1
|
Ristow I, Hancken-Pauschinger CV, Zhang S, Stark M, Kaul MG, Rickers C, Herrmann J, Adam G, Bannas P, Well L, Weinrich JM. Non-contrast free-breathing 2D CINE compressed SENSE T1-TFE cardiovascular MRI at 3T in sedated young children for assessment of congenital heart disease. PLoS One 2024; 19:e0297314. [PMID: 38330070 PMCID: PMC10852305 DOI: 10.1371/journal.pone.0297314] [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: 08/08/2023] [Accepted: 01/03/2024] [Indexed: 02/10/2024] Open
Abstract
Cardiac MRI is a crucial tool for assessing congenital heart disease (CHD). However, its application remains challenging in young children when performed at 3T. The aim of this retrospective single center study was to compare a non-contrast free-breathing 2D CINE T1-weighted TFE-sequence with compressed sensing (FB 2D CINE CS T1-TFE) with 3D imaging for diagnostic accuracy of CHD, image quality, and vessel diameter measurements in sedated young children. FB 2D CINE CS T1-TFE was compared with a 3D non-contrast whole-heart sequence (3D WH) and 3D contrast-enhanced MR angiography (3D CE-MRA) at 3T in 37 CHD patients (20♂, 1.5±1.4 years). Two radiologists independently assessed image quality, type of CHD, and diagnostic confidence. Diameters and measures of contrast and sharpness of the aorta and pulmonary vessels were determined. A non-parametric multi-factorial approach was used to estimate diagnostic accuracy for the diagnosis of CHD. Linear mixed models were calculated to compare contrast and vessel sharpness. Krippendorff's alpha was determined to quantify vessel diameter agreement. FB 2D CINE CS T1-TFE was rated superior regarding image quality, diagnostic confidence, and diagnostic sensitivity for both intra- and extracardiac pathologies compared to 3D WH and 3D CE-MRA (all p<0.05). FB 2D CINE CS T1-TFE showed superior contrast and vessel sharpness (p<0.001) resulting in the highest proportion of measurable vessels (740/740; 100%), compared to 3D WH (530/620; 85.5%) and 3D CE-MRA (540/560; 96.4%). Regarding vessel diameter measurements, FB 2D CINE CS T1-TFE revealed the closest inter-reader agreement (Krippendorff's alpha: 0.94-0.96; 3D WH: 0.78-0.94; 3D CE-MRA: 0.76-0.93). FB 2D CINE CS T1-TFE demonstrates robustness at 3T and delivers high-quality diagnostic results to assess CHD in sedated young children. Its ability to function without contrast injection and respiratory compensation enhances ease of use and could encourage widespread adoption in clinical practice.
Collapse
Affiliation(s)
- Inka Ristow
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Caroline-Viktoria Hancken-Pauschinger
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Section of Pediatric Radiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Shuo Zhang
- Philips GmbH Market DACH, Hamburg, Germany
| | - Maria Stark
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael G. Kaul
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Carsten Rickers
- University Heart Center, Adult Congenital Heart Disease Unit, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jochen Herrmann
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Section of Pediatric Radiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gerhard Adam
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Peter Bannas
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lennart Well
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Julius Matthias Weinrich
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Section of Pediatric Radiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
2
|
Lenz A, Warncke M, Wright F, Weinrich JM, Schoennagel BP, Henes FO, Adam G, von Kodolitsch Y, Schoen G, Bannas P. Longitudinal follow-up by MR angiography reveals progressive dilatation of the distal aorta after aortic root replacement in Marfan syndrome. Eur Radiol 2023; 33:6984-6992. [PMID: 37160424 PMCID: PMC10511572 DOI: 10.1007/s00330-023-09684-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 03/21/2023] [Accepted: 04/14/2023] [Indexed: 05/11/2023]
Abstract
OBJECTIVES To define and compare growth rates of the distal aorta in Marfan patients with and without aortic root replacement using serial MR angiography (MRA). METHODS We retrospectively included 136 Marfan patients with a total of 645 MRAs who underwent a median of five MRAs (range: 2-13) at 1.5 T and 3 T in annual intervals. Of these, 41 patients (34.8 ± 12 years) had undergone aortic root replacement. The remaining 95 patients (29.0 ± 17 years) still had a native aorta and served as the control group. Thoracic aortic diameters were independently measured at eleven predefined levels. Estimated growth rates were calculated using a mixed effects model adjusted for sex, age, BMI, and medication. RESULTS Marfan patients with aortic root replacement revealed the highest mean estimated growth rate in the proximal descending aorta (0.77 mm/year, CI: 0.31-1.21). Mean growth rates at all levels of the distal thoracic aorta were significantly higher in patients with aortic root replacement (0.28-0.77 mm/year) when compared to patients without aortic root replacement (0.03-0.07 mm/year) (all p < 0.001). Antihypertensive medication, gender, and BMI had no significant impact on the distal aortic growth rates. CONCLUSION Distal thoracic aortic diameters increase at a significantly higher rate in Marfan patients with aortic root replacement compared to Marfan patients without aortic root replacement. Further studies are warranted to investigate if the increased growth rate of the distal thoracic aorta after aortic root replacement is caused by altered hemodynamics due to the rigid aortic root graft or due to the general genetic disposition of post-operative Marfan patients. CLINICAL RELEVANCE STATEMENT High growth rates of the distal aorta after aortic root replacement underline the need for careful life-long aortic imaging of Marfan patients after aortic root replacement. KEY POINTS • Aortic growth rates in Marfan patients with aortic root replacement are highest in the mid-aortic arch, the proximal- and mid-descending aorta. • Growth rates of the distal thoracic aorta are significantly higher in Marfan patients with aortic root replacement compared to Marfan patients without aortic root replacement. • Antihypertensive medication, gender, and BMI have no significant impact on distal aortic growth rates in Marfan patients.
