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Svetlove A, Ritter CO, Dullin C, Schmid M, Schauer S, Uihlein J, Uecker M, Mietsch M, Stadelmann C, Lotz J, Unterberg-Buchwald C. Evaluation of MR-safe bioptomes for MR-guided endomyocardial biopsy in minipigs: a potential radiation-free clinical approach. Eur Radiol Exp 2023; 7:76. [PMID: 38049615 PMCID: PMC10695907 DOI: 10.1186/s41747-023-00391-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 09/21/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND Diagnostic accuracy of endomyocardial biopsy could improve if clinically safe magnetic resonance (MR)-compatible bioptomes were available. We explored two novel MR-compatible cardiac bioptomes for performance, safety, and clinical viability, employing in vivo minipig trials and phase-contrast synchrotron radiation computed microtomography (SRµCT). METHODS Analysis of ex vivo obtained pig endomyocardial biopsies was performed using phase-contrast SRµCT and conventional two-dimensional histology. The technical performance was evaluated by measuring volume, inner and outer integrities, compression, and histological diagnostic value in 3 sets (6 per set) of biopsies for each experimental bioptome. The bioptomes were tested in vivo in 3 healthy minipigs per bioptome. The clinical feasibility was evaluated by procedural and cutting success as well as histological diagnostic value. RESULTS The bioptome with the 'grind-grind' design achieved similar values to control in compression (p = 0.822), inner (p = 0.628), and outer (p = 0.507), integrities ex vivo. It showed a better performance in the in vivo real-time MRI setting demonstrating a higher cutting success (91.7%) than the 'grind-anvil' (86.2%) design. In both ex vivo and in vivo evaluations, the 'grind-grind' design displayed sufficient diagnostic value (83% and 95%). The 'grind-anvil' design showed adequate diagnostic value both ex vivo and in vivo (78% and 87.5%) but was not comparable to control according to the three-dimensional (3D) analysis. CONCLUSION A novel MR-compatible bioptome was identified as plausible in a clinical setting. Additionally, SRµCT and subsequent 3D structural analysis could be valuable in the label-free investigation of myocardial tissue at a micrometer level. RELEVANCE STATEMENT Implementation of MR-guided biopsy can improve animal studies on structural myocardial changes at any point in an experimental setup. With further improvements in guiding catheters, MR-guided biopsy, using the new bioptome, has a potential to increase quality and diagnostic accuracy in patients both with structural and inflammatory cardiomyopathies. KEY POINTS • Novel MR-compatible bioptomes show promise for a clinical application. • SRµCT enabled detailed analysis of endomyocardial biopsies. • The bioptomes showed adequate in vivo performance without major complications.
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Affiliation(s)
- Angelika Svetlove
- Translational Molecular Imaging, Max Planck Institute for Multidisciplinary Sciences, Göttingen, Germany
- Cluster of Excellence "Multiscale Bioimaging: From Molecular Machines to Networks of Excitable Cells" (MBExC), University of Göttingen, Göttingen, Germany
- Institute for Diagnostic and Interventional Radiology, University Medical Centre, Göttingen, Germany
| | - Christian O Ritter
- Institute for Diagnostic and Interventional Radiology, University Medical Centre, Göttingen, Germany
- Institute for Diagnostic and Interventional Radiology, Klinikum St. Marien Amberg, Amberg, Germany
| | - Christian Dullin
- Translational Molecular Imaging, Max Planck Institute for Multidisciplinary Sciences, Göttingen, Germany
- Institute for Diagnostic and Interventional Radiology, University Medical Centre, Göttingen, Germany
- Department for Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
- TLRC (Translational Lung Research Center), University Hospital Heidelberg, Heidelberg, Germany
| | - Michael Schmid
- EPflex Feinwerktechnik GmbH, Dettingen an der Erms, Germany
| | - Senta Schauer
- EPflex Feinwerktechnik GmbH, Dettingen an der Erms, Germany
| | | | - Martin Uecker
- Institute for Diagnostic and Interventional Radiology, University Medical Centre, Göttingen, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Göttingen, Göttingen, Germany
- Institute of Biomedical Imaging, Graz University of Technology, Graz, Austria
| | - Matthias Mietsch
- DZHK (German Centre for Cardiovascular Research), Partner Site Göttingen, Göttingen, Germany
- Laboratory Animal Science Unit, Leibniz-Institut Für Primatenforschung, Deutsches Primatenzentrum GmbH, Göttingen, Germany
| | | | - Joachim Lotz
- Institute for Diagnostic and Interventional Radiology, University Medical Centre, Göttingen, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Göttingen, Göttingen, Germany
| | - Christina Unterberg-Buchwald
- Institute for Diagnostic and Interventional Radiology, University Medical Centre, Göttingen, Germany.
- DZHK (German Centre for Cardiovascular Research), Partner Site Göttingen, Göttingen, Germany.
- Department of Cardiology and Pneumology, University Medical Centre, Göttingen, Germany.
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Soschynski M, Bunck AC, Beer M, Kloempken S, Schlett CL, Baeßler B, Kröger JR, Persigehl T, Pinto Dos Santos D, Steinmetz M, Niehaus A, Bamberg F, Ley S, Tiemann K, Beerbaum P, Lotz J, Maintz D, Kloth C, Brunner H, Ritter CO. Structured Reporting in Cross-Sectional Imaging of the Heart: Reporting Templates for CMR Imaging of Ischemia and Myocardial Viability and for Cardiac CT Imaging of Coronary Heart Disease and TAVI Planning. ROFO-FORTSCHR RONTG 2023; 195:293-296. [PMID: 36796410 DOI: 10.1055/a-1981-1196] [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: 02/18/2023]
Abstract
BACKGROUND Structured reporting allows a high grade of standardization and thus a safe and unequivocal report communication. In the past years, the radiological societies have started several initiatives to base radiological reports on structured reporting rather than free text reporting. METHODS Upon invitation of the working group for Cardiovascular Imaging of the German Society of Radiology, in 2018 an interdisciplinary group of Radiologists, Cardiologists, Pediatric Cardiologists and Cardiothoracic surgeons -all experts on the field of cardiovascular MR and CT imaging- met for interdisciplinary consensus meetings at the University Hospital Cologne. The aim of these meetings was to develop and consent templates for structured reporting in cardiac MR and CT of various cardiovascular diseases. RESULTS Two templates for structured reporting of CMR in ischemia imaging and vitality imaging and two templates for structured reporting of CT imaging for planning Transcatheter Aortic Valve Implantation (TAVI; pre-TAVI-CT) and coronary CT were discussed, consented and transferred to a HTML 5/IHR MRRT compatible format. The templates were made available for free use on the website www.befundung.drg.de. CONCLUSION This paper suggests consented templates in German language for the structured reporting of cross-sectional CMR imaging of ischemia and vitality as well as reporting of CT imaging pre-TAVI and coronary CT. The implementation of these templates is aimed at providing a constant level of high reporting quality and increasing the efficiency of report generation as well as a clinically based communication of imaging results. KEY POINTS · Structured reporting offers a constant level of high reporting quality and increases the efficiency of report generation as well as a clinically based communication of imaging results.. · For the first time templates in German language for the structured reporting of CMR imaging of ischemia and vitality and CT imaging pre-TAVI and coronary CT are reported.. · These templates will be made available on the website www.befundung.drg.de and can be commented via strukturierte-befundung@drg.de.. ZITIERWEISE · Soschynski M, Bunck AC, Beer M et al. Structured Reporting in Cross-Sectional Imaging of the Heart: Reporting Templates for CMR Imaging of Ischemia and Myocardial Viability and for Cardiac CT Imaging of Coronary Heart Disease and TAVI Planning. Fortschr Röntgenstr 2023; DOI: 10.1055/a-1981-1196.
