany.
| | - Hans Jonas Meyer
- Department of Diagnostic and Interventional Radiology, University of Leipzig, Leipzig, Germany
| | - Constantin Ehrengut
- Department of Diagnostic and Interventional Radiology, University of Leipzig, Leipzig, Germany
| | - Silke Zimmermann
- Department of Laboratory Medicine, University of Leipzig, Leipzig, Germany
| | - Dominik Schramm
- Department of Diagnostic and Interventional Radiology, University of Halle-Wittenberg, Halle (Saale), Germany
| | - Mattes Hinnerichs
- Department of Radiology and Nuclear Medicine, Otto von Guericke University, Magdeburg, Germany
| | - Caroline Bär
- Department of Radiology and Nuclear Medicine, Otto von Guericke University, Magdeburg, Germany
| | - Jan Borggrefe
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling Medical Center, Ruhr University Bochum, Germany
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Woeltjen MM, Niehoff JH, Roggel R, Michael AE, Gerdes B, Surov A, Borggrefe J, Kroeger JR. Pancreatic cancer in photon-counting CT: Low keV virtual monoenergetic images improve tumor conspicuity. Eur J Radiol 2024; 173:111374. [PMID: 38422607 DOI: 10.1016/j.ejrad.2024.111374] [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: 11/13/2023] [Revised: 02/07/2024] [Accepted: 02/14/2024] [Indexed: 03/02/2024]
Abstract
PURPOSE OF THE STUDY The aim of the study was to identify differences in the tumor conspicuity of pancreatic adenocarcinomas in different monoenergetic or polyenergetic reconstructions and contrast phases in photon-counting CT (PCCT). MATERIAL AND METHODS 34 patients were retrospectively enrolled in this study. Quantitative image analysis was performed with region of interest (ROI) measurements in different monoenergetic levels ranging from 40 up to 70 keV (5-point steps) and polyenergetic series. Tumor-parenchyma attenuation differences and contrast-to-noise-ratio (CNR) were calculated. A qualitative image analysis was accomplished by 4 radiologists using a 5-point Likert scale (1 = "not recognizable" up to 5 = "easy recognizable"). Differences between groups were evaluated for statistical significance using the Friedman test and in case of significant differences pair-wise post-hoc testing with Bonferroni correction was applied. RESULTS Tumor-parenchyma attenuation difference was significantly different between the different image reconstructions for both arterial- and portal-venous-phase-images (p < 0.001). Tumor-parenchyma attenuation difference was significantly higher on arterial-phase-images at mono40keV compared to polyenergetic images (p < 0.001) and mono55keV images or higher (p < 0.001). For portal-venous-phase-images tumor-parenchyma attenuation difference was significantly higher on mono40keV images compared to polyenergetic images (p < 0.001) and mono50keV images (p = 0.03) or higher (p < 0.001). The same trend was seen for CNR. Tumor conspicuity was rated best on mono40keV images with 4.3 ± 0.9 for arterial-phase-images and 4.3 ± 1.1 for portal-venous-phase-images. In contrast, overall image quality was rated best on polyenergetic-images with 4.8 ± 0.5 for arterial-phase-images and 4.7 ± 0.6 for portal-venous-phase-images. CONCLUSION Low keV virtual monoenergetic images significantly improve the tumor conspicuity of pancreatic adenocarcinomas in PCCT based on quantitative and qualitative results. On the other hand, readers prefer polyenergetic images for overall image quality.
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Affiliation(s)
- Matthias Michael Woeltjen
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Bochum, Germany.
| | - Julius Henning Niehoff
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Ruth Roggel
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Arwed Elias Michael
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Berthold Gerdes
- Department of General-, Visceral-, Thoracic- and Endocrine Surgery, Johannes Wesling University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Alexey Surov
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Jan Borggrefe
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Jan Robert Kroeger
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Bochum, Germany
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Surov A, Borggrefe J. In reply to the letter to the editor regarding: Sarcopenia is a predictor of patient death in acute ischemic stroke. J Stroke Cerebrovasc Dis 2024; 33:107565. [PMID: 38214241 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Accepted: 01/08/2024] [Indexed: 01/13/2024] Open
Affiliation(s)
- Alexey Surov
- Univ. Prof. Dr. med. Alexey Surov, Universitätsinstitut für Radiologie, Neuroradiologie und Nuklearmedizin, Johannes Wesling Universitätsklinikum Minden, Ruhr Universität Bochum, Hans-Nolte Str. 1, 32429 Minden, Germany.
| | - Jan Borggrefe
- Univ. Prof. Dr. med. Jan Borggrefe, Universitätsinstitut für Radiologie, Neuroradiologie und Nuklearmedizin, Johannes Wesling Universitätsklinikum Minden, Ruhr Universität Bochum, Hans-Nolte Str. 1, 32429 Minden, Germany.
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Elias Michael A, Schoenbeck D, Michael Woeltjen M, Boriesosdick J, Henning Niehoff J, Surov A, Borggrefe J, Schmidt B, Panknin C, Hickethier T, Maintz D, Christian Bunck A, Johannes Gertz R, Robert Kroeger J. Photon counting computed tomography of in-stent-stenosis in a phantom: Optimal virtual monoenergetic imaging in ultra high resolution. Heliyon 2024; 10:e27636. [PMID: 38509988 PMCID: PMC10950599 DOI: 10.1016/j.heliyon.2024.e27636] [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: 01/03/2024] [Revised: 02/12/2024] [Accepted: 03/04/2024] [Indexed: 03/22/2024] Open
Abstract
Rationale and objectives Coronary computed tomography angiography (CCTA) is becoming increasingly important for the diagnostic workup of coronary artery disease, nevertheless, imaging of in-stent stenosis remains challenging. For the first time, spectral imaging in Ultra High Resolution (UHR) is now possible in clinically available photon counting CT. The aim of this work is to determine the optimal virtual monoenergetic image (VMI) for imaging in-stent stenoses in cardiac stents. Materials and methods 6 stents with inserted hypodense stenoses were scanned in an established phantom in UHR mode. Images were reconstructed with 3 different kernels for spectral data (Qr56, Qr64, Qr72) with varying levels of sharpness. Based on region of interest (ROI) measurements image quality parameters including contrast-to-noise ratio (CNR) were analyzed for all available VMI (40 keV-190 keV). Finally, based on quantitative results and VMI used in clinical routine, a set of VMI was included in a qualitative reading. Results CNR showed significant variations across different keV levels (p < 0.001). Due to reduced noise there was a focal maximum in the VMI around 65 keV. The peak values were observed for kernel Qr56 at 116 keV with 19.47 ± 8.67, for kernel Qr64 at 114 keV with 13.56 ± 6.58, and for kernel Qr72 at 106 keV with 12.19 ± 3.25. However, in the qualitative evaluation the VMI with lower keV (55 keV) performed best. Conclusions Based on these experimental results, a photon counting CCTA in UHR with stents should be reconstructed with the Qr72 kernel for the assessment of in-stent stenoses, and a VMI 55 keV should be computed for the evaluation.
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Affiliation(s)
- Arwed Elias Michael
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Denise Schoenbeck
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Matthias Michael Woeltjen
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Jan Boriesosdick
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Julius Henning Niehoff
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Alexey Surov
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Jan Borggrefe
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Bochum, Germany
| | | | | | - Tilman Hickethier
- Institute for Diagnostic and Interventional Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - David Maintz
- Institute for Diagnostic and Interventional Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Alexander Christian Bunck
- Institute for Diagnostic and Interventional Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Roman Johannes Gertz
- Institute for Diagnostic and Interventional Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Jan Robert Kroeger
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Bochum, Germany
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Melekh O, Barajas Ordonez F, Melekh B, Rodríguez-Feria P, Pech M, Flintrop W, Surov A. Association between sacroiliac joint forms and subchondral changes in patients with Crohn's disease. Int J Rheum Dis 2024; 27:e15046. [PMID: 38414165 DOI: 10.1111/1756-185x.15046] [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: 08/09/2023] [Revised: 12/30/2023] [Accepted: 01/11/2024] [Indexed: 02/29/2024]
Abstract
AIM To assess the relationship between anatomical variants of sacroiliac joint (SIJ) and subchondral changes detected in magnetic resonance enterography (MRE) in patients with Crohn's disease (CD). METHODS This was a retrospective study of 60 CD patients, who were divided into two groups: with (n = 16) and without SIJ (n = 44) involvement, depending on the presence of inflammatory (bone marrow edema) and structural changes (sclerosis and erosions) in MRE. Anatomical variants of SIJ were assessed in CT of the abdomen and/or pelvis, distinguishing typical form with convex iliac surface and atypical forms. Univariate and multivariate analyses were performed to reveal an association between joint changes and forms. RESULTS Our study included 60 patients (38 males; mean age 38.72 years ± 13.33). Patients with SIJ changes were older (p = .044). No significant differences in CD localization and behavior were found. The most common SIJ lesions were structural changes (in 75% of patients); the main atypical form was the iliosacral complex. The univariate and multivariate analyses showed a significant association of atypical forms with total subchondral changes (odds ratio [OR]: 3.429, 95% confidence interval [CI] 1.043-11.268; p = .042; OR: 5.066, 95% CI: 1.273-20.167; p = .021, respectively), and with structural changes (OR: 4.185, 95% CI: 1.155-15.160; p = .029; OR: 5.986, 95% CI: 1.293-27.700; p = .022, respectively). CONCLUSION Atypical forms of SIJ are a risk factor for the occurrence of structural joint changes in CD patients. An association between bone marrow edema and atypical forms was not found.
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Affiliation(s)
- Oksana Melekh
- University Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
| | - Felix Barajas Ordonez
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH, Aachen, Germany
| | - Bohdan Melekh
- University Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
| | - Pablo Rodríguez-Feria
- Department of International Health, CAPHRI - Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Maciej Pech
- University Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
| | - Wiebke Flintrop
- Department of Pediatrics, University Hospital Magdeburg, Magdeburg, Germany
| | - Alexey Surov
- Institute for Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital by Muehlenkreiskliniken, Ruhr University Bochum, Minden, Germany
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Surov A, Diallo-Danebrock R, Radi A, Kröger JR, Niehoff JH, Michael AE, Gerdes B, Elhabash S, Wienke A, Borggrefe J. Photon Counting Computed Tomography in Rectal Cancer: Associations Between Iodine Concentration, Histopathology and Treatment Response: A Pilot Study. Acad Radiol 2024:S1076-6332(24)00076-X. [PMID: 38418345 DOI: 10.1016/j.acra.2024.02.006] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 01/29/2024] [Accepted: 02/04/2024] [Indexed: 03/01/2024]
Abstract
RATIONALE AND OBJECTIVES Common computed tomography (CT) investigation plays a limited role in characterizing and assessing the response of rectal cancer (RC) to neoadjuvant radiochemotherapy (NARC). Photon counting computed tomography (PCCT) improves the imaging quality and can provide multiparametric spectral image information including iodine concentration (IC). Our purpose was to analyze associations between IC and histopathology in RC and to evaluate the role of IC in response prediction to NARC. MATERIALS AND METHODS Overall, 41 patients were included into the study, 14 women and 27 men, mean age, 65.5 years. PCCT in a portal venous phase of the abdomen was performed. In every case, a polygonal region of interest (ROI) was manually drawn on iodine maps. Normalized IC (NIC) was also calculated. Tumor stage, grade, lymphovascular invasion, circumferential resection margin, and tumor markers were analyzed. Tumor regression grade (absence/presence of tumor cells) after NARC was analyzed. NIC values in groups were compared to Mann-Whitney-U tests. Sensitivity, specificity, and area under the curve values were calculated. Intraclass correlation coefficient (ICC) was calculated. RESULTS ICC was 0.93, 95%CI= (0.88; 0.96). Tumors with lymphovascular invasion showed higher NIC values in comparison to those without (p = 0.04). Tumors with response grade 2-4 showed higher pretreatment NIC values in comparison to lesions with response grade 0-1 (p = 0.01). A NIC value of 0.36 and higher can predict response grade 2-4 (sensitivity, 73.9%; specificity, 91.7%; area under the curve, 0.85). CONCLUSION NIC values showed an excellent interreader agreement in RC. NIC can predict treatment response to NARC.
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Affiliation(s)
- Alexey Surov
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital Minden, Ruhr University Bochum, Hans-Nolte-Str. 1, Minden 32429, Germany.
| | - Raihanatou Diallo-Danebrock
- Department of Pathology, Johannes Wesling University Hospital Minden, Ruhr University Bochum, Hans-Nolte-Str. 1, Minden 32429, Germany
| | - Amin Radi
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital Minden, Ruhr University Bochum, Hans-Nolte-Str. 1, Minden 32429, Germany
| | - Jan Robert Kröger
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital Minden, Ruhr University Bochum, Hans-Nolte-Str. 1, Minden 32429, Germany
| | - Julius Henning Niehoff
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital Minden, Ruhr University Bochum, Hans-Nolte-Str. 1, Minden 32429, Germany
| | - Arwed Elias Michael
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital Minden, Ruhr University Bochum, Hans-Nolte-Str. 1, Minden 32429, Germany
| | - Berthold Gerdes
- Department of General Surgery, Johannes Wesling University Hospital Minden, Ruhr University Bochum, Hans-Nolte-Str. 1, Minden 32429, Germany
| | - Saleem Elhabash
- Department of General Surgery, Johannes Wesling University Hospital Minden, Ruhr University Bochum, Hans-Nolte-Str. 1, Minden 32429, Germany
| | - Andreas Wienke
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Jan Borggrefe
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital Minden, Ruhr University Bochum, Hans-Nolte-Str. 1, Minden 32429, Germany
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Barajas Ordonez F, Wolleschak D, Zeller Y, Hinnerichs M, Rodríguez-Feria P, Aghayev A, Mikusko M, Borggrefe J, Mougiakakos D, Surov A. Parameters of body composition do not predict survival in patients with multiple myeloma undergoing autologous stem cell transplantation. Leuk Lymphoma 2024:1-8. [PMID: 38384127 DOI: 10.1080/10428194.2024.2319226] [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: 07/20/2023] [Accepted: 02/10/2024] [Indexed: 02/23/2024]
Abstract
Studies regarding the influence of body composition parameters as predictors on overall survival (OS) in patients with multiple myeloma (MM) are scarce. OS and progression-free survival (PFS) were retrospectively assessed in 129 patients with MM undergoing autologous stem cell transplantation (ASCT) after a follow-up of 2 years. A computed tomography (CT) based semi-automated assessment of body composition was performed. No statistically significant differences were noted in 2-year OS, PFS, or post-transplant adverse events in the body composition groups of subcutaneous adipose tissue (SAT) (low vs. high-SAT), visceral adipose tissue (VAT) (low vs. high-VAT), visceral-to-subcutaneous fat ratio (VSR) (low vs. high VSR), and sarcopenia in terms of skeletal muscle index (SMI) (non-sarcopenic vs. sarcopenic). In conclusion, adipose and muscle tissue do not limit OS or affect the PFS in patients with MM undergoing ASCT.