Collapse
Affiliation(s)
- Alexander Lenz
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - Malte Warncke
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Felicia Wright
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Julius Matthias Weinrich
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Bjoern P Schoennagel
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Frank Oliver Henes
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
- Department of Diagnostic and Interventional Radiology, BG Hospital Hamburg, Hamburg, Germany
| | - Gerhard Adam
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Yskert von Kodolitsch
- Department of Cardiovascular Medicine, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Gerhard Schoen
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Peter Bannas
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| |
Collapse
|
3
|
Wenzel JP, Nikorowitsch J, Bei der Kellen R, Dohm L, Girdauskas E, Lund G, Bannas P, Blankenberg S, Kölbel T, Cavus E, Müllerleile K, Kaul MG, Adam G, Weinrich JM. Comparison of cine cardiac magnetic resonance and echocardiography derived diameters of the aortic root in a large population-based cohort. Sci Rep 2022; 12:15307. [PMID: 36096919 PMCID: PMC9468025 DOI: 10.1038/s41598-022-19461-5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 08/30/2022] [Indexed: 12/01/2022] Open
Abstract
Transthoracic echocardiography (TTE) and cine cardiac magnetic resonance imaging (CMR) are established imaging methods of the aortic root. We aimed to evaluate the comparability of measurements in TTE and standard cine CMR sequences of the aortic root. Our study included 741 subjects (mean age 63.5 ± 8 years, 43.7% female) from the Hamburg City Health Study (HCHS). Subjects underwent CMR and TTE. Aortic root measurements were performed at the level of the aortic annulus (AoAn), sinus of Valsalva (SoV), and sinotubular junction (STJ) by standard cine CMR in left ventricular long axis and left ventricular outflow tract view. Measurements were performed applying the leading-edge to leading-edge (LL) convention and inner-edge to inner-edge (II) convention in TTE and the II convention in CMR. Inter correlation coefficients (ICCs) demonstrated high inter- and intraobserver reproducibility for CMR and TTE measurements of SoV and STJ (ICCs 0.9–0.98) and moderate reproducibility for AoAn (ICCs 0.68–0.91). CMR measurements of SoV and STJ showed strong agreement with TTE: while correlations were comparable (r = 0.75–0.85) bias was lower with TTE II (bias − 0.1 to − 0.74) versus TTE LL measurements (mean bias − 1.49 to − 2.58 mm). The agreement for AoAn was fair (r = 0.51–0.57) with variable bias (mean bias 0.39–3.9). Standard cine CMR and TTE derived aortic root measurements are reproducible and comparable with higher agreement for TTE II instead of LL measurements. These results support an interchangeable application of TTE and standard CMR for screening of aortic root diseases thereby possibly reducing redundant multimodality imaging.
Collapse
Affiliation(s)
- Jan-Per Wenzel
- Department of Cardiology, University Heart and Vascular Center Hamburg, UKE Hamburg, Hamburg, Germany. .,Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Julius Nikorowitsch
- Department of Cardiology, University Heart and Vascular Center Hamburg, UKE Hamburg, Hamburg, Germany
| | - Ramona Bei der Kellen
- Department of Cardiology, University Heart and Vascular Center Hamburg, UKE Hamburg, Hamburg, Germany
| | - Luisa Dohm
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Evaldas Girdauskas
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, UKE Hamburg, Hamburg, Germany
| | - Gunnar Lund
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Peter Bannas
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan Blankenberg
- Department of Cardiology, University Heart and Vascular Center Hamburg, UKE Hamburg, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Tilo Kölbel
- Department of Vascular Medicine, German Aortic Center Hamburg, University Heart and Vascular Center Hamburg, UKE Hamburg, Hamburg, Germany
| | - Ersin Cavus
- Department of Cardiology, University Heart and Vascular Center Hamburg, UKE Hamburg, Hamburg, Germany
| | - Kai Müllerleile
- Department of Cardiology, University Heart and Vascular Center Hamburg, UKE Hamburg, Hamburg, Germany
| | - Michael Gerhard Kaul
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gerhard Adam
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Julius Matthias Weinrich
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
4
|
Weinrich JM, Lenz A, Schön G, Behzadi C, Molwitz I, Henes FO, Schoennagel BP, Adam G, von Kodolitsch Y, Bannas P. Magnetic resonance angiography derived predictors of progressive dilatation and surgery of the aortic root in Marfan syndrome. PLoS One 2022; 17:e0262826. [PMID: 35113893 PMCID: PMC8812850 DOI: 10.1371/journal.pone.0262826] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 01/05/2022] [Indexed: 11/18/2022] Open
Abstract
Background To identify magnetic resonance (MR) angiography derived predictors of progressive dilatation and surgery of the aortic root in Marfan syndrome. Material and methods We retrospectively included 111 patients (32.7±16.5 years, range: 7–75 years) with a total of 446 MR angiographies. Aortic diameter growth rates of the entire thoracic aorta and Z-scores were estimated from annual diameter measurements. Aortic root shape was subdivided into three different types: (T0) normal; (T1) localized dilatation; (T2) generalized aortic root dilatation. Aortic diameter, Z-score, age, and aortic root shape at baseline were tested as predictors of aortic root dilatation using a multivariate logistic regression model. Results The highest aortic growth rate was observed at the level of the sinuses of Valsalva. Higher aortic root diameters and Z-scores at baseline predicted an increased growth of the aortic root (p = 0.003 and p<0.001). Young age (<30 years) was a predictor for the increase of Z-scores when compared to patients ≥30 years (p = 0.019). 25/111 patients (22.5%) had a T0 aortic root shape, 59/111 patients (53.2%) had a T1 aortic root shape, and 27/111 patients (24.3%) had a T2 aortic root shape. Aortic root shape did not predict further aortic growth (p>0.05). However, significantly more patients undergoing surgery had a generalized aortic dilatation (19/28, 76.9%) than a localized aortic root dilatation (9/28, 32.1%) (p = 0.001). Conclusion Larger baseline aortic root diameter and Z-score as well as young age predict solely progressive aortic root dilatation in Marfan patients. MR angiography derived type of aortic root shape does not predict aortic growth, but patients with generalized aortic root dilatation are referred more frequently for aortic surgery.
Collapse
Affiliation(s)
- Julius Matthias Weinrich
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- * E-mail:
| | - Alexander Lenz
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gerhard Schön
- Department of Medical Biometry and Epidemiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Cyrus Behzadi
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Isabel Molwitz
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Frank Oliver Henes
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Bjoern Philip Schoennagel
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gerhard Adam
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Yskert von Kodolitsch
- Department of Cardiology, University Heart Center Hamburg, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Peter Bannas
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
5
|
Kehl T, van Rüth V, Weinrich JM, Hübler M. Using three-dimensional visualization as an optimal tool to plan and validate an aortopexy in a congenital heart disease patient with severe tracheal stenosis. Interact Cardiovasc Thorac Surg 2021; 34:708-710. [PMID: 34738096 PMCID: PMC9026186 DOI: 10.1093/icvts/ivab315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 09/04/2021] [Accepted: 09/14/2021] [Indexed: 01/01/2023] Open
Abstract
We present a patient with severe tracheal stenosis resulting from a compression by the innominate artery 6 months after an arterial switch operation in a dextro-transposition of the great arteries. Segmentation and three-dimensional (3D) visualization were derived from a contrast-enhanced dual-source computed tomography and post-processing was performed using a dedicated open-source platform (3D Slicer). Post-processing allowed a comprehensible visualization of the relationship of the innominate artery to the trachea when compared to standard computer tomography reformations. Finally, the surgical approach to move the innominate artery anteriorly in order to relieve the tracheal obstruction was emphasized based on the improved 3D visualization of the actual pathology. An effective aortopexy could be performed and the postoperative result was confirmed by a second 3D visualization. About 3 months of follow-up, the patient is completely asymptomatic. Three-dimensional visualization offers excellent opportunities for diagnosis, treatment planning and follow-up in patients with a vascular-related tracheal stenosis in the context of congenital heart disease.
