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Hinsen M, Nagel AM, May MS, Wiesmueller M, Uder M, Heiss R. Lung Nodule Detection With Modern Low-Field MRI (0.55 T) in Comparison to CT. Invest Radiol 2024; 59:215-222. [PMID: 37490031 DOI: 10.1097/rli.0000000000001006] [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: 07/26/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate the accuracy of modern low-field magnetic resonance imaging (MRI) for lung nodule detection and to correlate nodule size measurement with computed tomography (CT) as reference. MATERIALS AND METHODS Between November 2020 and July 2021, a prospective clinical trial using low-field MRI at 0.55 T was performed in patients with known pulmonary nodules from a single academic medical center. Every patient underwent MRI and CT imaging on the same day. The primary aim was to evaluate the detection accuracy of pulmonary nodules using MRI with transversal periodically rotated overlapping parallel lines with enhanced reconstruction in combination with coronal half-Fourier acquired single-shot turbo spin-echo MRI sequences. The secondary outcome was the correlation of the mean lung nodule diameter with CT as reference according to the Lung Imaging Reporting and Data System. Nonparametric Mann-Whitney U test, Spearman rank correlation coefficient, and Bland-Altman analysis were applied to analyze the results. RESULTS A total of 46 participants (mean age ± SD, 66 ± 11 years; 26 women) were included. In a blinded analysis of 964 lung nodules, the detection accuracy was 100% for those ≥6 mm (126/126), 80% (159/200) for those ≥4-<6 mm, and 23% (147/638) for those <4 mm in MRI compared with reference CT. Spearman correlation coefficient of MRI and CT size measurement was r = 0.87 ( P < 0.001), and the mean difference was 0.16 ± 0.9 mm. CONCLUSIONS Modern low-field MRI shows excellent accuracy in lesion detection for lung nodules ≥6 mm and a very strong correlation with CT imaging for size measurement, but could not compete with CT in the detection of small nodules.
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Affiliation(s)
- Maximilian Hinsen
- From the Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany (M.H., A.M.N., M.S.M., M.W., M.U., R.H.); and Division of Medical Physics in Radiology, German Cancer Research Center, Heidelberg, Germany (A.M.N.)
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Kopp M, Wiesmueller M, Buchbender M, Kesting M, Nagel AM, May MS, Uder M, Roemer FW, Heiss R. MRI of Temporomandibular Joint Disorders: A Comparative Study of 0.55 T and 1.5 T MRI. Invest Radiol 2024; 59:223-229. [PMID: 37493286 DOI: 10.1097/rli.0000000000001008] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
OBJECTIVES Temporomandibular disorders (TMDs) are common and may cause persistent functional limitations and pain. Magnetic resonance imaging (MRI) at 1.5 and 3 T is commonly applied for the evaluation of the temporomandibular joint (TMJ). No evidence is available regarding the feasibility of modern low-field MRI for the assessment of TMDs. The objective of this prospective study was to evaluate the image quality (IQ) of 0.55 T MRI in direct comparison with 1.5 T MRI. MATERIALS AND METHODS Seventeen patients (34 TMJs) with suspected intraarticular TMDs were enrolled, and both 0.55 and 1.5 T MRI were performed on the same day. Two senior readers independently evaluated the IQ focusing on the conspicuity of disc morphology (DM), disc position (DP), and osseous joint morphology (OJM) for each joint. We analyzed the IQ and degree of artifacts using a 4-point Likert scale (LS) at both field strengths. A fully sufficient IQ was defined as an LS score of ≥3. Nonparametric Wilcoxon test for related samples was used for statistical comparison. RESULTS The median IQ for the DM and OJM at 0.55 T was inferior to that at 1.5 T (DM: 3 [interquartile range {IQR}, 3-4] vs 4 [IQR, 4-4]; OJM: 3 [IQR, 3-4] vs 4 [IQR 4-4]; each P < 0.001). For DP, the IQ was comparable (4 [IQR 3-4] vs 4 [IQR 4-4]; P > 0.05). A sufficient diagnostic IQ was maintained for the DM, DP, and OJM in 92% of the cases at 0.55 T and 100% at 1.5 T. Minor image artifacts (LS score of ≥3) were more prevalent at 0.55 T (29%) than at 1.5 T (12%). CONCLUSIONS Magnetic resonance imaging of the TMJ at 0.55 T yields a lower IQ than does MRI at 1.5 T but maintains sufficient diagnostic confidence in the majority of patients. Further improvements are needed for reliable clinical application.