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Affiliation(s)
- Felix Barajas Ordonez
- University Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH, Aachen, Germany
| | - Denise Wolleschak
- Department of Hematology and Oncology, University Hospital Magdeburg, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Yannic Zeller
- University Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Mattes Hinnerichs
- University Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Pablo Rodríguez-Feria
- Department of International Health, CAPHRI - Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Anar Aghayev
- University Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Martin Mikusko
- Department of Hematology and Oncology, University Hospital Magdeburg, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Jan Borggrefe
- Institute for Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital by Muehlenkreiskliniken, Ruhr University Bochum, Minden, Germany
| | - Dimitrios Mougiakakos
- Department of Hematology and Oncology, University Hospital Magdeburg, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Alexey Surov
- Institute for Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital by Muehlenkreiskliniken, Ruhr University Bochum, Minden, Germany
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Shahzadi I, Tamersoy B, Frohwein LJ, Subramanian S, Moenninghoff C, Niehoff JH, Kroeger JR, Surov A, Borggrefe J. Automated Patient Registration in Magnetic Resonance Imaging Using Deep Learning-Based Height and Weight Estimation with 3D Camera: A Feasibility Study. Acad Radiol 2024:S1076-6332(24)00050-3. [PMID: 38368163 DOI: 10.1016/j.acra.2024.01.029] [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: 09/20/2023] [Revised: 01/16/2024] [Accepted: 01/22/2024] [Indexed: 02/19/2024]
Abstract
RATIONALE AND OBJECTIVES Accurate and efficient estimation of patient height and weight is crucial to ensure patient safety and optimize the quality of magnetic resonance imaging (MRI) procedures. Several height and weight estimation methods have been proposed for use in adult patient management, but none is widely established. Estimation by the medical technologists for radiology (MTR) based on personal experience remains to be the most common method. This study aimed to compare a novel deep learning (DL)-based 3-dimensional (3D) camera estimation method to MTR staff in terms of estimation accuracy. METHODS A retrospective study was conducted to compare the accuracy of height and weight estimation with a DL-based 3D camera algorithm to the accuracy of height and weight estimation by the MTR. Depth images of the patients were captured during the regular imaging workflow on a low field 0.55 T MRI scanner (MAGNETOM Free.Max, Siemens Healthineers, Erlangen, Germany) and then processed retrospectively. Depth images of a total of 161 patients were used to validate the accuracy of the height and weight estimation algorithm. The accuracy of each estimation method was evaluated by computing the proportions of the estimates within 5% and 15% of actual height (PH05, PH15) and within 10% and 20% of actual weight (PW10, PW20). An acceptable accuracy for height estimation was predetermined to be PH05 = 95% and PH15 = 99% and an acceptable accuracy for weight estimation was predetermined to be PW10 = 70% and PW20 = 95%. The bias in height and weight estimation was measured by the mean absolute percentage error (MAPE). RESULTS The retrospective study included 161 adult patients. For 148/161 patients complying with inclusion criteria, DL-based 3D camera algorithm outperformed the MTR in estimating the patient's height and weight in term of accuracy (3D camera: PH05 =98.6%, PH15 =100%, PW10 =85.1%, PW20 =95.9%; MTR: PH05 =92.5%, PH15 =100%, PW10 =75.0%, PW20 =93.2%). MTR had a slightly higher bias in their estimates compared to the DL-based 3D camera algorithm (3D camera: MAPE height=1.8%, MAPE weight=5.6%, MTR: MAPE height=2.2%, MAPE weight=7.5%) CONCLUSION: This study has demonstrated that the estimation of the patient's height and weight by a DL-based 3D camera algorithm is accurate and robust. It has the potential to complement the regular MRI workflows, by providing further automation during patient registration.
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Affiliation(s)
- Iram Shahzadi
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Bochum, Germany; Siemens Healthineers GmbH, Erlangen, Germany
| | | | | | | | - Christoph Moenninghoff
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Julius Henning Niehoff
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Jan Robert Kroeger
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Alexey Surov
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Jan Borggrefe
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Bochum, Germany.
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Saeed S, Niehoff JH, Boriesosdick J, Michael A, Woeltjen MM, Surov A, Moenninghoff C, Borggrefe J, Kroeger JR. Minimizing Contrast Media Dose in CT Pulmonary Angiography with Clinical Photon Counting Using High Pitch Technique. Acad Radiol 2024; 31:686-692. [PMID: 37393176 DOI: 10.1016/j.acra.2023.05.018] [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: 03/09/2023] [Revised: 05/15/2023] [Accepted: 05/16/2023] [Indexed: 07/03/2023]
Abstract
RATIONALE AND OBJECTIVES To evaluate the potential to reduce the amount of iodinated contrast media (CM) for computer tomographic pulmonary angiography (CTPA) with a novel photon-counting-detector CT (PCCT). MATERIALS AND METHODS Overall, 105 patients referred for CTPA were retrospectively included in this study. CTPA was performed using bolus tracking and high-pitch dual-source scanning (FLASH mode) on a novel PCCT (Naeotom Alpha, Siemens Healthineers). CM (Accupaque 300, GE Healthcare) dose was lowered stepwise following the introduction of the new CT scanner. Thus, patients could be divided into 3 groups as follows: group 1, n = 29, 35 ml of CM; group 2, n = 62, 45 ml of CM and group 3, n = 14, 60 ml of CM. Four readers independently assessed the image quality (Likert-scale 1-5) and adequate assessment of the segmental pulmonary arteries. Additionally, the pulmonary arterial contrast opacification was measured. RESULTS The subjective image quality was rated highest in group 1 with 4.6 compared to 4.5 (group 2) and 4.1 (group 3) with a significant difference between groups 1 and 3 (p < 0.001) and between groups 2 and 3 (p = 0.003). In all groups, almost all segmental pulmonary arteries could be assessed adequately without significant differences (18.5 vs. 18.7 vs. 18.4). Mean attenuation in the pulmonary trunk did not differ significantly between groups 321 ± 92 HU versus 345 ± 93 HU versus 347 ± 88 HU (p = 0.69). CONCLUSION Significant CM dose reduction is possible without a reduction in image quality. PCCT enables diagnostic CTPA with 35 ml of CM.
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Affiliation(s)
- Saher Saeed
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Bochum, Germany.
| | - Julius H Niehoff
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Jan Boriesosdick
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Arwed Michael
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Matthias M Woeltjen
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Alexey Surov
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Christoph Moenninghoff
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Jan Borggrefe
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Jan Robert Kroeger
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Bochum, Germany
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13
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Surov A, Meyer HJ, Hinnerichs M, Ferraro V, Zeremski V, Mougiakakos D, Saalfeld S, Wienke A, Strobel A, Wolleschak D. CT-defined sarcopenia predicts treatment response in primary central nervous system lymphomas. Eur Radiol 2024; 34:790-796. [PMID: 37178198 DOI: 10.1007/s00330-023-09712-y] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 02/13/2023] [Accepted: 03/12/2023] [Indexed: 05/15/2023]
Abstract
OBJECTIVE Body composition assessment derived from cross-sectional imaging has shown promising results as a prognostic biomarker in several tumor entities. Our aim was to analyze the role of low skeletal muscle mass (LSMM) and fat areas for prognosis of dose-limiting toxicity (DLT) and treatment response in patients with primary central nervous system lymphoma (PCNSL). METHODS Overall, 61 patients (29 female patients, 47.5%) with a mean age of 63.8 ± 12.2 years, range 23-81 years, were identified in the data base between 2012 and 2020 with sufficient clinical and imaging data. Body composition assessment, comprising LSMM and visceral and subcutaneous fat areas, was performed on one axial slice on L3-height derived from staging computed tomography (CT) images. DLT was assessed during chemotherapy in clinical routine. Objective response rate (ORR) was measured on following magnetic resonance images of the head accordingly to the Cheson criteria. RESULTS Twenty-eight patients had DLT (45.9%). Regression analysis revealed that LSMM was associated with objective response, OR = 5.19 (95% CI 1.35-19.94, p = 0.02) (univariable regression), and OR = 4.23 (95% CI 1.03- 17.38, p = 0.046) (multivariable regression). None of the body composition parameters could predict DLT. Patients with normal visceral to subcutaneous ratio (VSR) could be treated with more chemotherapy cycles compared to patients with high VSR (mean, 4.25 vs 2.94, p = 0.03). Patients with ORR had higher muscle density values compared to patients with stable and/or progressive disease (34.46 ± vs 28.18 ± HU, p = 0.02). CONCLUSIONS LSMM is strongly associated with objective response in patients with PCNSL. Body composition parameters cannot predict DLT. CLINICAL RELEVANCE STATEMENT Low skeletal muscle mass on computed tomography (CT) is an independent prognostic factor of poor treatment response in central nervous system lymphoma. Analysis of the skeletal musculature on staging CT should be implemented into the clinical routine in this tumor entity. KEY POINTS • Low skeletal muscle mass is strongly associated with the objective response rate. • No body composition parameters could predict dose-limiting toxicity.
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Affiliation(s)
- Alexey Surov
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University, Bochum, Germany.
- Department of Radiology and Nuclear Medicine, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany.
| | - Hans Jonas Meyer
- Department of Radiology, University of Leipzig, Leipzig, Germany
| | - Mattes Hinnerichs
- Department of Radiology and Nuclear Medicine, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
| | - Vincenzo Ferraro
- Department of Radiology and Nuclear Medicine, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
| | - Vanja Zeremski
- Department of Hematology and Oncology, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
| | - Dimitrios Mougiakakos
- Department of Hematology and Oncology, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
| | - Sylvia Saalfeld
- Department for Simulation and Graphics, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
- Research Campus STIMULATE, Magdeburg, Germany
| | - Andreas Wienke
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Alexandra Strobel
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Denise Wolleschak
- Department of Hematology and Oncology, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
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Surov A, Niehoff JH. Bone Marrow Edema at Photon-Counting CT. Radiology 2024; 310:e231878. [PMID: 38376406 DOI: 10.1148/radiol.231878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Affiliation(s)
- Alexey Surov
- From the Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Hans-Nolte-Straße 1, 32429 Minden, Germany
| | - Julius Henning Niehoff
- From the Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Hans-Nolte-Straße 1, 32429 Minden, Germany
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15
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Klemenz AC, Albrecht L, Manzke M, Dalmer A, Böttcher B, Surov A, Weber MA, Meinel FG. Improved image quality in CT pulmonary angiography using deep learning-based image reconstruction. Sci Rep 2024; 14:2494. [PMID: 38291105 PMCID: PMC10827738 DOI: 10.1038/s41598-024-52517-2] [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: 11/20/2023] [Accepted: 01/19/2024] [Indexed: 02/01/2024] Open
Abstract
We investigated the effect of deep learning-based image reconstruction (DLIR) compared to iterative reconstruction on image quality in CT pulmonary angiography (CTPA) for suspected pulmonary embolism (PE). For 220 patients with suspected PE, CTPA studies were reconstructed using filtered back projection (FBP), adaptive statistical iterative reconstruction (ASiR-V 30%, 60% and 90%) and DLIR (low, medium and high strength). Contrast-to-noise ratio (CNR) served as the primary parameter of objective image quality. Subgroup analyses were performed for normal weight, overweight and obese individuals. For patients with confirmed PE (n = 40), we further measured PE-specific CNR. Subjective image quality was assessed independently by two experienced radiologists. CNR was lowest for FBP and enhanced with increasing levels of ASiR-V and, even more with increasing strength of DLIR. High strength DLIR resulted in an additional improvement in CNR by 29-67% compared to ASiR-V 90% (p < 0.05). PE-specific CNR increased by 75% compared to ASiR-V 90% (p < 0.05). Subjective image quality was significantly higher for medium and high strength DLIR compared to all other image reconstructions (p < 0.05). In CT pulmonary angiography, DLIR significantly outperforms iterative reconstruction for increasing objective and subjective image quality. This may allow for further reductions in radiation exposure in suspected PE.
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Affiliation(s)
- Ann-Christin Klemenz
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Centre Rostock, Schillingallee 36, 18057, Rostock, Germany
| | - Lasse Albrecht
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Centre Rostock, Schillingallee 36, 18057, Rostock, Germany
| | - Mathias Manzke
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Centre Rostock, Schillingallee 36, 18057, Rostock, Germany
| | - Antonia Dalmer
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Centre Rostock, Schillingallee 36, 18057, Rostock, Germany
| | - Benjamin Böttcher
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Centre Rostock, Schillingallee 36, 18057, Rostock, Germany
| | - Alexey Surov
- Department of Radiology, Mühlenkreiskliniken Minden, Ruhr-University Bochum, Bochum, Germany
| | - Marc-André Weber
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Centre Rostock, Schillingallee 36, 18057, Rostock, Germany
| | - Felix G Meinel
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Centre Rostock, Schillingallee 36, 18057, Rostock, Germany.
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Melekh B, Barajas Ordonez F, Melekh O, Flintrop W, Pech M, Surov A. Diagnostic value of apparent diffusion coefficient of psoas muscles for evaluating complications in patients with Crohn's disease. Prz Gastroenterol 2024; 19:74-80. [PMID: 38571545 PMCID: PMC10985760 DOI: 10.5114/pg.2024.134519] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 11/27/2023] [Indexed: 04/05/2024]
Abstract
Aim To assess the association of the apparent diffusion coefficient (ADC) of the psoas muscles and psoas muscle index (PMI) with the activity and behaviour of Crohn's disease (CD). Material and methods This was a retrospective study of 88 CD patients who underwent magnetic resonance enterography. Patients were classified according to the Montreal Classification in uncomplicated (non-stricturing, non-penetrating, B1), and complicated (structuring [B2] and penetrating disease [B3]). At the level of the third lumbar vertebra, the ADC and PMI were estimated. CD activity was analysed using the Magnetic Resonance Index of Activity (MaRIA), and depending on its values patients were categorized as high or low activity. Additionally, the presence of creeping fat (CrF) was used to evaluate activity. ADC and PMI were using Student's t-test. Results Our study included 47 males and 41 females (mean age of 38.69 ±14.4 years). The ADC in uncomplicated (B1, n = 45) and complicated disease (B2 + B3, n = 43) were 1.11 ±0.19 and 1.03 ±0.10 (10-3*mm2/s), respectively, (p = 0.02). ADC was significantly lower in patients with stricturing disease than in patients without strictures (1.02 ±0.11 and 1.10 ±0.18 [10-3 mm2/s], respectively, p = 0.01). The group with non-penetrating disease showed higher PMI than those with penetrating disease (5.71 ±1.88 vs. 4.42 ±1.55 cm2/m2, respectively, p = 0.10). There was no significant difference in PMI and ADC between patients with low and high MaRIA or positive and negative CrF. Conclusions The ADC of the psoas muscles is significantly lower in CD patients with uncomplicated disease, particularly those with stricturing disease. Therefore, ADC can be considered as an imaging biomarker of myopathic changes in CD patients.