Collapse
Affiliation(s)
- Torben Kehl
- Clinic for Children's Heart Medicine, University Heart & Vascular Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Victoria van Rüth
- Clinic for Children's Heart Medicine, University Heart & Vascular Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Julius Matthias Weinrich
- Section of Pediatric Radiology, Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Hübler
- Clinic for Children's Heart Medicine, University Heart & Vascular Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
6
|
Rausch VH, Weinrich JM, Schön G, Sabour L, Özden C, Kaul MG, Adam G, Bannas P, Henes FO. Accuracy of preoperative CT staging of acute colonic diverticulitis using the classification of diverticular disease (CDD) - Is there a beneficial impact of water enema and visceral obesity? Eur J Radiol 2021; 141:109813. [PMID: 34116453 DOI: 10.1016/j.ejrad.2021.109813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 05/13/2021] [Accepted: 06/02/2021] [Indexed: 11/18/2022]
Abstract
PURPOSE We evaluated the accuracy of preoperative CT in staging colonic diverticulitis (ACD) by using the classification of diverticular disease (CDD) and investigated the diagnostic impact of water enema (WE) and visceral obesity. METHODS In this retrospective study, the radiological and hospital information system was searched for patients who underwent CT for clinically suspected ACD prior to surgery between 2009 and 2019. From the initial population (n = 164), we included 155 patients (94.5 %) (85 women; mean age: 58 ± 13 years) matching the following inclusion criteria: i.) clinically suspected ACD, ii.) i.v. contrast-enhanced CT, iii.) surgery for ACD within 1 week after CT, iv.) histopathological report that proved ACD. The remaining 9 patients (5.5 %) were excluded because histopathological reports were lacking (n = 3) or CT was performed without intravenous contrast agent (n = 6). WE (+ butylscopolamine i.v.) was performed in 93 patients (group A, 60 %). 62 patients (group B, 40 %) had no WE. Visceral-to-subcutaneous fat ratio (V/S) was determined for each patient. Two radiologists blinded for final diagnosis independently staged ACD according to CDD and assessed prevalence and confidence ratings of ACD-related CT-findings: pericolonic fat stranding, covered- and free-perforation, local and generalized peritonitis, abscess. Interobserver-agreement of CT-findings were assessed and effects of WE and V/S ratio on the diagnostic accuracy of CT with surgical and histopathological findings as reference were determined by calculating a logistic regression model. RESULTS CT-staging showed high accuracy (94 %) and excellent interrater-correlation (ICC 0.96) for staging ACD. WE had no positive impact neither on diagnostic accuracy of staging, nor on confidence ratings of ACD-related CT-findings (all p > 0.5). Confidence ratings were significantly higher in examinations without WE for perforation, peritonitis as well as abscesses (all p < 0.5). Confidence ratings for the assessment of local peritonitis improved significantly with higher V/S (p = 0.049). The increase of V/S significantly correlated with the probability for correct CDD staging of ACD in CT (p = 0.023). CONCLUSION Increase of visceral obesity significantly improves accuracy of CT in preoperative staging acute colonic diverticulitis. However, independently of the degree of visceral obesity, water enema has no diagnostic benefit and may therefore be omitted. Overall, CT proves high accuracy in preoperative staging ACD using the classification of diverticular disease. LEVEL OF EVIDENCE Retrospective study, observational study.
Collapse
Affiliation(s)
- Vanessa Hanna Rausch
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Center for Radiology and Endoscopy, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - Julius Matthias Weinrich
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Center for Radiology and Endoscopy, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - Gerhard Schön
- Department of Medical Biometry and Epidemiology, University Medical Centre Hamburg-Eppendorf, Martinistrasse 52, D 20246, Hamburg, Germany.
| | - Layal Sabour
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Center for Radiology and Endoscopy, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - Cansu Özden
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Center for Radiology and Endoscopy, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - Michael Gerhard Kaul
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Center for Radiology and Endoscopy, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - Gerhard Adam
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Center for Radiology and Endoscopy, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - Peter Bannas
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Center for Radiology and Endoscopy, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - Frank Oliver Henes
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Center for Radiology and Endoscopy, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| |
Collapse
|
7
|
Avanesov M, Weinrich JM, Sinn M, Lenz A, von Düring F, Salamon J, Henes FO, Schönnagel BP, Adam G, von Kodolitsch Y, Bannas P. Intraindividual comparison of 1.5 T and 3 T non-contrast MR angiography for monitoring of aortic root diameters in Marfan patients. Int J Cardiol 2021; 337:119-126. [PMID: 33933510 DOI: 10.1016/j.ijcard.2021.04.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 04/12/2021] [Accepted: 04/26/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Reproducible aortic diameter measurements are crucial for assessment of aortic growth and aneurysm formation in patients with Marfan syndrome. The objective of this study was to perform an intraindividual comparison of aortic measurements at 1.5 T and 3 T using non-contrast magnetic resonance angiography (MRA) in pre-surgical and post-surgical Marfan patients. METHODS Forty consecutive Marfan patients were retrospectively evaluated by ECG-gated 2D balanced steady-state free precession (bSSFP) MRA at 1.5 T and 3 T after 363 ± 58 days. 24 patients were before and 16 patients after aortic root surgery. Two readers independently measured aortic diameters at seven aortic levels and rated the image quality/image artifacts (1 = poor/severe, 4 = excellent/none). Contrast-to-noise ratio (CNR) and signal intensity slopes between aortic lumen and vessel walls were semiautomatically determined. RESULTS In pre-surgical Marfan patients, interobserver agreement of aortic root diameter measurements was significantly higher at 3 T compared to 1.5 T (p < 0.05). In post-surgical Marfan patients, image quality and artifacts were significantly worse at 3 T compared to 1.5 T (p < 0.05). CNR was higher at 3 T compared to 1.5 T at all aortic levels. Significantly steeper slopes of signal intensity curves were observed at 3 T at all aortic levels (p < 0.001). CONCLUSIONS In pre-surgical Marfan patients, non-contrast MRA provides higher reproducibility of aortic diameter measurements at 3 T compared to 1.5 T. In post-surgical Marfan patients, metallic implants result in significantly worse imaging artifacts and reduced image quality at 3 T compared to 1.5 T. Therefore, we propose to monitor the thoracic aorta with non-contrast MRA at 3 T in pre-surgical Marfan patients and at 1.5 T in post-surgical Marfan patients.
