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Zöllner FG, Sadick M. Editorial for "Cotyledon-Specific Flow Evaluation of Rhesus Macaque Placental Injury Using Ferumoxytol Dynamic Contrast-Enhanced MRI". J Magn Reson Imaging 2024. [PMID: 38389260 DOI: 10.1002/jmri.29292] [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] [Received: 01/04/2024] [Accepted: 01/05/2024] [Indexed: 02/24/2024] Open
Affiliation(s)
- Frank G Zöllner
- Computer Assisted Clinical Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Mannheim Institute for Intelligent Systems in Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Cooperative Core Facility Animal Scanner ZI, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Maliha Sadick
- Department of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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Grill N, Struebing F, Weiss C, Schönberg SO, Sadick M. Management of congenital urogenital and perineal vascular malformations: correlation of clinical findings with diagnostic imaging for treatment decision. ROFO-FORTSCHR RONTG 2024; 196:186-194. [PMID: 37922942 DOI: 10.1055/a-2127-4132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
PURPOSE Analysis of clinical and diagnostic findings in rare urogenital and perineal vascular malformations only occurring in 2-3 % of vascular anomalies with regard to clinical symptoms and treatment decisions. MATERIALS AND METHODS All 25 out of 537 patients presenting with congenital urogenital and perineal vascular malformations at our institution from 2014 to 2021 were included. Vascular anomaly classification, anatomical location, clinical symptoms at presentation, diagnostic imaging, and pain intensity were retrospectively assessed from the patient record and therapy management was evaluated. RESULTS In total, 25 patients (10 females (40 %), 15 males (60 %)), aged 6 to 77 years were included. Diagnoses were: 10 (40 %) venous malformations (VMs), 5 (20 %) lymphatic malformations (LMs) and 10 (40 %) arteriovenous malformations (AVMs). Malformation manifestations were: 12 (32 %) lesser pelvis, 12 (32 %) external genitalia, and 13 (34 %) perineal/gluteal region. One AVM was located in the kidney. The leading clinical symptom was pain. The mean intensity was 6.0/10 for LM, 5.7/10 for VM, and 4.5/10 for AVM. Further major symptoms included physical impairment, local swelling, and skin discoloration. Bleeding complications or sexual dysfunction were rare findings. Patients with VM reported significantly more symptoms than patients with AVM (p = 0.0129). In 13 patients (52 %) minimally invasive therapy was indicated: 10 (77 %) sclerotherapies and 3 (23 %) transcatheter embolization procedures. Complete symptomatic remission was achieved in 9 (69 %) patients, partial response in 3 (23 %) patients, and 1 patient showed no clinical response to therapy. Follow-up appointments without the need for immediate minimally invasive therapy were significantly more common in patients with AVMs than in patients with VMs (p = 0.0198). CONCLUSION To create a higher awareness of congenital urogenital and perineal vascular malformations. Awareness of this rare condition avoids misdiagnosis. Therapy decisions should be symptom-oriented. Emergency intervention is rarely required, even in fast-flow vascular malformations. KEY POINTS · Venous malformations cause more symptoms with higher pain intensity than arteriovenous malformations.. · Diagnosis and adequate treatment can be hampered by a lack of awareness of the clinical presentation.. · Bleeding complications are rare, even in high-flow vascular malformations.. · Pain and physical impairment are the most commonly observed symptoms in these patients..
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Affiliation(s)
- Nadja Grill
- Clinic for Radiology and Nuclear Medicine, University Medical Centre Mannheim, Germany
| | - Felix Struebing
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Centre Ludwigshafen, Germany
| | - Christel Weiss
- Department of Medical Statistics, Biomathematics and Information Processing, Medical Faculty Mannheim, Ruprecht-Karls-University of Heidelberg, Heidelberg, Mannheim, Germany
| | - Stefan O Schönberg
- Clinic for Radiology and Nuclear Medicine, University Medical Centre Mannheim, Germany
| | - Maliha Sadick
- Clinic for Radiology and Nuclear Medicine, University Medical Centre Mannheim, Germany
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Strübing F, Laurich A, Weiss C, Kneser U, Schoenberg S, Sadick M. Patient characteristics and disease spectrum in a German vascular anomalies center. Acta Radiol 2024; 65:145-151. [PMID: 37743550 DOI: 10.1177/02841851231196872] [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: 09/26/2023]
Abstract
BACKGROUND Vascular malformations are rare diseases that should be treated in dedicated vascular anomaly centers (VAC). There is only a small amount of data on the diagnostic and therapeutic handling of these patients, before they are referred to a VAC. PURPOSE To demonstrate the disease-specific patient characteristics in a German VAC, which are required to determine diagnostic and therapeutic steps. MATERIAL AND METHODS In a retrospective study, all patients who were treated in the VAC from April 2014 until August 2021 were identified. In total, 593 patients were included in this study. RESULTS Almost all patients had previously consulted a physician (591/593, 99.7%). A mean of two different physicians had been consulted (range 0-10). Patients with more complex, syndromal vascular malformations had significantly more previous appointments (P = 0.0018). In only 44% (261/593) of patients, the referral diagnosis was made correctly. Most patients had been previously treated for their vascular anomaly: pharmacotherapy (n = 130; 21.9%), compression garments (n = 141; 23.8%), surgical resection (n = 80; 17.3%) and sclerotherapy (n = 68; 11.5%). Fifty-two patients who had been falsely diagnosed had also received therapy prior to their referral to the VAC (8.8%). Most patients received an ultrasound examination in the VAC (n = 464; 78.2%). Most frequently, compression therapy was prescribed (n = 256; 43.2%), followed by sclerotherapy (n = 175, 29.5%) and pharmacotherapy (n = 55; 9.3%). CONCLUSION Patients suffering from vascular anomalies often go through a complicated scheduling with numerous outpatient appointments and have a high risk of misdiagnosis and mistreatment prolonging the medical condition. Therefore, patients with vascular anomalies should be treated in a dedicated vascular anomaly center.
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Affiliation(s)
- Felix Strübing
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Hand and Plastic Surgery, University of Heidelberg, Ludwigshafen, Germany
| | - Annette Laurich
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Hand and Plastic Surgery, University of Heidelberg, Ludwigshafen, Germany
| | - Christel Weiss
- Department for Statistical Analysis, University Medical Center Mannheim, Faculty of Clinical Medicine Mannheim, University of Heidelberg, Ludwigshafen, Germany
| | - Ulrich Kneser
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Hand and Plastic Surgery, University of Heidelberg, Ludwigshafen, Germany
| | - Stefan Schoenberg
- Clinic for Radiology and Nuclear Medicine, University Medical Center Mannheim, Faculty of Clinical Medicine Mannheim, University of Heidelberg, Ludwigshafen, Germany
| | - Maliha Sadick
- Clinic for Radiology and Nuclear Medicine, University Medical Center Mannheim, Faculty of Clinical Medicine Mannheim, University of Heidelberg, Ludwigshafen, Germany
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Sadick M, Hofmann L, Weiß C, Tuschy B, Schönberg SO, Zöllner FG. Long-term evaluation of uterine fibroid embolisation using MRI perfusion parameters and patient questionnaires: preliminary results. BMC Med Imaging 2022; 22:214. [PMID: 36471287 PMCID: PMC9724260 DOI: 10.1186/s12880-022-00926-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 11/02/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Uterine fibroid embolisation (UFE) is an established treatment method for symptomatic uterine myomas. This study evaluates the efficacy of UFE using objective magnetic resonance imaging (MRI) data for size and perfusion analysis as well as patient questionnaires assessing fibroid-related symptoms. METHOD Patients underwent MR-Angiography before UFE and 4 days, 6 and 12 months after the procedure. The images were evaluated using dedicated software. Patient questionnaires were completed before UFE and at 12 months follow-up, focussing on the embolization procedure and symptoms associated with uterine fibroids. Statistical analysis of the questionnaires was performed using paired sample t-test and Wilcoxon signed rank test, while Kruskal-Wallis test and Friedman test were applied for MRI-analysis. RESULTS Eleven women were included. There was a significant reduction in fibroid-related symptoms. The volume reduction after 12 months was significant in both, uterus and myomas, after an initial increase in uterine volume at the first post-interventional MRI. The perfusion analysis showed that blood flow to the fibroids could be significantly reduced up to 12 months after UFE while uterine tissue was not affected. CONCLUSION This study shows that uterine fibroid embolisation induces a significant long-term decrease in myoma size and perfusion while healthy uterine tissue remains unaffected. Fibroid-related symptoms are reduced for the sake of improved quality of life.
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Affiliation(s)
- Maliha Sadick
- grid.7700.00000 0001 2190 4373Clinic for Radiology and Nuclear Medicine, University Medical Centre Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Leonie Hofmann
- grid.7700.00000 0001 2190 4373Clinic for Radiology and Nuclear Medicine, University Medical Centre Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Christel Weiß
- grid.7700.00000 0001 2190 4373Department for Medical Statistics and Biomathematics, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Benjamin Tuschy
- grid.7700.00000 0001 2190 4373Department for Gynaecology and Obstetrics, University Medical Centre Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Stefan O. Schönberg
- grid.7700.00000 0001 2190 4373Clinic for Radiology and Nuclear Medicine, University Medical Centre Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Frank G. Zöllner
- grid.7700.00000 0001 2190 4373Computer Assisted Clinical Medicine, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany ,grid.7700.00000 0001 2190 4373Mannheim Institute for Intelligent Systems in Medicine, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
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Strübing F, Laurich A, Weiss C, Schönberg S, Kneser U, Sadick M. Performance of a vascular anomaly center: a retrospective analysis of 461 cases over seven years. Acta Radiol 2022; 64:1712-1717. [PMID: 36226366 DOI: 10.1177/02841851221130869] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Vascular malformations are rare diseases that are best managed in multidisciplinary vascular anomaly centers (VAC). So far, there are few published data on the logistic structure, patient allotment, and internal workflow in an interdisciplinary VAC. PURPOSE To demonstrate the referral structure and patient allotment in a European VAC. MATERIAL AND METHODS A retrospective cohort study was conducted. All patients treated in the VAC since its establishment in April 2014 until June 2020 were identified. A total of 461 patients were included in this study. RESULTS Most often, a venous malformation was diagnosed (49.9%), followed by arteriovenous malformations (8.7%) and syndromal vascular malformations (8.2%). Only 45.1% of referral diagnoses were correct. Of referrals, 35.1% were internal on-campus references, 28.0% were external references through physicians in private practice, and 19.7% came via external cooperating hospitals. Of the patients, 17.1% were self-admissions without a referral. CONCLUSION The most important referring clinics are internal medicine, pediatric, and vascular surgery. A substantial proportion of referrals came from private practices. Recruiting these cooperation partners should be considered a high priority when establishing a new VAC. The rate of misdiagnosis is high, and more education of fellow clinicians is urgently needed. Therefore, patients with vascular malformations should be referred to and treated in dedicated centers for vascular anomalies.