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Affiliation(s)
- Bohdan Melekh
- University Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
| | - Felix Barajas Ordonez
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH, Aachen, Germany
| | - Oksana Melekh
- University Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
| | - Wiebke Flintrop
- Department of Paediatrics, University Hospital Magdeburg, Magdeburg, Germany
| | - Maciej Pech
- University Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
| | - Alexey Surov
- Institute for Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital by Muehlenkreiskliniken, Ruhr University Bochum, Minden, Germany
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Meyer HJ, Aghayev A, Hinnrichs M, Borggrefe J, Surov A. Epicardial Adipose Tissue as a Prognostic Marker in COVID-19. In Vivo 2024; 38:281-285. [PMID: 38148083 PMCID: PMC10756431 DOI: 10.21873/invivo.13436] [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: 07/20/2023] [Revised: 10/09/2023] [Accepted: 10/10/2023] [Indexed: 12/28/2023]
Abstract
BACKGROUND/AIM Epicardial adipose tissue (EAT) has been established as a quantitative imaging biomarker associated with the prognosis of several diseases, especially cardiovascular diseases. The cardiac injury by coronavirus disease 2019 (COVID-19) might be linked to the EAT. This study aimed to use this prognostic marker derived from computed tomography (CT) images to predict 30-day mortality in patients with COVID-19. PATIENTS AND METHODS Consecutive patients with COVID-19 were retrospectively screened between 2020 and 2022. Overall, 237 patients (78 female, 32.9%) were included in the present study. The study end-point was the 30-day mortality. EAT was measured using the diagnostic CT in a semiquantitative manner. EAT volume and density were measured for each patient. RESULTS Overall, 70 patients (29.5%) died within the 30-day observation period and 143 patients (60.3%) were admitted to the intensive care unit (ICU). The mean EAT volume was 140.9±89.1 cm3 in survivors and 132.9±77.7 cm3 in non-survivors, p=0.66. The mean EAT density was -71.9±8.1 Hounsfield units (HU) in survivors, and -67.3±8.4 HU in non-survivors, p=0.0001. EAT density was associated with 30-day mortality (p<0.0001) and ICU admission (p<0.0001). EAT volume was not associated with mortality and/or ICU admission. CONCLUSION EAT density was associated with 30-day mortality and ICU admission in patients with COVID-19.
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Affiliation(s)
- Hans-Jonas Meyer
- Department of Diagnostic and Interventional Radiology, University of Leipzig, Leipzig, Germany;
| | - Anar Aghayev
- Department of Radiology and Nuclear Medicine, Otto von Guericke University, Magdeburg, Germany
| | - Mattes Hinnrichs
- Department of Radiology and Nuclear Medicine, Otto von Guericke University, Magdeburg, Germany
| | - Jan Borggrefe
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Minden, Germany
| | - Alexey Surov
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Minden, Germany
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Karim H, Thormann M, Omari J, Surov A, Schinner R, Seidensticker R, Ingenerf M, Ricke J, Schmid-Tannwald C. Diffusion-weighted MRI (DWI) for assessment of response to high-dose-rate CT-guided brachytherapy (HDR-BT) of hepatocellular carcinoma. Acta Radiol 2024; 65:14-22. [PMID: 36843430 DOI: 10.1177/02841851231154498] [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: 02/28/2023]
Abstract
BACKGROUND High-dose-rate computed tomography (CT)-guided brachytherapy (HDR-BT) has shown promising results in patients with hepatocellular carcinoma (HCC). While growing evidence shows clear limitations of mRECIST, diffusion-weighted imaging (DWI) has relevant potential in improving the response assessment. PURPOSE To assess whether DWI allows evaluation of short- and long-term tumor response in patients with HCC after HDR-BT. MATERIAL AND METHODS A total of 22 patients with 11 non-responding HCCs (NR-HCC; local tumor recurrence within two years) and 24 responding HCCs (R-HCC; follow-up at least two years) were included in this retrospective bi-center study. HCCs were treated with HDR-BT and patients underwent pre- and post-interventional magnetic resonance imaging (MRI). Analyses of DWI were evaluated and compared between pre-interventional MRI, 1.follow-up after 3 months and 2.follow-up at the time of the local tumor recurrence (in NR-HCC) or after 12 months (in R-HCC). RESULTS ADCmean of R-HCC increased significantly after HDR-BT on the first and second follow-up (ADCmean: 0.87 ± 0.18 × 10-3 mm2/s [pre-interventional]: 1.14 ± 0.23 × 10-3 mm2/s [1. post-interventional]; 1.42 ± 0.32 × 10-3 mm2/s [2. post-interventional]; P < 0.001). ADCmean of NR-HCC did not show a significant increase from pre-intervention to 1. post-interventional MRI (ADCmean: 0.85 ± 0.24 × 10-3 mm2/s and 1.00 ± 0.30 × 10-3 mm2/s, respectively; P = 0.131). ADCmean increase was significant between pre-intervention and 2. follow-up (ADCmean: 1.03 ± 0.19 × 10-3 mm2/s; P = 0.018). There was no significant increase of ADCmean between the first and second follow-up. There was, however, a significant increase of ADCmin after 12 months (ADCmin: 0.87 ± 0.29 × 10-3 mm2/s) compared to pre-interventional MRI and first follow-up (P < 0.005) only in R-HCC. CONCLUSION The tumor response after CT-guided HDR-BT was associated with a significantly higher increase in ADCmean and ADCmin in short- and long-term follow-up.
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Affiliation(s)
- Homeira Karim
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Maximilian Thormann
- Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
| | - Jazan Omari
- Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
| | - Alexey Surov
- Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
| | - Regina Schinner
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | | | - Maria Ingenerf
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Jens Ricke
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
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Bucher AM, Henzel K, Meyer HJ, Ehrengut C, Müller L, Schramm D, Akinina A, Drechsel M, Kloeckner R, Isfort P, Sähn MJ, Fink M, More D, Melekh B, Meinel FG, Dreger F, May M, Siegler L, Münzfeld H, Ruppel R, Penzkofer T, Kim MS, Balzer M, Borggrefe J, Surov A. Pericardial Effusion Predicts Clinical Outcomes in Patients with COVID-19: A Nationwide Multicenter Study. Acad Radiol 2023:S1076-6332(23)00678-5. [PMID: 38155024 DOI: 10.1016/j.acra.2023.12.003] [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: 08/28/2023] [Revised: 11/25/2023] [Accepted: 12/01/2023] [Indexed: 12/30/2023]
Abstract
RATIONALE AND OBJECTIVES The prognostic role of pericardial effusion (PE) in Covid 19 is unclear. The aim of the present study was to estimate the prognostic role of PE in patients with Covid 19 in a large multicentre setting. MATERIALS AND METHODS This retrospective study is a part of the German multicenter project RACOON (Radiological Cooperative Network of the Covid 19 pandemic). The acquired sample comprises 1197 patients, 363 (30.3%) women and 834 (69.7%) men. In every case, chest computed tomography was analyzed for PE. Data about 30-day mortality, need for mechanical ventilation and need for intensive care unit (ICU) admission were collected. Data were evaluated by means of descriptive statistics. Group differences were calculated with Mann-Whitney test and Fisher exact test. Uni-and multivariable regression analyses were performed. RESULTS Overall, 46.4% of the patients were admitted to ICU, mechanical lung ventilation was performed in 26.6% and 30-day mortality was 24%. PE was identified in 159 patients (13.3%). The presence of PE was associated with 30-day mortality: HR= 1.54, CI 95% (1.05; 2.23), p = 0.02 (univariable analysis), and HR= 1.60, CI 95% (1.03; 2.48), p = 0.03 (multivariable analysis). Furthermore, density of PE was associated with the need for intubation (OR=1.02, CI 95% (1.003; 1.05), p = 0.03) and the need for ICU admission (OR=1.03, CI 95% (1.005; 1.05), p = 0.01) in univariable regression analysis. The presence of PE was associated with 30-day mortality in male patients, HR= 1.56, CI 95%(1.01-2.43), p = 0.04 (multivariable analysis). In female patients, none of PE values predicted clinical outcomes. CONCLUSION The prevalence of PE in Covid 19 is 13.3%. PE is an independent predictor of 30-day mortality in male patients with Covid 19. In female patients, PE plays no predictive role.
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Affiliation(s)
- Andreas Michael Bucher
- Institute of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfut, Germany (A.M.B., K.H.)
| | - Kristina Henzel
- Institute of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfut, Germany (A.M.B., K.H.)
| | - Hans Jonas Meyer
- Department of Radiology, University Hospital of Leipzig, Leipzig, Germany (H.J.M., C.E.)
| | - Constantin Ehrengut
- Department of Radiology, University Hospital of Leipzig, Leipzig, Germany (H.J.M., C.E.)
| | - Lukas Müller
- Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Mainz, Germany (L.M.)
| | - Dominik Schramm
- Department of Radiology University Hospital of Halle, Halle, Germany (D.S., A.A., M.D.)
| | - Alena Akinina
- Department of Radiology University Hospital of Halle, Halle, Germany (D.S., A.A., M.D.)
| | - Michelle Drechsel
- Department of Radiology University Hospital of Halle, Halle, Germany (D.S., A.A., M.D.)
| | - Roman Kloeckner
- Department of Radiology University Hospital Schleswig-Holstein-Campus Luebeck, Luebeck, Germany (R.K.)
| | - Peter Isfort
- Department of Radiology University Hospital of Aachen, Aachen, Germany (P.I., M.J.S.)
| | - Marwin-Jonathan Sähn
- Department of Radiology University Hospital of Aachen, Aachen, Germany (P.I., M.J.S.)
| | - Matthias Fink
- Clinic for Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany (M.F., D.M.)
| | - Dorottya More
- Clinic for Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany (M.F., D.M.)
| | - Bohdan Melekh
- Department of Radiology and Nuclear Medicine, University Hospital of Magdeburg, Magdeburg, Germany (B.M., A.S.)
| | - Felix G Meinel
- Department of Radiology University Hospital of Rostock, Rostock, Germany (F.G.M., F.D.)
| | - Franziska Dreger
- Department of Radiology University Hospital of Rostock, Rostock, Germany (F.G.M., F.D.)
| | - Matthias May
- Department of Radiology University Hospital of Erlangen, Erlangen, Germany (M.M., L.S.)
| | - Lisa Siegler
- Department of Radiology University Hospital of Erlangen, Erlangen, Germany (M.M., L.S.)
| | - Hanna Münzfeld
- Department of Radiology University Hospital of Berlin, Berlin, Germany (H.M., R.R., T.P.)
| | - Richard Ruppel
- Department of Radiology University Hospital of Berlin, Berlin, Germany (H.M., R.R., T.P.)
| | - Tobias Penzkofer
- Department of Radiology University Hospital of Berlin, Berlin, Germany (H.M., R.R., T.P.)
| | - Moon-Sung Kim
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany (M.S.K., B.M.)
| | - Miriam Balzer
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany (M.S.K., B.M.)
| | - Jan Borggrefe
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr-University-Bochum, Bochum, Germany (J.B., A.S.)
| | - Alexey Surov
- Department of Radiology and Nuclear Medicine, University Hospital of Magdeburg, Magdeburg, Germany (B.M., A.S.); Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr-University-Bochum, Bochum, Germany (J.B., A.S.).
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Surov A, Wienke A, Gutzmer R, Borggrefe J. Prognostic role of the skeletal musculature in oncology: significance, coherences and clinical implications. ROFO-FORTSCHR RONTG 2023. [PMID: 38134902 DOI: 10.1055/a-2213-2320] [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: 12/24/2023]
Abstract
BACKGROUND Sarcopenia is defined as a loss of muscle mass and strength as well as decreased physical performance. METHOD The present study provides a systematic overview of the current literature in regard to the prognostic role of sarcopenia in oncology. CONCLUSION In oncologic patients, sarcopenia occurs in 39.6 % of cases in a curative setting and in 49.2 % in a palliative setting. Sarcopenia is associated with dose-limiting toxicity. Furthermore, sarcopenia is associated with the occurrence of postoperative complications. Also, reduced muscle mass limits overall survival in most tumors both in a curative and a palliative setting. Therefore, analysis of the skeletal musculature on staging CT should be implemented in the clinical routine in oncology. KEY POINTS · In oncologic patients, the prevalence of sarcopenia is 39.6 % in a curative setting and 49.2 % in a palliative setting.. · Sarcopenia is associated with dose-limiting toxicity and treatment response.. · Sarcopenia predicts overall survival in oncologic patients.. CITATION FORMAT · Surov A, Wienke A, Gutzmer R et al. Prognostic role of the skeletal musculature in oncology: significance, coherences and clinical implications. Fortschr Röntgenstr 2023; DOI: 10.1055/a-2213-2320.
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Affiliation(s)
- Alexey Surov
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling Medical Center, Ruhr University Bochum, Germany
| | - Andreas Wienke
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Martin Luther University Halle Wittenberg, Halle, Germany
| | - Ralf Gutzmer
- Department of Dermatology, Johannes Wesling Medical Center, Ruhr University Bochum, Germany
| | - Jan Borggrefe
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling Medical Center, Ruhr University Bochum, Germany
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21
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Boriesosdick J, Surov A, Michael A, Mönninghoff C, Niehoff JH, Haag NP, Shahzadi I, Kroeger JR, Schellinger P, Borggrefe J. Sarcopenia is a predictor of patient death in acute ischemic stroke. J Stroke Cerebrovasc Dis 2023; 32:107421. [PMID: 37826941 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107421] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 07/14/2023] [Revised: 10/03/2023] [Accepted: 10/07/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Sarcopenia is proposed as a novel imaging biomarker in several acute conditions regarding outcome and mortality. The aim of the present study was to investigate the prognostic role of the masseter muscles in patients with acute ischemic stroke (AIS). METHODS Overall, 189 patients with AIS that received mechanical thrombectomy were retrospectively enrolled in this study. Outcome and overall survival after 90 days were analyzed. Transversal surface area and density of the masseter muscles were measured. The diagnostic performance for the estimation of a) favorable modified ranking scale 90 days (mRS 90) outcome and b) death at 90 days was calculated using univariate and multivariate logistic regression analysis, followed by receiver operating characteristics and Odds ratios. RESULTS The masseter muscle area provided a significant difference between patients who survived and those who died and between patients who had a favorable outcome (mRS 90 < 3) and those who did not. The cutoff for a favorable mRS 90 was found to be 435.8 mm2 for men and 338.8 mm2 for women, the cutoff for the prediction of death 421.3 mm2 for men and 326.6 mm2 for women. Masseter muscle area was the third strongest predictor in both categories after patient age and NIHSS. CONCLUSIONS Masseter muscle area is an independent predictor of mortality in patients with AIS.
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Affiliation(s)
- Jan Boriesosdick
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital Minden, Ruhr University Bochum, Hans-Nolte-Str. 1, Minden 32429, Germany
| | - Alexey Surov
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital Minden, Ruhr University Bochum, Hans-Nolte-Str. 1, Minden 32429, Germany
| | - Arwed Michael
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital Minden, Ruhr University Bochum, Hans-Nolte-Str. 1, Minden 32429, Germany
| | - Christoph Mönninghoff
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital Minden, Ruhr University Bochum, Hans-Nolte-Str. 1, Minden 32429, Germany
| | - Julius Henning Niehoff
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital Minden, Ruhr University Bochum, Hans-Nolte-Str. 1, Minden 32429, Germany
| | - Nina Pauline Haag
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital Minden, Ruhr University Bochum, Hans-Nolte-Str. 1, Minden 32429, Germany
| | - Iram Shahzadi
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital Minden, Ruhr University Bochum, Hans-Nolte-Str. 1, Minden 32429, Germany
| | - Jan-Robert Kroeger
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital Minden, Ruhr University Bochum, Hans-Nolte-Str. 1, Minden 32429, Germany
| | - Peter Schellinger
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital Minden, Ruhr University Bochum, Hans-Nolte-Str. 1, Minden 32429, Germany
| | - Jan Borggrefe
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital Minden, Ruhr University Bochum, Hans-Nolte-Str. 1, Minden 32429, Germany.