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Affiliation(s)
- Martin Soschynski
- Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | | | - Meinrad Beer
- Abteilung für Diagnostische und Interventionelle Radiologie, University Hospital Ulm, Germany
| | - Steffen Kloempken
- Abteilung für Diagnostische und Interventionelle Radiologie, University Hospital Ulm, Germany
| | - Christopher L Schlett
- Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Bettina Baeßler
- Department of Diagnostic and Interventional Radiology, University Hospital Wurzburg, Germany
| | - Jan Robert Kröger
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling Hospital Minden, Germany
| | | | - Daniel Pinto Dos Santos
- Institut für Diagnostische und Interventionelle Radiologie, University Hospital Cologne, Koln, Germany.,Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie, Johannes Gutenberg Universitat Universitatsmedizin, Mainz, Germany
| | - Michael Steinmetz
- Klinik für Pädiatrische Kardiologie und Intensivmedizin, University Medical Center Göttingen, Gottingen, Germany
| | - Adelheid Niehaus
- Klinik für Herz-, Thorax-, Transplantations- und Gefäßchirurgie, Hannover Medical School, Hannover, Germany
| | - Fabian Bamberg
- Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Sebastian Ley
- Diagnostic and Interventional Radiology, Artemed SE, Tutzing, Germany
| | - Klaus Tiemann
- Department of Cardiology and Intensive Care, Peter Osypka Heart Center Munich, Hospital Munich South, Munchen, Germany
| | - Philipp Beerbaum
- Clinic for Paediatric Cardiology and Paediatric Critical Care Medicine, Hannover Medical School, Hannover, Germany
| | - Joachim Lotz
- Diagnostic Radiology, University Medical Center Göttingen, Germany
| | | | - Christopher Kloth
- Diagnostic and Interventional Radiology, University Hospital Ulm, Germany
| | - Horst Brunner
- Diagnostic and Interventional Radiology, University Hospital Ulm, Germany
| | - Christian O Ritter
- Diagnostic and Interventional Radiology, University Medical Center Göttingen, Gottingen, Germany
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3
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Lerchbaumer MH, Aviram G, Ebner M, Ritter CO, Steimke L, Rozenbaum Z, Adam SZ, Granot Y, Hasenfuß G, Lotz J, Hamm B, Konstantinides SV, Lankeit M. Optimized definition of right ventricular dysfunction on computed tomography for risk stratification of pulmonary embolism. Eur J Radiol 2022; 157:110554. [PMID: 36308850 DOI: 10.1016/j.ejrad.2022.110554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 10/01/2022] [Accepted: 10/07/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES There is an ongoing discussion on the optimal right to left (RV/LV) diameter ratio threshold and the best definition of RV dysfunction on computed tomography pulmonary angiography (CTPA) for risk assessment of pulmonary embolism (PE). METHODS On routine diagnostic CTPA, volumetric and diameter measurements (axial and reconstructed views) of the ventricles and reflux of contrast medium into the inferior vena cava (IVC) and hepatic veins were assessed in consecutive PE patients enrolled in a prospective single-center registry. In-hospital adverse outcome was defined as PE-related death, cardiopulmonary resuscitation, mechanical ventilation or catecholamine administration. RESULTS Of 609 patients (median age, 69 [IQR, 56-77] years; 47 % male) included in the analysis, 68 patients (11.2 %) had an adverse outcome and 35 (5.7 %) died. While neither a RV/LV volume ratio ≥1.0 nor RV/LV diameter ratios ≥1.0 were able to predict an adverse outcome, higher thresholds increased specificity. Further, neither volumetric measurements nor reconstruction of images provided superior prognostic information compared to RV/LV ratios measured in axial planes. The combination of an axial RV/LV diameter ratio ≥1.5 with substantial reflux of contrast medium was present in 134 patients (22 %) and associated with the best prognostic performance to predict an adverse outcome in unselected (OR 3.7 [95 % CI, 2.0-6.6]) and normotensive (OR 2.8 [95 % CI, 1.1-6.7]) patients. CONCLUSION A new definition of RV dysfunction (axial RV/LV diameter ratio ≥1.5 and substantial reflux of contrast medium to the IVC and hepatic veins) allows an optimized CTPA-based prediction of PE-related adverse outcome.
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Affiliation(s)
| | - Galit Aviram
- Department of Radiology, Tel Aviv Medical Centre, Tel Aviv, Israel(2)
| | - Matthias Ebner
- Department of Cardiology and Angiology, Campus Charité Mitte (CCM), Charité - University Medicine Berlin, Germany
| | - Christian O Ritter
- Institute for Diagnostic and Interventional Radiology, University Medical Center, Goettingen, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Goettingen, Germany
| | - Laura Steimke
- Clinic of Cardiology and Pneumology, University Medical Center, Goettingen, Germany
| | - Zach Rozenbaum
- Department of Cardiology, Tel Aviv Medical Centre, Tel Aviv, Israel(3)
| | - Sharon Z Adam
- Department of Radiology, Tel Aviv Medical Centre, Tel Aviv, Israel(2)
| | - Yoav Granot
- Department of Cardiology, Tel Aviv Medical Centre, Tel Aviv, Israel(3)
| | - Gerd Hasenfuß
- German Center for Cardiovascular Research (DZHK), Partner Site Goettingen, Germany; Clinic of Cardiology and Pneumology, University Medical Center, Goettingen, Germany
| | - Joachim Lotz
- Institute for Diagnostic and Interventional Radiology, University Medical Center, Goettingen, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Goettingen, Germany
| | - Bernd Hamm
- Department of Radiology, Charité - University Medicine Berlin, Germany
| | - Stavros V Konstantinides
- Department of Cardiology, Democritus University of Thrace, Alexandroupolis, Greece; Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz, Germany
| | - Mareike Lankeit
- Clinic of Cardiology and Pneumology, University Medical Center, Goettingen, Germany; Department of Internal Medicine and Cardiology, Campus Virchow Klinikum (CVK), Charité - University Medicine Berlin, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Germany
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4
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Lerchbaumer MH, Ebner M, Ritter CO, Steimke L, Rogge NIJ, Sentler C, Thielmann A, Hobohm L, Keller K, Lotz J, Hasenfuß G, Wachter R, Hamm B, Konstantinides SV, Aviram G, Lankeit M. Prognostic value of right atrial dilation in patients with pulmonary embolism. ERJ Open Res 2021; 7:00414-2020. [PMID: 34046488 PMCID: PMC8141828 DOI: 10.1183/23120541.00414-2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 12/15/2020] [Indexed: 11/05/2022] Open
Abstract
Aims Right atrial (RA) dilation and stretch provide prognostic information in patients with cardiovascular diseases. We investigated the prevalence, confounding factors and prognostic relevance of RA dilation in patients with pulmonary embolism (PE). Methods Overall, 609 PE patients were consecutively included in a prospective single-centre registry between September 2008 and August 2017. Volumetric measurements of heart chambers were performed on routine non-electrocardiographic-gated computed tomography and plasma concentrations of mid-regional pro-atrial natriuretic peptide (MR-proANP) measured on admission. An in-hospital adverse outcome was defined as PE-related death, cardiopulmonary resuscitation, mechanical ventilation or catecholamine administration. Results Patients with an adverse outcome (11.2%) had larger RA volumes (median 120 (interquartile range 84-152) versus 102 (78-134) mL; p=0.013), RA/left atrial (LA) volume ratios (1.7 (1.2-2.4) versus 1.3 (1.1-1.7); p<0.001) and MR-proANP levels (282 (157-481) versus 129 (64-238) pmol·L-1; p<0.001) compared to patients with a favourable outcome. Overall, 499 patients (81.9%) had a RA/LA volume ratio ≥1.0 and a calculated cut-off value of 1.8 (area under the curve 0.64, 95% CI 0.56-0.71) predicted an adverse outcome, both in unselected (OR 3.1, 95% CI 1.9-5.2) and normotensive patients (OR 2.7, 95% CI 1.3-5.6). MR-proANP ≥120 pmol·L-1 was identified as an independent predictor of an adverse outcome, both in unselected (OR 4.6, 95% CI 2.3-9.3) and normotensive patients (OR 5.1, 95% CI 1.5-17.6). Conclusions RA dilation is a frequent finding in patients with PE. However, the prognostic performance of RA dilation appears inferior compared to established risk stratification markers. MR-proANP predicted an in-hospital adverse outcome, both in unselected and normotensive PE patients, integrating different prognostic relevant information from comorbidities.