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Affiliation(s)
- Felix Strübing
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Hand and Plastic Surgery, University of Heidelberg, Ludwigshafen, Germany
| | - Annette Laurich
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Hand and Plastic Surgery, University of Heidelberg, Ludwigshafen, Germany
| | - Christel Weiss
- Department of Medical Statistics and Biomathematics and Data Processing, University Medical Center Mannheim, Faculty for Clinical Medicine, University of Heidelberg, Mannheim, Germany
| | - Stefan Schönberg
- Clinic for Radiology and Nuclear Medicine, University Medical Center Mannheim, Faculty for Clinical Medicine, University of Heidelberg, Mannheim, Germany
| | - Ulrich Kneser
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Hand and Plastic Surgery, University of Heidelberg, Ludwigshafen, Germany
| | - Maliha Sadick
- Clinic for Radiology and Nuclear Medicine, University Medical Center Mannheim, Faculty for Clinical Medicine, University of Heidelberg, Mannheim, Germany
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Sadick H, Schäfer E, Weiss C, Rotter N, Müller C, Birk R, Sadick M, Häussler D. An in vitro study on the effect of bevacizumab on endothelial cell proliferation and VEGF concentration level in patients with hereditary hemorrhagic telangiectasia. Exp Ther Med 2022; 24:555. [PMID: 35978926 PMCID: PMC9366282 DOI: 10.3892/etm.2022.11493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 06/09/2022] [Indexed: 11/14/2022] Open
Abstract
Previous studies have demonstrated that vascular endothelial growth factor (VEGF) is upregulated in patients with hereditary hemorrhagic telangiectasia (HHT). The use of Bevacizumab as an anti-angiogenic treatment agent seems promising. The purpose of the present in vitro study was to determine the efficacy and potential toxicity levels of bevacizumab on cell proliferation and VEGF concentrations in endothelial cells of HHT patients. In this in vitro study, endothelial cells from patients with HHT and HUVECs (control) were incubated with different concentration levels of bevacizumab (2, 4, 6, 8 or 10 mg/ml). After 24, 48 or 72 h, the cell proliferation was assessed by Alamar Blue® Assay and the VEGF levels in the cell culture supernatants were measured by VEGF-ELISA. All endothelial cells incubated with bevacizumab showed an initial decrease in cell proliferation. Cell proliferation recovered within 72 h in cell cultures incubated with concentration levels of up to 4 mg/ml bevacizumab, whereas those incubated with higher concentration levels showed a continuous decline in cell proliferation. VEGF expression decreased after 24 h in cell cultures incubated with bevacizumab concentration levels of 2 and 4 mg/ml but increased again after 48 h. Cell cultures incubated with bevacizumab concentration levels of 10 mg/ml showed a constant decline in VEGF expression without any tendency for recovery. Translating these results into daily clinical practice, the present study suggests that the intranasal submucosal injection of bevacizumab in HHT patients should not exceed a concentration level of 4 mg/ml. Overall, higher bevacizumab concentration levels not only reduce VEGF expression but pose a higher risk of toxic effects on endothelial cells as they jeopardize cell proliferation.
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Affiliation(s)
- Haneen Sadick
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Mannheim, Medical Faculty Mannheim of the University of Heidelberg, D‑68135 Mannheim, Germany
| | - Elena Schäfer
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Mannheim, Medical Faculty Mannheim of the University of Heidelberg, D‑68135 Mannheim, Germany
| | - Christel Weiss
- Department of Medical Statistics, University Hospital Mannheim, Medical Faculty Mannheim of the University of Heidelberg, D‑68135 Mannheim, Germany
| | - Nicole Rotter
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Mannheim, Medical Faculty Mannheim of the University of Heidelberg, D‑68135 Mannheim, Germany
| | - Cornelia Müller
- Department of Otorhinolaryngology, University Hospital Marburg, Philipps‑Universität Marburg, D‑35043 Marburg, Germany
| | - Richard Birk
- Department of Otorhinolaryngology, University Hospital Marburg, Philipps‑Universität Marburg, D‑35043 Marburg, Germany
| | - Maliha Sadick
- Clinic for Radiology and Nuclear Medicine, University Hospital Mannheim, Medical Faculty Mannheim of the University of Heidelberg, D‑68135 Mannheim, Germany
| | - Daniel Häussler
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Mannheim, Medical Faculty Mannheim of the University of Heidelberg, D‑68135 Mannheim, Germany
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Strübing F, Sadick M, Porubsky S, Harhaus L, Bigdeli A, Kneser U. Fibroadipose Vascular Anomaly of the Upper Extremity: Case Report of Extensive Resection and Secondary Tendon Transfer. Ann Plast Surg 2021; 87:e92-e96. [PMID: 33833153 DOI: 10.1097/sap.0000000000002792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Alomari and colleagues described in 2014 for the first time a distinct combination of vascular malformation, fibrofatty muscular infiltration and contracture which was termed fibroadipose vascular anomaly (FAVA) (J Pediatr Orthoped 34, 109-117 (2014). So far only few publications (J Pediatr Orthoped (2014) 34, 109-117; J Hand Surg (2020). 45, 68.e1, 68.e13; Ann Vasc Dis (2014) 7, 316-319; Pediatr Radiol 46, 1179-1186 (2016)) concerning this newly described disease have been published, covering only a limited number of cases. We present a case of a 19-year-old male patient suffering from a FAVA of the proximal forearm with a severe contracture of the infiltrated flexor musculature. Upon surgery, we observed infiltration of the ulnar nerve. We were able to successfully resect the vascular malformation. Secondary tendon transfer was performed after extensive resection of the flexor musculature.FAVA presents a differential diagnosis in patients with solid growth of the upper or lower extremity and contracture of the involved extremity. We conclude that patients suffering from FAVA of the upper extremity should be referred to a center specialized in oncologic extremity surgery and reconstructive hand and microsurgery.
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Affiliation(s)
- Felix Strübing
- From the Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Hand and Plastic Surgery, University of Heidelberg, Heidelberg
| | - Maliha Sadick
- Institute for Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Mannheim
| | - Stefan Porubsky
- Institute of Pathology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Leila Harhaus
- From the Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Hand and Plastic Surgery, University of Heidelberg, Heidelberg
| | - Amir Bigdeli
- From the Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Hand and Plastic Surgery, University of Heidelberg, Heidelberg
| | - Ulrich Kneser
- From the Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Hand and Plastic Surgery, University of Heidelberg, Heidelberg
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Strübing FF, Porubsky S, Bigdeli AK, Schmidt VJ, Krebs L, Kneser U, Sadick M. Interdisciplinary management of peripheral arteriovenous malformations: review of the literature and current proceedings. J Plast Surg Hand Surg 2021; 56:1-10. [PMID: 34292124 DOI: 10.1080/2000656x.2021.1913743] [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] [Indexed: 10/20/2022]
Abstract
Arteriovenous malformations (AVMs) are a rare congenital vascular disorder. They represent a fast-flow vascular malformation. Clinically, AVMs present a heterogenous expression and can affect every part of the body. Here, we will solely focus on extracranial AVMs. Generally, AVMs progress with the patient's age. Patients often suffer from pulsation, skin discoloration, pain, ulceration, bleeding, and disfigurement. Diagnostic tools include color-coded duplex sonography, MRI and CT imaging, as well as the clinical examination. 4D dynamic perfusion-computed tomography may help in the interventional planning. Digital subtraction angiography is required during interventional therapy. AVMs pose a great challenge to the treating physician. The therapy of this rare disease should be managed in an interdisciplinary center for vascular malformations. It consists of conservative measures, such as compression garments and pain medication, transcatheter or, more rarely, percutanous embolization, and surgical resection. In smaller, localized lesions, resection with primary wound closure may be feasible, whereas extensive AVMs regularly require the reconstruction of the resulting soft tissue defect and possibly affected functional structures by means of free tissue transfer. In the interdisciplinary setting required for an appropriate treatment of AVMs, extensive knowledge of the various therapies, including those from different specialties, is necessary. Therefore, this article aims to provide an overview over both the interventional and surgical therapeutic options.
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Affiliation(s)
- Felix F Strübing
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Hand and Plastic Surgery, University of Heidelberg, Heidelberg, Germany
| | - Stefan Porubsky
- Institute for Pathology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Amir K Bigdeli
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Hand and Plastic Surgery, University of Heidelberg, Heidelberg, Germany
| | - Volker J Schmidt
- Department of Plastic and Breast Surgery, Zealand University Hospital, Roskilde, Copenhagen University, Copenhagen, Denmark
| | - Lena Krebs
- Clinic for Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim - Heidelberg University, Mannheim, Germany
| | - U Kneser
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Hand and Plastic Surgery, University of Heidelberg, Heidelberg, Germany
| | - Maliha Sadick
- Clinic for Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim - Heidelberg University, Mannheim, Germany
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Shchetynska-Marinova T, Amendt K, Sadick M, Keese M, Sigl M. Aortitis - An Interdisciplinary Challenge. In Vivo 2021; 35:41-52. [PMID: 33402448 DOI: 10.21873/invivo.12230] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 10/15/2020] [Accepted: 10/21/2020] [Indexed: 12/24/2022]
Abstract
The term 'aortitis' comprises a heterogeneous spectrum of diseases, with varied etiology and clinical presentations, whose common characteristic is the inflammation of the aortic wall. Since aortitis can mimic almost all common cardiovascular disorders, its clinical recognition remains a challenge. Some cases of aortitis remain undetected for a long time and may be diagnosed after severe life-threatening complications have already arisen. The diagnosis of aortitis is based on the presence of homogeneous circumferential thickening of the aortic wall detected on aortic imaging, or typical histological features in combination with clinical findings and laboratory parameters. Management of aortitis is usually conservative (immunosuppressive drugs in noninfectious aortitis; antimicrobial drugs in infectious). However, if vascular complications such as aortic aneurysm, rupture, or steno-occlusive events appear, aortic surgery or endovascular therapy may be required. This review article summarizes the current knowledge regarding the etiology, clinical presentation, diagnosis, and treatment of inflammatory diseases of the aorta to promote better clinical management of these entities.