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Abstract
OBJECTIVES Body composition assessment is comprised by skeletal muscle mass (SMM) and subcutaneous and visceral adipose tissue (SAT and VAT) and can be quantified by imaging. It can be predictive of several clinically outcomes in patients with hematological diseases. Our aim was to establish the effect of body composition parameters on overall survival (OS) and progression-free survival (PFS) in patients with multiple myeloma (MM). MATERIALS AND METHODS All patients with MM were retrospectively analyzed between 2009 and 2019. One hundred twenty-three patients were included into the analysis. Whole-body computed tomography (CT) was used to calculate SMM, VAT, and SAT. RESULTS Overall, 22 patients (17.9%) of the patient sample died. Forty patients were sarcopenic (32.5%), 79 patients were visceral obese (64.2%), and 18 patients (14.6%) were sarcopenic obese. Parameter of body composition did not influence OS: sarcopenia, hazard ratio (HR) = 1.3 (95% CI 0.50-3.34), p = .59; visceral obesity, HR = 1.6 (95% CI 0.70-3.76), p = .26; sarcopenic obesity, HR = 2.3 (95% CI 0.90-5.63), p = 0.08. Patients with infectious complications showed higher VAT values. CONCLUSIONS CT-defined body composition parameters have no influence on survival in patients with MM undergoing autologous stem-cell therapy. These results corroborate previous smaller studies that body composition might have a limited role in this tumor entity. VAT may predict the occurrence of infectious complications.
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Affiliation(s)
- Alexey Surov
- Department of Radiology and Nuclear Medicine, University of Magdeburg, Magdeburg, Germany
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University, Bochum, Germany
| | - Franz Benkert
- Department of Diagnostic and Interventional Radiology, University of Leipzig, Leipzig, Germany
| | - Wolfram Pönisch
- Department of Hematology and Cell Therapy, University of Leipzig, Leipzig, Germany
| | - Hans-Jonas Meyer
- Department of Diagnostic and Interventional Radiology, University of Leipzig, Leipzig, Germany
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Michael AE, Heuser A, Moenninghoff C, Surov A, Borggrefe J, Kroeger JR, Niehoff JH. Does bore size matter?-A comparison of the subjective perception of patient comfort during low field (0.55 Tesla) and standard (1.5 Tesla) MRI imaging. Medicine (Baltimore) 2023; 102:e36069. [PMID: 38013308 PMCID: PMC10681562 DOI: 10.1097/md.0000000000036069] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 10/20/2023] [Indexed: 11/29/2023] Open
Abstract
The purpose of the present study was to evaluate the subjectively perceived patient comfort during magnetic resonance imaging (MRI) examinations and to assess potential differences between a recently introduced low field MRI scanner and a standard MRI scanner. Among other characteristics, the low field MRI scanner differs from the standard MRI scanner by offering more space (wider bore size of 80 centimeter diameter) and producing less noise, which may influence the patient comfort. In total, 177 patients were surveyed after MRI scans with either the low field MRI scanner (n = 91, MAGNETOM Free.Max, Siemens Healthineers) or the standard MRI scanner (n = 86, MAGNETOM Avanto Fit, Siemens Healthineers). Patients rated different aspects of comfort on a 5 point Likert scale: (a) claustrophobia, (b) comfort of the scanner table, (c) noise level and (d) vertigo during the scanning procedure. In terms of claustrophobia and comfort of the scanner table, patients rated both MRI scanners similar (e.g., mean ratings for claustrophobia: standard MRI scanner = 4.63 ± 1.04, low field MRI scanner = 4.65 ± 1.02). However, when asked for a comparison, patients did favor the more spacious low field MRI scanner. In terms of noise level, the low field MRI scanner was rated significantly better (mean ratings: standard MRI scanner = 3.72 ± 1.46 [median 4 = "rather not unpleasant"], low field MRI scanner = 4.26 ± 1.22 [median 5 = "not unpleasant at all"]). Patients did not perceive any significant difference in terms of vertigo between both MRI scanners. The newly developed low field MRI scanner offers constructional differences compared to standard MRI scanners that are perceived positively by patients. Worth highlighting is the significantly lower noise level and the innovative bore diameter of 80 centimeter, which offers more space to the patients.
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Affiliation(s)
- Arwed Elias Michael
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Andreas Heuser
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Christoph Moenninghoff
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Alexey Surov
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Jan Borggrefe
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Jan Robert Kroeger
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Julius Henning Niehoff
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Bochum, Germany
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Thormann M, Neumann H, Behme D, Surov A. Digital hands-on learning in radiology-design and evaluation of a PACS-based concept for medical students. Radiologie (Heidelb) 2023; 63:82-89. [PMID: 37462750 DOI: 10.1007/s00117-023-01185-w] [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] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 06/09/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND The reorganization of the medical curriculum has increased the demands on medical didactics. For interdisciplinary fields such as radiology this offers the opportunity to be more visible in clinical medical teaching and to emphasize its integrative role in patient care. We present a novel integrative learning concept based on the notion of PACS (picture archiving and communication system) learning. In the initial phase it was available to students in their final-year internships. METHODS We designed 100 case vignettes on a designated workstation. Vignettes were prepared in a patient-based format in Aycan PACS (Aycan Medical Systems, NY, USA). The first image of each case included the case description and background information. Students worked through the vignettes independently. Each imaging examination was followed by small quizzes or open questions. Short texts provided additional information on the case, leading to the next examination. The typical case included several imaging modalities (CT, MRI, X‑ray, etc.) in diagnosis and follow-up. After processing the cases, the students completed an evaluation form on a five-point Likert scale. RESULTS Students approved the learning concept in terms of knowledge level, didactic structure, and motivation for self-study. A large proportion of respondents indicated that the new concept had sparked their interest in radiology Almost all students stated that they had benefited from the concept and favored its continuation. CONCLUSION Our PACS workstation enjoyed high acceptance among students. This underlines the importance of integrative, competence-based teaching models in the medical curriculum. Radiology as a cross-disciplinary discipline is in particular suitable for encouraging students to combine theoretical and practical knowledge and can become a central component in student education through innovative concepts.
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Affiliation(s)
- Maximilian Thormann
- Clinic of Radiology and Nuclear Medicine, University Clinic Magdeburg, Magdeburg, Germany
| | - Hannes Neumann
- Clinic of Radiology and Nuclear Medicine, University Clinic Magdeburg, Magdeburg, Germany
| | - Daniel Behme
- Clinic for Neuroradiology, University Clinic Magdeburg, Magdeburg, Germany
| | - Alexey Surov
- Clinic of Radiology and Nuclear Medicine, University Clinic Magdeburg, Magdeburg, Germany.
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University, Bochum, Germany.
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Meyer HJ, Gottschling S, Borggrefe J, Surov A. CT coronary artery calcification score as a prognostic marker in COVID-19. J Thorac Dis 2023; 15:5559-5565. [PMID: 37969270 PMCID: PMC10636427 DOI: 10.21037/jtd-23-728] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 09/01/2023] [Indexed: 11/17/2023]
Abstract
Background Coronary artery calcification (CA) score has been established as a quantitative imaging biomarker to reflect arteriosclerosis and general vessel status. It is established as an important prognostic factor for coronary heart disease but also for other disease entities. Our aim was to use this imaging marker derived from computed tomography (CT) images to elucidate the prognostic relevance in patients with coronavirus disease 2019 (COVID-19). Methods The clinical database was retrospectively screened for patients with COVID-19 between 2020 and 2022. A total of 241 patients (85 female patients, 35.3%) were included into the analysis. CA scoring was performed semiquantitatively on thoracic CT images with the established Weston score. Results Overall, 61 patients (25.3%) of the investigated patient sample died. In survivors, the mean CA score was 2.3±3.0 and in non-survivors, it was 4.2±4.1 (P=0.002). In univariable regression analysis, CA was associated with 30-day mortality [odds ratio (OR) =1.15; 95% confidence interval (CI): 1.06-1.25, P<0.001]. These results were confirmed by the multivariable regression analysis adjusted for age and sex, the CA score predicted 30-day mortality (OR =1.28; 95% CI: 1.08-1.4, P=0.002). Conclusions CA score is an independent risk factor in COVID-19. As CA scoring can easily be performed by the radiologist, it should be further investigated as an imaging marker in patients with COVID-19 and potentially be translated into clinical routine.
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Affiliation(s)
- Hans-Jonas Meyer
- Department of Diagnostic and Interventional Radiology, University of Leipzig, Leipzig, Germany
| | - Sebastian Gottschling
- Department of Radiology and Nuclear Medicine, Otto von Guericke University, Magdeburg, Germany
| | - Jan Borggrefe
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling Medical Center, Ruhr University Bochum Campus Minden, Minden, Germany
| | - Alexey Surov
- Department of Radiology and Nuclear Medicine, Otto von Guericke University, Magdeburg, Germany
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling Medical Center, Ruhr University Bochum Campus Minden, Minden, Germany
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Aghayev A, Hinnerichs M, Wienke A, Meyer HJ, Surov A. Epicardial adipose tissue as a prognostic marker in acute pulmonary embolism. Herz 2023:10.1007/s00059-023-05210-5. [PMID: 37847316 DOI: 10.1007/s00059-023-05210-5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 09/10/2023] [Accepted: 09/11/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND Epicardial adipose tissue (EAT) has been established as a quantitative imaging biomarker associated with disease severity in coronary heart disease. Our aim was to use this prognostic marker derived from computed tomography pulmonary angiography (CTPA) for the prediction of mortality and prognosis in patients with acute pulmonary embolism. METHODS The clinical database was retrospectively screened for patients with acute pulmonary embolism between 2015 and 2021. Overall, 513 patients (216 female, 42.1%) were included in the analysis. The study end-point was 30-day mortality. Epicardial adipose tissue was measured on the diagnostic CTPA in a semiquantitative manner. The volume and density of EAT were measured for every patient. RESULTS Overall, 60 patients (10.4%) died within the 30-day observation period. The mean EAT volume was 128.3 ± 65.0 cm3 in survivors and 154.6 ± 84.5 cm3 in nonsurvivors (p = 0.02). The density of EAT was -79.4 ± 8.3 HU in survivors and -76.0 ± 8.4 HU in nonsurvivors (p = 0.86), and EAT density was associated with 30-day mortality (odds ratio [OR] = 1.07; 95% confidence interval [CI]: 1.03; 1.1, p < 0.001) but did not remain statistically significant in multivariable analysis. No association was identified between EAT volume and 30-day mortality (OR = 1.0; 95% CI: 1.0; 1.0, p = 0.48). CONCLUSION There might be an association between EAT density and mortality in patients with acute pulmonary embolism. Further studies are needed to elucidate the prognostic relevance of EAT parameters in patients with acute pulmonary embolism.
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Affiliation(s)
- Anar Aghayev
- Department of Radiology and Nuclear Medicine, Otto von Guericke University, Magdeburg, Germany
| | - Mattes Hinnerichs
- Department of Radiology and Nuclear Medicine, Otto von Guericke University, Magdeburg, Germany
| | - Andreas Wienke
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Hans-Jonas Meyer
- Department of Diagnostic and Interventional Radiology, University of Leipzig, Leipzig, Germany.
| | - Alexey Surov
- Department of Radiology and Nuclear Medicine, Otto von Guericke University, Magdeburg, Germany
- Ruhr-University-Bochum, Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Minden, Germany
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Hille G, Agrawal S, Tummala P, Wybranski C, Pech M, Surov A, Saalfeld S. Joint liver and hepatic lesion segmentation in MRI using a hybrid CNN with transformer layers. Comput Methods Programs Biomed 2023; 240:107647. [PMID: 37329803 DOI: 10.1016/j.cmpb.2023.107647] [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] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 04/21/2023] [Accepted: 06/05/2023] [Indexed: 06/19/2023]
Abstract
Backgound and Objective: Deep learning-based segmentation of the liver and hepatic lesions therein steadily gains relevance in clinical practice due to the increasing incidence of liver cancer each year. Whereas various network variants with overall promising results in the field of medical image segmentation have been successfully developed over the last years, almost all of them struggle with the challenge of accurately segmenting hepatic lesions in magnetic resonance imaging (MRI). This led to the idea of combining elements of convolutional and transformer-based architectures to overcome the existing limitations. METHODS This work presents a hybrid network called SWTR-Unet, consisting of a pretrained ResNet, transformer blocks as well as a common Unet-style decoder path. This network was primarily applied to single-modality non-contrast-enhanced liver MRI and additionally to the publicly available computed tomography (CT) data of the liver tumor segmentation (LiTS) challenge to verify the applicability on other modalities. For a broader evaluation, multiple state-of-the-art networks were implemented and applied, ensuring direct comparability. Furthermore, correlation analysis and an ablation study were carried out, to investigate various influencing factors on the segmentation accuracy of the presented method. RESULTS With Dice similarity scores of averaged 98±2% for liver and 81±28% lesion segmentation on the MRI dataset and 97±2% and 79±25%, respectively on the CT dataset, the proposed SWTR-Unet proved to be a precise approach for liver and hepatic lesion segmentation with state-of-the-art results for MRI and competing accuracy in CT imaging. CONCLUSION The achieved segmentation accuracy was found to be on par with manually performed expert segmentations as indicated by inter-observer variabilities for liver lesion segmentation. In conclusion, the presented method could save valuable time and resources in clinical practice.
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Affiliation(s)
- Georg Hille
- Department of Simulation and Graphics, Otto-von-Guericke University, Magdeburg, Germany.
| | - Shubham Agrawal
- Department of Simulation and Graphics, Otto-von-Guericke University, Magdeburg, Germany
| | - Pavan Tummala
- Department of Simulation and Graphics, Otto-von-Guericke University, Magdeburg, Germany
| | - Christian Wybranski
- Department of Radiology, University Hospital of Magdeburg, Magdeburg, Germany
| | - Maciej Pech
- Department of Radiology, University Hospital of Magdeburg, Magdeburg, Germany
| | - Alexey Surov
- Department of Radiology, University Hospital of Magdeburg, Magdeburg, Germany
| | - Sylvia Saalfeld
- Department of Simulation and Graphics, Otto-von-Guericke University, Magdeburg, Germany
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Saalfeld S, Kreher R, Hille G, Niemann U, Hinnerichs M, Öcal O, Schütte K, Zech CJ, Loewe C, van Delden O, Vandecaveye V, Verslype C, Gebauer B, Sengel C, Bargellini I, Iezzi R, Berg T, Klümpen HJ, Benckert J, Gasbarrini A, Amthauer H, Sangro B, Malfertheiner P, Preim B, Ricke J, Seidensticker M, Pech M, Surov A. Prognostic role of radiomics-based body composition analysis for the 1-year survival for hepatocellular carcinoma patients. J Cachexia Sarcopenia Muscle 2023; 14:2301-2309. [PMID: 37592827 PMCID: PMC10570090 DOI: 10.1002/jcsm.13315] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 05/17/2023] [Accepted: 07/11/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND Parameters of body composition have prognostic potential in patients with oncologic diseases. The aim of the present study was to analyse the prognostic potential of radiomics-based parameters of the skeletal musculature and adipose tissues in patients with advanced hepatocellular carcinoma (HCC). METHODS Radiomics features were extracted from a cohort of 297 HCC patients as post hoc sub-study of the SORAMIC randomized controlled trial. Patients were treated with selective internal radiation therapy (SIRT) in combination with sorafenib or with sorafenib alone yielding two groups: (1) sorafenib monotherapy (n = 147) and (2) sorafenib and SIRT (n = 150). The main outcome was 1-year survival. Segmentation of muscle tissue and adipose tissue was used to retrieve 881 features. Correlation analysis and feature cleansing yielded 292 features for each patient group and each tissue type. We combined 9 feature selection methods with 10 feature set compositions to build 90 feature sets. We used 11 classifiers to build 990 models. We subdivided the patient groups into a train and validation cohort and a test cohort, that is, one third of the patient groups. RESULTS We used the train and validation set to identify the best feature selection and classification model and applied it to the test set for each patient group. Classification yields for patients who underwent sorafenib monotherapy an accuracy of 75.51% and area under the curve (AUC) of 0.7576 (95% confidence interval [CI]: 0.6376-0.8776). For patients who underwent treatment with SIRT and sorafenib, results are accuracy = 78.00% and AUC = 0.8032 (95% CI: 0.6930-0.9134). CONCLUSIONS Parameters of radiomics-based analysis of the skeletal musculature and adipose tissue predict 1-year survival in patients with advanced HCC. The prognostic value of radiomics-based parameters was higher in patients who were treated with SIRT and sorafenib.