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Affiliation(s)
| | - Matthias Ebner
- Dept of Nephrology and Medical Intensive Care, Charité - University Medicine Berlin, Berlin, Germany.,Dept of Internal Medicine and Cardiology, Charité - University Medicine Berlin, Berlin, Germany
| | - Christian O Ritter
- Institute for Diagnostic and Interventional Radiology, University Medical Center Göttingen, Göttingen, Germany.,German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
| | - Laura Steimke
- Clinic of Cardiology and Pneumology, University Medical Center Göttingen, Göttingen, Germany
| | - Nina I J Rogge
- Clinic of Cardiology and Pneumology, University Medical Center Göttingen, Göttingen, Germany
| | - Carmen Sentler
- Clinic of Cardiology and Pneumology, University Medical Center Göttingen, Göttingen, Germany
| | - Aaron Thielmann
- Clinic of Cardiology and Pneumology, University Medical Center Göttingen, Göttingen, Germany
| | - Lukas Hobohm
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz, Mainz, Germany.,Cardiology I, Center for Cardiology, University Medical Center Mainz, Mainz, Germany
| | - Karsten Keller
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz, Mainz, Germany.,Cardiology I, Center for Cardiology, University Medical Center Mainz, Mainz, Germany
| | - Joachim Lotz
- Institute for Diagnostic and Interventional Radiology, University Medical Center Göttingen, Göttingen, Germany.,German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
| | - Gerd Hasenfuß
- German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany.,Clinic of Cardiology and Pneumology, University Medical Center Göttingen, Göttingen, Germany
| | - Rolf Wachter
- German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany.,Clinic of Cardiology and Pneumology, University Medical Center Göttingen, Göttingen, Germany.,Clinic and Policlinic for Cardiology, University Hospital Leipzig, Leipzig, Germany
| | - Bernd Hamm
- Dept of Radiology, Charité - University Medicine Berlin, Berlin, Germany
| | - Stavros V Konstantinides
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz, Mainz, Germany.,Dept of Cardiology, Democritus University of Thrace, Alexandroupolis, Greece
| | - Galit Aviram
- Dept of Radiology, Tel Aviv Medical Center, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mareike Lankeit
- Dept of Internal Medicine and Cardiology, Charité - University Medicine Berlin, Berlin, Germany.,Clinic of Cardiology and Pneumology, University Medical Center Göttingen, Göttingen, Germany.,Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz, Mainz, Germany.,German Center for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany
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5
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Weng AM, Köstler H, Bley TA, Ritter CO. Effect of short-term smoking & L-arginine on coronary endothelial function assessed by cardiac magnetic resonance cold pressor testing: a pilot study. BMC Cardiovasc Disord 2021; 21:237. [PMID: 33980159 PMCID: PMC8114700 DOI: 10.1186/s12872-021-02050-1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 05/05/2021] [Indexed: 11/13/2022] Open
Abstract
Background The effect of smoking on coronary vasomotion has been investigated in the past with various imaging techniques in both short- and long-term smokers. Additionally, coronary vasomotion has been shown to be normalized in long-term smokers by L-Arginine acting as a substrate for NO synthase, revealing the coronary endothelium as the major site of abnormal vasomotor response. Aim of the prospective cohort study was to investigate coronary vasomotion of young healthy short-term smokers via magnetic resonance cold pressor test with and without the administration of L-Arginine and compare obtained results with the ones from nonsmokers. Methods Myocardial blood flow (MBF) was quantified with first-pass perfusion MRI on a 1.5 T scanner in healthy short-term smokers (N = 10, age: 25.0 ± 2.8 years, 5.0 ± 2.9 pack years) and nonsmokers (N = 10, age: 34.3 ± 13.6) both at rest and during cold pressor test (CPT). Smokers underwent an additional examination after administration of L-Arginine within a median of 7 days of the naïve examination. Results MBF at rest turned out to be 0.77 ± 0.30 (smokers with no L-Arginine; mean ± standard deviation), 0.66 ± 0.21 (smokers L-Arginine) and 0.84 ± 0.08 (nonsmokers). Values under CPT were 1.21 ± 0.42 (smokers no L-Arginine), 1.09 ± 0.35 (smokers L-Arginine) and 1.63 ± 0.33 (nonsmokers). In all groups, MBF was significantly increased under CPT compared to the corresponding rest examination (p < 0.05 in all cases). Additionally, MBF under CPT was significantly different between the smokers and the nonsmokers (p = 0.002). MBF at rest was significantly different between the smokers when L-Arginine was given and the nonsmokers (p = 0.035). Conclusion Short-term smokers showed a reduced response to cold both with and without the administration of L-Arginine. However, absolute MBF values under CPT were lower compared to nonsmokers independently of L-Arginine administration.
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Affiliation(s)
- Andreas M Weng
- Department of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany.
| | - Herbert Köstler
- Department of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| | - Thorsten A Bley
- Department of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| | - Christian O Ritter
- Department of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany.,Institute for Diagnostic and Interventional Radiology, University Medicine Goettingen, Goettingen, Germany
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6
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Stephani C, Herrmann P, Ritter CO, Lotz J, Saager L, Meissner K, Moerer O. Anatomic lung recruitment in the early phase of severe COVID-19-pneumonia. Pulmonology 2021; 27:345-347. [PMID: 33551267 PMCID: PMC7825885 DOI: 10.1016/j.pulmoe.2020.12.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 12/19/2020] [Accepted: 12/30/2020] [Indexed: 11/09/2022] Open
Affiliation(s)
- C Stephani
- Department for Anesthesiology, University Medical Center Göttingen, Robert-Koch-Strasse 40, 37075 Göttingen, Germany
| | - P Herrmann
- Department for Anesthesiology, University Medical Center Göttingen, Robert-Koch-Strasse 40, 37075 Göttingen, Germany
| | - C O Ritter
- Institute for Diagnostic and Interventional Radiology, University Medical Center Göttingen, Robert-Koch-Strasse 40, 37075 Göttingen, Germany
| | - J Lotz
- Institute for Diagnostic and Interventional Radiology, University Medical Center Göttingen, Robert-Koch-Strasse 40, 37075 Göttingen, Germany
| | - L Saager
- Department for Anesthesiology, University Medical Center Göttingen, Robert-Koch-Strasse 40, 37075 Göttingen, Germany
| | - K Meissner
- Department for Anesthesiology, University Medical Center Göttingen, Robert-Koch-Strasse 40, 37075 Göttingen, Germany
| | - O Moerer
- Department for Anesthesiology, University Medical Center Göttingen, Robert-Koch-Strasse 40, 37075 Göttingen, Germany.
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7
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Backhaus SJ, Staab W, Steinmetz M, Ritter CO, Lotz J, Hasenfuss G, Kowallick JT, Schuster A. P5284Fully automated quantification of biventricular volumes and function in cardiovascular magnetic resonance: applicability to clinical routine settings. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0255] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Cardiovascular magnetic resonance (CMR) represents the clinical gold standard for the assessment of biventricular morphology and function. Since manual post-processing is time-consuming and prone to observer variability, efforts have been directed towards automated volumetric quantification. In this study, we sought to validate the accuracy of a novel approach providing fully automated quantification of biventricular volumes and function in a “real-world” clinical setting.
Methods
Three-hundred CMR examinations were randomly selected from the local data base. Fully automatic quantification of left ventricular (LV) mass, LV and right ventricular (RV) end-diastolic and systolic volumes (EDV/ESV), stroke volume (SV) and ejection fraction (EF) were performed overnight using commercially available software. Parameters were compared to manual assessments. Sub-group analyses were further performed according to image quality, scanner field strength, the presence of implanted aortic valves and repaired Tetralogy of Fallot (ToF).
Results
Biventricular automatic segmentation was feasible in all 300 cases. Overall agreement between fully automated and manually derived LV parameters was good (LV-EF: intra-class correlation coefficient [ICC] 0.95; bias −2.5% [SD 5.9%]), whilst RV agreement was lower (RV-EF: ICC 0.72; bias 5.8% [SD 9.6%]). Lowest agreement was observed in case of severely altered anatomy, e.g. marked RV dilation but normal LV dimensions in repaired ToF (LV parameters ICC 0.73–0.91; RV parameters ICC 0.41–0.94) and/or reduced image quality (LV parameters ICC 0.86–0.95; RV parameters ICC 0.56–0.91), which was more common on 3.0T than on 1.5T.
Conclusions
Fully automated assessment of biventricular morphology and function is robust and accurate in a clinical routine setting with good image quality and can be performed without any user interaction. However, in case of demanding anatomy (e.g. repaired ToF, severe LV hypertrophy) or reduced image quality, quality check and manual re-contouring is still required.
