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Thiele T, Beider S, Kühl H, Mielke G, Holz A, Hirsch S, Witte T, Hoeper K, Cossmann A, Happle C, Jablonka A, Ernst D. [Care of rheumatology patients during the lockdown in early 2020 : Telemedicine, delegation, patient satisfaction and vaccination behavior]. Z Rheumatol 2022; 81:157-163. [PMID: 33974131 PMCID: PMC8111653 DOI: 10.1007/s00393-021-01005-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Telemedicine was implemented in outpatient care during the lockdown between March and May 2020. The aim of the study was to assess patients from a private practice and the university outpatient department with respect to patient satisfaction with telemedicine, COVID-19 worries and vaccination behavior and to compare the teleconsultation by a medical assistant for rheumatology (RFA) and a physician. METHODS Patients with rheumatoid arthritis, psoriatric arthropathy or spondylarthritis without treatment modifications since the previous presentation were offered a telemedical replacement appointment within the framework of this study in the case of appointment cancellation by the treating center. Participants were randomized to a telemedicine appointment by a physician or an RFA (RFA university only). The patient history was carried out by telephone and standardized using a questionnaire. The disease activity was determined using the modified clinical disease activity score (CDAI) and the BASDAI. Subsequently, all patients received a pseudonymized evaluation questionnaire. RESULTS In total 112/116 (96%) patients participated. Of these 88/112 (79%) returned the questionnaire. The RFAs conducted 19/112 (17%) of the telephone calls. The treatment was modified in 19/112 (17%) patients. Concerns about contracting COVID-19 correlated with high disease activity (p = 0.031) including the presence of painful joints (p = 0.001) and high pain levels (VAS ≥7, p = 0.009). These patients would have also cancelled their appointment themselves (p = 0.015). Patient satisfaction with the consultation was good (mean 4.3/5.0 modified FAPI) independent of the institution, the duration of the consultation and the consultation partner. Patients with a high pain intensity were the least satisfied (p = 0.036). Only 42/100 (38.2%) of the patients had been vaccinated against pneumococci and 59/100 (53.6%) against influenza. CONCLUSION Telemedical care within the framework of a telephone consultation is well-suited for selected patients. With respect to patient satisfaction the delegation of a telemedical consultation to an RFA is possible. There is a need for improvement with respect to the vaccination behavior.
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Affiliation(s)
- Thea Thiele
- Klinik für Rheumatologie und Immunologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - Sonja Beider
- Klinik für Rheumatologie und Immunologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - Henrik Kühl
- Klinik für Rheumatologie und Immunologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - Gudrun Mielke
- Klinik für Rheumatologie und Immunologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - Anna Holz
- Rheumatologische Facharztpraxis, Hildesheim, Deutschland
| | - Stefanie Hirsch
- Klinik für Rheumatologie und Immunologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - Torsten Witte
- Klinik für Rheumatologie und Immunologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - Kirsten Hoeper
- Klinik für Rheumatologie und Immunologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
- Regionales kooperatives Rheumazentrum Niedersachsen e. V., Hannover, Deutschland
| | - Anne Cossmann
- Klinik für Rheumatologie und Immunologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - Christine Happle
- Klinik für Pädiatrische Pneumologie, Allergologie und Neonatologie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Alexandra Jablonka
- Klinik für Rheumatologie und Immunologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - Diana Ernst
- Klinik für Rheumatologie und Immunologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland.
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Thiele T, Beider S, Kühl H, Miehlke G, Cossmann A, Holz A, Happle C, Hoeper K, Witte T, Jabonka A, Ernst D. AB0707 RHEUMATOLOGY PATIENT CARE IN THE COVID-19 PANDEMIC: TELEMEDICINE, DELEGATION, PATIENT SATISFACTION AND VACCINATION BEHAVIOUR. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.4005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Use of telemedicine in Germany has increased due to the COVID-19 lockdown. Between March and May 2020, government restrictions led to cancellation of routine outpatient appointments to limit viral spread and optimize resources.Objectives:This study assesses patient satisfaction of follow-up telemedicine appointments among patients known to be in disease remission, attending either secondary or tertiary care Rheumatology clinics. Appointments were conducted either by a rheumatologist or a qualified medical assistant for rheumatology (RFA). Additional data regarding perceived concerns arising from the COVID-19 pandemic as well as attitudes to vaccination were collected.Methods:Methods: Patients not requiring adjustment of their DMARDs at the two previous attendances were considered stable. At cancellation of the planned attendance, patients were offered participation in the study and provided verbal informed consent. Participants were randomized to a telemedicine appointment by either a physician or RFA. Telemedicine appointments consisted of a standardized patient interview, including assessment of disease activity (modified CDAI