Collapse
Affiliation(s)
- Maxim Avanesov
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany.
| | - Julius Matthias Weinrich
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Martin Sinn
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Alexander Lenz
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Felicia von Düring
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Johannes Salamon
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Frank-Oliver Henes
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Björn Peter Schönnagel
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Gerhard Adam
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Yskert von Kodolitsch
- Department of General and Interventional Cardiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Peter Bannas
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| |
Collapse
|
8
|
Well L, Weinrich JM, Meyer M, Kehl T, Salamon J, Rüffer A, Adam G, Herrmann J, Groth M. Sensitivity of High-Pitch Dual-Source Computed Tomography for the Detection of Anomalous Pulmonary Venous Connection in Infants. ROFO-FORTSCHR RONTG 2020; 193:551-558. [PMID: 33302310 DOI: 10.1055/a-1290-6843] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE To evaluate the sensitivity, specificity, and interobserver reliability of high-pitch dual-source computed tomography angiography (CTA) in the detection of anomalous pulmonary venous connection (APVC) in infants with congenital heart defects and to assess the associated radiation exposure. MATERIALS AND METHODS 78 pulmonary veins in 17 consecutively enrolled patients with congenital heart defects (6 females; 11 males; median age: 6 days; range: 1-299 days) were retrospectively included in this study. All patients underwent high-pitch dual-source CTA of the chest at low tube voltages (70 kV). APVC was evaluated independently by two radiologists. Sensitivity, specificity, positive (PPV) and negative predictive values (NPV), and interobserver agreement were determined. For standard of reference, one additional observer reviewed CT scans, echocardiography reports, clinical reports as well as surgical reports. In cases of disagreement the additional observer made the final decision based on all available information. RESULTS Detection of APVC with high-pitch dual-source CTA revealed a good sensitivity (91 %) and specificity (99 %), with PPV and NPV of 98 % and 97 %. Interobserver agreement was almost perfect (Kappa = 0.84). The median DLP was 3.8 mGy*cm (IQR 3.3-4.7 mGy*cm) and the median radiation dose was 0.33 mSv (IQR 0.26-0.39 mSv). CONCLUSION High-pitch dual-source CTA in infants with congenital heart defects allows for accurate and reliable assessment of APVC at a low radiation dose. KEY POINTS · High-pitch dual-source CTA enables detection of anomalous pulmonary vein connection with high sensitivity in infants.. · Interrater reliability in the detection of anomalous pulmonary vein connection with high-pitch dual-source CTA is almost perfect.. · Radiation dose of high-pitch dual-source CTA in the cardiac examination of infants is low.. CITATION FORMAT · Well L, Weinrich JM, Meyer M et al. Sensitivity of High-Pitch Dual-Source Computed Tomography for the Detection of Anomalous Pulmonary Venous Connection in Infants. Fortschr Röntgenstr 2021; 193: 551 - 558.
Collapse
Affiliation(s)
- Lennart Well
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Julius Matthias Weinrich
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Mathias Meyer
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Torben Kehl
- Department of Pediatric Cardiology, University Heart & Vascular Center Hamburg, Germany
| | - Johannes Salamon
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - André Rüffer
- Department of Pediatric Cardiology, University Heart & Vascular Center Hamburg, Germany
| | - Gerhard Adam
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jochen Herrmann
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Department of Pediatric Radiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Groth
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Department of Pediatric Radiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
9
|
Weinrich JM, Warncke M, Wiese N, Regier M, Tahir E, Heinemann A, Sehner S, Püschel K, Adam G, Laqmani A. Feasibility of extremely reduced-dose CT of the thoracic spine in human cadavers. Acta Radiol 2020; 61:1034-1041. [PMID: 31840526 DOI: 10.1177/0284185119891417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND According to the as low as reasonably achievable (ALARA) principle, radiation exposure in computed tomography (CT) should be minimized while maintaining adequate image quality. Dedicated CT protocols combined with iterative reconstruction (IR) can reduce radiation dose and/or improve image quality. PURPOSE To investigate the feasibility of extremely reduced-dose (RD) CT of the thoracic spine in human cadavers using a standard-dose (SD) and three different RDCT protocols reconstructed with filtered back projection (FBP) and IR. MATERIAL AND METHODS The thoracic spines of 11 cadavers were examined using different RDCT protocols with decreasing reference tube currents (RDCT-1: 50 mAs; RDCT-2: 30 mAs; RDCT-3: 10 mAs) at 140 kV. A clinical SDCT (70 mAs, 140 kV) served as reference. Raw data were reconstructed using FBP and two increasing levels of IR (IRL4 and IRL6). Images were evaluated for image quality, diagnostic acceptability, and visibility of anatomical structures according to a 5-point-scale. RESULTS Regardless of the reconstruction technique, image quality was rated as diagnostically acceptable for all cadavers in SDCT and RDCT-1. Image quality of reconstructions with FBP were generally rated lower. Application of IR improved image quality ratings in SDCT and RDCT. RDCT-2 with IR was the most reduced-dose CT protocol which enabled diagnostically acceptable image quality in all cadavers. Compared to SDCT, RDCT protocols resulted in significantly reduced effective radiation doses (SDCT: 4.1 ± 1.5 mSv; RDCT-1: 2.9 ± 1.1 mSv; 2:1.7 ± 0.6 mSv; 3:0.6 ± 0.1 mSv; P = 0.001). CONCLUSION Diagnostically acceptable RDCT of the thoracic spine with 1.7 mSv is feasible using IR.