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Affiliation(s)
- Tetyana Shchetynska-Marinova
- First Department of Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Klaus Amendt
- Vascular Center Oberrhein, Internal Medicine I, Diakonissenkrankenhaus Mannheim, Mannheim, Germany
| | - Maliha Sadick
- Clinic for Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Michael Keese
- Department of Vascular Surgery, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Martin Sigl
- First Department of Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany;
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Grill N, Struebing F, Krebs L, Sadick M. Diagnostic radiology findings and spectrum of therapeutic interventions in gynaecological and urogenital vascular anomalies. Br J Radiol 2021; 94:20210246. [PMID: 34048274 DOI: 10.1259/bjr.20210246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Vascular anomalies represent a rare congenital disease with manifestation at diverse anatomical sights and presenting with heterogenous symptoms. Undetected, they can progress and create acute and chronic complications with functional impairment. The manifestation in the female and male pelvis and the urogenital tract represents a multidisciplinary challenge for physicians. Especially outpatient management in gynaecology and urology is affected. Diagnostic Radiology holds an important supportive role in early diagnosis of the underlying urogenital vascular anomaly and referral to interventional radiology, either for minimal invasive treatment, or to surgery for further assessment. This pictorial review creates awareness for the spectrum of vascular anomalies of the gynaecological and urogenital tract, their characteristic imaging findings and dedicated interventional treatment options. The individual description of vascular anomalies, based on an appropriate nomenclature and classification standard, is a guide for radiologists to distinguish the underlying vascular anomaly from other vascular disorders and to accelerate diagnosis as well as therapeutic proceedings. In consequence, interdisciplinary management of patients with vascular anomalies of the female and male pelvis will benefit.
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Affiliation(s)
- Nadja Grill
- Clinic for Radiology and Nuclear Medicine, University Medical Center Mannheim, Faculty of Clinical Medicine of Heidelberg University - Theodor Kutzer Ufer 1-3,68167 Mannheim, Germany Universitatsklinikum Mannheim, Klinik für Radiologie undNuklearmedizin, Heidelberg, Germany
| | - Felix Struebing
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Heidelberg, Germany
| | - Lena Krebs
- Clinic for Radiology and Nuclear Medicine, University Medical Center Mannheim, Faculty of Clinical Medicine of Heidelberg University - Theodor Kutzer Ufer 1-3,68167 Mannheim, Germany Universitatsklinikum Mannheim, Klinik für Radiologie undNuklearmedizin, Heidelberg, Germany
| | - Maliha Sadick
- Clinic for Radiology and Nuclear Medicine, University Medical Center Mannheim, Faculty of Clinical Medicine of Heidelberg University - Theodor Kutzer Ufer 1-3,68167 Mannheim, Germany Universitatsklinikum Mannheim, Klinik für Radiologie undNuklearmedizin, Heidelberg, Germany
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Hübers C, Strübing F, Sadick M, Wohlfeil S, Géraud C, Felcht M. [Longitudinal hard tumor of the lower lip]. Hautarzt 2021; 72:925-927. [PMID: 33721047 DOI: 10.1007/s00105-021-04787-4] [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] [Accepted: 02/17/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Corinne Hübers
- Klinik für Dermatologie, Venerologie und Allergologie, Exzellenzzentrum Dermatologie Mannheim des Landes Baden-Württemberg, Universitätsklinikum Mannheim, Medizinische Fakultät Mannheim, Ruprecht-Karls-Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland.,Abteilung für vaskuläre Onkologie und Metastasierung, Deutsches Krebsforschungszentrum Heidelberg (DKFZ-ZMBH Alliance), Heidelberg, Deutschland.,European Center for Angioscience (ECAS), Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Deutschland
| | - Felix Strübing
- Interdisziplinäre Zentrum für Gefäßanomalien, Universitätsklinikum Mannheim, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Deutschland.,Klinik für Hand‑, Plastische und Rekonstruktive Chirurgie, Berufsgenossenschaftliche Unfallklinik, Ludwigshafen, Deutschland
| | - Maliha Sadick
- Interdisziplinäre Zentrum für Gefäßanomalien, Universitätsklinikum Mannheim, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Deutschland.,Institut für klinische Radiologie und Nuklearmedizin, Universitätsklinikum Mannheim, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Deutschland
| | - Sebastian Wohlfeil
- Klinik für Dermatologie, Venerologie und Allergologie, Exzellenzzentrum Dermatologie Mannheim des Landes Baden-Württemberg, Universitätsklinikum Mannheim, Medizinische Fakultät Mannheim, Ruprecht-Karls-Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland
| | - Cyrill Géraud
- Klinik für Dermatologie, Venerologie und Allergologie, Exzellenzzentrum Dermatologie Mannheim des Landes Baden-Württemberg, Universitätsklinikum Mannheim, Medizinische Fakultät Mannheim, Ruprecht-Karls-Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland.,European Center for Angioscience (ECAS), Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Deutschland.,Sektion Klinische und Molekulare Dermatologie an der Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Mannheim, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Deutschland
| | - Moritz Felcht
- Klinik für Dermatologie, Venerologie und Allergologie, Exzellenzzentrum Dermatologie Mannheim des Landes Baden-Württemberg, Universitätsklinikum Mannheim, Medizinische Fakultät Mannheim, Ruprecht-Karls-Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland. .,Abteilung für vaskuläre Onkologie und Metastasierung, Deutsches Krebsforschungszentrum Heidelberg (DKFZ-ZMBH Alliance), Heidelberg, Deutschland. .,European Center for Angioscience (ECAS), Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Deutschland. .,Interdisziplinäre Zentrum für Gefäßanomalien, Universitätsklinikum Mannheim, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Deutschland.
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Sadick M, Overhoff D, Baessler B, von Spangenberg N, Krebs L, Wohlgemuth WA. Peripheral Vascular Anomalies – Essentials in Periinterventional Imaging. ROFO-FORTSCHR RONTG 2019; 192:150-162. [DOI: 10.1055/a-0998-4300] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background Peripheral vascular anomalies represent a rare disease with an underlying congenital mesenchymal and angiogenetic disorder. Vascular anomalies are subdivided into vascular tumors and vascular malformations. Both entities include characteristic features and flow dynamics. Symptoms can occur in infancy and adulthood. Vascular anomalies may be accompanied by characteristic clinical findings which facilitate disease classification. The role of periinterventional imaging is to confirm the clinically suspected diagnosis, taking into account the extent and location of the vascular anomaly for the purpose of treatment planning.
Method In accordance with the International Society for the Study of Vascular Anomalies (ISSVA), vascular anomalies are mainly categorized as slow-flow and fast-flow lesions. Based on the diagnosis and flow dynamics of the vascular anomaly, the recommended periinterventional imaging is described, ranging from ultrasonography and plain radiography to dedicated ultrafast CT and MRI protocols, percutaneous phlebography and transcatheter angiography. Each vascular anomaly requires dedicated imaging. Differentiation between slow-flow and fast-flow vascular anomalies facilitates selection of the appropriate imaging modality or a combination of diagnostic tools.
Results Slow-flow congenital vascular anomalies mainly include venous and lymphatic or combined malformations. Ultrasound and MRI and especially MR-venography are essential for periinterventional imaging. Arteriovenous malformations are fast-flow vascular anomalies. They should be imaged with dedicated MR protocols, especially when extensive. CT with 4D perfusion imaging as well as time-resolved 3D MR-A allow multiplanar perfusion-based assessment of the multiple arterial inflow and venous drainage vessels of arterio-venous malformations. These imaging tools should be subject to intervention planning, as they can reduce procedure time significantly. Fast-flow vascular tumors like hemangiomas should be worked up with ultrasound, including color-coded duplex sonography, MRI and transcatheter angiography in case of a therapeutic approach. In combined malformation syndromes, radiological imaging has to be adapted according to the dominant underlying vessels and their flow dynamics.
Conclusion Guide to evaluation of flow dynamics in peripheral vascular anomalies, involving vascular malformations and vascular tumors with the intention to facilitate selection of periinterventional imaging modalities and diagnostic and therapeutic approach to vascular anomalies.
Key Points:
Citation Format
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Affiliation(s)
- Maliha Sadick
- University Medical Center Mannheim, Institute for Clinical Radiology and Nuclear Medicine, Mannheim, Germany
| | - Daniel Overhoff
- University Medical Center Mannheim, Institute for Clinical Radiology and Nuclear Medicine, Mannheim, Germany
| | - Bettina Baessler
- University Medical Center Mannheim, Institute for Clinical Radiology and Nuclear Medicine, Mannheim, Germany
| | - Naema von Spangenberg
- University Medical Center Mannheim, Institute for Clinical Radiology and Nuclear Medicine, Mannheim, Germany
| | - Lena Krebs
- University Medical Center Mannheim, Institute for Clinical Radiology and Nuclear Medicine, Mannheim, Germany
| | - Walter A. Wohlgemuth
- Department for Radiology, Martin-Luther-Universität Halle-Wittenberg, Halle, Germany
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Abstract
Malignant vascular tumors as part of the vascular anomalies spectrum are extremely rare in children and young adults. Instead, benign vascular neoplasias are frequently encountered in the pediatric patient population. While vascular malformations are congenital vascular lesions, originating from a mesenchymal stem cell defect, vascular tumors are neoplastic transformations of endothelial and other vascular cells. The appropriate differential diagnosis and nomenclature according to the classification of the International Society for the Study of Vascular Anomalies (ISSVA) is decisive to initiate correct therapy. While infantile hemangioma can be routinely diagnosed by clinical means and rarely require therapy, more rare vascular tumors are frequently difficult to diagnose, require dedicated cross-sectional imaging, and benefit from an interdisciplinary treatment approach. The focus of this review is to provide an overview over the spectrum of vascular tumors, typical imaging characteristics, and summarize treatment options including interventional radiology approaches.