score), attitudes to vaccination as well as current vaccine status and concerns about COVID-19. Following participation, all patients received a pseudonymized postal questionnaire to evaluate appointment satisfaction (FAPI-Score).Results:In total 112/116 (96%) patients that were offered appointments, participated in the study (RA 50%, axSpA 30%, PsA 20%). Of these 88/112 (79%) returned their postal questionnaires. Overall patient satisfaction was excellent (mean 4.3/5 modified FAPI score) and did not differ between care setting or clinical status of the interviewer. RFAs conducted 19/112 (17%) of appointments, 6 (32%) of which required additional physician intervention. Change of DMARDs occurred in 19/112 (17%) appointments. Patients reporting a pain score ≥7 (VAS 1-10) were most dissatisfied with the telemedicine appointment (p=0.036). Concerns about COVID-19 correlated with disease activity: high disease activity (p = 0.031), presence of tender joints (p=0.001), high pain levels (p=0.009) correlated with concern of contracting COVID-19 or experiencing severe disease course. Only 38% of the patients had been vaccinated against pneumococci in the past 5 years and 54% had been vaccinated against influenza in 2019/2020.Conclusion:Telemedicine can contribute to patient care in stable patients. RFAs can also contribute to patient care especially for follow-up appointment when patients are in remission. Vaccination rates and motivation needs to be improved as influenza and pneumococcal vaccination is recommended to all patients with rheumatic diseases without contraindications.Disclosure of Interests:None declared
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Dalhoff K, Abele-Horn M, Andreas S, Deja M, Ewig S, Gastmeier P, Gatermann S, Gerlach H, Grabein B, Heußel CP, Höffken G, Kolditz M, Kramme E, Kühl H, Lange C, Mayer K, Nachtigall I, Panning M, Pletz M, Rath PM, Rohde G, Rosseau S, Schaaf B, Schreiter D, Schütte H, Seifert H, Spies C, Welte T. [Epidemiology, Diagnosis and Treatment of Adult Patients with Nosocomial Pneumonia - Update 2017 - S3 Guideline of the German Society for Anaesthesiology and Intensive Care Medicine, the German Society for Infectious Diseases, the German Society for Hygiene and Microbiology, the German Respiratory Society and the Paul-Ehrlich-Society for Chemotherapy, the German Radiological Society and the Society for Virology]. Pneumologie 2018; 72:15-63. [PMID: 29341032 DOI: 10.1055/s-0043-121734] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Nosocomial pneumonia (HAP) is a frequent complication of hospital care. Most data are available on ventilator-associated pneumonia. However, infections on general wards are increasing. A central issue are infections with multidrug resistant (MDR) pathogens which are difficult to treat in the empirical setting potentially leading to inappropriate use of antimicrobial therapy.This guideline update was compiled by an interdisciplinary group on the basis of a systematic literature review. Recommendations are made according to GRADE giving guidance for the diagnosis and treatment of HAP on the basis of quality of evidence and benefit/risk ratio.This guideline has two parts. First an update on epidemiology, spectrum of pathogens and antimicrobials is provided. In the second part recommendations for the management of diagnosis and treatment are given. New recommendations with respect to imaging, diagnosis of nosocomial viral pneumonia and prolonged infusion of antibacterial drugs have been added. The statements to risk factors for infections with MDR pathogens and recommendations for monotherapy vs combination therapy have been actualised. The importance of structured deescalation concepts and limitation of treatment duration is emphasized.
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Affiliation(s)
- K Dalhoff
- Medizinische Klinik III, Pneumologie, Universitätsklinikum Schleswig-Holstein, Lübeck
| | - M Abele-Horn
- Institut für Hygiene und Mikrobiologie der Universität Würzburg, Würzburg
| | - S Andreas
- Lungenfachklinik Immenhausen, Immenhausen
| | - M Deja
- Charité, Universitätsmedizin Berlin, Klinik für Anästhesiologie m. S. operative Intensivmedizin, Campus Virchow Klinikum und Campus Mitte, Berlin
| | - S Ewig
- Thoraxzentrum Ruhrgebiet, Kliniken für Pneumologie und Infektiologie, Evangelisches Krankenhaus Herne und Augusta-Kranken-Anstalt Bochum, Herne und Bochum
| | - P Gastmeier
- Institut für Hygiene und Umweltmedizin, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin
| | - S Gatermann
- Institut für Hygiene und Mikrobiologie, Abteilung für Medizinische Mikrobiologie, Ruhr-Universität Bochum, Bochum
| | - H Gerlach
- Klinik für Anästhesie, operative Intensivmedizin und Schmerztherapie, Vivantes Klinikum Neukölln, Berlin
| | - B Grabein
- Stabsstelle Klinische Mikrobiologie und Krankenhaushygiene am Klinikum der Universität München, München
| | - C P Heußel
- Thoraxklinik Heidelberg gGmbH, Abteilung für Diagnostische und Interventionelle Radiologie
| | - G Höffken
- Universitätsklinikum Carl Gustav Carus an der TU Dresden, Medizinische Klinik und Poliklinik 1, Fachabteilung für Pneumologie, Dresden
| | - M Kolditz
- Universitätsklinikum Carl Gustav Carus an der TU Dresden, Medizinische Klinik und Poliklinik 1, Fachabteilung für Pneumologie, Dresden
| | - E Kramme
- Medizinische Klinik III, Pneumologie, Universitätsklinikum Schleswig-Holstein, Lübeck
| | - H Kühl
- St. Bernhard-Hospital Kamp-Lintfort GmbH, Klinik für Radiologie, Kamp-Lintfort
| | - C Lange
- Medizinische Klinik, Forschungszentrum Borstel, Borstel
| | - K Mayer