Collapse
Affiliation(s)
- Julius Matthias Weinrich
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Malte Warncke
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Nis Wiese
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Marc Regier
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Enver Tahir
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Axel Heinemann
- Department of Legal Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Susanne Sehner
- Department of Medical Biometry and Epidemiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Klaus Püschel
- Department of Legal Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Gerhard Adam
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Azien Laqmani
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
10
|
|
11
|
Weinrich JM, Avanesov M, Lenz A, Tahir E, Henes FO, Schoennagel BP, Rybczinsky M, Adam G, von Kodolitsch Y, Bannas P. Reliability of non-contrast magnetic resonance angiography-derived aortic diameters in Marfan patients: comparison of inner vs. outer vessel wall measurements. Int J Cardiovasc Imaging 2020; 36:1533-1542. [PMID: 32314122 PMCID: PMC7381445 DOI: 10.1007/s10554-020-01850-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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] [Received: 12/02/2019] [Accepted: 04/10/2020] [Indexed: 02/05/2023]
Abstract
Aortic diameter measurements play a crucial role for the indication of aortic root surgery in Marfan patients. However, for magnetic resonance angiography (MRA)-derived measurements, there is no consensus on whether the aortic wall should be included or excluded in the aortic diameter. The purpose of this retrospective study was to compare the reliability of non-contrast bright blood MRA aortic inner-to-inner and outer-to-outer edge measurements in patients with Marfan syndrome. Forty Marfan patients underwent ECG-gated balanced steady-state free-precession MRA of the aorta at 1.5 T. Two readers independently performed inner and outer measurements at different aortic levels. They rated the image quality of the delineation of both inner and outer vessel wall edges on a four-point scale. MRA-derived diameters of the sinuses of Valsalva were compared with echocardiography-derived diameters. Aortic vessel wall delineation score was rated higher at all levels for inner than for outer vessel walls (p < 0.001). Inter- and intraobserver variances of aortic measurements were smaller for inner-to-inner measurements at the sinuses of Valsalva, sinotubular junction and ascending aorta (p < 0.03). There was a difference of 1.1 ± 2.3 mm for inner MRA measurements (p = 0.014) and 6.9 ± 3.1 mm for outer MRA measurements (p < 0.001) when compared to echocardiographic leading-edge measurements. Inner-to-inner vessel wall diameter measurements in non-contrast bright blood MRA provide more reliable diameters when compared to outer-to-outer vessel wall measurements of the aortic root. Therefore, we propose to rely on inner rather than outer aortic wall measurements in non-contrast-MRA when monitoring aortic diameters in patients with Marfan syndrome.
Collapse
Affiliation(s)
- Julius Matthias Weinrich
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Centre Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - Maxim Avanesov
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Centre Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Alexander Lenz
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Centre Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Enver Tahir
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Centre Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Frank-Oliver Henes
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Centre Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Bjoern Philip Schoennagel
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Centre Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Meike Rybczinsky
- Department of General and Interventional Cardiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Gerhard Adam
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Centre Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Yskert von Kodolitsch
- Department of General and Interventional Cardiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Peter Bannas
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Centre Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| |
Collapse
|
12
|
Tozakidou M, Apine I, Petersen KU, Weinrich JM, Schindera S, Jopp-van Well E, Püschel K, Herrmann J. Comparison of different iterative CT reconstruction techniques and filtered back projection for assessment of the medial clavicular epiphysis in forensic age estimation. Int J Legal Med 2019; 134:355-361. [PMID: 31773319 DOI: 10.1007/s00414-019-02214-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 11/13/2019] [Indexed: 02/01/2023]
Abstract
PURPOSE To assess the impact of iterative reconstruction and filtered back projection (FBP) on image quality in computed tomography (CT)-based forensic age estimation of the medial clavicular epiphysis. METHODS AND MATERIALS CT of the clavicle was performed in 19 patients due to forensic reasons (70 mAs/140 kVp). Raw data were reconstructed with FBP and with an iterative algorithm at level 4 and 6. Clavicular ossification stage was determined by two radiologists in consensus, firstly on FBP reconstructed images and secondly after reviewing all reconstructions including iDose 4 and 6. In addition, the 3 reconstructions were compared regarding artefacts and delineation of the meta-/epiphyseal interface. Quantitative image noise was measured. RESULTS Quantitative noise was lower in iDose 6 reconstructed images than in FBP (P < 0.042), but not significantly lower between iDose 4 and FBP (P = 0.127). Side by side comparison revealed lesser qualitative image noise on both iDose reconstructed images than for FBP. The meta-/epiphyseal interface delineation was rated better on both iDose levels than with FBP. In 3 of 19 patients, the clavicular ossification stage was reclassified after iterative reconstructions had been additionally reviewed. CONCLUSION Using iterative CT reconstruction algorithms, a reduction of image noise and an enhancement of image quality regarding the meta-/epiphyseal clavicular interface can be achieved. The study highlights the importance of image standardization as variation of reconstruction technique has impact on forensic age estimation.
Collapse
Affiliation(s)
- Magdalini Tozakidou
- Department of Diagnostic and Interventional Radiology and Nuclear medicine, Section of Pediatric Radiology, University Hospital Hamburg-Eppendorf, 20246, Hamburg, Germany.
| | - Ilze Apine
- Children Clinical University Hospital, Riga, Latvia
| | - Kay U Petersen
- Department of Psychiatry and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Julius Matthias Weinrich
- Department of Diagnostic and Interventional Radiology and Nuclear medicine, University Hospital Hamburg-Eppendorf, 20246, Hamburg, Germany
| | | | - Eilin Jopp-van Well
- Department of Forensic Medicine, University Hospital Hamburg-Eppendorf, 22529, Hamburg, Germany
| | - Klaus Püschel
- Department of Forensic Medicine, University Hospital Hamburg-Eppendorf, 22529, Hamburg, Germany
| | - Jochen Herrmann
- Department of Diagnostic and Interventional Radiology and Nuclear medicine, Section of Pediatric Radiology, University Hospital Hamburg-Eppendorf, 20246, Hamburg, Germany
| |
Collapse
|
13
|
Weinrich JM, Regier M, Well L, Bannas P, Nykolyn O, Heinemann A, Sehner S, Behzadi C, Püschel K, Adam G, Laqmani A. Feasibility of sub-milliSievert CT of the cervical spine: Initial results in fresh human cadavers. Eur J Radiol 2019; 120:108697. [PMID: 31589994 DOI: 10.1016/j.ejrad.2019.108697] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 07/08/2019] [Accepted: 09/25/2019] [Indexed: 12/14/2022]
Abstract
PURPOSE To investigate the feasibility of sub-milliSievert CT of the cervical spine in fresh human cadavers using a standard-dose (SD) and four different reduced-dose (RD) protocols reconstructed with filtered back projection (FBP) and iterative reconstruction (IR). METHODS The cervical spine of 29 cadavers was examined using different RDCT protocols with decreasing reference tube currents (RDCT-1:70 mAs; RDCT-2:50 mAs; RDCT-3:30 mAs; RDCT-4:10 mAs) at 140 kV. A clinical SDCT (160 mAs, 120 kV) served as reference. Raw data were reconstructed using FBP and two increasing levels of IR (IRL4&6). Images of the upper (C1-4) and lower (C5-7) cervical spine were evaluated for image quality, diagnostic acceptability and visibility of anatomical structures according to a 5-point-scale. RESULTS Image quality of the upper cervical spine was diagnostically acceptable for all protocols using FBP and IR except for RDCT-4 with FBP. Image quality of the lower cervical spine was rated as non-diagnostic in RDCT-3 with FBP and RDCT-4 with FBP and IR. RDCT-3 with IR was the most reduced dose CT protocol allowing diagnostically acceptable image quality for both upper and lower cervical spine in all cadavers. RDCT protocols achieved significantly reduced effective radiation doses (SDCT: 1.5 ± 0.7 mSv; RDCT-1:1 ± 0.6 mSv; RDCT-2:0.7 ± 0.4 mSv; RDCT-3:0.4 ± 0.2 mSv; RDCT-4:0.2 ± 0.1 mSv; p < 0.001). CONCLUSION Diagnostically acceptable sub-milliSievert CT of the cervical spine is feasible with a low reference tube current at 140 kV using iterative reconstruction and could be suitable for isolated cervical trauma in cooperative patients.