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Affiliation(s)
- Sylvia Saalfeld
- Research Campus STIMULATE at the University of MagdeburgMagdeburgGermany
- Department of Simulation and GraphicsUniversity of MagdeburgMagdeburgGermany
| | - Robert Kreher
- Research Campus STIMULATE at the University of MagdeburgMagdeburgGermany
- Department of Simulation and GraphicsUniversity of MagdeburgMagdeburgGermany
| | - Georg Hille
- Research Campus STIMULATE at the University of MagdeburgMagdeburgGermany
- Department of Simulation and GraphicsUniversity of MagdeburgMagdeburgGermany
| | - Uli Niemann
- University LibraryUniversity of MagdeburgMagdeburgGermany
| | - Mattes Hinnerichs
- Department of Radiology and Nuclear MedicineOvGU MagdeburgMagdeburgGermany
| | - Osman Öcal
- Department of RadiologyLMU University HospitalMunichGermany
| | - Kerstin Schütte
- Department of Internal Medicine and GastroenterologyNiels‐Stensen‐Kliniken MarienhospitalOsnabrückGermany
- Klinik für Gastroenterologie, Hepatologie und EndokrinologieMedizinische Hochschule Hannover (MHH)HannoverGermany
| | - Christoph J. Zech
- Department of Radiology and Nuclear MedicineUniversity Hospital Basel, University of BaselBaselSwitzerland
| | - Christian Loewe
- Section of Cardiovascular and Interventional Radiology, Department of Bioimaging and Image‐Guided TherapyMedical University of ViennaViennaAustria
| | - Otto van Delden
- Department of Radiology and Nuclear MedicineAcademic University Medical CentersAmsterdamThe Netherlands
| | | | - Chris Verslype
- Department of Digestive OncologyUniversity Hospitals LeuvenLeuvenBelgium
| | - Bernhard Gebauer
- Department of RadiologyCharité – University Medicine BerlinBerlinGermany
| | - Christian Sengel
- Department of RadiologyGrenoble University HospitalLa TroncheFrance
| | - Irene Bargellini
- Diagnostic and Interventional RadiologyCandiolo Cancer InstituteTurinItaly
| | - Roberto Iezzi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Radiologia d'Urgenza e Interventistica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed EmatologiaRomeItaly
- Università Cattolica del Sacro CuoreRomeItaly
| | - Thomas Berg
- Klinik und Poliklinik für Gastroenterologie, Sektion HepatologieUniversitätsklinikum LeipzigLeipzigGermany
| | - Heinz J. Klümpen
- Department of Medical OncologyAmsterdam University Medical CentersAmsterdamThe Netherlands
| | - Julia Benckert
- Department of Hepatology and GastroenterologyCampus Virchow Klinikum, Charité – Universitätsmedizin BerlinBerlinGermany
| | - Antonio Gasbarrini
- Fondazione Policlinico Universitario Gemelli IRCCS, Università Cattolica del Sacro CuoreRomeItaly
| | - Holger Amthauer
- Department of Nuclear MedicineCharité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu BerlinBerlinGermany
| | - Bruno Sangro
- Liver UnitClínica Universidad de Navarra and CIBEREHDPamplonaSpain
| | | | - Bernhard Preim
- Research Campus STIMULATE at the University of MagdeburgMagdeburgGermany
- Department of Simulation and GraphicsUniversity of MagdeburgMagdeburgGermany
| | - Jens Ricke
- Department of RadiologyLMU University HospitalMunichGermany
| | | | - Maciej Pech
- Department of Radiology and Nuclear MedicineOvGU MagdeburgMagdeburgGermany
| | - Alexey Surov
- Department of Radiology, Neuroradiology and Nuclear MedicineJohannes Wesling University Hospital, Ruhr University BochumBochumGermany
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Meyer HJ, Gottschling S, Bär C, Wienke A, Borggrefe J, Surov A. CT coronary calcium score is a prognostic marker in acute pulmonary embolism. Thromb Res 2023; 229:255-257. [PMID: 37597399 DOI: 10.1016/j.thromres.2023.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 07/16/2023] [Accepted: 07/18/2023] [Indexed: 08/21/2023]
Affiliation(s)
- Hans-Jonas Meyer
- Department of Diagnostic and Interventional Radiology, University of Leipzig, Leipzig, Germany.
| | - Sebastian Gottschling
- Department of Radiology and Nuclear Medicine, Otto von Guericke University, Magdeburg, Germany
| | - Caroline Bär
- Department of Radiology and Nuclear Medicine, Otto von Guericke University, Magdeburg, Germany
| | - Andreas Wienke
- Department of Epidemiology, Martin-Luther University of Halle (Saale), Halle (Saale), Germany
| | - Jan Borggrefe
- Department of Radiology, Mühlenkreiskliniken Minden, Ruhr-University Bochum, Bochum, Germany
| | - Alexey Surov
- Department of Radiology, Mühlenkreiskliniken Minden, Ruhr-University Bochum, Bochum, Germany
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Surov A, Eger KI, Potratz J, Gottschling S, Wienke A, Jechorek D. Apparent diffusion coefficient correlates with different histopathological features in several intrahepatic tumors. Eur Radiol 2023; 33:5955-5964. [PMID: 37347430 PMCID: PMC10415451 DOI: 10.1007/s00330-023-09788-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 12/21/2022] [Revised: 05/05/2023] [Accepted: 05/14/2023] [Indexed: 06/23/2023]
Abstract
OBJECTIVES To investigate associations between apparent diffusion coefficient (ADC) and cell count, Ki 67, tumor-stroma ratio (TSR), and tumoral lymphocytes in different hepatic malignancies. METHODS We identified 149 cases with performed liver biopsies: hepatocellular cancer (HCC, n = 53), intrahepatic cholangiocarcinoma (iCC, n = 29), metastases of colorectal cancer (CRC, n = 24), metastases of breast cancer (BC, n = 28), and metastases of pancreatic cancer (PC, n = 15). MRI was performed on a 1.5-T scanner with an axial echo-planar sequence. MRI was done before biopsy. Biopsy images of target lesions were selected. The cylindrical region of interest was placed on the ADC map of target lesions in accordance with the needle position on the biopsy images. Mean ADC values were estimated. TSR, cell counts, proliferation index Ki 67, and number of tumor-infiltrating lymphocytes were estimated. Spearman's rank correlation coefficients and intraclass correlation coefficients were calculated. RESULTS Inter-reader agreement was excellent regarding the ADC measurements. In HCC, ADC correlated with cell count (r = - 0.68, p < 0.001) and with TSR (r = 0.31, p = 0.024). In iCC, ADC correlated with TSR (r = 0.60, p < 0.001) and with cell count (r = - 0.54, p = 0.002). In CRC metastases, ADC correlated with cell count (r = - 0.54 p = 0.006) and with Ki 67 (r = - 0.46, p = 0.024). In BC liver metastases, ADC correlated with TSR (r = 0.55, p < 0.002) and with Ki 67 (r = - 0.51, p = 0.006). In PC metastases, no significant correlations were found. CONCLUSIONS ADC correlated with tumor cellularity in HCC, iCC, and CRC liver metastases. ADC reflects TSR in BC liver metastases, HCC, and iCC. ADC cannot reflect intratumoral lymphocytes. CLINICAL RELEVANCE STATEMENT The present study shows that the apparent diffusion coefficient can be used as a surrogate imaging marker for different histopathological features in several malignant hepatic lesions. KEY POINTS • ADC reflects different histopathological features in several hepatic tumors. • ADC correlates with tumor cellularity in HCC, iCC, and CRC metastases. • ADC strongly correlates with tumor-stroma ratio in BC metastases and iCC.
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Affiliation(s)
- Alexey Surov
- Department of Radiology, Neuroradiology and Nuclear Medicine , Johannes Wesling University Hospital, Ruhr-University, Bochum, Germany.
| | - Kai Ina Eger
- Institute of Pathology, University of Magdeburg, Leipziger Str. 44, 39112, Magdeburg, Germany
| | - Johann Potratz
- Department of Radiology, Neuroradiology and Nuclear Medicine , Johannes Wesling University Hospital, Ruhr-University, Bochum, Germany
- Institute of Pathology, University of Magdeburg, Leipziger Str. 44, 39112, Magdeburg, Germany
| | - Sebastian Gottschling
- Department of Radiology and Nuclear Medicine, University of Magdeburg, Leipziger Str. 44, 39112, Magdeburg, Germany
| | - Andreas Wienke
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Martin-Luther-University Halle-Wittenberg, Magdeburger Str. 8, 06097, Halle, Germany
| | - Dörthe Jechorek
- Institute of Pathology, University of Magdeburg, Leipziger Str. 44, 39112, Magdeburg, Germany
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Surov A, Strobel A, Borggrefe J, Wienke A. Low skeletal muscle mass predicts treatment response in oncology: a meta-analysis. Eur Radiol 2023; 33:6426-6437. [PMID: 36929392 DOI: 10.1007/s00330-023-09524-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 08/04/2022] [Revised: 12/24/2022] [Accepted: 02/04/2023] [Indexed: 03/18/2023]
Abstract
OBJECTIVES Low skeletal muscle mass (LSMM) predicts relevant clinical outcomes in oncologic patients. The purpose of this study was to perform a meta-analysis of data regarding associations between LSMM and treatment response (TR) in oncology. METHODS MEDLINE, Cochrane, and SCOPUS databases were screened for relationships between LSMM and TR in oncologic patients up to November 2022. Overall, 35 studies met the inclusion criteria. The meta-analysis was performed using RevMan 5.4 software. RESULTS The collected 35 studies comprised 3858 patients. In 1682 patients (43.6%), LSMM was diagnosed. In the overall sample, LSMM predicted a negatively objective response rate (ORR), OR = 0.70, 95% CI = (0.54-0.91), p = 0.007, and disease control rate (DCR), OR = 0.69, 95% CI = (0.50-0.95), p = 0.02. In the curative setting, LSMM predicted a negatively ORR, OR = 0.24, 95% CI = (0.12-0.50), p = 0.0001, but not DCR, OR = 0.60, 95% CI = (0.31-1.18), p = 0.14. In palliative treatment with conventional chemotherapies, LSMM did not predict ORR: OR = 0.94, 95% CI (0.57-1.55), p = 0.81, and DCR: OR = 1.13, 95% CI (0.38-3.40), p = 0.82. In palliative treatment with tyrosine kinase inhibitors (TKI), LSMM did not predict TR: ORR, OR = 0.74, 95% CI (0.44-1.26), p = 0.27, and DCR, OR = 1.04, 95% CI (0.53-2.05), p = 0.90. In palliative immunotherapy, LSMM tended to predict ORR, OR = 0.74, 95% CI = (0.54-1.01), p = 0.06, and predicted DCR, OR = 0.53, 95% CI = (0.37-0.76), p = 0.0006. CONCLUSION LSMM is a risk factor for poor TR in curative chemotherapy in the adjuvant and/or neoadjuvant setting. LSMM is a risk factor for treatment failure in treatment with immunotherapy. Finally, LSMM does not influence TR in palliative treatment with conventional chemotherapy and/or TKIs. KEY POINTS • Low skeletal muscle mass (LSMM) predicts treatment response (TR) to chemotherapy in the adjuvant and/or neoadjuvant setting. • LSMM predicts TR in immunotherapy. • LSMM does not influence TR in palliative chemotherapy.
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Affiliation(s)
- Alexey Surov
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University, Bochum, Germany.
| | - Alexandra Strobel
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Jan Borggrefe
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University, Bochum, Germany
| | - Andreas Wienke
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Martin-Luther-University Halle-Wittenberg, Halle, Germany
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Mengoni M, Braun AD, Hinnerichs MS, Tüting T, Surov A. Subcutaneous Fat Abundance and Density Are Associated with an Enhanced Response to Immunotherapy in Metastatic Melanoma: A Retrospective Cohort Study. Acad Radiol 2023; 30 Suppl 1:S257-S267. [PMID: 37331867 DOI: 10.1016/j.acra.2023.05.007] [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: 04/06/2023] [Revised: 05/07/2023] [Accepted: 05/08/2023] [Indexed: 06/20/2023]
Abstract
RATIONALE AND OBJECTIVES Despite the impressive efficacy of immune checkpoint inhibitors (ICIs) in the treatment of metastatic melanoma, not all patients respond to therapy. In addition, ICI harbors the risk for serious adverse events (AEs), highlighting the need for novel biomarkers predicting treatment response and occurrence of AEs. Recently, the identification of enhanced response to ICI in obese patients has indicated that body composition might influence treatment efficacy. The aim of the current study is to assess radiologic measurements of body composition as biomarkers for treatment response and AEs to ICI in melanoma. MATERIALS AND METHODS In the current work, we analyze adipose tissue abundance and density, as well as muscle mass via computed tomography scans in a retrospective cohort of 100 patients with non-resectable stage III/IV melanoma receiving first-line treatment with ICI in our department. From these, we investigate the impact of the subcutaneous adipose tissue gauge index (SATGI) and other parameters of body composition on treatment efficacy and occurrence of AEs. RESULTS Low SATGI was associated with prolonged progression-free survival (PFS) in univariate and multivariate analyses (hazard ratio 2.56 [95% CI 1.18-5.55], P = .02), as well as an enhanced objective response rate (50.0% vs 27.1%; P = .02). Further analysis with a random forest survival model highlighted a nonlinear relationship between SATGI and PFS with a clear separation into high- and low-risk cohorts separated by the median. Finally, a significant enrichment of cases with vitiligo, but no other AEs, was observed in the SATGI-low cohort (11.5% vs 0%; P = .03). CONCLUSION We identify SATGI as a biomarker predicting treatment response to ICI without increased risk for severe AEs in melanoma.