Acknowledgement/Funding
DZHK - German Centre for Cardiovascular Research
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Affiliation(s)
| | - W Staab
- University Medical Center Göttingen, Institute for Diagnostic and Interventional Radiology, Göttingen, Germany
| | - M Steinmetz
- University Medical Center Göttingen, Department of Pediatric Cardiology and Intensive Care Medicine, Goettingen, Germany
| | - C O Ritter
- University Medical Center Göttingen, Institute for Diagnostic and Interventional Radiology, Göttingen, Germany
| | - J Lotz
- University Medical Center Göttingen, Institute for Diagnostic and Interventional Radiology, Göttingen, Germany
| | - G Hasenfuss
- Heart Centre Goettingen, Goettingen, Germany
| | - J T Kowallick
- University Medical Center Göttingen, Institute for Diagnostic and Interventional Radiology, Göttingen, Germany
| | - A Schuster
- Heart Centre Goettingen, Goettingen, Germany
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8
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Unterberg-Buchwald C, Fasshauer M, Staab W, Steinmetz M, Kowallick J, Ritter CO. P408Unusual case of pericardial effusion. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez109.047] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- C Unterberg-Buchwald
- Universitaetsmedizin Goettingen, Dept. of Cardiology and Pneumology, Insitute of Diag. and Interv. Radiology, Goettingen, Germany
| | - M Fasshauer
- Institute of Diagn. and Interv. Radiology, Goettingen, Germany
| | - W Staab
- Institute of Diagn. and Interv. Radiology, Goettingen, Germany
| | - M Steinmetz
- Universitatesmedizin Goettingen, Dep.t of Pediatric Cardiology and Intensive Care medicine, Goettingen, Germany
| | - J Kowallick
- Institute of Diagn. and Interv. Radiology, Goettingen, Germany
| | - C O Ritter
- Institute of Diagn. and Interv. Radiology, Goettingen, Germany
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Unterberg-Buchwald C, Kowallick J, Fasshauer M, Steinmetz M, Backhaus S, Lotz J, Ritter CO. P392Fulminant autoimmune myocarditis in Hashimoto thyreoidtis. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez109.033] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- C Unterberg-Buchwald
- Universitaetsmedizin Goettingen, Dept. of Cardiology and Pneumology, Insitute of Diag. and Interv. Radiology, Goettingen, Germany
| | - J Kowallick
- Institute of Diagn. and Interv. Radiology, Goettingen, Germany
| | - M Fasshauer
- Institute of Diagn. and Interv. Radiology, Goettingen, Germany
| | - M Steinmetz
- Universitatesmedizin Goettingen, Dep.t of Pediatric Cardiology and Intensive Care medicine, Goettingen, Germany
| | - S Backhaus
- Universitatesmedizin, Dept. of Cardiology and Pneumology, Goettingen, Germany
| | - J Lotz
- Institute of Diagn. and Interv. Radiology, Goettingen, Germany
| | - C O Ritter
- Institute of Diagn. and Interv. Radiology, Goettingen, Germany
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10
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Backhaus SJ, Staab W, Steinmetz M, Ritter CO, Lotz J, Hasenfuß G, Schuster A, Kowallick JT. Fully automated quantification of biventricular volumes and function in cardiovascular magnetic resonance: applicability to clinical routine settings. J Cardiovasc Magn Reson 2019; 21:24. [PMID: 31023305 PMCID: PMC8059518 DOI: 10.1186/s12968-019-0532-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 03/12/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Cardiovascular magnetic resonance (CMR) represents the clinical gold standard for the assessment of biventricular morphology and function. Since manual post-processing is time-consuming and prone to observer variability, efforts have been directed towards automated volumetric quantification. In this study, we sought to validate the accuracy of a novel approach providing fully automated quantification of biventricular volumes and function in a "real-world" clinical setting. METHODS Three-hundred CMR examinations were randomly selected from the local data base. Fully automated quantification of left ventricular (LV) mass, LV and right ventricular (RV) end-diastolic and end-systolic volumes (EDV/ESV), stroke volume (SV) and ejection fraction (EF) were performed overnight using commercially available software (suiteHEART®, Neosoft, Pewaukee, Wisconsin, USA). Parameters were compared to manual assessments (QMass®, Medis Medical Imaging Systems, Leiden, Netherlands). Sub-group analyses were further performed according to image quality, scanner field strength, the presence of implanted aortic valves and repaired Tetralogy of Fallot (ToF). RESULTS Biventricular automated segmentation was feasible in all 300 cases. Overall agreement between fully automated and manually derived LV parameters was good (LV-EF: intra-class correlation coefficient [ICC] 0.95; bias - 2.5% [SD 5.9%]), whilst RV agreement was lower (RV-EF: ICC 0.72; bias 5.8% [SD 9.6%]). Lowest agreement was observed in case of severely altered anatomy, e.g. marked RV dilation but normal LV dimensions in repaired ToF (LV parameters ICC 0.73-0.91; RV parameters ICC 0.41-0.94) and/or reduced image quality (LV parameters ICC 0.86-0.95; RV parameters ICC 0.56-0.91), which was more common on 3.0 T than on 1.5 T. CONCLUSIONS Fully automated assessments of biventricular morphology and function is robust and accurate in a clinical routine setting with good image quality and can be performed without any user interaction. However, in case of demanding anatomy (e.g. repaired ToF, severe LV hypertrophy) or reduced image quality, quality check and manual re-contouring are still required.
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Affiliation(s)
- Sören J. Backhaus
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Wieland Staab
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
- Institute for Diagnostic and Interventional Radiology, University Medical Centre Göttingen, Georg-August University, Robert-Koch-Str. 40, 37075 Göttingen, Germany
| | - Michael Steinmetz
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
- Department of Pediatric Cardiology and Intensive Care Medicine, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
| | - Christian O. Ritter
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
- Institute for Diagnostic and Interventional Radiology, University Medical Centre Göttingen, Georg-August University, Robert-Koch-Str. 40, 37075 Göttingen, Germany
| | - Joachim Lotz
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
- Institute for Diagnostic and Interventional Radiology, University Medical Centre Göttingen, Georg-August University, Robert-Koch-Str. 40, 37075 Göttingen, Germany
| | - Gerd Hasenfuß
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Andreas Schuster
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
- Department of Cardiology, Royal North Shore Hospital, The Kolling Institute, Nothern Clinical School, University of Sydney, Sydney, Australia
| | - Johannes T. Kowallick
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
- Institute for Diagnostic and Interventional Radiology, University Medical Centre Göttingen, Georg-August University, Robert-Koch-Str. 40, 37075 Göttingen, Germany
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11
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Weng AM, Wilimsky S, Bender G, Hahner S, Köstler H, Ritter CO. Magnetic resonance cold pressor test to investigate potential endothelial dysfunction in patients suffering from type 1 diabetes. J Magn Reson Imaging 2018; 48:1595-1601. [PMID: 29897641 DOI: 10.1002/jmri.26191] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 03/21/2018] [Accepted: 04/27/2018] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND In its course, diabetes impairs microvascular function through endothelial dysfunction. As the response of myocardial perfusion to sympathetic stimulation through cold is modulated by endothelium-related factors, an incipient endothelial dysfunction might be observed noninvasively by investigation of myocardial perfusion with a cold pressor test (CPT). This approach has been used in clinical MRI previously. PURPOSE To assess endothelial function of patients suffering from type 1 diabetes by MR CPT. STUDY TYPE Prospective cohort study. SUBJECTS Twenty type 1 diabetics and 20 healthy volunteers. FIELD STRENGTH/SEQUENCE 3T, dynamic contrast enhanced perfusion (steady-state free precession). ASSESSMENT Absolute quantitative myocardial perfusion values at rest and under CPT. STATISTICAL TESTS Kolmogorov-Smirnov test to determine normal distribution of the results. T-test for independent samples. RESULTS Patients' mean myocardial perfusion was 0.68 cc/g/min at rest and 0.80 cc/g/min during CPT, respective values of 0.81 cc/g/min and 1.36 cc/g/min were found in healthy volunteers. Perfusion values differed significantly for CPT (P < 0.01) but not for resting conditions (P = 0.06). DATA CONCLUSION This study demonstrated that endothelial function might be impaired in type 1 diabetes patients. This fosters the thesis that endothelial function may serve as an early biomarker for coronary artery disease in patients with type 1 diabetes while these patients are still clinically asymptomatic. LEVEL OF EVIDENCE 2 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2018;48:1595-1601.
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Affiliation(s)
- Andreas M Weng
- Department of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Germany
| | - Stefan Wilimsky
- Department of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Germany.,Department of Diagnostic and Interventional Neuroradiology, University Hospital of Würzburg, Germany
| | - Gwendolyn Bender
- Department of Internal Medicine 1, University Hospital of Würzburg, Germany
| | - Stefanie Hahner
- Department of Internal Medicine 1, University Hospital of Würzburg, Germany
| | - Herbert Köstler
- Department of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Germany
| | - Christian O Ritter
- Department of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Germany.,Department of Diagnostic and Interventional Radiology, University Medicine Göttingen, Germany
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Fasshauer M, Krüwel T, Zapf A, Stahnke V, Rave-Fränk M, Staab W, Steinmetz M, Unterberg-Buchwald C, Schuster A, Sohns JM, Ritter CO, Lotz J. Absence of DNA double strand breaks in human peripheral blood mononuclear cells after magnetic resonance imaging assessed by γH2AX flow cytometry: a prospective blinded trial. J Cardiovasc Magn Reson 2016. [PMCID: PMC5032129 DOI: 10.1186/1532-429x-18-s1-o129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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13
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Baur J, Ritter CO, Germer CT, Klein I, Kickuth R, Steger U. Transarterial chemoembolization with drug-eluting beads versus conventional transarterial chemoembolization in locally advanced hepatocellular carcinoma. Hepat Med 2016; 8:69-74. [PMID: 27382341 PMCID: PMC4920234 DOI: 10.2147/hmer.s105395] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Purpose In hepatocellular carcinoma patients with large or multinodal tumors, where curative treatment options are not feasible, transarterial therapies play a major role. Transarterial chemoembolization (TACE) with drug-eluting beads (DEB-TACE) is a promising new approach due to higher intratumoral and lower systemic concentration of the chemotherapeutic agent compared to conventional TACE (cTACE). Patients and methods In a retrospective analysis, 32 patients with hepatocellular carcinoma who received either DEB or a cTACE were compared regarding survival time, disease recurrence, and side effects such as pain and fever. Results No significant differences could be detected between the cTACE and DEB-TACE groups with regard to mean hospital stay, appearance of postinterventional fever, or 30-day mortality. However, the application of intravenous analgesics as postinterventional pain medication was needed more often in patients treated with DEB-TACE (57.1% vs 12.5%, P=0.0281). The overall median survival after the initial procedure was 10.8 months in the cTACE group and 9.2 months in the DEB-TACE group, showing no significant difference. Conclusion No survival benefit for patients treated with either DEB-TACE or cTACE was observed. Surprisingly, a higher rate of postinterventional pain could be detected after DEB-TACE.