Collapse
Affiliation(s)
- Julius Matthias Weinrich
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Centre Hamburg-Eppendorf, Martinistrasse 52, D 20246, Hamburg, Germany.
| | - Marc Regier
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Centre Hamburg-Eppendorf, Martinistrasse 52, D 20246, Hamburg, Germany
| | - Lennart Well
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Centre Hamburg-Eppendorf, Martinistrasse 52, D 20246, Hamburg, Germany
| | - Peter Bannas
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Centre Hamburg-Eppendorf, Martinistrasse 52, D 20246, Hamburg, Germany
| | - Oleh Nykolyn
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Centre Hamburg-Eppendorf, Martinistrasse 52, D 20246, Hamburg, Germany
| | - Axel Heinemann
- Department of Legal Medicine, University Medical Centre Hamburg-Eppendorf, Martinistrasse 52, D 20246, Hamburg, Germany
| | - Susanne Sehner
- Department of Medical Biometry and Epidemiology, University Medical Centre Hamburg-Eppendorf, Martinistrasse 52, D 20246, Hamburg, Germany
| | - Cyrus Behzadi
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Centre Hamburg-Eppendorf, Martinistrasse 52, D 20246, Hamburg, Germany
| | - Klaus Püschel
- Department of Legal Medicine, University Medical Centre Hamburg-Eppendorf, Martinistrasse 52, D 20246, Hamburg, Germany
| | - Gerhard Adam
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Centre Hamburg-Eppendorf, Martinistrasse 52, D 20246, Hamburg, Germany
| | - Azien Laqmani
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Centre Hamburg-Eppendorf, Martinistrasse 52, D 20246, Hamburg, Germany
| |
Collapse
|
14
|
Weinrich JM, Lenz A, Girdauskas E, Adam G, von Kodolitsch Y, Bannas P. Current and Emerging Imaging Techniques in Patients with Genetic Aortic Syndromes. ROFO-FORTSCHR RONTG 2019; 192:50-58. [DOI: 10.1055/a-0914-3321] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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
Background Patients with genetic aortic syndromes such as Marfan or Loeys-Dietz syndrome have a decreased life expectancy due to the risk of aortic dissection and rupture. Imaging plays an important role in the acute setting but also in the initial diagnosis and image-based monitoring. In this article, we provide an overview of the most common genetic aortic syndromes and recommended imaging strategies. Furthermore, we highlight modern imaging methods allowing for the quantification of hemodynamic changes in aortic disease.
Method This is a narrative review article on genetic aortic syndromes and recommended imaging strategies, where we take into account expert opinions and standard-of-care practices from our own center.
Results and Conclusion Radiological imaging plays a key role in the initial diagnosis and surveillance of patients with genetic aortic syndromes. Radiologists contribute significantly to the multi-disciplinary setting of genetic aortic syndromes with knowledge of special features and recommended imaging methods. Accurate measurement of the aorta is crucial, particularly in terms of diameter-based surgical treatment algorithms. Modern imaging methods like 4D-flow MRI and pulse wave velocity have a potential to further improve individualized risk stratification in patients with genetic aortic syndromes.
Key points:
Citation Format
Collapse
Affiliation(s)
- Julius Matthias Weinrich
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alexander Lenz
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Evaldas Girdauskas
- Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany
| | - Gerhard Adam
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Peter Bannas
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
15
|
Tahir E, Starekova J, Muellerleile K, Freiwald E, von Stritzky A, Münch J, Avanesov M, Weinrich JM, Stehning C, Cavus E, Bohnen S, Radunski UK, Blankenberg S, Adam G, Simon P, Pressler A, Patten M, Lund GK. Impact of Myocardial Fibrosis on Left Ventricular Function Evaluated by Feature-Tracking Myocardial Strain Cardiac Magnetic Resonance in Competitive Male Triathletes With Normal Ejection Fraction. Circ J 2019; 83:1553-1562. [PMID: 31080228 DOI: 10.1253/circj.cj-18-1388] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND To analyze the effect of myocardial fibrosis on left ventricular (LV) function evaluated by feature-tracking strain analysis by cine cardiac magnetic resonance (CMR) in competitive male triathletes with normal ejection fraction (EF).Methods and Results:78 asymptomatic male triathletes with >10 weekly training hours (43±11 years) and 28 male age-matched controls were studied by late gadolinium enhancement (LGE) and cine CMR. Global and segmental radial, longitudinal and circumferential strains were analyzed using feature-tracking cine CMR. Focal non-ischemic LGE was observed in 15 of 78 triathletes (19%, LGE+) with predominance in the basal inferolateral segments. LVEF was normal in LGE+ (62±6%) and LGE- triathletes (62±5%, P=0.958). In contrast, global radial strain was lower in LGE+ triathletes at 40±7% compared with LGE- triathletes (45±7%, P<0.05). Reduced segmental radial strain occurred either in LGE+ segments or in directly adjacent segments. Strain analysis revealed regional differences in controls, with the highest radial and longitudinal strain in the inferolateral segments, which were typically affected by fibrosis in LGE+ triathletes. CONCLUSIONS Reduced global and regional radial strain suggests a negative effect of myocardial fibrosis on LV function in LGE+ triathletes with normal EF. The observed regional differences in controls with the highest radial and longitudinal strain in the inferolateral segments may explain the typical occurrence of fibrosis in this myocardial region in triathletes.