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Affiliation(s)
- Moritz Wildgruber
- Institut für Klinische Radiologie, Universitätsklinikum Münster, Albert-Schweitzer Campus 1, 48149, Münster, Germany.
| | - Maliha Sadick
- Institut für Klinische Radiologie und Nuklearmedizin, Universitätsmedizin Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - René Müller-Wille
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsmedizin Göttingen, Robert-Koch Strasse 40, 37075, Göttingen, Germany
| | - Walter A Wohlgemuth
- Universitätsklinik und Poliklinik für Radiologie, Ernst-Grube-Strasse 40, 06120, Halle (Saale), Germany
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Sadick M, Richers J, Tuschy B, Schad LR, Schoenberg SO, Zöllner FG. Feasibility of quantitative MR-perfusion imaging to monitor treatment response after uterine artery embolization (UAE) in symptomatic uterus fibroids. Magn Reson Imaging 2019; 59:31-38. [PMID: 30807812 DOI: 10.1016/j.mri.2019.02.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 09/07/2018] [Revised: 02/14/2019] [Accepted: 02/15/2019] [Indexed: 01/06/2023]
Abstract
INTRODUCTION In 25% of women, symptomatic uterus myomas are diagnosed with clinical and functional impairment ranging from abdominal and pelvic pain to dys- and hypermenorrhea, dyspareunia, pollakiuria and infertility. Women undergoing a treatment increasingly prefer nowadays minimal invasive, uterus preserving therapies like uterine artery embolization (UAE) over surgical hysterectomy, nowadays. To emphasize the efficacy of UAE as a uterus preserving treatment with targeted therapy of myomas only, analysis of tissue perfusion pre and post embolization is required. The purpose of this study was to assess treatment response in UAE in females with symptomatic uterus myomas by quantitative magnetic resonance perfusion imaging. METHODS Seven females scheduled for uterus myoma embolization underwent three MRI examinations (pre, post, follow-up) including morphological and dynamic contrast enhanced perfusion imaging at 3 T. To measure tumor volume, regions-of-interest covering the tumor and the uterus were drawn by two readers in consensus. Blood flow, blood volume, and mean transit time were calculated by a pixel-by-pixel deconvolution approach. Kruskal-Wallis/Friedman test was employed to test whether the group medians differ significantly with correction for multiple comparisons using Bonferroni method. RESULTS Change of volume could be observed in all patients after embolization but was significantly different only between pre/post and follow-up time point. Measured differences in all perfusion parameters were significant between pre-intervention and post-intervention/follow-up in the myomas, no significant differences could be detected for the uterus tissue. CONCLUSIONS Our results demonstrate devascularization of symptomatic myomas which correlates with cessation of hypermenorrhea in all treated patients without affecting healthy uterus tissue. Supplementing UAE with perfusion imaging to monitor early treatment response is feasible and might provide valuable information for the follow-up of patients and contribute to providing confidence for the patients in treatment success.
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Affiliation(s)
- Maliha Sadick
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer Ufer 1-3, 68167 Mannheim, Germany
| | - Jakob Richers
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer Ufer 1-3, 68167 Mannheim, Germany
| | - Benjamin Tuschy
- Department of Gynaecology and Obstetrics, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer Ufer 1-3, 68167 Mannheim, Germany
| | - Lothar R Schad
- Computer Assisted Clinical Medicine, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer Ufer 1-3, 68167 Mannheim, Germany
| | - Stefan O Schoenberg
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer Ufer 1-3, 68167 Mannheim, Germany
| | - Frank G Zöllner
- Computer Assisted Clinical Medicine, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer Ufer 1-3, 68167 Mannheim, Germany.
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Harder F, Schönberg S, Sadick M. Einseitige Armschwellung – Leitsymptom einer Gefäßanomalie. ROFO-FORTSCHR RONTG 2018; 190:1166-1168. [DOI: 10.1055/a-0640-3442] [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)
- Felix Harder
- Institute for Clinical Radiology and Nuclear Medicine, University-Medical-Center Mannheim, University-Medical-Center Mannheim, Germany
| | - Stefan Schönberg
- Institute for Clinical Radiology and Nuclear Medicine, University-Medical-Center Mannheim, University-Medical-Center Mannheim, Germany
| | - Maliha Sadick
- Institute for Clinical Radiology and Nuclear Medicine, University-Medical-Center Mannheim, University-Medical-Center Mannheim, Germany
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Sadick M, Müller-Wille R, Wildgruber M, Wohlgemuth WA. Vascular Anomalies (Part I): Classification and Diagnostics of Vascular Anomalies. ROFO-FORTSCHR RONTG 2018; 190:825-835. [PMID: 29874693 DOI: 10.1055/a-0620-8925] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Vascular anomalies are a diagnostic and therapeutic challenge. They require dedicated interdisciplinary management. Optimal patient care relies on integral medical evaluation and a classification system established by experts in the field, to provide a better understanding of these complex vascular entities. METHOD A dedicated classification system according to the International Society for the Study of Vascular Anomalies (ISSVA) and the German Interdisciplinary Society of Vascular Anomalies (DiGGefA) is presented. The vast spectrum of diagnostic modalities, ranging from ultrasound with color Doppler, conventional X-ray, CT with 4 D imaging and MRI as well as catheter angiography for appropriate assessment is discussed. RESULTS Congenital vascular anomalies are comprised of vascular tumors, based on endothelial cell proliferation and vascular malformations with underlying mesenchymal and angiogenetic disorder. Vascular tumors tend to regress with patient's age, vascular malformations increase in size and are subdivided into capillary, venous, lymphatic, arterio-venous and combined malformations, depending on their dominant vasculature. According to their appearance, venous malformations are the most common representative of vascular anomalies (70 %), followed by lymphatic malformations (12 %), arterio-venous malformations (8 %), combined malformation syndromes (6 %) and capillary malformations (4 %). CONCLUSION The aim is to provide an overview of the current classification system and diagnostic characterization of vascular anomalies in order to facilitate interdisciplinary management of vascular anomalies. KEY POINTS · Vascular anomalies are comprised of vascular tumors and vascular malformations, both considered to be rare diseases.. · Appropriate treatment depends on correct classification and diagnosis of vascular anomalies, which is based on established national and international classification systems, recommendations and guidelines.. · In the classification, diagnosis and treatment of congenital vascular anomalies, radiology plays an integral part in patient management.. CITATION FORMAT · Sadick M, Müller-Wille R, Wildgruber M et al. Vascular Anomalies (Part I): Classification and Diagnostics of Vascular Anomalies. Fortschr Röntgenstr 2018; 190: 825 - 835.
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Affiliation(s)
- Maliha Sadick
- University Medical Center Mannhein, Institute for Clinical Radiology and Nuclear Medicine, Mannheim, Germany
| | - René Müller-Wille
- Department for Radiology, Universitätsmedizin Göttingen, Georg-August-Universität, Göttingen, Germany
| | - Moritz Wildgruber
- Department for Clinical Radiology, Universitätsklinikum Münster, Westfälische Wilhelms Universität, Münster, Germany
| | - Walter A Wohlgemuth
- Department for Radiology, Martin-Luther-Universität Halle-Wittenberg, Halle, Germany
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Mosebach J, Haller S, Sadick M. Persistierendes Galleleck: Coiling einer Gallenfistel nach posttraumatischer Hemihepatektomie über eine einliegende T-Drainage. ROFO-FORTSCHR RONTG 2018. [PMID: 29514387 DOI: 10.1055/s-0043-125450] [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)
- Jennifer Mosebach
- Department of Radiology, Deutsches Krebsforschungszentrum, Heidelberg, Germany
| | - Sarah Haller
- Institute of Clinical Radiology and Nuclear Medicine, Universitätsklinikum Mannheim, Germany
| | - Maliha Sadick
- Institute of Clinical Radiology and Nuclear Medicine, Universitätsklinikum Mannheim, Germany
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Müller-Wille R, Wildgruber M, Sadick M, Wohlgemuth WA. Vascular Anomalies (Part II): Interventional Therapy of Peripheral Vascular Malformations. ROFO-FORTSCHR RONTG 2018; 190:927-937. [PMID: 29415296 DOI: 10.1055/s-0044-101266] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [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
BACKGROUND The International Society for the Study of Vascular Anomalies (ISSVA) categorizes vascular anomalies into vascular tumors and vascular malformations. Vascular malformations are further divided into slow-flow (venous, lymphatic, and capillary malformation) and fast-flow malformations (arteriovenous malformation and arteriovenous fistula). This interdisciplinary classification has therapeutic implications. METHODS The objective of this article is to provide concise information about the current terminology and treatment strategies of peripheral vascular malformations, based on the currently available literature, with a focus on interventional therapy of venous malformations (VM), lymphatic malformations (LM), arteriovenous malformations (AVM) and arteriovenous fistulae (AVF). RESULTS AND CONCLUSION Accurate classification is crucial for appropriate therapy of peripheral vascular malformations. Modern imaging technologies and refined interventional treatment strategies are now central parts in the multidisciplinary management of these patients. Slow-flow and fast-flow vascular malformations can be treated successfully by percutaneous sclerotherapy and endovascular embolotherapy as first-line interventions. KEY POINTS · The ISSVA classification is essential for the correct diagnosis of vascular malformations. · The Schobinger classification as well as the Cho classification should be used for description of arteriovenous malformations (AVM). · Sclerotherapy and embolotherapy are the primary treatments of choice for vascular malformations. CITATION FORMAT · Müller-Wille R, Wildgruber M, Sadick M et al. Vascular Anomalies (Part II): Interventional Therapy of Peripheral Vascular Malformations. Fortschr Röntgenstr 2018; DOI: 10.1055/s-0044-101266.