- Zentrum für Innere Medizin, Medizinische Klinik II, Pneumologie und Intensivmedizin, Universitätsklinikum Gießen und Marburg, Standort Gießen
| | | | - M Panning
- Universitätsklinikum Freiburg, Institut für Medizinische Mikrobiologie und Hygiene, Freiburg
| | - M Pletz
- Zentrum für Infektionsmedizin und Krankenhaushygiene, Universitätsklinikum Jena, Jena
| | - P-M Rath
- Institut für Medizinische Mikrobiologie, Universitätsklinikum Essen, Essen
| | - G Rohde
- Klinikum der Johann Wolfgang Goethe-Universität, Pneumologie/Allergologie, Medizinische Klinik 1, Frankfurt am Main
| | - S Rosseau
- Klinik Ernst von Bergmann Bad Belzig gGmbH, Pneumologisches Beatmungszentrum, Bad Belzig
| | - B Schaaf
- Klinikum Dortmund gGmbH, Medizinischen Klinik, Pneumologie und Infektiologie, Dortmund
| | - D Schreiter
- Helios Park-Klinikum Leipzig GmbH und Herzzentrum Leipzig GmbH, Universitätsklinik, Leipzig
| | - H Schütte
- Klinikum Ernst von Bergmann gGmbH, Klinik für Pneumologie, Potsdam
| | - H Seifert
- Institut für Medizinische Mikrobiologie, Immunologie und Hygiene, Klinikum der Universität zu Köln, Köln
| | - C Spies
- Charitè, Universitätsmedizin Berlin, Klinik für Anästhesiologie m. S. operative Intensivmedizin, Campus Virchow Klinikum und Campus Mitte, Berlin
| | - T Welte
- Klinik für Pneumologie, Medizinische Hochschule Hannover, Hannover
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Pietrzyk U, Knoess C, Vollmar S, Wienhard K, Kracht L, Bockisch A, Maderwald S, Kühl H, Fitzek M, Beyer T. Multi-modality imaging of uveal melanomas using combined PET/CT, high-resolution PET and MR imaging. Nuklearmedizin 2018; 47:65-72. [DOI: 10.3413/nukmed-0125] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
SummaryWe investigated the efficacy of combined FDG-PET/CT imaging for the diagnosis of small-size uveal melanomas and the feasibility of combining separate, high-resolution (HR) FDG-PET with MRI for its improved localization and detection. Patients, methods: 3 patients with small-size uveal melanomas (0.2–1.5 ml) were imaged on a combined whole-body PET/CT, a HR brain-PET, and a 1.5 T MRI. Static, contrast-enhanced FDG-PET/CT imaging was performed of head and torso with CT contrast enhancement. HR PET imaging was performed in dynamic mode 0–180 min post-injection of FDG. MRI imaging was performed using a high-resolution small-loop-coil placed over the eye in question with T2–3D-TSE and T1–3D-SE with 18 ml Gd-contrast. Patients had their eyes shaded during the scans. Lesion visibility on high-resolution FDGPET images was graded for confidence: 1: none, 2: suggestive, 3: clear. Mean tumour activity was calculated for summed image frames that resulted in confidence grades 2 and 3. Whole-body FDG-PET/CT images were reviewed for lesions. PET-MRI and PET/ CT-MRI images of the head were co-registered for potentially improved lesion delineation. Results: Whole-body FDG-PET/CT images of 3/3 patients were positive for uveal melanomas and negative for disseminated disease. HR FDG-PET was positive already in the early time frames. One patient exhibited rising tumour activity with increasing uptake time on FDG-PET. MRI images of the eye were co-registered successfully to FDG-PET/CT using a manual alignment approach. Conclusions: Small-size uveal melanomas can be detected with whole-body FDG-PET/CT. This feasibility study suggests the exploration of HR FDG-PET in order to provide additional diagnostic information on patients with uveal melanomas. First results support extended uptake times and high-sensitivity PET for improved tumour visibility. MRI/PET co-registration is feasible and provides correlated functional and anatomical information that may support alternative therapy regimens.
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Lieber M, Behr M, Eichinger S, Eichinger W, Kühl H. First Transcatheter SAPIEN 3 Valve-in-Valve Implantation in an Early Degenerated Lotus Valve Prosthesis. Thorac Cardiovasc Surg 2018. [DOI: 10.1055/s-0038-1628120] [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: 10/28/2022]
Affiliation(s)
- M. Lieber
- Klinikum Bogenhausen, Herzchirurgie, München, Germany
| | - M. Behr
- Klinikum Harlaching, Kardiologie, München, Germany
| | - S. Eichinger
- Klinikum Bogenhausen, Herzchirurgie, München, Germany
| | - W. Eichinger
- Klinikum Bogenhausen, Herzchirurgie, München, Germany
| | - H. Kühl
- Klinikum Harlaching, Kardiologie, München, Germany
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Abstract
Sunitinib treatment leads to improvement in progression-free survival in patients with advanced pancreatic neuroendocrine tumours (pNETs). However, limited data exist regarding the effectiveness, safety and tolerability in clinical practice. We present the results of the first detailed pNET cohort analysis since sunitinib was approved. Patients with advanced, differentiated pNET treated with sunitinib were retrospectively analysed. All patients had progressive disease before start of sunitinib treatment. Twenty-one patients, with a median age of 64 years (range 28-78), were included in this study. Nineteen patients could be analysed for treatment effectiveness. Twelve (57%) patients exhibited either a partial response (1 patient) or stable disease (11 patients) according to the RECIST criteria. The median progression-free survival was 7.0 months (95% CI 3.0-12.0); the probability of being event-free at 6 months was 52.6% (95% CI 28.4-72.1). Potential influencing factors as Ki-67 index, age or duration of disease did not show significant correlations with the response to sunitinib therapy. Considering the differences in patients' characteristics, sunitinib in daily practice showed effectiveness parameters similar to the phase III trial.