Collapse
Affiliation(s)
- Enver Tahir
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg Eppendorf
| | - Jitka Starekova
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg Eppendorf
| | - Kai Muellerleile
- Department of General and Interventional Cardiology, University Heart Center
| | - Eric Freiwald
- Institute for Medical Biometry and Epidemiology, University Hospital Hamburg Eppendorf
| | | | - Julia Münch
- Department of General and Interventional Cardiology, University Heart Center
| | - Maxim Avanesov
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg Eppendorf
| | - Julius Matthias Weinrich
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg Eppendorf
| | | | - Ersin Cavus
- Department of General and Interventional Cardiology, University Heart Center
| | - Sebastian Bohnen
- Department of General and Interventional Cardiology, University Heart Center
| | - Ulf K Radunski
- Department of General and Interventional Cardiology, University Heart Center
| | - Stefan Blankenberg
- Department of General and Interventional Cardiology, University Heart Center
| | - Gerhard Adam
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg Eppendorf
| | - Perikles Simon
- Department of Sports Medicine, Johannes Gutenberg University Mainz
| | - Axel Pressler
- Department of Prevention, Rehabilitation and Sports Medicine, Klinikum rechts der Isar, Technische Universität München.,Center of Sports and Preventive Cardiology
| | - Monica Patten
- Department of General and Interventional Cardiology, University Heart Center
| | - Gunnar K Lund
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg Eppendorf
| |
Collapse
|
16
|
Ruether DF, Weinrich JM, Bannas P. Solitäre Harnblasenmetastase eines Mammakarzinoms: Fallbericht einer seltenen Differenzialdiagnose in der Computertomografie. ROFO-FORTSCHR RONTG 2018; 191:442-443. [PMID: 30212920 DOI: 10.1055/a-0719-5448] [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)
- Darius Ferenc Ruether
- Department for Diagnostic and Interventional Radiology and Nuclear Medicine, University-Medical-Center Hamburg-Eppendorf, Hamburg, Germany
| | - Julius Matthias Weinrich
- Department for Diagnostic and Interventional Radiology and Nuclear Medicine, University-Medical-Center Hamburg-Eppendorf, Hamburg, Germany
| | - Peter Bannas
- Department for Diagnostic and Interventional Radiology and Nuclear Medicine, University-Medical-Center Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
17
|
Affiliation(s)
- Julius Matthias Weinrich
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg-Eppendorf, Martinistraße 52, 20251, Hamburg, Germany.
| | - Peter Bannas
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg-Eppendorf, Martinistraße 52, 20251, Hamburg, Germany
| |
Collapse
|
18
|
Weinrich JM, Beyer R, Well L, Tahir E, Lindemann M, Wilke U, Adam G, Bannas P, Lund GK. Assessment of Congenital Vascular and Organ Anomalies in Subjects With Thalidomide Embryopathy Using Non-Contrast Magnetic Resonance Angiography. Circ J 2018; 82:2364-2371. [PMID: 29998932 DOI: 10.1253/circj.cj-18-0414] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND To determine the type and frequency of vascular and organ malformations in adults with thalidomide embryopathy (TE) using non-contrast magnetic resonance angiography (MRA) and to assess the effect of the observed malformations on renal function. Methods and Results: The institutional ethics committee approved this prospective study and written informed consent was given by all 78 subjects (50 females) with TE (mean age: 55±1.1 years), who were examined by non-contrast MRA at 3T. ECG-triggered balanced turbo field echo images of the chest, abdomen and pelvis were obtained in coronal and sagittal orientations. Two observers assessed the frequency of vascular and organ malformations. Serum creatinine and estimated glomerular filtration rate (eGFR) were obtained to assess renal function. In 58 subjects, 99 vascular anomalies were observed, including 68 arterial (69%) and 31 venous anomalies (31%); 15 patients had 16 abdominal organ malformations including 12 kidney anomalies and 4 cases of gallbladder agenesis. Most vascular anomalies affected the renal vessels (n=66, 67%) or supraaortic arteries (n=28, 28%). Serum creatinine and eGFR revealed normal renal function in all subjects. CONCLUSIONS Vascular and organ anomalies occurred in a high number of subjects with TE without evidence of renal dysfunction. Information about the presence of malformations may be important for future surgical interventions in subjects with TE.
Collapse
Affiliation(s)
- Julius Matthias Weinrich
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg Eppendorf
| | | | - Lennart Well
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg Eppendorf
| | - Enver Tahir
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg Eppendorf
| | | | | | - Gerhard Adam
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg Eppendorf
| | - Peter Bannas
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg Eppendorf
| | - Gunnar K Lund
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg Eppendorf
| |
Collapse
|
19
|
Molwitz I, Weinrich JM, Henes FOG. Metastasen der Skelettmuskulatur als seltene Erstmanifestation eines Magenkarzinoms. ROFO-FORTSCHR RONTG 2018; 190:972-974. [PMID: 29665590 DOI: 10.1055/a-0591-5464] [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: 10/17/2022]
Affiliation(s)
- Isabel Molwitz
- Department for Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Germany
| | - Julius Matthias Weinrich
- Department for Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Germany
| | - Frank Oliver Gerhard Henes
- Department for Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Germany
| |
Collapse
|
20
|
Weinrich JM, Well L, Regier M, Behzadi C, Sehner S, Adam G, Laqmani A. MDCT in suspected lumbar spine fracture: comparison of standard and reduced dose settings using iterative reconstruction. Clin Radiol 2018; 73:675.e9-675.e15. [PMID: 29576224 DOI: 10.1016/j.crad.2018.02.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 02/16/2018] [Indexed: 01/16/2023]
Abstract
AIM To compare standard (SD-) and reduced-dose computed tomography (RD-CT) in combination with iterative reconstruction (IR) in emergency patients with suspected lumbar spine fracture. MATERIAL AND METHODS Forty emergency patients with suspected lumbar spinal disorder who underwent RD-CT and 40 body mass index-matched patients undergoing SD-CT were enrolled in this retrospective study. Raw data for RD-CT were reconstructed using two increasing IR levels (IRL) 4 and 6, while SD-CT was reconstructed with IRL3. Two radiologists assessed image quality, image noise, and reader confidence in interpreting findings of spinal fractures in a blinded manner. RESULTS Effective radiation dose was reduced by 50% using RD-CT. Overall subjective image quality (SIQ) was high for both protocols and slightly superior in the RD-CT protocol for both IRL compared to SD-CT. The detection rate of spinal disorders was high for both protocols with a high interobserver agreement. CONCLUSION RD-CT with higher levels of IR results in substantial dose reduction of 50% in lumbar spine CT while maintaining an excellent subjective image quality resulting in a high diagnostic confidence.