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Affiliation(s)
- René Müller-Wille
- Institute for Diagnostic and Interventional Radiology, Georg-August-Universität Göttingen, Universitätsmedizin, Göttingen, Germany
| | - Moritz Wildgruber
- Department for Clinical Radiology, Westfälische Wilhelms Universität Münster, Medizinische Fakultät, Münster, Germany
| | - Maliha Sadick
- University Medical Center Mannhein, Institute for Clinical Radiology and Nuclear Medicine, Mannheim, Germany
| | - Walter A Wohlgemuth
- Department for Radiology, Martin-Luther-Universität Halle-Wittenberg, Halle, Germany
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Sadick M, Dally FJ, Schönberg SO, Stroszczynski C, Wohlgemuth WA. Strategies in Interventional Radiology: Formation of an Interdisciplinary Center of Vascular Anomalies - Chances and Challenges for Effective and Efficient Patient Management. ROFO-FORTSCHR RONTG 2017; 189:957-966. [PMID: 28834967 DOI: 10.1055/s-0043-117047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Background Radiology is an interdisciplinary field dedicated to the diagnosis and treatment of numerous diseases and is involved in the development of multimodal treatment concepts. Method Interdisciplinary case management, a broad spectrum of diagnostic imaging facilities and dedicated endovascular radiological treatment options are valuable tools that allow radiology to set up an interdisciplinary center for vascular anomalies. Results Image-based diagnosis combined with endovascular treatment options is an essential tool for the treatment of patients with highly complex vascular diseases. These vascular anomalies can affect numerous parts of the body so that a multidisciplinary treatment approach is required for optimal patient care. Conclusion This paper discusses the possibilities and challenges regarding effective and efficient patient management in connection with the formation of an interdisciplinary center for vascular anomalies with strengthening of the clinical role of radiologists. Key points · Vascular anomalies, which include vascular tumors and malformations, are complex to diagnose and treat.. · There are far more patients with vascular anomalies requiring therapy than interdisciplinary centers for vascular anomalies - there is currently a shortage of dedicated interdisciplinary centers for vascular anomalies in Germany that can provide dedicated care for affected patients.. · Radiology includes a broad spectrum of diagnostic and minimally invasive therapeutic tools which allow the formation of an interdisciplinary center for vascular anomalies for effective, efficient and comprehensive patient management.. Citation Format · Sadick M, Dally FJ, Schönberg SO et al. Strategies in Interventional Radiology: Formation of an Interdisciplinary Center of Vascular Anomalies - Chances and Challenges for Effective and Efficient Patient Management. Fortschr Röntgenstr 2017; 189: 957 - 966.
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Affiliation(s)
- Maliha Sadick
- Interdisciplinary Center of Vascular Anomalies, Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Germany
| | - Franz Josef Dally
- Interdisciplinary Center of Vascular Anomalies, Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Germany
| | - Stefan O Schönberg
- Interdisciplinary Center of Vascular Anomalies, Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Germany
| | - Christian Stroszczynski
- Department of Radiology, University Hospital Regensburg, Department of Radiology, Regensburg, Germany
| | - Walter A Wohlgemuth
- Interdisciplinary Center for Vascular Anomalies, University Hospital Halle, University Clinic and Polyclinic of Radiology, Halle (Saale), Germany
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Sadick M, Wohlgemuth WA, Huelse R, Lange B, Henzler T, Schoenberg SO, Sadick H. Interdisciplinary Management of Head and Neck Vascular Anomalies: Clinical Presentation, Diagnostic Findings and Minimalinvasive Therapies. Eur J Radiol Open 2017; 4:63-68. [PMID: 28540347 PMCID: PMC5432672 DOI: 10.1016/j.ejro.2017.05.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [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: 02/07/2017] [Accepted: 05/03/2017] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES Vascular anomalies are included in the 30 000 rare diseases worldwide affecting less than 5/10 000 people. Depending on their morphology and biological properties, they can cause varied disorders with organ involvement. Almost 60% of vascular anomalies have a predilection for the head and neck region in children. Clinical and scientific effort to establish interdisciplinary management concepts for vascular anomalies is increasing worldwide. METHODS Especially in the head and neck region, clinical impairment and organ dysfunction is associated with cosmetic issues that may represent a physical and psychological issue for the patient. Correct diagnosis, based on clinical presentation and symptoms, is a prerequisite for appropriate therapy, ranging from conservative management to a spectrum of minimally invasive treatment options. We searched PubMed for German and English language published data until December 2016 with focus on clinical studies, review articles and case reports on vascular anomalies with a focus on the head and neck region. RESULTS The last ISSVA update in 2014 has contributed to a better understanding of vascular anomalies, classifying them in vascular tumors and vascular malformations. The predominant representatives of vascular tumors are congenital and infantile hemangiomas. Infantile hemangiomas have the ability of spontaneous regression in more than 80%. Patients with symptomatic growing hemangiomas with ulcerations, bleeding complications and restriction of hearing, swallowing disorder, impairment of vision, or cosmetic dysfigurement require treatment. Therapies include oral propanolol, transcatheter embolization and surgery. Vascular malformations tend to progress with patientś age and are subdivided in slow flow and fast flow lesions. Symptomatic slow flow lesions, e.g. venous and lymphatic malformations, benefit from percutaneous sclerotherapy. Fast flow lesions, as arteriovenous malformations, are rare but undoubtedly therapeutically the most challenging vascular anomaly. Depending on location and size, they may require multiple transcatheter embolization procedures for successful occlusion of the AVM. CONCLUSIONS This review provides knowledge on the current ISSVA classification of vascular anomalies, their clinical presentation, diagnostic evaluation and minimally invasive therapy options to encourage the establishment of a comprehensive interdisciplinary management for head and neck vascular anomalies.
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Affiliation(s)
- Maliha Sadick
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Walter A. Wohlgemuth
- Department of Radiology, University Medical Center Regensburg, Franz-Josef- Strauß-Allee 11, 93053 Regensburg, Germany
| | - Roland Huelse
- Department of Otorhinolaryngology and Head and Neck Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Bettina Lange
- Department of Pediatric Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Thomas Henzler
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Stefan O. Schoenberg
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Haneen Sadick
- Department of Otorhinolaryngology and Head and Neck Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
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Rathmann N, Sadick M, Rathmann B, Kostrzewa M, Weiss C, Schoenberg SO, Diehl SJ, Antoni C. Benefit of Patients with an Early and Progressed State of Hepatocellular Carcinoma Treated with Drug-eluting Beads. In Vivo 2016; 30:707-712. [PMID: 27566095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 06/06/2016] [Indexed: 06/06/2023]
Abstract
AIM To evaluate drug-eluting beads (DEB) for transarterial chemoembolization (TACE) in patients with Barcelona Clinic Liver Cancer (BCLC) A to D suffering from hepatocellular carcinoma. MATERIAL AND METHODS The progression-free interval (PFI), survival and laboratory findings of 46 patients were retrospectively analyzed after DEB TACE. RESULTS The mean survival interval was 16.93 months. The BCLC A/B group had significantly (p=0.01) longer survival compared to C/D: 20.44 and 10.36 months. Mean PFI was 10.75 months with a significantly (p=0.002) longer PFI of the BCLC A/B group (12.71 months) compared to BCLC C/D (3.91 months). In terms of possible adverse events (AEs) significant changes (p<0.05) were observed in cholinesterase, white blood cells, alkaline phosphatase and C-reactive protein. CONCLUSION Mean survival and PFI results in the BCLC A/B patient group were comparable to historical controls. In addition, the results suggest that patients with BCLC stage C/D also benefited from DEB TACE.
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Affiliation(s)
- Nils Rathmann
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Maliha Sadick
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Bjoern Rathmann
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Michael Kostrzewa
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Christel Weiss
- Department of Biomathematics, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Stefan O Schoenberg
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Steffen J Diehl
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Christoph Antoni
- Department of Internal Medicine II, Division of Gastroenterology and Hepatology, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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Henzler T, Vogler N, Lange B, Dally F, Meyer M, Schoenberg SO, Sadick M. Low dose time-resolved CT-angiography in pediatric patients with venous malformations using 3rd generation dual-source CT: Initial experience. Eur J Radiol Open 2016; 3:216-22. [PMID: 27570804 PMCID: PMC4990662 DOI: 10.1016/j.ejro.2016.08.003] [Citation(s) in RCA: 8] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 08/09/2016] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVES To prospectively evaluate the diagnostic value and radiation dose of time-resolved CT-Angiography (4D-CTA) in pediatric patients with venous malformations using 3rd generation dual-source CT (DSCT) at 70 kVp tube voltage. METHODS Between November 2014 and August 2015, seven children (2 male, 5 female; median age, 9 years; range 3-12 years) with suspected peripheral, non-cerebral, venous malformations were included in this feasibility study and underwent US, MRI and 4D-CTA. All three imaging modalities were analyzed and compared individually by an experienced interventional radiologist and a pediatric surgeon using a 5-point Likert scale, with regard to diagnosis of the vascular anomaly, additional information like presence of thrombophlebitis and lesion extension, flow dynamics, localization, volume and significance for treatment planning. For quantitative statistical analysis, an unifactorial analysis of variance was performed for every parameter and all three imaging modalities. Radiation dose values as expressed by the volume CT dose index (CTDIvol) and dose-length product (DLP) were recorded for of all patients. RESULTS Three out of six patients had isolated type I venous malformations without peripheral venous drainage which could be demonstrated on MRI and CT. In two out of six patients a type II venous malformation with drainage into normal veins was diagnosed. In one case, 4D-CT was the only imaging modality that revealed a slow-flow venous malformation with shunting supply by a hypodynamic arterial feeder. TREATMENT PLANNING 4D-CTA was rated as the best imaging modality for treatment planning with agreement between radiologist and surgeon, especially with respect to the hemodynamics of the venous malformation. CONCLUSIONS 4D-CTA at 70 kVp is a fast imaging modality that provides comprehensive diagnostic information of venous malformations in pediatric patients and is very valuable for therapy planning. Radiation dose of 4D-CTA must be weighted against the diagnostic information as well as the potential risk for sedation and contrast administration during MRI.
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Affiliation(s)
- Thomas Henzler
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Nils Vogler
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Bettina Lange
- Department of Pediatric Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Franz Dally
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Mathias Meyer
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Stefan O. Schoenberg
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Maliha Sadick
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
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Rathmann N, Budjan J, Mari F, Grimm R, Attenberger U, Kostrzewa M, Sadick M, Schoenberg SO, Diehl SJ. Semiautomatic Whole-lesion Apparent Diffusion Coefficient Assessment for Early Prediction of Liver Tumor Response to Radioembolization. Anticancer Res 2016; 36:2961-2966. [PMID: 27272811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 05/17/2016] [Indexed: 06/06/2023]
Abstract
AIM To evaluate volume-based apparent diffusion coefficient (ADCVOL) values for early prediction of therapy response after radioembolization (RE) of primary and secondary liver malignancies using a semiautomatic, image analysis software prototype. PATIENTS AND METHODS In a retrospective analysis, 74 target lesions were assessed in terms of therapy response 1 month after RE using magnetic resonance imaging. Changes of the diameter of the target lesions, the mean ADC value in a representative single-slice region of interest (ADCROI) and mean ADCVOL were correlated. RESULTS The median progression-free interval (PFI) of patients overall was 3.5±5.9 months. PFI in patients with an ADCVOL increase was statistically significantly longer than in patients with an ADCVOL decrease (mean PFI=6.5 vs. 2.5 months; p=0.0374). No correlation between PFI and early changes in lesion diameter or ADCROI was found. CONCLUSION Semiautomatic, software-based ADC volume measurements seem to offer a clinically valuable parameter for early prediction of therapy response in patients after RE.