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Affiliation(s)
- H Lahner
- Department of Endocrinology and Metabolism, Division of Laboratory Research, University of Duisburg-Essen, Essen, Germany
| | - A Rinke
- Department of Gastroenterology and Endocrinology, Philipps University Marburg, Marburg Germany
| | - N Unger
- Department of Endocrinology and Metabolism, Division of Laboratory Research, University of Duisburg-Essen, Essen, Germany
| | - T D Poeppel
- Department of Nuclear Medicine, University of Duisburg-Essen, Essen, Germany
| | - H Kühl
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University of Duisburg-Essen, Essen, Germany
| | - N Lehmann
- Institute of Medical Informatics, Biometry, and Epidemiology, University of Duisburg-Essen, Essen, Germany
| | - D Führer
- Department of Endocrinology and Metabolism, Division of Laboratory Research, University of Duisburg-Essen, Essen, Germany
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Kühl H. Fehldiagnosen im Röntgenbild des Thorax. ROFO-FORTSCHR RONTG 2016. [DOI: 10.1055/s-0036-1581820] [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: 10/22/2022]
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Kühl H. Charakterisierung, Quantifizierung und risikoadaptierte Konsequenzen. ROFO-FORTSCHR RONTG 2015. [DOI: 10.1055/s-0035-1551372] [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: 10/23/2022]
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Kühl H, Theegarten D, Balzen L, Hahn S, Herbrik M, Darwiche K, Wetter A. Kombination von CT-gesteuerter Stanzbiopsie und zytologischer Sofortbefundung bei Patienten mit peripheren Lungentumoren: Diagnostische Wertigkeit der Zytologie im Vergleich zur Histologie. ROFO-FORTSCHR RONTG 2015. [DOI: 10.1055/s-0035-1551039] [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: 10/23/2022]
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Kühl H, Fistera D, Hahn S, Bonella F, Wessendorf T. Stellenwert CT-morphologischer Gefäßparameter zur Beurteilung der pulmonalen Hypertonie bei Patienten mit interstitiellen Lungenerkrankungen. ROFO-FORTSCHR RONTG 2015. [DOI: 10.1055/s-0035-1551383] [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: 10/23/2022]
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Nensa F, Köhler J, Pöppel TD, Heusch P, Schlosser T, Kühl H. Multimodale Tumorcharakterisierung mit PET/MRT: Korrelation von Tumorperfusion und 18F-FDG-Aufnahme bei Patienten mit NSCLC. ROFO-FORTSCHR RONTG 2014. [DOI: 10.1055/s-0034-1373259] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Kühl H. Lungenparenchymerkrankungen. ROFO-FORTSCHR RONTG 2014. [DOI: 10.1055/s-0034-1373487] [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: 10/25/2022]
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Koppitz H, Kühl H, Hesse K, Kohl JG. Some Aspects of the Importance of Genetic Diversity inPhragmites australis(Cav.) Trin. ex Steudel for the Development of Reed Stands. ACTA ACUST UNITED AC 2014. [DOI: 10.1111/j.1438-8677.1997.tb00632.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Dohle DS, Tsagakis K, Liubov P, Kühl H, Lieder H, Benedik J, Wendt D, Thielmann M, Jakob H. Aortic remodeling in acute aortic dissection after frozen elephant trunk. Thorac Cardiovasc Surg 2014. [DOI: 10.1055/s-0034-1367205] [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: 10/25/2022]
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Heusch P, Buchbender C, Köhler J, Nensa F, Beiderwellen K, Kühl H, Lanzman RS, Wittsack HJ, Gomez B, Gauler T, Schuler M, Forsting M, Bockisch A, Antoch G, Heusner TA. Correlation of the apparent diffusion coefficient (ADC) with the standardized uptake value (SUV) in hybrid 18F-FDG PET/MRI in non-small cell lung cancer (NSCLC) lesions: initial results. ROFO-FORTSCHR RONTG 2013; 185:1056-62. [PMID: 23860802 DOI: 10.1055/s-0033-1350110] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE To compare the apparent diffusion coefficient (ADC) in non-small cell lung cancer lesions with standardized uptake values (SUV) derived from combined 18F-fluoro-deoxy-glucose-positron emission tomography/magnetic resonance imaging (FDG-PET/MRI) and those derived from FDG-PET/CT. MATERIALS AND METHODS In 18 consecutive patients with histologically proven NSCLC (17 men, 1 woman; mean age, 61 ± 12 years), whole-body FDG-PET/MRI was performed after whole-body FDG-PET/CT. Regions of interest (ROI) encompassing the entire primary tumor were drawn into FDG-PET/CT and FDG-PET/MR images to determine the maximum and mean standardized uptake value (SUVmax; SUVmean) and into ADC parameter maps to assess mean ADC values. Pearson's correlation coefficients were calculated to compare SUV and ADC values. RESULTS The SUVmax of NSCLC was 12.3 ± 4.8 [mean ±SD], and the SUVmean was 7.2 ± 2.8 as assessed by FDG-PET/MRI. The SUVmax and SUVmean derived from FDG-PET/CT and FDG-PET/MRI correlated well (R = 0.93; p < 0.001 and R = 0.92; p < 0.001, respectively). The ADCmean of the pulmonary tumors was 187.9 ± 88.8 × 10-5 mm²/s [mean ± SD]. The ADCmean exhibited a significant inverse correlation with the SUVmax (R = -0.72; p < 0.001) as well as with the SUVmean assessed by FDG-PET/MRI (R = -0.71; p < 0.001). CONCLUSION This simultaneous PET/MRI study corroborates the assumed significant inverse correlation between increased metabolic activity on FDG-PET and restricted diffusion on DWI in NSCLC.Citation Format:
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Affiliation(s)
- P Heusch
- Department of Diagnostic and Interventional Radiology, D-40225 Dusseldorf, Germany, Univ Dusseldorf, Medical Faculty, Düsseldorf
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Buchbender C, Heusch P, Hartung-Knemeyer V, Kühl H, Lauenstein TC, Forsting M, Bockisch A, Antoch G, Heusner TA. „Standardized uptake values“ von [18F]-FDG in gesunden Organen: Vergleich zwischen Ganzkörper PET/CT und PET/MRT. ROFO-FORTSCHR RONTG 2013. [DOI: 10.1055/s-0033-1346372] [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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Beiderwellen K, Pöppel TD, Hartung-Knemeyer V, Buchbender C, Kühl H, Bockisch A, Lauenstein TC. PET/MRT mit 68Ga-DOTATOC in der Diagnostik neuroendokriner Tumoren - Erste Resultate. ROFO-FORTSCHR RONTG 2013. [DOI: 10.1055/s-0033-1346377] [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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Beiderwellen K, Grüneisen J, Hartung-Knemeyer V, Heusch P, Kühl H, Bockisch A, Lauenstein TC, Umutlu L. Ganzkörper-PET/MRT mit 18F-FDG versus Ganzkörper-PET/CT in der Rezidivdiagnostik von gynäkologischen Tumoren des kleinen Beckens - erste Ergebnisse. ROFO-FORTSCHR RONTG 2013. [DOI: 10.1055/s-0033-1346373] [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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Kühl H, Altenbernd J. CT - Medizinische Vorteile der Dualsource-Technik. ROFO-FORTSCHR RONTG 2013. [DOI: 10.1055/s-0033-1346570] [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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Kühl H, Theegarten D, Souri K, Lütkes P, Herbrick M, Darwiche K, Freitag L. Diagnostische Sicherheit und Kosteneffizienz einer Kombination von CT-gesteuerter Stanzbiopsie und zytologischer Sofortbefundung bei Patienten mit peripheren Lungentumoren. ROFO-FORTSCHR RONTG 2013. [DOI: 10.1055/s-0033-1346317] [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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Beiderwellen KJ, Pöppel TD, Hartung-Knemeyer V, Buchbender C, Kühl H, Bockisch A, Lauenstein TC. Simultane PET/MRT mit 68Ga-DOTATOC bei Patienten mit neuroendokrinen Tumoren – Erste Resultate. ROFO-FORTSCHR RONTG 2012. [DOI: 10.1055/s-0032-1329767] [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: 10/27/2022]