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Affiliation(s)
- Miriam Mengoni
- Department of Dermatology, University Hospital Magdeburg, Leipziger Straße 44, 39120 Magdeburg, Germany.
| | - Andreas Dominik Braun
- Department of Dermatology, University Hospital Magdeburg, Leipziger Straße 44, 39120 Magdeburg, Germany
| | - Mattes Simon Hinnerichs
- Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
| | - Thomas Tüting
- Department of Dermatology, University Hospital Magdeburg, Leipziger Straße 44, 39120 Magdeburg, Germany
| | - Alexey Surov
- Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany; Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University, Bochum, Germany
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Surov A, Thormann M, Bär C, Wienke A, Borggrefe J. Validation of clinical-radiological scores for prognosis of mortality in acute pulmonary embolism. Respir Res 2023; 24:195. [PMID: 37543614 PMCID: PMC10403935 DOI: 10.1186/s12931-023-02489-0] [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: 10/05/2022] [Accepted: 07/03/2023] [Indexed: 08/07/2023] Open
Abstract
INTRODUCTION Acute pulmonary embolism (APE) is a hazardous disorder with a high mortality. Combination of clinical, radiological, and serological parameters can improve risk stratification of APE. Most of the proposed combined scores were not validated in independent cohorts. Our aim was to validate the proposed clinical-radiological scores for prognosis of 7- and 30-day mortality in APE. MATERIALS AND METHODS Our sample comprised 531 patients with APE, mean age 64.8 ± 15.6 years, 221 (41.6%) females and 310 (58.4%) males. The following parameters were collected: Age and sex of the patients, mortality within the observation time of 30 days, simplified pulmonary embolism severity index (sPESI), pH troponin level (pg/ml), minimal systolic and diastolic blood pressures (mmHg), heart rate, O2 saturation, episodes of syncope, and need for vasopressors. On CT pulmonary angiography (CTPA), short axis ratio right ventricle/left ventricle (RV/LV), and reflux of contrast medium into the inferior vena cava were obtained. The following clinical-radiological scores were calculated: BOVA score, pulmonary embolism mortality score (PEMS), European Society of Cardiology (ESC) score, Kumamaru score, and Calgary acute pulmonary embolism (CAPE) score. RESULTS Overall, 31 patients (5.8%) died within seven and 64 patients (12%) within 30 days. All scores showed high negative prognostic values ranging from 89.0 to 99.0%. PEMS and CAPE score demonstrated the highest specificity for 7-day mortality (93.4% and 85.0%), PEMS and BOVA for 30-day mortality (94.2% and 90.4%). The highest sensitivity was observed for ESC 2019 (96.8% and 95.3%). Kumamaru and CAPE scores had low sensitivity. All scores had low positive and high negative predictive values. CONCLUSION For prognosis of 7- and 30-day mortality in APE, PEMS score has the highest specificity. ESC 2019 shows the highest sensitivity. All scores had low positive and high negative predictive values.
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Affiliation(s)
- Alexey Surov
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Minden, Germany
| | - Maximilian Thormann
- Department of Radiology and Nuclear Medicine, Otto-von-Guericke University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany.
| | - Caroline Bär
- Department of Radiology and Nuclear Medicine, Otto-von-Guericke University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Andreas Wienke
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Martin-Luther- University Halle-Wittenberg, Halle, Germany
| | - Jan Borggrefe
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Minden, Germany
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Thormann M, Hinnerichs M, Barajas Ordonez F, Saalfeld S, Perrakis A, Croner R, Omari J, Pech M, Zamsheva M, Meyer HJ, Wienke A, Surov A. Sarcopenia is an Independent Prognostic Factor in Patients With Pancreatic Cancer - a Meta-analysis. Acad Radiol 2023; 30:1552-1561. [PMID: 36564257 DOI: 10.1016/j.acra.2022.10.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 08/09/2022] [Revised: 10/08/2022] [Accepted: 10/26/2022] [Indexed: 12/24/2022]
Abstract
RATIONALE AND OBJECTIVES Sarcopenia is defined as skeletal muscle loss and can be assessed by cross-sectional imaging. Our aim was to establish the effect of sarcopenia on relevant outcomes in patients with pancreatic ductal adenocarcinoma (PDAC) in curative and palliative settings based on a large patient sample. MATERIALS AND METHODS MEDLINE library, EMBASE and SCOPUS databases were screened for the associations between sarcopenia and mortality in patients with PDAC up to March 2022. The primary endpoint of the systematic review was the hazard ratio of Sarcopenia on survival. 22 studies were included into the present analysis. RESULTS The included 22 studies comprised 3958 patients. The prevalence of sarcopenia was 38.7%. Sarcopenia was associated with a higher prevalence in the palliative setting (OR 53.23, CI 39.00-67.45, p<0.001) compared to the curative setting (OR 36.73, CI 27.81-45.65, p<0.001). Sarcopenia was associated with worse OS in the univariable (HR 1.79, CI 1.41-2.28, p<0.001) and multivariable analysis (HR 1.62, CI 1.27-2.07, p<0.001) in the curative setting. For the palliative setting the pooled hazards ratio showed that sarcopenia was associated with overall survival (HR 1.56, CI 1.21-2.02, p<0.001) as well as in multivariable analysis (HR 1.77, CI 1.39-2.26, p<0.001). Sarcopenia was not associated with a higher rate of post-operative complications in univariable analysis (OR 1.10, CI 0.70-1.72, p = 0.69). CONCLUSION Sarcopenia occurs in 38.7% of patients with pancreatic cancer, significantly more in the palliative setting. Sarcopenia is associated with overall survival in both settings. The assessment of sarcopenia is therefore relevant for personalized oncology. Sarcopenia is not associated with postoperative complications.
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Affiliation(s)
- Maximilian Thormann
- Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Leipziger Str. 44,Magdeburg, Germany, 39120.
| | - Mattes Hinnerichs
- Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Leipziger Str. 44,Magdeburg, Germany, 39120
| | - Felix Barajas Ordonez
- Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Leipziger Str. 44,Magdeburg, Germany, 39120
| | - Sylvia Saalfeld
- Research Campus STIMULATE, Otto-von-Guericke University Magdeburg, Magdeburg, Germany; Department of Simulation and Graphics, University of Magdeburg, Magdeburg, Germany
| | - Aristoteles Perrakis
- Department of General - Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Magdeburg, Germany
| | - Roland Croner
- Department of General - Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Magdeburg, Germany
| | - Jazan Omari
- Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Leipziger Str. 44,Magdeburg, Germany, 39120
| | - Maciej Pech
- Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Leipziger Str. 44,Magdeburg, Germany, 39120
| | - Marina Zamsheva
- Institute of Medical Epidemiology, Biometry, and Informatics, Martin Luther University, Germany
| | - Hans-Jonas Meyer
- Department for Radiology, University Clinic Leipzig, Leipzig, Germany
| | - Andreas Wienke
- Institute of Medical Epidemiology, Biometry, and Informatics, Martin Luther University, Germany
| | - Alexey Surov
- Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Leipziger Str. 44,Magdeburg, Germany, 39120
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Surov A, Wienke A, Gutzmer R, Borggrefe J. Time to include sarcopenia into the oncological routine. Eur J Cancer 2023; 190:112939. [PMID: 37413844 DOI: 10.1016/j.ejca.2023.112939] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 06/02/2023] [Indexed: 07/08/2023]
Affiliation(s)
- Alexey Surov
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling Medical Center, Ruhr University Bochum Campus Minden, Minden, Germany
| | - Andreas Wienke
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Ralf Gutzmer
- Department of Dermatology, Johannes Wesling Medical Center, Ruhr University Bochum Campus Minden, Minden, Germany.
| | - Jan Borggrefe
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling Medical Center, Ruhr University Bochum Campus Minden, Minden, Germany
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Haag F, Pech M, Surov A. [Chronic-intermittent diffuse alveolar hemorrhage of unknown origin]. ROFO-FORTSCHR RONTG 2023; 195:620-622. [PMID: 36863372 DOI: 10.1055/a-2018-3464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Affiliation(s)
- Florian Haag
- Department of Radiology and Nuclear Medicine, Heidelberg University Medical Faculty Mannheim, Mannheim, Germany
- Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
| | - Maciej Pech
- Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
| | - Alexey Surov
- Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Minden, Germany
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Thormann M, Heitmann F, Wrobel V, Heinze C, March C, Hass P, Damm R, Surov A, Pech M, Omari J. Interstitial Brachytherapy for Hepatocellular Carcinoma: Analysis of Prognostic Factors for Overall Survival and Progression-Free Survival and Application of a Risk Stratification Model. Dig Dis 2023; 41:957-966. [PMID: 37385234 PMCID: PMC10716867 DOI: 10.1159/000531732] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 06/20/2023] [Indexed: 07/01/2023]
Abstract
INTRODUCTION Interstitial brachytherapy (iBT) is an effective treatment for hepatocellular carcinoma (HCC). Identification of prognostic factors is pivotal for patient selection and treatment efficacy. This study aimed to assess the impact of low skeletal muscle mass (LSMM) on overall survival (OS) and progression-free survival (PFS) of iBT in patients with HCC. METHODS For this single-center study, we retrospectively identified 77 patients with HCC who underwent iBT between 2011 and 2018. Follow-up visits were recorded until 2020. The psoas muscle area, psoas muscle index, psoas muscle density (MD), and the skeletal muscle gauge were assessed on the L3 level on pre-treatment cross-sectional CT scans. RESULTS Median OS was 37 months. 42 patients (54.5%) had LSMM. An AFP level of >400 ng/ml (hazard ratio [HR] 5.705, 95% confidence interval [CI]: 2.228-14.606, p = 0.001), BCLC stage (HR 3.230, 95% CI: 0.972-10.735, p = 0.026), and LSMM (HR 3.365, 95% CI: 1.490-7.596, p = 0.002) showed a relevant association with OS. Weighted hazard ratios were used to form a predictive risk stratification model with three groups: patients with low risk (median OS 62 months), intermediate risk (median OS 31 months), and high risk (median OS 9 months). The model showed a good prediction of 1-year mortality, with an AUC of 0.71. Higher MD was associated with better PFS (HR 0.920, 95% CI: 0.881-0.962, p < 0.001). CONCLUSION In patients undergoing iBT for HCC, LSMM is associated with worse OS. A risk stratification model based on LSMM, AFP >400 ng/mL, and BCLC stage successfully predicted patient mortality. The model may support and enhance patient selection.
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Affiliation(s)
- Maximilian Thormann
- Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
| | - Franziska Heitmann
- Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
| | - Vanessa Wrobel
- Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
| | - Constanze Heinze
- Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
| | - Christine March
- Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
| | - Peter Hass
- Department of Radiation Oncology, University Hospital Magdeburg, Magdeburg, Germany
| | - Robert Damm
- Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
| | - Alexey Surov
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Minden, Germany
| | - Maciej Pech
- Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
| | - Jazan Omari
- Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
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Meyer HJ, Melekh B, Wienke A, Surov A. Clinical importance of thoracal lymphadenopathy in COVID-19. J Infect Public Health 2023; 16:1244-1248. [PMID: 37290317 DOI: 10.1016/j.jiph.2023.05.031] [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: 02/24/2023] [Revised: 05/22/2023] [Accepted: 05/25/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND Thoracal lymphadenopathy may predict prognosis in patients with coronavirus disease 2019 (COVID-19), albeit the reported data is inconclusive. The aim of the present analysis was to analyze the affected lymph node stations and the cumulative lymph node size derived from computed tomography (CT) for prediction of 30-day mortality in patients with COVID-19. METHODS The clinical database was retrospectively screened for patients with COVID-19 between 2020 and 2022. Overall, 177 patients (63 female, 35.6%) were included into the analysis. Thoracal lymphadenopathy was defined by short axis diameter above 10 mm. Cumulative lymph node size of the largest lymph nodes was calculated and the amount of affected lymph node stations was quantified. RESULTS Overall, 53 patients (29.9%) died within the 30-day observation period. 108 patients (61.0%) were admitted to the ICU and 91 patients needed to be intubated (51.4%). Overall, there were 130 patients with lymphadenopathy (73.4%). The mean number of affected lymph node levels were higher in non-survivors compared to survivors (mean, 4.0 vs 2.2, p < 0.001). The cumulative size was also higher in non-survivors compared to survivors (mean 55.9 mm versus 44.1 mm, p = 0.006). Presence of lymphadenopathy was associated with 30-day mortality in a multivariable analysis, OR = 2.99 (95% CI 1.20 - 7.43), p = 0.02. CONCLUSIONS Thoracal lymphadenopathy comprising cumulative size and affected levels derived from CT images is associated with 30-day mortality in patients with COVID-19. COVID-19 patients presenting with thoracic lymphadenopathy should be considered as a risk group.
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Affiliation(s)
- Hans-Jonas Meyer
- Department of Diagnostic and Interventional Radiology, University of Leipzig, Leipzig, Germany.
| | - Bohdan Melekh
- Department of Radiology and Nuclear Medicine, University of Magdeburg, Magdeburg, Germany
| | - Andreas Wienke
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Alexey Surov
- Department of Radiology and Nuclear Medicine, University of Magdeburg, Magdeburg, Germany; Radiology and Nuclear Medicine, Kreisklinikum Minden, University of Bochum, Bochum, Germany
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Surov A, Thormann M, Hinnerichs M, Seidensticker M, Seidensticker R, Öcal O, Schütte K, Zech CJ, Loewe C, van Delden O, Vandecaveye V, Verslype C, Gebauer B, Sengel C, Bargellini I, Iezzi R, Berg T, Klümpen HJ, Benckert J, Gasbarrini A, Amthauer H, Sangro B, Malfertheiner P, Omari J, Wienke A, Ricke J, Pech M. Impact of body composition in advanced hepatocellular carcinoma: A subanalysis of the SORAMIC trial. Hepatol Commun 2023; 7:02009842-202306010-00019. [PMID: 37219875 DOI: 10.1097/hc9.0000000000000165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 03/09/2023] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND Body composition parameters have been reported to be prognostic factors in patients with oncologic diseases. However, the available data on patients with HCC are conflicting. The aim of this study was to assess the impact of body composition on survival in patients with HCC treated with sorafenib or selective internal radioembolization (SIRT) and sorafenib. METHODS This is an exploratory subanalysis of the prospective, randomized controlled SORAMIC trial. Within the palliative arm of the study, patients were selected if a baseline abdominal CT was available. A broad set of skeletal muscle and adipose tissue parameters were measured at the L3 level. Low skeletal muscle mass (LSMM) and density parameters were defined using published cutoffs. The parameters were correlated with overall survival. RESULTS Of 424 patients in the palliative study arm, 369 patients were included in the analysis. There were 192 patients in the combined sorafenib/SIRT and 177 patients in the sorafenib group. Median overall survival was 9.9 months for the entire cohort and 10.8 and 9.2 months for the SIRT/sorafenib and sorafenib groups, respectively. There was no relevant association of either body composition parameter with overall survival in either the overall cohort or in the SIRT/sorafenib or sorafenib subgroups. CONCLUSIONS This subanalysis of the prospective SORAMIC trial does not suggest a relevant influence of body composition parameters of survival in patients with advanced HCC. Body composition parameters therefore do not serve in patient allocation in this palliative treatment cohort.