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Affiliation(s)
- Nils Rathmann
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim - Heidelberg University, Mannheim, Germany
| | - Johannes Budjan
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim - Heidelberg University, Mannheim, Germany
| | - Fatinah Mari
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim - Heidelberg University, Mannheim, Germany
| | | | - Ulrike Attenberger
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim - Heidelberg University, Mannheim, Germany
| | - Michael Kostrzewa
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim - Heidelberg University, Mannheim, Germany
| | - Maliha Sadick
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim - Heidelberg University, Mannheim, Germany
| | - Stefan O Schoenberg
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim - Heidelberg University, Mannheim, Germany
| | - Steffen J Diehl
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim - Heidelberg University, Mannheim, Germany
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Sadick M. Alles über Ballonkatheter. ROFO-FORTSCHR RONTG 2016. [DOI: 10.1055/s-0036-1581511] [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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Hohenberger P, Rathmann N, Menge F, Sadick M, Schönberg S, Diehl S. Abstract 3598: Selective internal radiation (SIRT) is most effective when comparing local treatment to control progressive liver metastases of gastro-intestinal stromal tumors beyond treatment with tyrosine kinase inhibitors. Cancer Res 2015. [DOI: 10.1158/1538-7445.am2015-3598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Objective: The liver and the peritoneum are the main area of metastatic spread in gastrointestinal stromal tumors (GIST). Liver surgery plays a minor role for hepatic metastases in comparison to f.e. colorectal cancer. However, once the metastases are resistant to 1st line TKI, surgery, 2nd line therapy, interventional ablation techniques like RFA or selective internal radiation therapy (SIRT) are treatment options. We were interested to analyze the contribution of the different modalities in controlling hepatic progression.
Methods: 731 pts with biopsy proven GIST were followed since 2004 (median follow-up 43.6 months); data were prospectively documented. There were 337 males (46.1%) and 101 (13.8%) pts. presented with M1 disease initially. Of the remaining 630 pts, 358 pts (56.8%) developed tumor recurrence after a median time interval of 22 months. 312/358 pts (87%) developed metastases within the abdomen: liver n = 96, peritoneal n = 97, liver+peritoneal n = 78, locoregional n = 10, locoreg.+hep/per n = 21. Imatinib was the initial treatment in all patients with M1 disease.
Results: Out of 205 patients with liver metastases, 118 remained controlled by drug therapy or showed multi-site progression. In the remaining 87 pts., 26 pts each underwent liver resection or 2nd/3rd line drug therapy (sunitinib, regorafenib), 22 pts had RFA and 13 pts were treated by SIRT. Follow-up was done via dynamic MRI and contrast-enhanced (CE)-CT. The median hepatic-progression free survival (H-PFS) was 15.9 months (4-29) after SIRT (with 3 CR, 6 PR), however, only 5.6 (range, 2 - 13) months after 2nd line drug, 8.2 (3-15) months after surgery, and 7.7 (5-14) months after RFA, p<0.02.
Conclusion: 90Y radiation loaded particles (SIRT) provides the best hepatic progression free survival when compared to 2nd line drugs, RFA or even surgery in imatinib resistant GIST liver metastases. The effect could be mediated by eliminating small (subclinical, micro-) metastases. In patients known to have a GIST resistant to known TKIs, such as wildtype (non-KIT, non-PDGFRA mutated f.e. NF1-associated) lesions, SIRT could be used in earlier treatment lines.
Citation Format: Peter Hohenberger, Nils Rathmann, Franka Menge, Maliha Sadick, Stefan Schönberg, Steffen Diehl. Selective internal radiation (SIRT) is most effective when comparing local treatment to control progressive liver metastases of gastro-intestinal stromal tumors beyond treatment with tyrosine kinase inhibitors. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 3598. doi:10.1158/1538-7445.AM2015-3598
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Affiliation(s)
| | - Nils Rathmann
- 2Institut für Klinische Radiologie und Nuklearmedizin, Mannheim, Germany
| | | | - Maliha Sadick
- 2Institut für Klinische Radiologie und Nuklearmedizin, Mannheim, Germany
| | - Stefan Schönberg
- 2Institut für Klinische Radiologie und Nuklearmedizin, Mannheim, Germany
| | - Steffen Diehl
- 2Institut für Klinische Radiologie und Nuklearmedizin, Mannheim, Germany
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Sadick M. Alles über Ballonkatheter. ROFO-FORTSCHR RONTG 2015. [DOI: 10.1055/s-0035-1551086] [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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Sadick M. Standard-PTA: Ein Auslaufmodell? ROFO-FORTSCHR RONTG 2015. [DOI: 10.1055/s-0035-1551023] [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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Sadick M, Weiss C, Piniol R, Frey S, Hoermann K, Schoenberg SO, Sadick H. 18F-Fluorodeoxyglucose Uptake Level-Based Lymph Node Staging in Oropharyngeal Squamous Cell Cancer - Role of Molecular Marker Expression on Diagnostic Outcome. Oncol Res Treat 2015; 38:16-22. [DOI: 10.1159/000370234] [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] [Received: 08/15/2014] [Accepted: 11/19/2014] [Indexed: 11/19/2022]
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Rathmann N, Haeusler U, Diezler P, Weiss C, Kostrzewa M, Sadick M, Schoenberg SO, Diehl SJ. Evaluation of radiation exposure of medical staff during CT-guided interventions. J Am Coll Radiol 2014; 12:82-9. [PMID: 25086959 DOI: 10.1016/j.jacr.2014.04.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [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: 02/14/2014] [Accepted: 04/09/2014] [Indexed: 11/18/2022]
Abstract
PURPOSE The purpose of this prospective study was to investigate absolute radiation exposure values and factors that influence radiation exposure of interventionists during CT-guided interventions (CTGIs). To our knowledge, no data exist regarding the radiation dose to which the interventionist is exposed during these procedures. METHODS Absolute radiation dose values from a total of 131 CTGIs were analyzed. Radiation dose values were collected by thermoluminescent dosimeters that were positioned above the lead protection being worn, on the forehead, thyroid, chest, gonads, and right and left hand and foot. The radiation doses were analyzed with respect to the experience level of the person performing the procedure, the degree of difficulty measured on a 4-point Likert scale, the lesion size measured on a 3-point Likert scale, and the CT system used. RESULTS Median whole-body dose was 12 μSv. With the exception of the forehead, all whole-body radiation doses were statistically significantly lower in CTGIs performed using the modern dual-source CT system compared with the 16-slice multi-detector CT. For CTGIs rated as more complex, the radiation exposure of the radiologist performing the procedure was statistically significantly higher, with the exception of the left hand. A statistically significantly lower median whole-body dose was measured for inexperienced compared with experienced radiologists. However, a few dose measurements of more than 1 mSv were found at the right hand. CONCLUSIONS Radiation exposure measured during CTGIs is low (<50 μSv). Because the radiation dose was higher in more-complex interventions and for 16-slice multi-detector row CT, inexperienced radiologists should focus on less-complex procedures.
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Affiliation(s)
- Nils Rathmann
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim-Heidelberg University, Mannheim, Germany.
| | - Uwe Haeusler
- Department of Medical and Occupational Radiation Protection, Federal Office for Radiation Protection, Berlin, Germany
| | - Patricius Diezler
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim-Heidelberg University, Mannheim, Germany
| | - Christel Weiss
- Department of Biomathematics, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Michael Kostrzewa
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim-Heidelberg University, Mannheim, Germany
| | - Maliha Sadick
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim-Heidelberg University, Mannheim, Germany
| | - Stefan O Schoenberg
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim-Heidelberg University, Mannheim, Germany
| | - Steffen J Diehl
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim-Heidelberg University, Mannheim, Germany
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Li CY, Klohr S, Sadick H, Weiss C, Hoermann K, Schoenberg SO, Sadick M. Effect of time-of-flight technique on the diagnostic performance of 18F-FDG PET/CT for assessment of lymph node metastases in head and neck squamous cell carcinoma. J Nucl Med Technol 2014; 42:181-7. [PMID: 24970897 DOI: 10.2967/jnmt.114.141192] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
UNLABELLED Precise assessment of lymph node metastases is critical to the treatment outcome and overall survival of patients with head and neck squamous cell carcinoma (HNSCC). The purpose of this study was to investigate the effect of time-of-flight (TOF) technique on the diagnostic performance of (18)F-FDG PET/CT for assessment of lymph node metastases in HNSCC patients. METHODS In 39 patients with an initial diagnosis of HNSCC, preoperative staging (18)F-FDG PET/CT was performed to assess lymph node metastases before surgery and histologic verification. Potential lymph node metastases were evaluated and documented separately for the right and left neck in accordance with the head and neck lymph node level classification. Two experienced readers measured lesion volume and uptake for every PET-positive lymph node. Sensitivity, specificity, image quality, and the PET characterization of the lesion (benign or malignant) were compared between different reconstruction methods (TOF PET and standard high-definition PET) and matrices for both readers. RESULTS TOF PET significantly increased the maximal standardized uptake value (SUVmax) but had no significant effect on lesion volume. However, a higher SUVmax did not result in a significant increase in small-lesion detection. Sensitivity and image quality were slightly improved with TOF PET but not significantly so. Matrix, on the other hand, had a significant effect on detected lesion numbers, sensitivity, and image quality. CONCLUSION For preoperative assessment of lymph node metastases in HNSCC, (18)F-FDG PET/CT using TOF technique increases SUVmax in lesions and improves image quality but has no significant impact on small-lesion detectability.