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Wohlschläger J, Darwiche K, Ting S, Hager T, Freitag L, Schmid K, Kühl H, Theegarten D. „Rapid on-site evaluation“ (ROSE) in der zytologischen Diagnostik von Lungen- und Mediastinalerkrankungen. Pathologe 2012; 33:308-15. [DOI: 10.1007/s00292-012-1578-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Kühl H, Michiels I. Orthopädische Anforderungen an eine radiologische Abteilung. ROFO-FORTSCHR RONTG 2012. [DOI: 10.1055/s-0032-1311370] [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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Welter S, Stöcker C, Dicken V, Kühl H, Krass S, Stamatis G. Lung Segment Geometry Study: Simulation of Largest Possible Tumours That Fit into Bronchopulmonary Segments. Thorac Cardiovasc Surg 2011; 60:93-100. [DOI: 10.1055/s-0030-1271009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- S. Welter
- Department of Thoracic Surgery, Ruhrlandklinik, Essen, Germany
| | - C. Stöcker
- Institute for Medical Image Computing, Fraunhofer MEVIS, Bremen, Germany
| | - V. Dicken
- Institute for Medical Image Computing, Fraunhofer MEVIS, Bremen, Germany
| | - H. Kühl
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Duisburg-Essen, Essen, Germany
| | - S. Krass
- Institute for Medical Image Computing, Fraunhofer MEVIS, Bremen, Germany
| | - G. Stamatis
- Department of Thoracic Surgery, Ruhrlandklinik, Essen, Germany
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Engelhardt H, Paul A, Niebel W, Dechêne A, Przyborek M, Tsagakis K, Kühl H, Jakob H, Erbel R, Eggebrecht H. [Successful treatment of secondary aortoesophageal fistula after thoracic endovascular aortic repair]. Dtsch Med Wochenschr 2010; 135:2076-80. [PMID: 20941681 DOI: 10.1055/s-0030-1267486] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
UNLABELLED HISTORY AND CLINICAL SYMPTOMS: A 58-year-old man was admitted to our hospital with acute chest pain and subfebrile temperatures. Two years ago, endovascular aortic stent-graft placement had been performed for acute type B aortic dissection complicated by malperfusion syndrome. DIAGNOSTIC ASSESSMENT CT angiography showed a discrete soft-tissue attenuation mass between the aorta and esophagus. The patient developed progressive swallow disorder and esophago-gastro-duodenoscopy demonstrated deep esophageal ulcerations at the level of the implanted aortic stent-graft. Intravenous treatment with broad spectrum antibiotics was started. The FDG-PET/CT scan showed increased FDG uptake and air entrapment in the affected region establishing the diagnosis of aortoesophageal fistula formation. THERAPY AND OUTCOME Given the generally poor condition of the patient and the high risk of any aggressive surgical intervention, a new limited surgical approach was chosen consisting of open transthoracic esophageal resection, blind closure of the stomach and cervical esophagostomy. A percutaneous endoscopic gastrostomy tube was placed. After three months, esophageal continuity was restored by retrosternal colon interposition. The presented therapeutic management resulted in a full recovery of the patient. CONCLUSION Aortoesophageal fistula is a rare complication of thoracic aortic stent-graft placement. Patient may present with unspecific symptoms such as fever and rised inflammatory markers, but may also present with massive upper gastrointestinal bleeding. The herein presented limited therapy with esophageal resection represents a promising to the otherwise difficult therapy of aortoesophageal fistula.
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Affiliation(s)
- H Engelhardt
- Klinik für Kardiologie, Westdeutsches Herzzentrum, Universitätsklinikum Essen.
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Wendt D, Schmidt D, Wasserfuhr D, Osswald B, Thielmann M, Tossios P, Kühl H, Jakob H, Massoudy P. Comparison of sequential left internal thoracic artery grafting and separate left internal thoracic artery and venous grafting : A 5-year follow-up. Herz 2010; 35:397-402. [PMID: 20814654 DOI: 10.1007/s00059-010-3368-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2010] [Accepted: 06/15/2010] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The superiority of left internal thoracic artery (LITA) grafting to the left anterior descending artery (LAD) is well established. Patency rates of 80%-90% have been reported at 10-year follow-up. However, the superiority of sequential LITA grafting has not been proven. Our aim was to compare patency rates after sequential LITA grafting to a diagonal branch and the LAD with patency rates of LITA grafting to the LAD and separate vein grafting to a diagonal branch. METHODS A total of 58 coronary artery bypass graft (CABG) patients, operated on between 01/2000 and 12/2002, underwent multi-slice computed tomography (MSCT) between 2006 and 2008. Of these patients, 29 had undergone sequential LITA grafting to a diagonal branch and to the LAD ("Sequential" Group), while in 29 the LAD and a diagonal branch were separately grafted with LITA and vein ("Separate" Group). Patencies of all anastomoses were investigated. RESULTS Mean follow-up was 1958±208 days. The patency rate of the LAD anastomosis was 100% in the Sequential Group and 93% in the Separate Group (p=0.04). The patency rate of the diagonal branch anastomosis was 100% in the Sequential Group and 89% in the Separate Group (p=0.04). Mean intraoperative flow on LITA graft was not different between groups (69±8ml/min in the Sequential Group and 68±9ml/min in the Separate Group, p=n.s.). CONCLUSION Patency rates of both the LAD and the diagonal branch anastomoses were higher after sequential arterial grafting compared with separate arterial and venous grafting at 5-year follow-up. This indicates that, with regard to the antero-lateral wall of the left ventricle, there is an advantage to sequential arterial grafting compared with separate arterial and venous grafting.