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Affiliation(s)
- Alexey Surov
- University Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
| | - Maximilian Thormann
- University Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
| | - Mattes Hinnerichs
- University Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
| | - Max Seidensticker
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | | | - Osman Öcal
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Kerstin Schütte
- Department of Internal Medicine and Gastroenterology, Niels-Stensen-Kliniken Marienhospital, Osnabrück, Germany
- Department of Gastroenterology, Hepatology, and Endocrinology, Hannover Medical School, Hannover, Niedersachsen, Germany
| | - Christoph J Zech
- Radiology and Nuclear Medicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Christian Loewe
- Section of Cardiovascular and Interventional Radiology, Department of Bioimaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Otto van Delden
- Department of Radiology and Nuclear Medicine, Academic University Medical Centers, Amsterdam, The Netherlands
| | | | - Chris Verslype
- Department of Digestive Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Bernhard Gebauer
- Department of Radiology, Charité-University Medicine Berlin, Berlin, Germany
| | - Christian Sengel
- Radiology Department, Grenoble University Hospital, La Tronche, France
| | - Irene Bargellini
- Department of Vascular and Interventional Radiology, University Hospital of Pisa, Pisa, Italy
| | - Roberto Iezzi
- Department of Diagnostic Imaging, Oncologic Radiotherapy and Hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Thomas Berg
- Division of Hepatology, Clinic and Polyclinic for Gastroenterology, Hepatology, Infectiology, and Pneumology, University Clinic Leipzig, Germany
| | - Heinz J Klümpen
- Department of Medical Oncology, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Julia Benckert
- Department of Hepatology and Gastroenterology, Charité-University Medicine Berlin, Berlin, Germany
| | - Antonio Gasbarrini
- Department of Internal Medicine, Università Cattolica Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Holger Amthauer
- Department of Nuclear Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Bruno Sangro
- Liver Unit, Clínica Universidad de Navarra and CIBEREHD, Pamplona, Spain
| | | | - Jazan Omari
- University Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
| | - Andreas Wienke
- Institute of Medical Epidemiology, Biometry and Informatics, University of Halle, Halle, Germany
| | - Jens Ricke
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Maciej Pech
- University Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
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Barajas Ordonez F, Melekh B, Rodríguez-Feria P, Damm R, Thormann M, March C, Omari J, Pech M, Surov A. Parameters of body composition and creeping fat are associated with activity of Crohn's disease. Magn Reson Imaging 2023; 98:1-6. [PMID: 36634829 DOI: 10.1016/j.mri.2023.01.005] [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: 11/07/2022] [Accepted: 01/06/2023] [Indexed: 01/11/2023]
Abstract
AIM This study aimed at assessing body composition parameters, creeping fat (CrF), and Crohn's disease's (CD) activity based on the Magnetic Resonance Index of Activity (MaRIA). METHODS 114 CD patients who underwent magnetic resonance enterography (MRE) between June 2010 and April 2020 were retrospectively assessed. The semi-automated body composition segmentation, the qualitative evaluation of CrF, and MaRIA were performed. Based on their MaRIA score, patients were divided into two groups: mild-to-moderate disease (MaRIA <11, n = 50) and severe disease (MaRIA ≥11, n = 64). MRE parameters were analyzed between both groups. Patients were dichotomized according to body composition categories and the presence of CrF. Univariate regression analyses were performed to investigate the association between dichotomized variables and severe disease. Significant variables were incorporated into the multivariate logistic regression model. RESULTS The severe disease group exhibited higher serum C-reactive protein (CRP) levels compared to the mild-to-moderate disease group (p ≤0.001). In the mild-to-moderate disease group, a higher proportion of patients had a body mass index (BMI) ≥ 25 (kg/m2) (32.0%) compared to the severe disease group (16.5%) (p = 0.04). The subcutaneous adipose tissue index (SATI) was significantly higher in the mild-to-moderate disease group (p = 0.04). The visceral to subcutaneous adipose tissue (VAT/SAT) ratio tended to be higher in the severe disease group (p = 0.09). There was no significant difference between both groups regarding total adipose tissue index (TATI) (p = 0.10), visceral adipose tissue index (VATI) (p = 0.51), intramuscular adipose tissue index (IMATI) (p = 0.38), skeletal muscle index (SMI) (p = 0.83), and sarcopenia (p = 0.75). In the multivariate analysis, CrF was significantly associated with severe disease (odds ratio [OR] 11.50, 95% confidence interval [CI] 3.13-42.17; p ≤0.001). Additionally, a BMI ≥ 25 (kg/m2) was protective against severe disease (OR: 0.34, 95% CI 0.12-0.95; p = 0.04). CONCLUSION CrF is significantly associated with CD activity.
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Affiliation(s)
- Felix Barajas Ordonez
- University Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany.
| | - Bohdan Melekh
- University Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany.
| | - Pablo Rodríguez-Feria
- Department of International Health, CAPHRI - Care and Public Health Research Institute, Maastricht University, the Netherlands.
| | - Robert Damm
- University Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany.
| | - Maximilian Thormann
- University Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany.
| | - Christine March
- University Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany.
| | - Jazan Omari
- University Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany.
| | - Maciej Pech
- University Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany.
| | - Alexey Surov
- University Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany.
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Meyer HJ, Kardas H, Schramm D, Bär C, Wienke A, Borggrefe J, Surov A. CT-defined pectoralis muscle mass and muscle density are associated with mortality in acute pulmonary embolism. A multicenter analysis. Clin Nutr 2023; 42:1036-1040. [PMID: 37156143 DOI: 10.1016/j.clnu.2023.04.022] [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: 09/16/2022] [Revised: 04/05/2023] [Accepted: 04/24/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND & AIMS Computed tomography (CT) defined muscle mass can be used as a surrogate parameter for sarcopenia. The present study used thoracic CT to assess pectoralis muscle area and density as an imaging biomarker for prognosis of 30-day mortality in patients with acute pulmonary embolism (PE) METHODS: The clinical database was retrospectively screened for patients with thoracic CT in 3 centers. Pectoralis musculature was measured on axial slices of the thoracic CT at the level of T4 of contrast enhanced pulmonary angiography CT. Skeletal muscle area (SMA), skeletal muscle index (SMI), muscle density and gauge were calculated. RESULTS Overall, 981 patients (440 female, 44.9%) with a mean age of 63.5 ± 15.9 years were included into the study and 144 patients (14.6%) died within the 30-days period. Every pectoral muscle value was higher in survivors compared to non-survivors (exemplarily for SMI 9.9 ± 3.5 cm2/m2 versus 7.8 ± 2.6 cm2/m2, p < 0.001). Moreover, 91 patients were defined as hemodynamically instable (9.3%). Comparable, every pectoral muscle parameter was higher in patients with hemodynamically stable course compared to instable course. Different muscle variables are related to 30-day mortality: SMA, OR = 0.94 (95%CI= (0.92; 0.96), p < 0.001); SMI, OR = 0.78 (95%CI= (0.72; 0.84), p < 0.001); muscle density, OR = 0.96 (95%CI = (0.94; 0.97), p < 0.001); muscle gauge OR = 0.96 (95%CI = (0.94; 0.99), p < 0.001). SMI and muscle density were independently associated with 30-days mortality: SMI, OR = 0.81 (95%CI = (0.75; 0.88), p < 0.001); muscle density: OR = 0.96 (95%CI= (0.95; 0.98), p < 0.001). CONCLUSION Parameters of the pectoralis musculature are associated with 30-day mortality in patients with acute PE. These findings should lead to an independent validation study and ultimately to the inclusion into clinical routine as a prognostic factor.
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Affiliation(s)
- Hans-Jonas Meyer
- Department of Diagnostic and Interventional Radiology, University of Leipzig, Leipzig, Germany.
| | - Hakan Kardas
- Department of Radiology and Nuclear Medicine, Otto von Guericke University, Magdeburg, Germany
| | - Dominik Schramm
- Department of Diagnostic and Interventional Radiology, University of Halle-Wittenberg, Halle (Saale), Germany
| | - Caroline Bär
- Department of Radiology and Nuclear Medicine, Otto von Guericke University, Magdeburg, Germany
| | - Andreas Wienke
- Institute of Medical Epidemiology, Biostatistics, and Informatics, University Halle-Wittenberg, Germany
| | - Jan Borggrefe
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr-University-Bochum, Bochum, Germany
| | - Alexey Surov
- Department of Radiology and Nuclear Medicine, Otto von Guericke University, Magdeburg, Germany; Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr-University-Bochum, Bochum, Germany
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Thormann M, Heitmann F, Wrobel V, Barajas Ordonez F, Pech M, Surov A, Damm R, Omari J. Erratum: Sarcopenia does not limit overall survival in patients with colorectal liver metastases undergoing interstitial brachytherapy. ROFO-FORTSCHR RONTG 2023; 195:e1. [PMID: 36796392 DOI: 10.1055/a-2030-6723] [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: 02/18/2023]
Affiliation(s)
- Maximilian Thormann
- University Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
| | - Franziska Heitmann
- University Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
| | - Vanessa Wrobel
- University Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
| | - Felix Barajas Ordonez
- University Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
| | - Maciej Pech
- University Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
| | - Alexey Surov
- University Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
| | - Robert Damm
- University Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
| | - Jazan Omari
- University Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
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Heinze C, Damm R, Othmer M, Thormann M, Surov A, Hass P, Seidesticker R, Seidensticker M, Ricke J, Powerski M, Pech M, Omari J. Local tumor control of intermediate and advanced stage hepatocellular carcinoma after local ablative treatment with image-guided interstitial high-dose-rate brachytherapy: A subgroup analysis of 286 HCC nodules. Brachytherapy 2023; 22:231-241. [PMID: 36697267 DOI: 10.1016/j.brachy.2022.11.014] [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: 06/28/2022] [Revised: 11/08/2022] [Accepted: 11/25/2022] [Indexed: 01/24/2023]
Abstract
PURPOSE Image-guided interstitial high-dose-rate brachytherapy (iBT) has been demonstrated to offer high local tumor control rates (LTC) of >90% after local ablation of intermediate and advanced hepatocellular carcinoma (HCC; BCLC B and C). The purpose of this study was to show the efficacy of iBT stratified by subgroups and to identify clinical characteristics associated with superior local tumor control (LTC) based on a highly heterogenous patient population METHODS AND MATERIALS: A cumulative number of 286 HCC nodules in 107 patients were retrospectively analyzed. Clinical and imaging follow-ups were conducted every 3 months after treatment. Analyzed clinical factors were: etiology, presence of liver cirrhosis, radiographic features, lesion size, pretreatment, administered dose, presence of portal hypertension, portal vein thrombosis, and level of alpha-fetoprotein (AFP). RESULTS LTC rate was 88.8% for a median follow-up of 14.3 months (range 3-81 months; 95% CI: 85-92%). Median minimal enclosing tumor dose (D100) was 16.1 Gy (range 7.1-30.3 Gy; reference dose 15 Gy). Subgroup analysis showed significant fewer local recurrences for alcoholic liver disease (ALD)-related HCCs compared to those related to other causes of liver cirrhosis (nonalcoholic fatty liver disease, virus-related liver cirrhosis and other causes) (p = 0.015). LTC was significantly lower after prior surgical resection (p = 0.046). No significant variance was observed for the applied D100 in each group or for all other clinical factors tested. CONCLUSIONS IBT achieves high LTC rates across treated subgroups. However, further studies should particularly address the possible impact of underlying etiology on local recurrence with emphasis on a possible higher radiosensitivity of ALD-related HCCs.
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Affiliation(s)
- Constanze Heinze
- Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany.
| | - Robert Damm
- Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
| | - Max Othmer
- Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
| | - Maximilian Thormann
- Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
| | - Alexey Surov
- Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
| | - Peter Hass
- Department of Radiotherapy, University Hospital Magdeburg, Magdeburg, Germany
| | | | - Max Seidensticker
- Department of Radiology, University Hospital Munich, Munich, Germany
| | - Jens Ricke
- Department of Radiology, University Hospital Munich, Munich, Germany
| | - Maciej Powerski
- Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
| | - Maciej Pech
- Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
| | - Jazan Omari
- Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
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Thormann M, Heitmann F, Wrobel V, Barajas Ordonez F, Pech M, Surov A, Damm R, Omari J. Sarcopenia does not limit overall survival in patients with colorectal liver metastases undergoing interstitial brachytherapy. ROFO-FORTSCHR RONTG 2023; 195:217-223. [PMID: 36283404 DOI: 10.1055/a-1936-2937] [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: 11/05/2022]
Abstract
PURPOSE Several studies report an association of sarcopenia with survival in oncologic patients. The aim of this study is to assess the influence of sarcopenia on overall survival (OS) in patients with colorectal liver metastases undergoing interstitial brachytherapy (iBT) METHODS: We identified 144 patients with colorectal liver metastases from our database from 2014-2017. Computed tomography (CT) chest scans at the L3 level were retrospectively analyzed. Psoas muscle area (PMA), psoas muscle index (PMI), and skeletal muscle gauge (SMG) were measured on the CT scan before treatment. Parameters were associated with overall survival. RESULTS 116 patients were included. Median overall survival was 27 months. Median PMA was 13.79 cm2, median PMI 4.51 cm2/m2. Neither PMA (HR 1.036, 95 % CI 0.996-1.078, p = 0.080), PMI (HR 1.068, 95 % CI 0.922-1.238, p = 0.382), nor SMG (HR 1.00, 95 % CI 0.998-1.003, p = 0.955) were significantly associated with overall survival. CONCLUSION Sarcopenic patients undergoing iBT for colorectal liver metastases did not show decreased overall survival. If confirmed by comparative studies, sarcopenia may serve as a biomarker for treatment decision in patients with CRLM. KEY POINTS Sarcopenia is not a risk factor for survival in patients with CLRM undergoing iBT. CITATION FORMAT · Thormann M, Heitmann F, Wrobel V et al. Sarcopenia does not limit overall survival in patients with colorectal liver metastases undergoing interstitial brachytherapy. Fortschr Röntgenstr 2023; 195: 217 - 223.
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Affiliation(s)
- Maximilian Thormann
- University Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
| | - Franziska Heitmann
- University Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
| | - Vanessa Wrobel
- University Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
| | - Felix Barajas Ordonez
- University Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
| | - Maciej Pech
- University Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
| | - Alexey Surov
- University Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
| | - Robert Damm
- University Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
| | - Jazan Omari
- University Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
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45
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Surov A, Thormann M, Kardas H, Hinnerichs M, Omari J, Cingöz E, Cingöz M, Dursun M, Kormaz İ, Orhan Ç, Yıldız Ö, Hocaoğlu E, Inci E, Önder H, Erk H, Chousein O, Sasani H, Gönen KA, Pech M, Wienke A. Visceral to subcutaneous fat ratio predicts short-term mortality in patients with Covid 19. A multicenter study. Br J Radiol 2023; 96:20220869. [PMID: 36744766 PMCID: PMC10078869 DOI: 10.1259/bjr.20220869] [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: 02/07/2023] Open
Abstract
OBJECTIVE To evaluate the association of body composition parameters with outcomes in Covid-19. METHODS 173 patients hospitalized for Covid-19 infection in 6 European centers were included in this retrospective study. Measurements were performed at L3-level and comprised skeletal muscle index (SMI), muscle density (MD), and adipose tissue measurements [visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), intramuscular adipose tissue (IMAT), visceral-to-subcutaneous-adipose-tissue-area-ratio (VSR)]. The association with mortality, the need for intubation (MV), and the need for admission to ICU within 30 days were evaluated. RESULTS Higher SAT density was associated with a greater risk of MV (OR = 1.071, 95%CI=(1.034;1.110), p < 0.001). Higher VAT density was associated with admission to ICU (OR = 1.068, 95%CI=(1.029;1.109), p < 0.001). Higher MD was a protective factor for MV and ICU admission (OR = 0.914, 95%CI=(0.870;0.960), p < 0.001; OR = 0.882, 95%CI=(0.832;0.934), p = 0.028). Higher VSR was associated with mortality (OR = 2.147, 95%CI=(1.022;4.512), p = 0.044). Male sex showed the strongest influence on the risk of ICU admission and MV. SMI was not associated with either parameter. CONCLUSION In patients hospitalized for Covid-19 infection, higher VSR seems to be a strong prognostic factor of short-term mortality. Weak associations with clinical course were found for MD and adipose tissue measurements. Male sex was the strongest prognostic factor of adverse clinical course. ADVANCES IN KNOWLEDGE VSR is a prognostic biomarker for 30-day mortality in patients hospitalized for Covid-19 disease.