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Affiliation(s)
- Johannes Baur
- Department of General, Visceral, Vascular, and Pediatric Surgery
| | | | | | - Ingo Klein
- Department of General, Visceral, Vascular, and Pediatric Surgery
| | - Ralph Kickuth
- Institute of Radiology, University Hospital Würzburg, Würzburg, Germany
| | - Ulrich Steger
- Department of General, Visceral, Vascular, and Pediatric Surgery
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Hijazi S, Meller B, Leitsmann C, Strauss A, Meller J, Ritter CO, Lotz J, Schildhaus HU, Trojan L, Sahlmann CO. Pelvic lymph node dissection for nodal oligometastatic prostate cancer detected by 68Ga-PSMA-positron emission tomography/computerized tomography. Prostate 2015; 75:1934-40. [PMID: 26356236 DOI: 10.1002/pros.23091] [Citation(s) in RCA: 109] [Impact Index Per Article: 12.1] [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: 06/08/2015] [Accepted: 08/31/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND The first evaluation of pelvic extended lymph node dissection (pLND) in oligometastatic prostate cancer (PCa) detected by (68)Ga-PSMA PET/CT. METHODS Retrospective analysis of 35 PCa patients underwent (68)Ga-PSMA PET/CT affected by biochemical recurrence (BCR) after curative treatment (n = 23) or before primary therapy of high-risk PCa (n = 12). We performed pLND associated with pathologic imaging in 17 men with nodal oligometastatic PCa. RESULTS Indicative lesions for PCa in PET/CT were detected in 91.4% (32 of 35) of patients. Nodal, bone, visceral (pulmonary), and within the prostate suspected disease were detected in 72% (23 of 32), 16% (5 of 32), 6% (2 of 32), and 47% (15 of 32) of patients, respectively. Median serum PSA in patients with pathological radiotracer uptake in recurrent and high-risk PCa patients was 2.9 ng/ml (range 0.18-30) and 19.5 ng/ml (range 6-90), respectively. The median number of removed lymph nodes with pLND in recurrent and high-risk PCa was 10 (range 4-17) and 12 (range 8-29) per patient and the median number of positive lymph nodes was 1 (range 1-2) and 3 (2-3) per patient, respectively. In total, two false positive and one false-negative lymph node were found. Diagnostic accuracies per nodal lesion in total of 213 removed nodes: sensitivity, 94%; specificity, 99%; positive predictive value (PPV), 89%, and negative predictive value (NPV), 99.5%. After pLND, 53% (9 of 17) of patients received androgen deprivation therapy and/or radiation therapy and hormonal therapy, while 47% (8 of 17) of patients remained free of any post-surgery therapy. Follow-up PSA remained less than 0.2 ng/ml in 82% (14 of 17) of patients. After pLND, immediate BCR (PSA never measured less than 0.2 ng/ml) in 18% (3 of 17) of patients was recorded. CONCLUSIONS This represents the first study of pLND in the setting of nodal oligometastatic PCa detected by (68)Ga-PSMA PET/CT. The use of (68)Ga-PSMA PET/CT could be to improve the accuracy for the detection of nodal micrometastases. These promising findings need validation in larger studies.
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Affiliation(s)
- S Hijazi
- Department of Urology, University Medical Center Goettingen, Goettingen, Germany
| | - B Meller
- Department of Nuclear Medicine, University Medical Center Goettingen, Goettingen, Germany
| | - C Leitsmann
- Department of Urology, University Medical Center Goettingen, Goettingen, Germany
| | - A Strauss
- Department of Urology, University Medical Center Goettingen, Goettingen, Germany
| | - J Meller
- Department of Nuclear Medicine, University Medical Center Goettingen, Goettingen, Germany
| | - C O Ritter
- Department of Radiology, University Medical Center Goettingen, Goettingen, Germany
| | - J Lotz
- Department of Radiology, University Medical Center Goettingen, Goettingen, Germany
| | - H-U Schildhaus
- Institute of Pathology, University Medical Center Goettingen, Goettingen, Germany
| | - L Trojan
- Department of Urology, University Medical Center Goettingen, Goettingen, Germany
| | - C O Sahlmann
- Department of Nuclear Medicine, University Medical Center Goettingen, Goettingen, Germany
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Petersenn S, Richter PA, Broemel T, Ritter CO, Deutschbein T, Beil FU, Allolio B, Fassnacht M. Computed tomography criteria for discrimination of adrenal adenomas and adrenocortical carcinomas: analysis of the German ACC registry. Eur J Endocrinol 2015; 172:415-22. [PMID: 25599706 DOI: 10.1530/eje-14-0916] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Thresholds of 2-20 hounsfield units (HU) in unenhanced computed tomography (CT) are suggested to discriminate benign adrenal tumors (BATs) from malignant adrenal tumors. However, these studies included only low numbers of adrenocortical carcinomas (ACCs). This study defines a HU threshold by inclusion of a large cohort of ACCs. DESIGN Retrospective, blinded, comparative analysis of CT scans from 51 patients with ACCs (30 females, median age 49 years) and 25 patients with BATs (12 females, median age 64 years) diagnosed during the period of 2005-2010 was performed. METHODS Tumor density was evaluated in unenhanced CT by two blinded investigators. RESULTS Median tumor size was 9 cm (range 2.0-20) for ACCs vs 4 cm (2.0-7.5) for BATs (P<0.0001). In ACCs, the median unenhanced HU value was 34 (range 14-74) in comparison with 5 (-13 to 40) in BATs (P<0.0001). ROC analysis revealed a HU of 21 as threshold with the best diagnostic accuracy (sensitivity 96%, specificity 80%, and AUC 0.89). However, two ACCs that were 5 and 6 cm in size would have been missed. Setting the threshold to 13.9 allowed for 100% sensitivity, but a lower specificity of 68%. CONCLUSIONS This first large study on ACCs confirmed that the vast majority of ACCs have unenhanced HU >21. However, to avoid misdiagnosing an ACC as benign, a threshold of 13 should be used.