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Affiliation(s)
- D Wendt
- Department of Thoracic and Cardiovascular Surgery, West German Heart Center Essen, University Clinic Essen, 45122 Essen, Germany.
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Zettl RP, Kühne CA, Kalinowski M, Kray M, Kühl H, Asgari S, Nast-Kolb D, Ruchholtz S. [The importance of CT angiography for screening supra-aortic vascular damage in severely injured patients]. Unfallchirurg 2010; 113:394-400. [PMID: 20393837 DOI: 10.1007/s00113-010-1751-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE Traumatic injury of supra-aortic vessels remains a challenge in the initial diagnostics of severely injured patients. The presented prospective study analyzed the impact of multislice computed tomography angiography (CTA) as the primary diagnostic method. METHODS Patients with the following criteria were included and screened for a dissection of the supra-aortic vessels: a) admission directly from the scene, b) resuscitation room treatment indicated by the official criteria of the DGU (German Society for the Surgery of Trauma), c) suspected blunt trauma to head or trunk as well as d) age over 16 years. RESULTS During a period of 18 months 374 patients were treated for blunt trauma in the resuscitation room. In 176 cases CTA of the supra-aortic vessels was performed and pathological findings were observed in 16 patients. In 4 cases (2%) a traumatic dissection of supra-aortal vessels was diagnosed and confirmed by magnetic resonance imaging (MRI). All patients received heparin in a PTT effective dosage for 2 weeks and after rehabilitation there were no neurologic deficits. CONCLUSION Traumatic supra-aortic dissection was found in 2% of cases in the presented study group. The mechanisms of injury were not distinct in this group. Essentially MSCT angiography screening was demonstrated to be a safe diagnostic tool.
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Affiliation(s)
- R P Zettl
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Giessen und Marburg, Standort Marburg, Baldingerstr., 35043 Marburg.
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Kühl H, Hamami ME, Heusner T, Bockisch A, Stahl A, Antoch G. Kombination von Chemoembolisation, Thermoablation und selektiver interstiteller Radiatio bei Patienten mit fortgeschrittenem hepatozellulärem Karzinom. ROFO-FORTSCHR RONTG 2010. [DOI: 10.1055/s-0030-1252551] [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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Wendt D, Tossios P, Thielmann M, Kahlert P, Eggebrecht H, Kühl H, Kamler M, Jakob H. Coronary ostium topography: an implication for transcatheter aortic valve implantation? Thorac Cardiovasc Surg 2010. [DOI: 10.1055/s-0029-1246701] [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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Kühl H, Stattaus J, Hamami M, Kaiser G, Bockisch A, Antoch G. Radiofrequenzablation extrahepatischer Metastasen bei Patienten mit hepatozellulärem Karzinom. ROFO-FORTSCHR RONTG 2009. [DOI: 10.1055/s-0029-1221312] [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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31
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Honnef D, Hövels-Gürich HH, Gkalpakiotis D, Kühl H, Neizel M, Krämer N, Schwartz CA, Günther RW, Krombach GA. Kontrastangehobene kardiale Magnetresonanztomographie (cMRT) bei Kindern und Jugendlichen mit klinischem Verdacht auf eine akute Myokarditis. ROFO-FORTSCHR RONTG 2009. [DOI: 10.1055/s-0029-1221452] [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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32
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Kühl H, Hamami M, Heusner T, Hilgard P, Bockisch A, Forsting M, Antoch G. Stellenwert einer sequentiellen Therapie mit Chemoembolisation, Thermoablation und selektiver interstiteller Radiatio bei Patienten mit fortgeschrittenem hepatozellulärem Karzinom. ROFO-FORTSCHR RONTG 2009. [DOI: 10.1055/s-0029-1221612] [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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Krombach GA, Hahnen C, Lodemann KP, Neitzel M, Boehringer J, Kühl H, Krämer N, Schoth F, Günther RW. Potenzial von Gd-BOPTA zur Darstellung der myokardialen Vitalität: T1-Werte und Kontrastmittelspätanreicherung. ROFO-FORTSCHR RONTG 2009. [DOI: 10.1055/s-0029-1221512] [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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Kühl H, Gervink M, Hertel S, Hamami M, Bockisch A, Antoch G. Häufigkeit von morphologischen Arteriosklerose-Manifestationen und 18F-FDG-Uptake in der Gefäßwand: eine PET/CT-Untersuchung. ROFO-FORTSCHR RONTG 2009. [DOI: 10.1055/s-0029-1221404] [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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Massoudy P, Wasserfuhr D, Schmidt D, Thielmann M, Kamler M, Kühl H, Jakob H. Patency of sequential LITA grafting and separate LITA and venous grafting – a five year follow-up. Thorac Cardiovasc Surg 2009. [DOI: 10.1055/s-0029-1191540] [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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Stattaus J, Kühl H, Forsting M. [Diagnosis of an accessory liver lobe established by magnetic resonance imaging-guided core biopsy]. Z Gastroenterol 2008; 46:351-4. [PMID: 18393154 DOI: 10.1055/s-2007-963526] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
An accessory liver is a rare developmental anomaly. There are two subtypes: the accessory liver lobe (ALL), which is connected to the liver and the true ectopic liver. An accessory liver is usually of no clinical relevance in spite of the very rare cases in which torsion or other complications may cause serious problems. This anomaly should not be misinterpreted as a malignant tumour. We report the case of an accessory liver lobe, located below the left diaphragm, which was misdiagnosed as a metastasis of a known malignant melanoma. The diagnosis ALL was established by a biopsy under guidance of magnetic resonance tomography (MRT). In our opinion, an accessory liver and its appearance should be known, to include this entity in differential diagnosis of perihepatic masses.