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Affiliation(s)
- Markus Kopp
- From the Department of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany (M.K., M.W., A.M.N., M.S.M., M.U., F.W.R., R.H.); Department of Oral and Maxillofacial Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany (M.B., M.K.); and Department of Radiology, Boston University Chobanian and Avedisian School of Medicine, Boston, MA (F.W.R.)
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Daniel S, Kopp M, Vollbrecht T, Zeilinger M, Fitz T, Muttke A, Feuerlein U, Uder M, May MS. Personalization of thoracoabdominal CT examinations using scanner integrated clinical decision support systems - Impact on the acquisition technique, scan range, and reconstruction type. Eur J Radiol 2023; 167:111078. [PMID: 37688917 DOI: 10.1016/j.ejrad.2023.111078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 08/10/2023] [Accepted: 08/30/2023] [Indexed: 09/11/2023]
Abstract
OBJECTIVES This study evaluates the impact of a scanner-integrated, customized clinical decision support system (CDSS) on the acquisition technique, scan range, and reconstruction in thoracoabdominal CT. MATERIALS AND METHODS We applied CDSS in contrast-enhanced examinations of the trunk with various clinical indications on a recent scanner with the capability of dual-energy CT (DECT), anatomic landmark detection (ALD), and iterative metal-artifact reduction (MAR). Simple and comprehensive questions about the patient's breath hold capability, the anatomical region of interest, and metal implants can be answered after the localizer. The acquisition technique (single energy, SECT, or dual energy), scan range (chest-abdomen-pelvis or chest-abdomen), and reconstruction technique (with or without MAR) were then automatically adapted in the examination protocols in coherence with these selections. Retrospectively, we compared the usage rates for these techniques in 624 examinations on the study scanner with 740 examinations on a comparable scanner without CDSS. Subgroup analysis of effective dose (ED), scan duration, and image quality (IQ) was performed in the study group. RESULTS CDSS leads to an increased usage rate of DECT (64.4% vs. 2.8%) and MAR (75.4% vs. 44.0%). All scan range adaptations by ALD were successful. The resulting subjective IQ between single energy and DECT acquisitions was comparable (all p > 0.05). Scan duration was significantly longer in DECT than in SECT (16.9 s vs. 6.5 s; p < 0.001). However, the objective IQ was significantly higher in DECT (CNRD 2.1 vs. 1.8; p < 0.01), and the ED significantly lower (6.7 mSv vs. 7.6 mSv; p = 0.004). CONCLUSION CDSS for thoracoabdominal CT leads to a substantially increased usage rate of innovative techniques during acquisition and reconstruction. Patients with adapted protocols benefit from improved image quality and increased post-processing options at lower radiation doses.
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Affiliation(s)
- Sascha Daniel
- Departement of Radiology, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nuremberg, 91054, Erlangen, Germany.
| | - Markus Kopp
- Departement of Radiology, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nuremberg, 91054, Erlangen, Germany
| | - Thomas Vollbrecht
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Germany
| | - Martin Zeilinger
- Departement of Radiology, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nuremberg, 91054, Erlangen, Germany
| | - Tim Fitz
- Departement of Radiology, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nuremberg, 91054, Erlangen, Germany
| | | | | | - Michael Uder
- Departement of Radiology, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nuremberg, 91054, Erlangen, Germany; Imaging Science Institute, University Hospital Erlangen, Erlangen, Germany
| | - Matthias S May
- Departement of Radiology, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nuremberg, 91054, Erlangen, Germany; Imaging Science Institute, University Hospital Erlangen, Erlangen, Germany
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Wiesmueller M, Kopp M, Sievert M, May MS, Nagel AM, Iro H, Uder M, Heiss R. Comparison of vestibular schwannoma visualization between 0.55 T and 1.5 T MRI. Eur J Radiol 2023; 165:110927. [PMID: 37379624 DOI: 10.1016/j.ejrad.2023.110927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/23/2023] [Accepted: 06/12/2023] [Indexed: 06/30/2023]
Abstract