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Affiliation(s)
- Stephan Petersenn
- ENDOC Center for Endocrine TumorsAltonaer Street 59, 20357 Hamburg, GermanyDepartment of Internal MedicineUniversity of Hamburg, Hamburg, GermanyPraenobis HamburgHamburg, GermanyDepartment of RadiologyEndocrine and Diabetes UnitDepartment of Internal Medicine I, University HospitalComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, Germany
| | - Paul-Ajoy Richter
- ENDOC Center for Endocrine TumorsAltonaer Street 59, 20357 Hamburg, GermanyDepartment of Internal MedicineUniversity of Hamburg, Hamburg, GermanyPraenobis HamburgHamburg, GermanyDepartment of RadiologyEndocrine and Diabetes UnitDepartment of Internal Medicine I, University HospitalComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, Germany
| | - Thomas Broemel
- ENDOC Center for Endocrine TumorsAltonaer Street 59, 20357 Hamburg, GermanyDepartment of Internal MedicineUniversity of Hamburg, Hamburg, GermanyPraenobis HamburgHamburg, GermanyDepartment of RadiologyEndocrine and Diabetes UnitDepartment of Internal Medicine I, University HospitalComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, Germany
| | - Christian O Ritter
- ENDOC Center for Endocrine TumorsAltonaer Street 59, 20357 Hamburg, GermanyDepartment of Internal MedicineUniversity of Hamburg, Hamburg, GermanyPraenobis HamburgHamburg, GermanyDepartment of RadiologyEndocrine and Diabetes UnitDepartment of Internal Medicine I, University HospitalComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, Germany
| | - Timo Deutschbein
- ENDOC Center for Endocrine TumorsAltonaer Street 59, 20357 Hamburg, GermanyDepartment of Internal MedicineUniversity of Hamburg, Hamburg, GermanyPraenobis HamburgHamburg, GermanyDepartment of RadiologyEndocrine and Diabetes UnitDepartment of Internal Medicine I, University HospitalComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, Germany
| | - Frank-Ulrich Beil
- ENDOC Center for Endocrine TumorsAltonaer Street 59, 20357 Hamburg, GermanyDepartment of Internal MedicineUniversity of Hamburg, Hamburg, GermanyPraenobis HamburgHamburg, GermanyDepartment of RadiologyEndocrine and Diabetes UnitDepartment of Internal Medicine I, University HospitalComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, Germany
| | - Bruno Allolio
- ENDOC Center for Endocrine TumorsAltonaer Street 59, 20357 Hamburg, GermanyDepartment of Internal MedicineUniversity of Hamburg, Hamburg, GermanyPraenobis HamburgHamburg, GermanyDepartment of RadiologyEndocrine and Diabetes UnitDepartment of Internal Medicine I, University HospitalComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, Germany
| | - Martin Fassnacht
- ENDOC Center for Endocrine TumorsAltonaer Street 59, 20357 Hamburg, GermanyDepartment of Internal MedicineUniversity of Hamburg, Hamburg, GermanyPraenobis HamburgHamburg, GermanyDepartment of RadiologyEndocrine and Diabetes UnitDepartment of Internal Medicine I, University HospitalComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, Germany ENDOC Center for Endocrine TumorsAltonaer Street 59, 20357 Hamburg, GermanyDepartment of Internal MedicineUniversity of Hamburg, Hamburg, GermanyPraenobis HamburgHamburg, GermanyDepartment of RadiologyEndocrine and Diabetes UnitDepartment of Internal Medicine I, University HospitalComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, Germany
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Fischer A, Weick S, Ritter CO, Beer M, Wirth C, Hebestreit H, Jakob PM, Hahn D, Bley T, Köstler H. SElf-gated Non-Contrast-Enhanced FUnctional Lung imaging (SENCEFUL) using a quasi-random fast low-angle shot (FLASH) sequence and proton MRI. NMR Biomed 2014; 27:907-917. [PMID: 24820869 DOI: 10.1002/nbm.3134] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [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: 08/29/2013] [Revised: 04/04/2014] [Accepted: 04/10/2014] [Indexed: 06/03/2023]
Abstract
Obtaining functional information on the human lung is of tremendous interest in the characterization of lung defects and pathologies. However, pulmonary ventilation and perfusion maps usually require contrast agents and the application of electrocardiogram (ECG) triggering and breath holds to generate datasets free of motion artifacts. This work demonstrates the possibility of obtaining highly resolved perfusion-weighted and ventilation-weighted images of the human lung using proton MRI and the SElf-gated Non-Contrast-Enhanced FUnctional Lung imaging (SENCEFUL) technique. The SENCEFUL technique utilizes a two-dimensional fast low-angle shot (FLASH) sequence with quasi-random sampling of phase-encoding (PE) steps for data acquisition. After every readout, a short additional acquisition of the non-phase-encoded direct current (DC) signal necessary for self-gating was added. By sorting the quasi-randomly acquired data according to respiratory and cardiac phase derived from the DC signal, datasets of representative respiratory and cardiac cycles could be accurately reconstructed. By application of the Fourier transform along the temporal dimension, functional maps (perfusion and ventilation) were obtained. These maps were compared with dynamic contrast-enhanced (DCE, perfusion) as well as standard Fourier decomposition (FD, ventilation) reference datasets. All datasets were additionally scored by two experienced radiologists to quantify image quality. In addition, one initial patient examination using SENCEFUL was performed. Functional images of healthy volunteers and a patient diagnosed with hypoplasia of the left pulmonary artery and left-sided pulmonary fibrosis were successfully obtained. Perfusion-weighted images corresponded well to DCE-MRI data; ventilation-weighted images offered a significantly better depiction of the lung periphery compared with standard FD. Furthermore, the SENCEFUL technique hints at a potential clinical relevance by successfully detecting a perfusion defect in the patient scan. It can be concluded that SENCEFUL enables highly resolved ventilation- and perfusion-weighted maps of the human lung to be obtained using proton MRI, and might be interesting for further clinical evaluation.
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Affiliation(s)
- André Fischer
- Department of Radiology, University of Würzburg, Würzburg, Germany
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Abstract
OBJECTIVE To calculate and evaluate absolute quantitative myocardial perfusion maps from rest first-pass perfusion MRI. METHODS 10 patients after revascularization of myocardial infarction underwent cardiac rest first-pass perfusion MRI. Additionally, perfusion examinations were performed in 12 healthy volunteers. Quantitative myocardial perfusion maps were calculated by using a deconvolution technique, and results were compared were the findings of a sector-based quantification. RESULTS Maps were typically calculated within 3 min per slice. For the volunteers, myocardial blood flow values of the maps were 0.51 ± 0.16 ml g(-1) per minute, whereas sector-based evaluation delivered 0.52 ± 0.15 ml g(-1) per minute. A t-test revealed no statistical difference between the two sets of values. For the patients, all perfusion defects visually detected in the dynamic perfusion series could be correctly reproduced in the maps. CONCLUSION Calculation of quantitative perfusion maps from myocardial perfusion MRI examinations is feasible. The absolute quantitative maps provide additional information on the transmurality of perfusion defects compared with the visual evaluation of the perfusion series and offer a convenient way to present perfusion MRI findings. ADVANCES IN KNOWLEDGE Voxelwise analysis of myocardial perfusion helps clinicians to assess the degree of tissue damage, and the resulting maps are a good tool to present findings to patients.
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Affiliation(s)
- A M Weng
- 1 Institute of Radiology, University of Würzburg, Würzburg, Germany
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Wiegering A, Ritter CO, Allolio B, Buck AK, Germer CT, Lorenz U. Early development of a celiac trunk aneurysm during anti-vascular endothelial growth factor receptor therapy. Surgery 2014; 155:729-30. [PMID: 24612626 DOI: 10.1016/j.surg.2013.12.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2013] [Accepted: 12/19/2013] [Indexed: 12/21/2022]
Affiliation(s)
- Armin Wiegering
- Department of General-, Visceral-, Vascular- and Pediatric Surgery, University of Wuerzburg, Wuerzburg, Germany.
| | | | - Bruno Allolio
- Endocrinology and Diabetes Unit, Department of Internal Medicine I, University of Wuerzburg, Wuerzburg, Germany
| | - Andreas K Buck
- Department of Nuclear Medicine, University of Wuerzburg, Wuerzburg, Germany
| | - Christoph-Thomas Germer
- Department of General-, Visceral-, Vascular- and Pediatric Surgery, University of Wuerzburg, Wuerzburg, Germany
| | - Udo Lorenz
- Department of General-, Visceral-, Vascular- and Pediatric Surgery, University of Wuerzburg, Wuerzburg, Germany
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Wilimsky S, Weng AM, Bender G, Hahn D, Köstler H, Ritter CO. MR-Cold Pressor Test zur Absolutquantifizierung der myokardialen Perfusion bei Typ I Diabetikern. ROFO-FORTSCHR RONTG 2013. [DOI: 10.1055/s-0033-1346321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Fischer A, Ritter CO, Köstler H, Hahn D. Quantitative funktionelle MRT der Lunge in freier Atmung - ohne Kontrastmittel und ohne EKG-Trigger. ROFO-FORTSCHR RONTG 2013. [DOI: 10.1055/s-0033-1346485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Goltz JP, Ritter CO, Kellersmann R, Klein D, Hahn D, Kickuth R. Endovascular Treatment of Popliteal Artery Segments P1 and P2 in Patients With Critical Limb Ischemia: Initial Experience Using a Helical Nitinol Stent With Increased Radial Force. J Endovasc Ther 2012; 19:450-6. [DOI: 10.1583/11-3591mr.1] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Ritter CO. Methodisches Einmaleins der CTA und MRA. ROFO-FORTSCHR RONTG 2012. [DOI: 10.1055/s-0032-1310995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Fischer A, Ritter CO, Hahn D, Köstler H. Quantitative MR-Lungenperfusionsmessung: Vergleich von kontrastverstärkter MR und SEEPAGE bei 3.0 T. ROFO-FORTSCHR RONTG 2012. [DOI: 10.1055/s-0032-1311065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Schedelbeck U, Gattenlöhner S, Hahn D, Ritter CO. [Splenomegaly with multiple unclear parenchymal lesions. Splenomegaly]. Radiologe 2012; 52:263-6. [PMID: 22290454 DOI: 10.1007/s00117-011-2289-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A 53-year-old female patient presented with splenomegaly, uncertain lesions of the spleen, pancytopenia and suspected aortitis. Reduced strength and muscular pain but no B symptoms were also present. Alterations of the spleen had been known for a long time. Blood examination, laboratory tests and magnetic resonance imaging (MRI) confirmed an aortitis. Concerning the splenic changes neither ultrasound nor MRI could provide conclusive or even pathognomonic findings. Because of an existing pancytopenia and diagnostic obscurity, the patient underwent splenectomy. The histological diagnosis was finally concluded as multifocal littoral cell angioma.
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Affiliation(s)
- U Schedelbeck
- Institut für Röntgendiagnostik, Universitätsklinikum Würzburg, Oberdürrbacherstr. 6, 97080 Würzburg.