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Affiliation(s)
- J Stattaus
- Institut für Diagnostische und Interventionelle Radiologie und Neuroradiologie, Universitätsklinikum Essen, Essen.
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Beyer T, Pietrzyk U, Knoess C, Vollmar S, Wienhard K, Kracht L, Bockisch A, Maderwald S, Kühl H, Fitzek M. Multi-modality imaging of uveal melanomas using combined PET/CT, high-resolution PET and MR imaging. Nuklearmedizin 2008; 47:73-79. [PMID: 18392316] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
UNLABELLED We investigated the efficacy of combined FDG-PET/CT imaging for the diagnosis of small-size uveal melanomas and the feasibility of combining separate, high-resolution (HR) FDG-PET with MRI for its improved localization and detection. PATIENTS, METHODS 3 patients with small-size uveal melanomas (0.2-1.5 ml) were imaged on a combined whole-body PET/CT, a HR brain-PET, and a 1.5 T MRI. Static, contrast-enhanced FDG-PET/CT imaging was performed of head and torso with CT contrast enhancement. HR PET imaging was performed in dynamic mode 0-180 min post-injection of FDG. MRI imaging was performed using a high-resolution small-loop-coil placed over the eye in question with T2-3D-TSE and T1-3D-SE with 18 ml Gd-contrast. Patients had their eyes shaded during the scans. Lesion visibility on high-resolution FDG-PET images was graded for confidence: 1: none, 2: suggestive, 3: clear. Mean tumour activity was calculated for summed image frames that resulted in confidence grades 2 and 3. Whole-body FDG-PET/CT images were reviewed for lesions. PET-MRI and PET/CT-MRI images of the head were co-registered for potentially improved lesion delineation. RESULTS Whole-body FDG-PET/CT images of 3/3 patients were positive for uveal melanomas and negative for disseminated disease. HR FDG-PET was positive already in the early time frames. One patient exhibited rising tumour activity with increasing uptake time on FDG-PET. MRI images of the eye were co-registered successfully to FDG-PET/CT using a manual alignment approach. CONCLUSIONS Small-size uveal melanomas can be detected with whole-body FDG-PET/CT. This feasibility study suggests the exploration of HR FDG-PET in order to provide additional diagnostic information on patients with uveal melanomas. First results support extended uptake times and high-sensitivity PET for improved tumour visibility. MRI/PET co-registration is feasible and provides correlated functional and anatomical information that may support alternative therapy regimens.
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Affiliation(s)
- T Beyer
- Department of Nuclear Medicine, University Hospital, Essen, Germany.
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Heusner T, Kühl H, Veit P, Stahl A, Bockisch A, Forsting M, Antoch G. Hochkonzentriertes, jodhaltiges, intravenöses Kontrastmittel in der PET/CT: Sind kontrastmittelassoziierte PET-Artefakte zu erwarten? ROFO-FORTSCHR RONTG 2008. [DOI: 10.1055/s-2008-1073838] [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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Kühl H, Antoch G, Forsting M, Bockisch A. Stellenwert der PET/CT beim Rezidiv des kolorektalen Karzinoms. ROFO-FORTSCHR RONTG 2008. [DOI: 10.1055/s-2008-1073384] [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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Antoch G, Rölle G, Ladd SC, Kühl H, Hilgard P, Sotiropoulos GC, Forsting M, Verhagen R. Therapie des hepatozellulären Karzinoms: Die selektive transarterielle Chemoembolisation (TACE) verlängert das Überleben! ROFO-FORTSCHR RONTG 2008. [DOI: 10.1055/s-2008-1073581] [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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Kühl H, Stattaus J, Hertel S, Hunold P, Kaiser G, Bockisch A, Forsting M. Effektivität der PET/CT-assistierten Radiofrequenzablation maligner Lebertumoren – Ergebnisse im 2-Jahres-Follow-up. ROFO-FORTSCHR RONTG 2008. [DOI: 10.1055/s-2008-1073703] [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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Sotiropoulos GC, Fouzas I, Paul A, Nadalin S, Molmenti EP, Valentin-Gamazo C, Radtke A, Kühl H, Malagó M, Broelsch CE. Inferior vena cava thrombosis after right hepatectomy for live donor liver transplantation: a major donor complication and a satisfactory treatment modality. Am J Transplant 2007; 7:2836-7. [PMID: 17949459 DOI: 10.1111/j.1600-6143.2007.02008.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Stattaus J, Kühl H, Hauth EA, Kalkmann J, Baba HA, Forsting M. [Liver biopsy under guidance of multislice computed tomography: comparison of 16G and 18G biopsy needles]. Radiologe 2007; 47:430-8. [PMID: 16440187 DOI: 10.1007/s00117-005-1336-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [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: 10/25/2022]
Abstract
BACKGROUND Percutaneous cutting needle biopsy of focal liver lesions under CT guidance has established itself as a standard method. The purpose of this study was to evaluate which diagnostic quality can be achieved under guidance of multislice CT (MSCT) and with the use of different needle sizes. METHODS The data of 163 MSCT-guided core biopsies of focal liver lesions were evaluated. A 16G biopsy needle was used in 121 cases and an 18G needle in 42 cases. RESULTS The sensitivity, specificity, and accuracy for all biopsies were 93.3, 100.0, and 94.5%. The corresponding values were 97.2, 100.0, and 97.5% for the 16G needle and 78.6, 100.0, and 85.7% for the 18G needle, respectively. A definite histological diagnosis could be obtained in 90.0% of the cases (16G 94.0%, 18G 75.8%). These differences were statistically highly significant. Bleeding complications were recognized in seven biopsies (4.3%). In one patient a fatal bleeding occurred after the biopsy. Median biopsy duration was 27 min. CONCLUSIONS Core biopsy under MSCT guidance is a fast and very accurate method to obtain a histological diagnosis in focal liver lesions. The usage of a 16G needle in comparison to an 18G needle yielded a significantly higher rate of correct results with regard to differentiation between benign and malignant disease as well as establishing a definite histological diagnosis. For an accurate diagnosis of liver lesions a 16G needle is recommended. After biopsy, the patients have to be closely monitored.