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Affiliation(s)
- Alexey Surov
- Department of Radiology,, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Maximilian Thormann
- Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
| | - Hakan Kardas
- Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
| | - Mattes Hinnerichs
- Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
| | - Jazan Omari
- Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
| | - Eda Cingöz
- Istanbul Medical Faculty Radiology Department, Istanbul University, Istanbul, Turkey
| | - Mehmet Cingöz
- Department of Radiology, Istanbul Cam and Sakura City Hospital, Istanbul, Turkey
| | - Memduh Dursun
- Istanbul Medical Faculty Radiology Department, Istanbul University, Istanbul, Turkey
| | - İnan Kormaz
- Department of Radiology, Hatay Mustafa Kemal University, Antakya, Hatay, Turkey
| | - Çağrı Orhan
- Department of Radiology, Hatay Mustafa Kemal University, Antakya, Hatay, Turkey
| | - Ömer Yıldız
- Radiology Department, University of Health Sciences, Bakirkoy Dr. Sadi Konuk Research and Training Hospital, Bakirkoy, Istanbul, Turkey
| | - Elif Hocaoğlu
- Radiology Department, University of Health Sciences, Bakirkoy Dr. Sadi Konuk Research and Training Hospital, Bakirkoy, Istanbul, Turkey
| | - Ercan Inci
- Radiology Department, University of Health Sciences, Bakirkoy Dr. Sadi Konuk Research and Training Hospital, Bakirkoy, Istanbul, Turkey
| | - Hakan Önder
- Radiology Department, Health Science University, Prof. Dr. Cemil Tascioğlu City Hospital, Istanbul, Turkey
| | - Hamdullah Erk
- Radiology Department, Health Science University, Prof. Dr. Cemil Tascioğlu City Hospital, Istanbul, Turkey
| | - Ougkour Chousein
- Department of Radiology, Tekirdag Namik Kemal University, Tekirdag, Turkey
| | - Hadi Sasani
- Department of Radiology, Tekirdag Namik Kemal University, Tekirdag, Turkey
| | - Korcan Aysun Gönen
- Department of Radiology, Tekirdag Namik Kemal University, Tekirdag, Turkey
| | - Maciej Pech
- Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
| | - Andreas Wienke
- Institute of Medical Epidemiology, Biometry, and Informatics, Martin- Luther- University, Halle-Wittenberg, Germany
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Barajas Ordonez F, Melekh B, Rodríguez-Feria P, Melekh O, Thormann M, Damm R, Omari J, Pech M, Surov A. Body Composition Predictors of Complicated Crohn's Disease. Dig Dis 2023; 41:589-599. [PMID: 36720207 PMCID: PMC10777712 DOI: 10.1159/000529426] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 01/26/2023] [Indexed: 02/02/2023]
Abstract
BACKGROUND High visceral adipose tissue (VAT) and creeping fat (CrF) in Crohn's disease (CD) have been widely recognized. The VAT to subcutaneous adipose tissue (SAT) ratio and sarcopenia have been associated with CD complications. Studies regarding the influence of body composition predictors on CD complications assessed with magnetic resonance enterography (MRE) are scarce. AIM The aim of this study was to assess body composition parameters and CrF in opportunistic MRE as predictors of complicated CD. METHODS This was a retrospective study of 114 patients with inflammatory (n = 54) and complicated (n = 60) CD. The semiautomated assessment of body composition and the qualitative evaluation of CrF were performed. RESULTS Body composition parameters did not differ between both groups regarding the body mass index (p = 0.50), total adipose tissue index (TATI) (p = 0.14), subcutaneous adipose tissue index (SATI) (p = 0.17), visceral adipose tissue index (VATI) (p = 0.33), VAT/SAT ratio (p = 0.77), intramuscular adipose tissue (p = 0.64), skeletal muscle index (p = 0.22), and sarcopenia (p = 0.50). 47 strictures, 18 fistulae, and seven abscesses were identified. Fistulae were more likely to occur in patients with CrF (odds ratio [OR] 5.07, 95% confidence interval [CI] 1.76-14.56; p=<0.001) and high VAT/SAT ratio (OR: 3.82, 95% CI 1.34-10.85; p = 0.01). CONCLUSION Body composition measurements in CD patients displayed no statistically significant difference between the groups of inflammatory and complicated disease. Nonetheless, CD patients stratified in the group of high VAT/SAT ratio and the presence of CrF should be recognized as risk groups for the occurrence of fistulae.
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Affiliation(s)
- Felix Barajas Ordonez
- University Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
| | - Bohdan Melekh
- University Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
| | - Pablo Rodríguez-Feria
- Department of International Health, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Oksana Melekh
- University Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
| | - Maximilian Thormann
- University Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
| | - Robert Damm
- University Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
- Radiology Practice, Dessau, Germany
| | - Jazan Omari
- University Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
| | - Maciej Pech
- University Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
| | - Alexey Surov
- University Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Minden, Germany
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Meyer HJ, Wienke A, Zamsheva M, Surov A. Low Skeletal Muscle Mass Predicts Relevant Outcomes in Palliative Urological Oncology: A Systematic Review and Meta-Analysis. Urol Int 2023; 107:219-229. [PMID: 36455534 PMCID: PMC10064389 DOI: 10.1159/000527277] [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: 08/03/2022] [Accepted: 08/26/2022] [Indexed: 12/03/2022]
Abstract
INTRODUCTION Low skeletal muscle mass (LSMM) can be assessed by cross-sectional imaging. LSMM is associated with several clinically relevant factors in various disorders with predictive and prognostic implications. METHODS Our aim was to establish the effect of computed tomography (CT)-defined LSMM on mortality in renal cell cancer (RCC) and urothelial carcinoma (UC) undergoing palliative treatment. The MEDLINE library, Cochrane, and SCOPUS databases were screened for the associations between CT-defined LSMM up to May 2022. In total, 11 studies were suitable for the analysis. RESULTS The included studies comprised 481 patients with RCC and 394 patients with UC. The pooled hazard ratio for the association between LSMM and overall survival was 1.64 (95% CI: 0.90-2.99), p = 0.10 in univariable analysis and 1.55 (95% CI: 0.91-2.63), p = 0.10 in multivariable analysis for RCC. For UC, the pooled hazard ratio was 2.75 (95% CI: 1.77-4.28), p < 0.00001 in univariable, and 2.77 (95% CI: 1.91-4.02), p < 0.00001 in multivariable analysis. For progression-free survival, it was 2.02 (95% CI: 1.24-3.27), p = 0.004 for RCC and 2.43 (95% CI: 1.59-3.74), p < 0.0001 for UC (univariable analysis). CONCLUSIONS CT-defined LSMM predicts OS and PFS in RCC and UC in the palliative setting. The effect was higher in UC. Therefore, LSMM assessment should be included as a relevant prognostic biomarker in clinical routine.
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Affiliation(s)
- Hans-Jonas Meyer
- Department of Diagnostic and Interventional Radiology, University of Leipzig, Leipzig, Germany
| | - Andreas Wienke
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Martin- Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Marina Zamsheva
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Martin- Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Alexey Surov
- Department of Radiology and Nuclear Medicine, University of Magdeburg, Magdeburg, Germany
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Meyer HJ, Uhlig J, Surov A. [Primary renal sarcomas: a rare cancer entity]. ROFO-FORTSCHR RONTG 2023; 195:7-8. [PMID: 36283403 DOI: 10.1055/a-1948-1708] [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)
- Hans Jonas Meyer
- Diagnostic and Interventional Radiology, University of Leipzig Faculty of Medicine, Leipzig, Germany
| | - Johannes Uhlig
- Diagnostic and Interventional Radiology, University of Göttingen, Gottingen, Germany
| | - Alexey Surov
- Radiology and Nuclear Medicine, University Hospital Magdeburg, Germany
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Meyer HJ, Wienke A, Pech M, Surov A. Computed Tomography-Defined Fat Composition as a Prognostic Marker in Gastric Adenocarcinoma: A Systematic Review and Meta-Analysis. Dig Dis 2023; 41:177-186. [PMID: 36228589 PMCID: PMC10015760 DOI: 10.1159/000527532] [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: 07/04/2022] [Accepted: 10/12/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Computed tomography (CT)-defined fat quantification has been an emergent field of research in oncology. It was shown that this parameter is predictive and prognostic of several clinically relevant factors in several tumor entities. OBJECTIVE Our aim was to establish the effect of visceral (VFA) and subcutaneous fat areas (SFA) on overall survival (OS), disease-free survival (DFS), and postoperative complications in gastric cancer patients based on a large patient sample. METHODS MEDLINE library, EMBASE, and SCOPUS databases were screened for the associations between VFA and SFA defined by CT images and OS, DFS, and postoperative complications in gastric cancer patients up to August 2022. The primary endpoint of the systematic review was the hazard ratio for the outcome parameters. High VFA was, in most studies, defined by the threshold value of 100 cm2. In total, 9 studies were suitable for the analysis and included in the present study. RESULTS The included studies comprised 3,713 patients. The identified frequency of visceral obesity was 44.9%. The pooled hazard ratio for the effect of high VFA on OS was 1.28 (95% CI 1.09-1.49, p = 0.002). For SFA, it was 1.87 (95% CI 1.45-2.42, p < 0.0001). The pooled hazard ratio for the influence of high VFA on DFS was 1.17 (95% CI 0.95-1.43, p = 0.14). The pooled odds ratio for the associations between VFA and postoperative complications was 1.36 (95% CI 1.09-1.69, p = 0.006). CONCLUSION CT-defined VFA and SFA influence OS in patients with gastric cancer. VFA also influences the occurrence of postoperative complications. Therefore, assessment of fat areas should be included in clinical routine in patients with gastric cancer.
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Affiliation(s)
- Hans-Jonas Meyer
- Department of Diagnostic and Interventional Radiology, University of Leipzig, Leipzig, Germany
| | - Andreas Wienke
- Institute of Medical Epidemiology, Biostatistics, And Informatics, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Maciej Pech
- Department of Radiology and Nuclear Medicine, University of Magdeburg, Magdeburg, Germany
| | - Alexey Surov
- Department of Radiology and Nuclear Medicine, University of Magdeburg, Magdeburg, Germany
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Surov A, Kardas H, Besutti G, Pellegrini M, Ottone M, Onur MR, Atak F, Erdemir AG, Hocaoglu E, Yıldız Ö, Inci E, Cingöz E, Cingöz M, Dursun M, Korkmaz İ, Orhan Ç, Strobel A, Wienke A, Pech M. Prognostic Role of the Pectoralis Musculature in Patients with COVID-19. A Multicenter Study. Acad Radiol 2023; 30:77-82. [PMID: 35667979 PMCID: PMC9108033 DOI: 10.1016/j.acra.2022.05.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [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: 04/27/2022] [Revised: 05/04/2022] [Accepted: 05/05/2022] [Indexed: 01/28/2023]
Abstract
RATIONALE AND OBJECTIVES To evaluate the impact of low skeletal muscle mass in patients with COVID-19 on relevant outcomes like 30-day mortality, need for intubation and need for intensive care unit admission. MATERIALS AND METHODS For this study, data from six centers were acquired. The acquired sample comprises 1138 patients. There were 547 women (48.1%) and 591 men (51.9%) with a mean age of 54.5 ± 18.8 years; median age, 55 years; range, 18-84 years). In every case, thoracic CT without intravenous application of contrast medium was performed. The following parameters of the pectoralis muscles were estimated: muscle area as a sum of the bilateral areas of the pectoralis major and minor muscles, muscle density, muscle index (PMI) (pectoralis muscle area divided by the patient's body height square) as a ratio pectoralis major and minor muscles divided by the patient's body height2, and muscle gauge as PMI x muscle density. RESULTS Overall, 220 patients (19.33%) were admitted to the intensive care unit. In 171 patients (15.03%), mechanical lung ventilation was performed. Finally, 154 patients (13.53%) died within the observation time of 30-day. All investigated parameters of pectoralis muscle were lower in the patients with unfavorable courses of Covid-19. All pectoralis muscle parameters were associated with 30-day mortality in multivariate analyses adjusted for age and sex: pectoralis muscle area, HR = 0.93 CI 95% (0.91-0.95) p < 0.001; pectoralis muscle density, HR = 0.94 CI 95% (0.93-0.96) p < 0.001; pectoralis muscle index, HR = 0.79 CI 95% (0.75-0.85) p < 0.001, pectoralis muscle gauge, HR = 0.995 CI 95% (0.99-0.996) p < 0.001. CONCLUSION in COVID-19, survivors have larger areas and higher index, gauge and density of the pectoralis muscles in comparison to nonsurvivors. However, the analyzed muscle parameters cannot be used for prediction of disease courses.
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Affiliation(s)
- Alexey Surov
- Department of Radiology and Nuclear Medicine, Otto-von-Guericke University Magdeburg (A.S., H.K., M.P.).
| | - Hakan Kardas
- Department of Radiology and Nuclear Medicine, Otto-von-Guericke University Magdeburg (A.S., H.K., M.P.)
| | - Giulia Besutti
- Radiology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy (G.B., M.P., M.O.)
| | - Massimo Pellegrini
- Radiology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy (G.B., M.P., M.O.)
| | - Marta Ottone
- Radiology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy (G.B., M.P., M.O.)
| | - Mehmet Ruhi Onur
- Department of Radiology, University of Hacettepe School of Medicine, Ankara, Turkey (M.R.O., F.A., A.G.E.)
| | - Firat Atak
- Department of Radiology, University of Hacettepe School of Medicine, Ankara, Turkey (M.R.O., F.A., A.G.E.)
| | - Ahmet Gurkan Erdemir
- Department of Radiology, University of Hacettepe School of Medicine, Ankara, Turkey (M.R.O., F.A., A.G.E.)
| | - Elif Hocaoglu
- Department of Radiology, University of Health Sciences, Bakirkoy Dr. Sadi Konuk Research and Training Hospital, Radiology (E.H., O.Y., E.I.)
| | - Ömer Yıldız
- Department of Radiology, University of Health Sciences, Bakirkoy Dr. Sadi Konuk Research and Training Hospital, Radiology (E.H., O.Y., E.I.)
| | - Ercan Inci
- Department of Radiology, University of Health Sciences, Bakirkoy Dr. Sadi Konuk Research and Training Hospital, Radiology (E.H., O.Y., E.I.)
| | - Eda Cingöz
- İstanbul Medical Faculty Radiology Department, Istanbul Turkey (E.C., M.C., M.D.)
| | - Mehmet Cingöz
- İstanbul Medical Faculty Radiology Department, Istanbul Turkey (E.C., M.C., M.D.),Basaksehir Cam and Sakura City Hospital Radiology Department (M.C.)
| | - Memduh Dursun
- İstanbul Medical Faculty Radiology Department, Istanbul Turkey (E.C., M.C., M.D.)
| | - İnan Korkmaz
- Hatay Mustafa Kemal University, Faculty of Medicine, Department of Radiology, Antakya, Hatay, Turkey (I.K., C.O.)
| | - Çağrı Orhan
- Hatay Mustafa Kemal University, Faculty of Medicine, Department of Radiology, Antakya, Hatay, Turkey (I.K., C.O.)
| | - Alexandra Strobel
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Profile Area Clinical Studies & Biostatistics, Martin-Luther-University Halle-Wittenberg, Halle, Germany (A.S., A.W.)
| | - Andreas Wienke
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Profile Area Clinical Studies & Biostatistics, Martin-Luther-University Halle-Wittenberg, Halle, Germany (A.S., A.W.)
| | - Maciej Pech
- Department of Radiology and Nuclear Medicine, Otto-von-Guericke University Magdeburg (A.S., H.K., M.P.)
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