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Ritter CO, Wilke A, Wichmann T, Beer M, Hahn D, Köstler H. Comparison of intravascular and extracellular contrast media for absolute quantification of myocardial rest-perfusion using high-resolution MRI. J Magn Reson Imaging 2011; 33:1047-51. [PMID: 21509860 DOI: 10.1002/jmri.22557] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To use the contrast agent gadofosveset for absolute quantification of myocardial perfusion and compare it with gadobenate dimeglumine (Gd-BOPTA) using a high-resolution generalized autocalibrating partially parallel acquisition (GRAPPA) sequence. MATERIALS AND METHODS Ten healthy volunteers were examined twice at two different dates with a first-pass perfusion examination at rest using prebolus technique. We used a 1.5 T scanner and a 32 channel heart-array coil with a steady-state free precession (SSFP) true fast imaging with steady state precession (trueFISP) GRAPPA sequence (acceleration-factor 3). Manual delineation of the myocardial contours was performed and absolute quantification was performed after baseline and contamination correction. At the first appointment, 1cc/4cc of the extracellular contrast agent Gd-BOPTA were administered, on the second date, 1cc/4cc of the blood pool contrast agent (CA) gadofosveset. At each date the examination was repeated after a 15-minute time interval. RESULTS Using gadofosveset perfusion the value (in cc/g/min) at rest was 0.66 ± 0.25 (mean ± standard deviation) for the first, and 0.55 ± 0.24 for the second CA application; for Gd-BOPTA it was 0.62 ± 0.25 and 0.45 ± 0.23. No significant difference was found between the acquired perfusion values. The apparent mean residence time in the myocardium was 23 seconds for gadofosveset and 19.5 seconds for Gd-BOPTA. Neither signal-to-noise ratio (SNR) nor subjectively rated image contrast showed a significant difference. CONCLUSION The application of gadofosveset for an absolute quantification of myocardial perfusion is possible. Yet the acquired perfusion values show no significant differences to those determined with Gd-BOPTA, maintained the same SNR and comparable perfusion values, and did not picture the expected concentration time-course for an intravasal CA in the first pass.
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Affiliation(s)
- Christian O Ritter
- Institut für Röntgendiagnostik der Universität Würzburg, Würzburg, Germany.
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Ritter CO, Kowalski M, Weng AM, Beer M, Hahn D, Köstler H. Quantitative myocardial perfusion imaging with a MR cold pressor test. Magn Reson Med 2011; 67:246-50. [PMID: 21630345 DOI: 10.1002/mrm.22941] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2010] [Revised: 03/04/2011] [Accepted: 03/07/2011] [Indexed: 01/30/2023]
Abstract
The response of myocardial blood flow to sympathetic stimulation with cold is modulated by endothelium-related factors. As endothelial dysfunction is an early step in patients with coronary artery disease, the aim of this study was to establish a cold pressor test (CPT) setting for quantitative analysis of myocardial perfusion in a MR scanner. First pass perfusion studies were performed in 10 healthy volunteers using a 1.5 T MR scanner with a multislice steady state free precession perfusion trueFISP sequence in prebolus technique (1 cc/4 cc gadobenate dimeglumine). MR-CPT was established using an over head ice-water bath of the left hand. First pass perfusion imaging was started after 1 min to assure an adequate stimulus followed by a second series after 15 min to evaluate the rest perfusion. After motion correction images were segmented with an adapted, automated tool, myocardial contours were determined. Perfusion was quantitatively evaluated after contamination and baseline correction by deconvolution with the arterial input function using an exponential function model as residuum. All data could be evaluated. Mean myocardial perfusion rose from 0.61 ± 0.22 cc/g/min at rest to 1.15 ± 0.34 cc/g/min under CPT. MR myocardial perfusion values show a comparable increase under CPT as published positron emission tomography data. Consequently, CPT for the presence of endothelial dysfunction is feasible in the MR environment.
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Affiliation(s)
- C O Ritter
- Institute of Radiology, University of Würzburg, Würzburg, Germany.
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Goltz JP, Ritter CO, Petritsch B, Kellersmann R, Hahn D, Kickuth R. Endovascular Treatment of Acute Limb Ischemia Secondary to Fracture of a Popliteal Artery Stent. J Vasc Interv Radiol 2010; 21:1739-45. [DOI: 10.1016/j.jvir.2010.07.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2010] [Revised: 06/15/2010] [Accepted: 07/16/2010] [Indexed: 10/19/2022] Open
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Goltz JP, Ritter CO, Kenn W, Hahn D, Kickuth R. Immediate and Complete Stent Collapse in the Superficial Femoral Artery Solved by Implantation of a New Helical Nitinol Stent. Cardiovasc Intervent Radiol 2010; 34 Suppl 2:S307-11. [DOI: 10.1007/s00270-010-9873-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Goltz JP, Scholl A, Ritter CO, Wittenberg G, Hahn D, Kickuth R. Peripherally Placed Totally Implantable Venous-access Port Systems of the Forearm: Clinical Experience in 763 Consecutive Patients. Cardiovasc Intervent Radiol 2010; 33:1159-67. [DOI: 10.1007/s00270-010-9854-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2009] [Accepted: 03/23/2010] [Indexed: 01/02/2023]
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Özdil S, Weng A, Ritter CO, Hahn D, Köstler H. Automatische Segmentierung von MR-Herz-Bildern zur Bestimmung kardialer Funktionsparameter. ROFO-FORTSCHR RONTG 2010. [DOI: 10.1055/s-0030-1252895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Goltz JP, Ritter CO, Kenn W, Hahn D, Kickuth R. Optionale Vena-Cava-Filter: Ergebnisse einer Single-Center Studie. ROFO-FORTSCHR RONTG 2010. [DOI: 10.1055/s-0030-1252828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Goltz JP, Wittenberg G, Ritter CO, Hahn D, Kickuth R. Explantation von interventionell-radiologisch implantierten Port-a-Cath-Systemen im Unterarm: Indikationen und Komplikationen. ROFO-FORTSCHR RONTG 2010. [DOI: 10.1055/s-0030-1252597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Weng AM, Ritter CO, Lotz J, Beer M, Hahn D, Köstler H. Pixelbasierte Absolutquantifizierung der myokardialen Perfusion in der MRT – Berechnung von Perfusionskarten aus MR First-Pass Perfusionsuntersuchungen. ROFO-FORTSCHR RONTG 2010. [DOI: 10.1055/s-0029-1247986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Weininger M, Ritz K, Ritter CO, Hahn D, Beissert M. Koronares Kalzium-Scoring in der CT: Ergeben verschiedene Analyseprogramme vergleichbare Ergebnisse? – Bestimmung des koronaren Kalzium-Scores. ROFO-FORTSCHR RONTG 2010. [DOI: 10.1055/s-0029-1247988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Ritter CO, Baier U, Sommer SP, Leyh R, Hahn D, Beer M. Vergleichende funktionelle MR-Bildgebung bei Patienten nach ROSS-Operation in Wurzelersatz- und subkoronarer Technik im ersten postoperativen Jahr – Kardio-MRT nach ROSS-OP. ROFO-FORTSCHR RONTG 2010. [DOI: 10.1055/s-0029-1247968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Affiliation(s)
- Christian O Ritter
- Institut fuer Roentgendiagnostik, ZOM, Oberduerrbacherstrasse 6, 97080 Wuerzburg, Germany.
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Oechsner M, Mühlhäusler M, Ritter CO, Weininger M, Beissert M, Jakob PM, Beer M, Hahn D, Köstler H. Quantitative contrast-enhanced perfusion measurements of the human lung using the prebolus approach. J Magn Reson Imaging 2009; 30:104-11. [DOI: 10.1002/jmri.21793] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Weininger M, Sommer C, Ritter CO, Hahn D, Beissert M. Diagnostik der akuten Mediastinitis nach Sternotomie: Gibt es typische CT-Befunde? ROFO-FORTSCHR RONTG 2009. [DOI: 10.1055/s-0029-1221583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Goltz JP, Scholl A, Ritter CO, Klein D, Wittenberg G, Hahn D, Kickuth R. Minimal-invasive perkutane Implantation von Port-a-Cath-Systemen am Unterarm: klinische Erfahrungen bei 750 Patienten. ROFO-FORTSCHR RONTG 2009. [DOI: 10.1055/s-0029-1221437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Weng A, Ritter CO, Lotz J, Hahn D, Beer M, Köstler H. Evaluation einer vollautomatischen Quantifizierung von MR-Herz-Perfusionsuntersuchungen. ROFO-FORTSCHR RONTG 2009. [DOI: 10.1055/s-0029-1221498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Ritter CO, Kowalski M, Weng A, Beer M, Hahn D, Köstler H. Quantitative MR Herz Perfusionsbildgebung in Ruhe und unter Cold Pressor Test. ROFO-FORTSCHR RONTG 2009. [DOI: 10.1055/s-0029-1221467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Weininger M, Ritter CO, Hahn D, Beissert M. Cardiac computed tomography of aortocoronary bypass in type a aortic dissection. Asian Cardiovasc Thorac Ann 2008; 16:86-7. [PMID: 18245717 DOI: 10.1177/021849230801600123] [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: 11/16/2022]
Affiliation(s)
- Markus Weininger
- University Hospital of Wuerzburg, Department of Radiology, Oberduerrbacher Strasse 6, 97080 Wuerzburg, Germany.