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Affiliation(s)
- J Stattaus
- Institut für Diagnostische und Interventionelle Radiologie und Neuroradiologie, Universitätsklinikum Essen, Universität Duisburg-Essen, Germany.
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Keck A, Kühl H, Jensen A. Das Tubenkarzinom – eine differenzialdiagnostische Kasuistik. Geburtshilfe Frauenheilkd 2007. [DOI: 10.1055/s-2007-983676] [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] Open
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Kalkmann J, Kühl H, Forsting M, Stattaus J. Evaluation von 512 CT-gesteuerten perkutanen Schneid- und Stanzbiopsien fokaler thorakoabdominaler und muskuloskelettaler Läsionen unter Verwendung verschiedener Nadelkaliber. ROFO-FORTSCHR RONTG 2007. [DOI: 10.1055/s-2007-977317] [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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Antoch G, Bauer S, Kühl H, Bockisch A, Forsting M. Postoperative FDG-PET/CT nach R0 Resektion eines gastrointestinalen Stromatumors: Gibt es einen klinischen Benefit bei Hoch-Risiko-Patienten. ROFO-FORTSCHR RONTG 2007. [DOI: 10.1055/s-2007-976905] [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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Kühl H, Antoch G, Rosenbaum S, Stattaus J, Veit P, Stergar H, Bockisch A, Forsting M. Vergleich von CT, PET/CT und MRI in der Verlaufskontrolle nach RF-Ablation colorektaler Lebermetastasen. ROFO-FORTSCHR RONTG 2007. [DOI: 10.1055/s-2007-976838] [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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Hauth E, Kühl H, Kimmig R, Forsting M. Wertigkeit der Magnetresonanztomographie (MRT) des Beckens in der Stadieneinteilung, Verlaufskontrolle und Rezidivdiagnostik des Zervixkarzinoms. Geburtshilfe Frauenheilkd 2006. [DOI: 10.1055/s-2006-955876] [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: 10/23/2022] Open
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Kühl H, Stattaus J, Kühl B, Boes T, Antoch G, Frilling A, Forsting M. Radiofrequenzablation von malignen Lebertumoren: Erlaubt ein volumetrischer Nekrose-/Tumor-Quotient eine Vorhersage zur lokalen Tumorkontrolle? ROFO-FORTSCHR RONTG 2006; 178:1243-9. [PMID: 17136648 DOI: 10.1055/s-2006-927141] [Citation(s) in RCA: 1] [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: 10/23/2022]
Abstract
PURPOSE Sufficient safety margins are essential for preventing local tumor recurrence after radiofrequency ablation RFA of malignant liver tumors. The aim was to determine the initial tumor volume, ablation necrosis volume, and the necrosis-tumor quotient in order to compare these parameters with the rate of local control during follow-up. MATERIALS AND METHODS 35 patients with 53 tumor nodules (29 colorectal metastases and 24 HCC nodules) were enrolled. RFA procedures were performed under CT guidance with intravenous conscious sedation. Tumor volumes were measured based on CT data sets and the necrosis volume was assessed using the sum-of-area method. A volumetric necrosis/tumor quotient (NTQ) was calculated for all lesions. Follow-up examinations were performed after 3, 6, and 12 months and then on a yearly basis to identify local recurrent tumors. RESULTS The CRC metastases and HCC nodules had a median tumor volume of 8.3 ml and 7.4 ml, respectively. The mean ablation volumes were 37.6 ml and 29.5 ml, respectively. This resulted in a median NTQ of 3.9 for metastases and 3.4 for HCC. The follow-up (mean time 18 months) revealed local tumor recurrence in 16 of 29 (55 %) metastases and 10 of 24 (42 %) HCC nodules. In lesions with local recurrence, the initial tumor volume was significantly greater and the NTQ was significantly smaller. A threshold value of 3.4 for NTQ has the highest predictive value for local tumor recurrence. CONCLUSION The volumetric necrosis/tumor quotient NTQ makes it possible to predict the local outcome and can be used for the planning of additional therapy.
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Affiliation(s)
- H Kühl
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinik Essen.
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Abstract
Positron emission tomography (PET) is a functional imaging modality that has been documented to be useful in patient care. Oncologic PET imaging is used for a wide variety of neoplasms, mainly for staging and follow-up, differentiation of equivocal morphologic findings, therapy stratification, and monitoring. Because PET imaging is based on the physiologically mediated distribution of the administered tracer but not on anatomic information, the addition of computed tomography (CT) to PET may improve the interpretation of PET. Combined PET and CT offers several potential advantages over PET alone that may influence the clinical routine. PET/CT was introduced into clinical use only 3 years ago and has found widespread application within only 1 to 2 years. This article summarizes preliminary data of clinical applications for PET/CT in gastrointestinal tumors.
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Affiliation(s)
- S J Rosenbaum
- Clinic for Nuclear Medicine, University of Essen, Hufelandstrasse 55, 45122 Essen, Germany.
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