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Affiliation(s)
- Chun-Yan Li
- Institute of Clinical Radiology and Nuclear Medicine, University Hospital Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Heidelberg, Germany Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Sarah Klohr
- Institute of Clinical Radiology and Nuclear Medicine, University Hospital Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Heidelberg, Germany
| | - Haneen Sadick
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Heidelberg, Germany; and
| | - Christel Weiss
- Department of Biostatistics, University Hospital Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Heidelberg, Germany
| | - Karl Hoermann
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Heidelberg, Germany; and
| | - Stefan O Schoenberg
- Institute of Clinical Radiology and Nuclear Medicine, University Hospital Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Heidelberg, Germany
| | - Maliha Sadick
- Institute of Clinical Radiology and Nuclear Medicine, University Hospital Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Heidelberg, Germany
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Sadick M. Alles über Ballonkatheter. ROFO-FORTSCHR RONTG 2014. [DOI: 10.1055/s-0034-1373037] [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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Diehl S, Sadick M, Riester T, Huck K, Schönberg SO. Grafts - bail out oder geplant? ROFO-FORTSCHR RONTG 2013. [DOI: 10.1055/s-0033-1345960] [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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Sadick M, Molina F, Frey S, Piniol R, Sadick H, Brade J, Fink C, Schoenberg SO, He Y. Effect of Reconstruction Parameters in High-Definition PET/CT on Assessment of Lymph Node Metastases in Head and Neck Squamous Cell Carcinoma. J Nucl Med Technol 2013; 41:19-25. [DOI: 10.2967/jnmt.112.116806] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Sadick M, Schoenberg SO, Hoermann K, Sadick H. Current oncologic concepts and emerging techniques for imaging of head and neck squamous cell cancer. GMS Curr Top Otorhinolaryngol Head Neck Surg 2012; 11:Doc08. [PMID: 23320060 PMCID: PMC3544205 DOI: 10.3205/cto000090] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The incidence of head and neck squamous cell carcinoma (HNSCC) is increasing and currently they account for 5% of all malignancies worldwide. Inspite of ongoing developments in diagnostic imaging and new therapeutic options, HNSCC still represents a multidisciplinary challenge.One of the most important prognostic factors in HNSCC is the presence of lymph node metastases. Patients with confirmed nodal involvement have a considerable reduction of their 5-year overall survival rate. In the era of individually optimised surgery, chemotherapy and intensity modulated radiotherapy, the main role of pre- and posttherapeutic imaging remains cancer detection at an early stage and accurate follow-up. The combined effort of early diagnosis and close patient monitoring after surgery and/or radio-chemotherapy influences disease progression and outcome predicition in patients with HNSCC.This review article focuses on currrent oncologic concepts and emerging tools in imaging of head and neck squamous cell cancer. Besides the diagnostic spectrum of the individual imaging modalities, their limitations are also discussed. One main part of this article is dedicated to PET-CT which combines functional and morphological imaging. Furthermore latest developments in MRI are presented with regard to lymph node staging and response prediction. Last but not least, a clinical contribution in this review explains, which information the head and neck surgeon requires from the multimodality imaging and its impact on operation planning.
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Affiliation(s)
- Maliha Sadick
- Institute of Clinical Radiology and Nuclear Medicine, University Hospital Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany
| | - Stefan O. Schoenberg
- Institute of Clinical Radiology and Nuclear Medicine, University Hospital Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany
| | - Karl Hoermann
- Department of ORL and Head and Neck Surgery, University Hospital Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany
| | - Haneen Sadick
- Department of ORL and Head and Neck Surgery, University Hospital Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany
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Hausmann D, Dinter DJ, Sadick M, Brade J, Schoenberg SO, Büsing K. The impact of acquisition time on image quality in whole-body 18F-FDG PET/CT for cancer staging. J Nucl Med Technol 2012; 40:255-8. [PMID: 23071347 DOI: 10.2967/jnmt.112.103291] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
UNLABELLED Our objective was to evaluate the impact of acquisition time on image quality, lesion detection rate, standardized uptake values, and lesion volume for (18)F-FDG PET in cancer patients. METHODS Over 7 mo, 33 cancer patients were included in this study. In these patients, 63 lesions were independently evaluated by 2 nuclear medicine specialists (experienced and beginner). Two consecutive whole-body (18)F-FDG PET/CT scans using a 3-min and 1.5-min acquisition time per bed position were obtained for each patient. Lesions were visually identified, and their locations were compared. The lesion volumes and standardized uptake values of the primary tumor, lymph nodes, and metastases were determined and compared. Image quality was scored using a 5-range Likert-type scale. For all parameters, interobserver agreement was assessed. RESULTS All relevant lesions could be identified at both acquisition times. Image quality was slightly adversely affected by an acquisition time of 1.5 min but was excellent or good in 85% of the scans. In a patient with increased blood sugar levels, the image quality was rated moderate at 3 min and poor at 1.5 min. The quality of lesion visualization was excellent regardless of the acquisition time. Lesion volume and maximum standardized uptake value on PET images showed an excellent correlation between the 2 acquisition times (Pearson correlation coefficient, 0.99 and 0.97, respectively). Interobserver agreement was excellent (κ > 0.83). CONCLUSION Although image quality is slightly poorer, reducing the acquisition time to 1.5 min per bed position seems to be clinically feasible without decreasing the lesion detection rate even for less experienced observers.
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Affiliation(s)
- Daniel Hausmann
- Institute for Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
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Diehl SJ, Gerblich F, Jochum S, Huck K, Keese M, Schoenberg SO, Sadick M. Twelve-month Results of the EverFlex Stent in the Superficial Femoral Artery. J Vasc Interv Radiol 2012; 23:1317-22. [DOI: 10.1016/j.jvir.2012.05.045] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2011] [Revised: 05/14/2012] [Accepted: 05/16/2012] [Indexed: 10/28/2022] Open
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Gottmann U, Sadick M, Kleinhuber K, Benck U, Huck K, Krämer BK, Birck R. Central vein stenosis in a dialysis patient: a case report. J Med Case Rep 2012; 6:189. [PMID: 22776267 PMCID: PMC3410761 DOI: 10.1186/1752-1947-6-189] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Accepted: 07/09/2012] [Indexed: 11/29/2022] Open
Abstract
Introduction Central vein stenosis is not a rare problem in patients on dialysis. Placement of a central vein catheter for dialysis access substantially increases the risk of central vein stenosis. However, even in patients without a previous history of central vein catheter placement, a stenosis can be found in up to 40% of patients. Case presentation We report the case of a 60-year-old male Caucasian German dialysis patient who complained of dry cough, swelling of his right arm and facial edema. Computed tomography venography showed a near-total stenosis of his brachiocephalic vein. We discuss the incidence and risk of central vein stenosis in patients on dialysis and report on a successful minimally invasive interventional treatment. Conclusion Central vein stenosis is not a rare problem in patients on hemodialysis and can even occur without previous placement of central venous catheters. High shunt volumes seem to increase the risk associated with central vein catheters.
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Affiliation(s)
- Uwe Gottmann
- 5th Department of Medicine (Nephrology/Endocrinology/Rheumatology), University Hospital Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, D-68135, Mannheim, Germany.
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Sadick M, Schoenberg SO, Hoermann K, Sadick H. [Current oncologic concepts and emerging techniques for imaging of head and neck squamous cell cancer]. Laryngorhinootologie 2012; 91 Suppl 1:S27-47. [PMID: 22456918 DOI: 10.1055/s-0031-1297259] [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] [Indexed: 10/28/2022]
Abstract
The incidence of head and neck squamous cell carcinoma (HNSCC) is increasing and currently they account for 5% of all malignancies worldwide. Inspite of ongoing developments in diagnostic imaging and new therapeutic facilities, HNSCC still represents a multidisciplinary challenge. One of the most important prognostic factors in HNSCC is the presence of lymph node metastases. Patients with confirmed nodal involvement have a considerable reduction of their 5-year overall survival rate. In the era of individually optimised surgery, chemotherapy and intensity modulated radiotherapy, the main role of pre- and posttherapeutic imaging remains cancer detection at an early stage and accurate follow-up. The combined effort of early diagnosis and close patient monitoring after surgery and/or radio-chemotherapy influences disease progression and outcome prediction in patients with HNSCC. This review article focuses on currrent oncologic concepts and emerging tools in imaging of head and neck squamous cell cancer. Besides the diagnostic spectrum of the individual imaging modalities, their limitations are also discussed. One main part of this article is dedicated to PET-CT which combines functional and morphological imaging. Furthermore latest developments in MRT are presented with regard to lymph node staging and response prediction. Last but not least, a clinical contribution in this review explains, which information the head and neck surgeon requires from the multimodality imaging and its impact on operation planning.
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Affiliation(s)
- M Sadick
- Institut für Klinische Radiologie und Nuklearmedizin, Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim der Universität Heidelberg.
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Sadick M, Kayed H, Pinol R, Frey S, Fink C, Schoenberg SO, Brade J, Sadick H, Hoermann K, He V. Optimierung von Rekonstruktionsalgorithmen bei der Truepoint HD PET/CT zur Erhöhung der diagnostischen Treffsicherheit von Lymphknotenmetastasen bei Plattenepithelkarzinomen (PE) der Kopf-Hals-Region. ROFO-FORTSCHR RONTG 2011. [DOI: 10.1055/s-0031-1279448] [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: 10/18/2022]
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Sadick M, Attenberger U, Kraenzlin B, Kayed H, Schoenberg SO, Gretz N, Schock-Kusch D. Two non-invasive GFR-estimation methods in rat models of polycystic kidney disease: 3.0 Tesla dynamic contrast-enhanced MRI and optical imaging. Nephrol Dial Transplant 2011; 26:3101-8. [PMID: 21444361 DOI: 10.1093/ndt/gfr148] [Citation(s) in RCA: 21] [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: 11/14/2022] Open
Abstract
BACKGROUND The aim of this study was the assessment of kidney morphology and glomerular filtration rate (GFR) in rat models of polycystic kidney disease and a healthy control group of Sprague-Dawley rats (SD rats). The performance of two non-invasive GFR estimation methods-3.0 Tesla magnetic resonance imaging (MRI) and optical imaging were investigated. Data of GFR assessment was compared to surrogate markers of kidney function and renal histology. METHODS Optical imaging of GFR was performed transcutaneously in a small animal imaging system with the fluorescent renal marker fluorescein-isothiocyanate-labelled-sinistrin. Morphologic and dynamic renal imaging was done on a clinical 3.0T MR scanner. Renal perfusion analysis was performed with a two-compartment filtration model. RESULTS The healthy SD rats showed physiological levels of creatinine and urea, indicating normal kidney function. These parameters were elevated in the small animal groups of polycystic kidney disease. For the calculation of perfusion and filtration parameters of kidney function in MRI, a 2D turbo FLASH sequence was performed and allowed to distinguish between normal GFR of healthy rats and reduced GFR of rats with polycystic kidney disease. Also, MRI GFR varied among two different rat strains of polycystic kidney disease, according to their status of renal function impairment. Optical imaging GFR confirmed higher GFR values in healthy rats compared to ill rats but did not show different results among the two rat strains of polycystic kidney disease. For this reason, MRI and optical imaging GFR estimation presented an intra-method bias. CONCLUSIONS Both non-invasive estimation methods of GFR, MRI and optical imaging, can differentiate between healthy rats and animals with limited kidney function. Furthermore, optical imaging, unlike MRI, seems to consider that disease progression with increase of renal polycystic deterioration does not correlate with decrease of GFR in the initial stage of compensatory hyperfiltration.