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Weng A, Ritter CO, Lotz J, Beer M, Hahn D, Köstler H. Erstellung von Perfusionskarten bei Herz-MR-Perfusionsuntersuchungen. ROFO-FORTSCHR RONTG 2008. [DOI: 10.1055/s-2008-1073530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Ritter CO, del Savio K, Brackertz A, Beer M, Hahn D, Köstler H. [High-resolution MRI for the quantitative evaluation of subendocardial and subepicardial perfusion under pharmacological stress and at rest]. ROFO-FORTSCHR RONTG 2007; 179:945-52. [PMID: 17705117 DOI: 10.1055/s-2007-963350] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE MR stress perfusion imaging of the heart allows the quantification of myocardial perfusion and the evaluation of myocardial perfusion reserve (MPR) and the ratio of subendocardial to subepicardial perfusion at rest and under adenosine stress. The aim of this study was to evaluate a high-resolution GRAPPA sequence for quantitative MR first pass perfusion imaging in healthy volunteers. MATERIALS AND METHODS First pass stress and rest perfusion studies were performed on 10 healthy volunteers using a 1.5 T MR scanner with a multislice SR-TrueFISP first pass perfusion sequence with a GRAPPA algorithm (acceleration factor 3) in prebolus technique and an image resolution of 1.8 x 1.8 mm. For the comparison group, we examined 12 different healthy volunteers with a standard first pass perfusion SR-TrueFISP sequence using a resolution of 2.7 x 3.3 mm. Myocardial contours were manually delineated followed by an automatic division of the myocardium into two rings with an equal thickness for the subendo- and subepicardial layer. Eight sectors per slice were evaluated using contamination and baseline correction. RESULTS Using the GRAPPA sequence, the ratio of subendo- to subepimyocardial perfusion was 1.18 +/- 0.32 for the examination at rest. Under pharmacologically induced stress, the ratio was 1.08 +/- 0.27. For the standard sequence the ratio was 1.15 +/- 0.28 at rest and 1.11 +/- 0.33 under stress. For the high resolution sequence higher mean values for the subendo- to subepimyocardial ratio were obtained with comparable standard deviations. The difference between the sequences was not significant. CONCLUSION The evaluation of subendomyocardial and subepimyocardial perfusion is feasible with a high-resolution first pass perfusion sequence. The use of a higher resolution to avoid systematic error leads to increased image noise. However, no relevant reduction in the quantitative perfusion values under stress and at rest was able to be depicted.
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Affiliation(s)
- C O Ritter
- Universität Würzburg, Institut für Röntgendiagnostik.
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Beer M, Buchner S, Wirbelauer J, Fuchs J, Machann W, Ritter CO, Beissert M, Darge K, Hahn D, Köstler H. MR-Bildgebung und MR-Spektroskopie zur Charakterisierung von Kardiomyopathien bei Jugendlichen - erste Ergebnisse. ROFO-FORTSCHR RONTG 2007; 179:932-7. [PMID: 17705115 DOI: 10.1055/s-2007-963302] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE Cardiomyopathy is a rare but life-threatening disease in children and adolescents. Recent studies reported morphological, functional or metabolic alterations of the heart. We discuss a combined MR imaging and (31)P MR spectroscopy (MRS) protocol allowing the analysis of interdependencies between these parameters. Since normal values of cardiac MR parameters in this age group are not available, we included studies of age-matched healthy adolescents. MATERIALS AND METHODS 2D-CINE was used to assess left ventricular (LV) parameters. Additional 3D-Chemical Shift Imaging (3D-CSI) and Spectral Localization with Optimal Pointspread Function (SLOOP) reconstruction allowed quantification of the cardiac energy metabolism. Patients (n = 4; all male; age 16.8 +/- 2.9 years) were included on the basis of an echocardiographic diagnosis of possible cardiomyopathy. The same protocol was applied to healthy young volunteers (n = 4; 1 female, 3 male; age 15.5 +/- 0.6 years). RESULTS The patients had a significantly higher LV mass index compared to the control group (147 +/- 41 g/m (2) versus 97 +/- 16 g/m2; p = 0.04). The other LV parameters (including LV EF with 59 +/- 22 % versus 67 +/- 10 %) showed no significant differences. The phosphocreatine to adenosine triphosphate ratio (PCr/ATP-ratio) of the patients was reduced to 1.71 +/- 0.40 versus 2.44 +/- 0.30 (p = 0.01), combined with a tendency towards decreased PCr concentrations of 9.1 +/- 2.5 versus 7.9 +/- 1.0 mmol/kg. CONCLUSION The combination of (31)P MR spectroscopy and MR imaging allows quantitative determination of morphologic, functional and metabolic alterations in adolescents with suspected cardiomyopathy in one examination procedure. The reduction of energy metabolism combined with unaltered global function may indicate a primary role of metabolism in the pathogenesis of cardiomyopathies in adolescents.
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Affiliation(s)
- M Beer
- Institut für Röntgendiagnostik, Universitätsklinikum Würzburg.
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Weininger M, Ritter CO, Beer M, Hahn D, Beissert M. Bestimmung des koronaren Kalzium-Scores mittels 64-Zeilen-CT - Variabilität der Scores und Einfluss des Rekonstruktionszeitpunktes. ROFO-FORTSCHR RONTG 2007; 179:938-44. [PMID: 17705116 DOI: 10.1055/s-2007-963296] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE To evaluate the variability of coronary calcium scores depending on the image reconstruction interval using a 64-slice CT scanner. MATERIALS AND METHODS 30 patients (18 male, 12 female; mean age 57 +/- 9 yrs; mean heart rate 66 +/- 10 bpm) underwent coronary calcium scoring using a 64-slice CT scanner (Somatom Sensation 64, Siemens Medical Solutions, Erlangen) and a standardized scanning protocol. Oral beta-blockers were administered to 12 patients with a baseline heart rate > 70 bpm. Images were reconstructed in 10 % increments from 10 - 100 % of the RR interval. Two blinded experienced observers independently calculated Agatston (AS), calcium mass (MS) and volume scores (VS) for every reconstructed image series. The results were compared to similar studies for 16-slice CT scanners. RESULTS The mean values and mean coefficients of variation among all patients were as follows: AS, 397 +/- 829, 109 % MS, 88 +/- 225, 154 % VS, 335 +/- 669, 100 %. Regarding the reconstruction intervals, the mean coefficients of variation were as follows: 107 % (AS), 97 % (VS), 116 % (MS). No specific image reconstruction interval with statistically significant lower variability for each score could be identified. High inter-observer agreement was achieved (K = 0.98). With statistical significance (p < 0.05) 10/30 patients (pts) were able to be allocated to more than one risk group (RG): 6 pts = 2 RG; 3 pts = 3 RG; 1 pts = 4 RG. The scores for 5/30 patients were zero for at least one reconstruction interval, but further reconstructions revealed calcifications. The number of patients assignable to different risk groups was significantly lower compared to published data using a 16-slice scanner (p < 0.05). CONCLUSION Coronary calcium scores determined using a 64-slice scanner display a wide range of variability depending on the image reconstruction interval as already described for 16-slice CT scanners. However, compared to previous studies, our data indicate that this vendor's generation of scanners reduces the influence of score variations on the risk stratification.
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Affiliation(s)
- M Weininger
- Institut für Röntgendiagnostik, Universitätsklinikum Würzburg.
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Ritter CO, Wilke A, Wichmann T, Beer M, Hahn D, Köstler H. Vergleich von intravasalem und extrazellulärem Kontrastmittel zur Absolut-Quantifizierung der myokardialen Ruheperfusion mit hochaufgelöster MR-Bildgebung. ROFO-FORTSCHR RONTG 2007. [DOI: 10.1055/s-2007-977122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Ritter CO. MR-Perfusionsmessung. ROFO-FORTSCHR RONTG 2005. [DOI: 10.1055/s-2005-867218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Ross AJ, Moore HA, Ritter CO, Moros SA. Differential pulse polarographic determination of 2,3-dimercaptosuccinic acid and tin (II) in radiopharmaceuticals. J Pharm Sci 1979; 68:657-8. [PMID: 219198 DOI: 10.1002/jps.2600680541] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
A differential pulse polarographic procedure was developed for the assay of dimercaptosuccinic acid and tin(II), components of a commercially available pharmaceutical kit for kidney scintigraphy. The method is quantitative and qualitative for both the chelated and unchelated forms of dimercaptosuccinic acid and tin(II) in a mixture of the two.
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