Collapse
Affiliation(s)
- J M Weinrich
- Department for Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - L Well
- Department for Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - M Regier
- Department for Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - C Behzadi
- Department for Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - S Sehner
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - G Adam
- Department for Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - A Laqmani
- Department for Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
21
|
Keller S, Venkatesh SK, Avanesov M, Weinrich JM, Zenouzi R, Schramm C, Adam G, Yamamura J. Gadolinium-based relative contrast enhancement in primary sclerosing cholangitis: additional benefit for clinicians? Clin Radiol 2018; 73:677.e1-677.e6. [PMID: 29576223 DOI: 10.1016/j.crad.2018.02.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 02/13/2018] [Indexed: 02/06/2023]
Abstract
AIM To evaluate the benefit of extracellular gadolinium-based contrast agent (GBCA) enhanced magnetic resonance imaging (MRI) in addition to conventional non-enhanced T2-weighted imaging (WI) for quantification of inflammatory or fibrotic alterations in the liver parenchyma of patients with primary sclerosing cholangitis (PSC). MATERIAL AND METHODS MRI (3 T) examinations were reviewed retrospectively by two radiologists in 27 PSC patients (age 42.9±15.6 years), and 19 controls. Regions of interest (ROIs) were drawn onto T2 hyperintense and T2 isointense areas and copied to section position matched non-enhanced and delayed-phase contrast-enhanced T1WI. Signal intensities (SI) obtained from ROIs of the multiphase T1WI were used to calculate relative liver enhancement (RLE). The interobserver agreement of RLE and quantified T2 signal was calculated using Bland-Altman analysis. RLE assessed for both T2 hyperintense (RLEhyper) and T2 isointense (RLEiso) areas were compared in patients and controls (RLEhealthy). RESULTS The interobserver agreement of RLE in affected hyperintense areas (bias -0.77, limits of agreement -51.7 to 50.1) was superior to the quantification of T2 signal only in these areas (bias -3.35, limits of agreement -162.4 to 155.7). The RLEhyper (86.2±9.7%) was higher than the RLEiso (59.8±6.2%, p=0.03) and the RLEhealthy (53.2±2.7%, p=0.002). The mean RLEiso was not significantly different from the RLEhealthy (p=0.3). CONCLUSION The extracellular gadolinium-based RLE of T2 hyperintense areas could be a useful add-on for routine follow up MRI in the detection of early inflammatory changes, possibly preceding formation of fibrotic scarring in PSC patients, if validated in larger cohorts.
Collapse
Affiliation(s)
- S Keller
- University Medical Center Hamburg-Eppendorf (UKE), Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Hamburg, Germany
| | - S K Venkatesh
- Department of Radiology, Mayo Clinic Rochester, Rochester, MN, USA
| | - M Avanesov
- University Medical Center Hamburg-Eppendorf (UKE), Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Hamburg, Germany
| | - J M Weinrich
- University Medical Center Hamburg-Eppendorf (UKE), Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Hamburg, Germany
| | - R Zenouzi
- University Medical Center Hamburg-Eppendorf (UKE), Department of Internal Medicine, Hamburg, Germany
| | - C Schramm
- University Medical Center Hamburg-Eppendorf (UKE), Department of Internal Medicine, Hamburg, Germany
| | - G Adam
- University Medical Center Hamburg-Eppendorf (UKE), Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Hamburg, Germany
| | - J Yamamura
- University Medical Center Hamburg-Eppendorf (UKE), Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Hamburg, Germany.
| |
Collapse
|
22
|
Weinrich JM, Ajabnoor W, Bannas P. Case report of a novel nonsyndromic unilateral syndactyly of the hand. Skeletal Radiol 2017; 46:1741-1743. [PMID: 28748361 DOI: 10.1007/s00256-017-2725-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 02/17/2017] [Revised: 06/20/2017] [Accepted: 07/05/2017] [Indexed: 02/02/2023]
Abstract
Syndactyly is a cutaneous and/or bony digital malformation with possible webbing of adjacent fingers or toes and uni- or bilateral occurrence. We report an 84-year old woman with a novel non-syndromic congenital malformation of her left hand. Clinical examination showed that she only had four digits. Radiograph of the hand revealed synostosis of the second and third proximal phalanx, resulting in a triangular shaped bone with relatively normal articulations at both ends. The phalangeal base of the fused finger tapers distally and is broader than the middle phalangeal bases of the ring and little finger. This malformation does not fit in any of the known types of syndromic or non-syndromic syndactylies. Our case report highlights that radiological imaging is crucial for identification of bony syndactyly and correct classification of a given syndactyly. Knowledge of the different types of syndactylies is important because certain malformations may occur as a defining part of a syndromic disease.
Collapse
Affiliation(s)
- Julius Matthias Weinrich
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg-Eppendorf, Martinistraße 52, 20251, Hamburg, Germany.
| | - Waleed Ajabnoor
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg-Eppendorf, Martinistraße 52, 20251, Hamburg, Germany
| | - Peter Bannas
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg-Eppendorf, Martinistraße 52, 20251, Hamburg, Germany
| |
Collapse
|
23
|
Well L, Weinrich JM, Adam G, Bannas P. Transient Severe Respiratory Motion Artifacts After Application of Gadoxetate Disodium: What We Currently Know. ROFO-FORTSCHR RONTG 2017; 190:20-30. [PMID: 29156475 DOI: 10.1055/s-0043-120116] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Gadoxetate disodium is an intracellular contrast agent for magnetic resonance imaging (MRI) of the liver. Recent publications revealed that injection of gadoxetate disodium can lead to imaging artifacts due to transient severe motion (TSM) in the arterial phase of contrast-enhanced liver MRI. In this review we present and discuss published frequencies of TSM, contrast injection and image acquisition protocols, potential risk factors, and proposed strategies to avoid or minimize the effects of TSM. METHOD Two reviewers independently searched the PubMed search engine for "transient severe motion artifact" and related terms. Reference lists of retrieved articles were also searched. The two reviewers selected in consensus nine studies that reported both frequencies of TSM and potential risk factors. Study data were extracted by both reviewers, and disagreement was resolved by consensus. RESULTS AND CONCLUSION TSM is caused by impaired breath-hold ability after gadoxetate disodium injection and occurs in 5 - 22 % of patients. The dose of applied contrast agent, repeated exposure to gadoxetate disodium, high BMI and pulmonary disease have been described as potential risk factors for TSM. However, there are only few concordant results on this topic and the pathophysiology of TSM has not been identified. Proposed strategies for the prevention of TSM are slow injection rates and low doses of diluted gadoxetate disodium. Accelerated and free-breathing MRI sequence protocols and breath-hold training may minimize the effects of TSM. Further prospective studies are needed to confirm these strategies and to identify the underlying mechanism of TSM. KEY POINTS · TSM occurs in 5 - 22 % of patients after gadoxetate disodium injection.. · Potential risk factors of TSM are dose, repeated exposure, BMI, pulmonary disease.. · The underlying mechanism for TSM has not been identified.. · Slow injection rates and diluted gadoxetate disodium may prevent TSM.. · Accelerated image acquisition or free-breathing sequences may mitigate the effects of TSM.. CITATION FORMAT · Well L, Weinrich JM, Adam G et al. Transient Severe Respiratory Motion Artifacts After Application of Gadoxetate Disodium: What We Currently Know. Fortschr Röntgenstr 2018; 190: 20 - 30.
Collapse
|
24
|
Weinrich JM, Diel R, Sauer M, Henes FO, Meywald-Walter K, Adam G, Schön G, Bannas P. Yield of chest X-ray tuberculosis screening of immigrants during the European refugee crisis of 2015: a single-centre experience. Eur Radiol 2017; 27:3244-3248. [DOI: 10.1007/s00330-016-4684-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 10/28/2016] [Accepted: 11/29/2016] [Indexed: 01/15/2023]
|