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Affiliation(s)
- Maliha Sadick
- Institute of Clinical Radiology and Nuclear Medicine, University Hospital Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Germany.
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Diehl SJ, Jochum S, Gerblich FM, Huck K, Ziegler P, Schönberg S, Sadick M. Behandlung arteriosklerotischer Läsionen mittels EVERFLEX-Stents: Mittelfristige Ergebnisse. ROFO-FORTSCHR RONTG 2010. [DOI: 10.1055/s-0030-1252674] [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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Bartling S, Budjan J, Aviv H, Michaely HJ, Semmler W, Schönberg S, Kränzlin B, Diehl SJ, Margel S, Sadick M. Entwicklung aus der molekularen Bildgebung: Erste multimodal-sichtbare (CT & MRT) Embolisationspartikel. ROFO-FORTSCHR RONTG 2010. [DOI: 10.1055/s-0030-1252532] [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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Sadick M, Haas S, Loehr M, Elshwi M, Singer MV, Brade J, Schoenberg SO, Diehl SJ. Application of DC beads in hepatocellular carcinoma: clinical and radiological results of a drug delivery device for transcatheter superselective arterial embolization. ACTA ACUST UNITED AC 2010; 33:31-7. [PMID: 20164659 DOI: 10.1159/000264620] [Citation(s) in RCA: 11] [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: 11/19/2022]
Abstract
AIM Application of a drug delivery device for transarterial chemoembolization (TACE) in patients with hepatocellular carcinoma (HCC). Clinical and radiological treatment assessment. PATIENTS AND METHODS 24 patients with liver cirrhosis and uni- or multifocal HCC underwent TACE with doxorubicin beads (DC Bead). The underly-ing cause of liver cirrhosis was hepatitis (A: n = 7; B: n = 10) or alcohol consumption (n = 7). Patients presented with Child Pugh stage A (n = 15) and B (n = 9). The mean intrahepatic tumor size, considering the sum of diameters of all lesions treated, was 3.83 cm (+/-2.4). Liver function and hematological parameters were documented before and after each TACE. Magnetic resonance imaging (MRI) was performed before and 4 weeks after TACE. The T1-w 3D volume-interpolated breathhold exam (VIBE) sequence was applied for evaluation of the therapy response. RESULTS 24 patients received a total number of 69 TACE treatments with DC beads (mean dose 160 mg). The elevation of liver function parameters after treatment did not affect the patients' clinical condition. The T1-w VIBE sequence proved very valuable for assessment of the intrahepatic tumor spread. Post-contrast images enabled delineation of the viable HCC lesions, hence facilitating the selective transcatheter approach. The tumor marker a-fetoprotein (AFP), available in 19/24 patients, dropped from 347.5 to 299.5 ng/ml, without being a reliable predictor of treatment response. A decrease of tumor size after TACE from 3.83 (+/-2.40) to 3.01 cm (+/-2.67; p < 0.0001) was evident on the T1w-VIBE sequences. The mean follow-up period was 30 months. At the time of data analysis, 10 (42%) out of 14 patients were alive. CONCLUSION TACE with DC beads in HCC offers a safe and efficient treatment resulting in tumor response within a very short time.
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Affiliation(s)
- Maliha Sadick
- Institute of Clinical Radiology and Nuclear Medicine, University Hospital Mannheim, Mannheim, Germany.
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Abstract
Osler disease is an autosomal dominant disorder of the fibrovascular tissue characterized by arteriovenous malformations with multi-systemic haemorrhages. Recurrent epistaxis is the predominant symptom in more than 90% of patients. Recent studies showed circadian and seasonal patterns in the onset of nosebleeds, similar to acute cardiovascular events, such as myocardial infarction and stroke. The aim of this study was to determine whether such patterns would also apply to the onset of epistaxis in patients with Osler disease. In all, 110 patients with Osler disease who were under treatment for recurrent epistaxis at the University Hospital of Mannheim were requested to complete a questionnaire addressing the intensity and frequency of epistaxis according to the classification of Bergler et al., as well as circadian and circannual rhythmicity in the occurrence of epistaxis according to visual analogue scales (VAS). More than half of the patients claimed to experience daily to weekly episodes of recurrent epistaxis. The occurrence of epistaxis showed a biphasic 24 h pattern, with a primary peak in the morning (05:00-8:00 h) and smaller secondary peaks in the evening (17:00-20:00 h and 21:00-00:00 h). No significant seasonal variation was found in the onset of epistaxis. However, a slight tendency, with a peak in winter months, was observed. Similar to other chronobiological studies on nosebleeds, this study showed that the 24 h pattern and seasonal tendency in the onset of epistaxis even applied to patients with Osler disease. Further investigations are necessary to determine the pathological mechanism underlying this phenomenon.
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Affiliation(s)
- Haneen Sadick
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Mannheim, Mannheim, Germany.
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Schock-Kusch D, Sadick M, Henninger N, Kraenzlin B, Claus G, Kloetzer HM, Weiss C, Pill J, Gretz N. Transcutaneous measurement of glomerular filtration rate using FITC-sinistrin in rats. Nephrol Dial Transplant 2009; 24:2997-3001. [PMID: 19461009 DOI: 10.1093/ndt/gfp225] [Citation(s) in RCA: 94] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Inulin/sinistrin (I/S) clearance is a gold standard for an accurate assessment of glomerular filtration rate (GFR). Here we describe and validate an approach for a transcutaneous determination of GFR by using fluorescein-isothiocyanate-labelled sinistrin (FITC-S) in rats. METHODS Using a small animal imager, fluorescence is measured over the depilated ear of a rat after the injection of FITC-S. The decay curve of fluorescence is used for the calculation of half-life and GFR. The thus obtained transcutaneous data were validated by simultaneously performed enzymatic and fluorometric measurements in plasma of both FITC-S and sinistrin. RESULTS The results of enzymatic sinistrin determination versus transcutaneous half-life of FITC-S or plasma fluorescence correlated well with each other (R(2) > 0.90). Furthermore, Bland-Altman analyses proved a good degree of agreement of the three methods used. The measurements performed in healthy animals as well as different models of renal failure demonstrate its appropriateness in a wide range of renal function. CONCLUSIONS The transcutaneous method described offers a precise assessment of GFR in small animals. As neither blood and/or urine sampling nor time-consuming lab work is required, GFR can be determined immediately after the clearance procedure is finished. This method, therefore, simplifies and fastens GFR determinations in small lab animals compared to conventional bolus clearance techniques based on blood sampling. A low-cost device for the measurement of transcutaneous fluorescence intensity over time is under construction.
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Brockmann C, Jochum S, Huck K, Ziegler P, Sadick M, Fink C, Schoenberg SO, Diehl S. Dual energy CT Angiographie der Becken Bein Region bei peripherer Verschlusskrankheit. ROFO-FORTSCHR RONTG 2009. [DOI: 10.1055/s-0029-1221442] [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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Voggenreiter G, Brocker K, Röhrl B, Sadick M, Obertacke U. Ergebnisse der Ballonkyphoplastie in der Behandlung von osteoporotischen Wirbelkörperfrakturen. Unfallchirurg 2008; 111:403-12. [DOI: 10.1007/s00113-008-1453-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [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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Sadick M, Michaely HJ, Kränzlin B, Schock D, Skude V, Gretz N, Schönberg SO. Morphologische und dynamische renale MR-Bildgebung an einem 3.0T Scanner – Evaluation der technischen Realisierbarkeit an einem pcy-Mausmodell. ROFO-FORTSCHR RONTG 2008. [DOI: 10.1055/s-2008-1073647] [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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Röhrl B, Sadick M, Morgen N, Herber S, Düber C, Pitton MB. Vertebroplastie und Kyphoplastie osteoporotischer Sinterungsfrakturen: Höhenentwicklung im Ein-Jahres-Verlauf nach Augmentation. ROFO-FORTSCHR RONTG 2008. [DOI: 10.1055/s-2008-1073769] [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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Sadick M, Röhrl B, Schnülle P, Düber C, Diehl SJ. Multislice CT-angiography in percutaneous postinterventional hematuria and kidney bleeding: Influence of diagnostic outcome on therapeutic patient management. Preliminary results. Arch Med Res 2007; 38:126-32. [PMID: 17174736 DOI: 10.1016/j.arcmed.2006.07.008] [Citation(s) in RCA: 7] [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] [Received: 06/11/2006] [Accepted: 07/26/2006] [Indexed: 11/26/2022]
Abstract
BACKGROUND The aims of this study were to assess the value of multislice CT-angiography (MS-CT-A) in percutaneous postinterventional kidney bleeding and to determine the influence of diagnostic outcome on therapeutic patient management. A recommendation for the interdisciplinary patient work-up for the emergency room was offered. METHODS Between April 2003 and January 2006, 12 patients with hematuria and clinically suspected renal bleeding underwent MS-CT-A for emergency diagnostic assessment. The spectrum of kidney injuries on CT was analyzed according to an organ-scaling scheme. The efficacy of MS-CT-A with regard to confirmation of active arterial bleeding was evaluated as well as the therapeutic consequences for patient management. RESULTS In seven patients (59%) staged grade V renal injury, active renal arterial bleeding was detected on CT-A. Patients immediately underwent therapeutic angiography with confirmation of arterial bleeding and successful embolization. Four patients (33%) were staged grade I renal injury with subcapsular kidney hematoma but no active hemorrhage. Therefore, these patients were not exposed to further therapeutic intervention. One patient (8%) was diagnosed grade II renal injury with superficial cortical renal parenchyma tear and no active bleeding on CT-A. CONCLUSIONS MS-CT-A is a valuable, fast and objective emergency tool for assessment of postinterventional renal hemorrhage. Detection of contrast material extravasation to affirm ongoing arterial bleeding and to localize bleeding site at the level of segmental or interlobar renal artery is a predictor for the need for further treatment and justifies therapeutic radiological or surgical management.
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Affiliation(s)
- Maliha Sadick
- Institute of Clinical Radiology, University Hospital Manheim, Faculty for Clinical Medicine of the University of Heidelberg, Mannheim, Gemany.
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