OBJECTIVES Vestibular schwannoma (VS) is the most common mass of the internal auditory canal (IAC) and is responsible for unilateral sensorineural hearing loss. Magnetic resonance imaging (MRI) at 1.5 T and 3 T is the standard of care for the evaluation of VS, and the feasibility of using modern low-field MRI for imaging of the IAC has not yet been elucidated. Hence, the purpose of this prospective study was to assess image quality and diagnostic performance of a modern 0.55 T MRI. MATERIALS AND METHODS Fifty-six patients with known unilateral VS underwent routine MRI of the IAC at 1.5 T, followed immediately by 0.55 T MRI. Two radiologists independently evaluated the image quality, conspicuity of VS, diagnostic confidence, and image artifacts separately for isotropic T2-weighted SPACE images and for transversal and coronal T1-weighted fat-saturated contrast-enhanced images at 1.5 T and 0.55 T using 5-point Likert scales. In a second independent reading, both readers assessed lesion conspicuity and subjective diagnostic confidence in a direct comparison of 1.5 T and 0.55 T images. RESULTS Image quality of transversal T1-weighted images (p = 0.13 and p = 0.16 for Reader 1 and Reader 2, respectively) and T2-weighted SPACE images (p = 0.39 and p = 0.58) were rated equally at 1.5 T and 0.55 T by both readers, whereas image quality of coronal T1-weighted images was superior at 1.5 T (p = 0.009 and p = 0.001). Analysis of the conspicuity of VS, diagnostic confidence, and image artifacts of all sequences revealed no significant differences between 1.5 T and 0.55 T. In the direct comparison of 1.5 T with 0.55 T images, there were no significant differences in lesion conspicuity or diagnostic confidence for any sequence (p = 0.60-0.73). CONCLUSIONS Modern low-field MRI at 0.55 T provided a sufficient diagnostic image quality and seems feasible for the evaluation of VS of the IAC.
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Affiliation(s)
- Marco Wiesmueller
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Markus Kopp
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Matti Sievert
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Matthias S May
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Armin M Nagel
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Heinrich Iro
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Michael Uder
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Rafael Heiss
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany.
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Elbayomi M, Weyand M, Uder M, May MS, Steger K, Roth J, Tandler R. Endovascular stenting of an HVAD™ outflow graft pseudoaneurysm that exerts compression and kinking stenosis on the soft portion of the prosthesis. Clin Case Rep 2023; 11:e7349. [PMID: 37215974 PMCID: PMC10196405 DOI: 10.1002/ccr3.7349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 04/21/2023] [Accepted: 04/30/2023] [Indexed: 05/24/2023] Open
Abstract
Key Clinical Message Complex presentations of MCS patients may necessitate a multidisciplinary approach involving HF cardiologists, CT surgeons, advanced cardiac imagers, and interventional cardiologists in order to define the optimal management strategy. Abstract Left ventricle assist devices (LVADs) provide life-sustaining treatment for patients with terminal heart failure, but their intricacy allows for complications. One complication is LVAD outflow graft obstruction due to the graft's intraluminal thrombus or extraluminal compression. It may be treated endovascularly with stenting. We report an endovascular stenting of an outflow tract in HVAD™ (HeartWare Inc.) due to a pseudoaneurysm causing compression and kinking stenosis.
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Affiliation(s)
- Mohamed Elbayomi
- Department of Cardiac SurgeryFriedrich‐Alexander‐University Erlangen‐NurembergErlangenGermany
| | - Michael Weyand
- Department of Cardiac SurgeryFriedrich‐Alexander‐University Erlangen‐NurembergErlangenGermany
| | - Michael Uder
- Department of RadiologyFriedrich‐Alexander‐University Erlangen‐NurembergErlangenGermany
| | - Matthias S. May
- Department of RadiologyFriedrich‐Alexander‐University Erlangen‐NurembergErlangenGermany
| | - Katrin Steger
- Department of Cardiac SurgeryFriedrich‐Alexander‐University Erlangen‐NurembergErlangenGermany
| | - Jan‐Peter Roth
- Department of RadiologyFriedrich‐Alexander‐University Erlangen‐NurembergErlangenGermany
| | - Rene Tandler
- Department of Cardiac SurgeryFriedrich‐Alexander‐University Erlangen‐NurembergErlangenGermany
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Wiesmueller M, Meixner CR, Weber M, Kesting M, Nagel AM, Wuest W, May MS, Roemer FW, Uder M, Heiss R. Time-of-Flight Angiography in Ultra-High-Field 7 T MRI for the Evaluation of Peroneal Perforator Arteries Before Osseomyocutaneous Flap Surgery. Invest Radiol 2023; 58:216-222. [PMID: 36165876 PMCID: PMC9914154 DOI: 10.1097/rli.0000000000000926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 08/11/2022] [Indexed: 10/14/2022]
Abstract
OBJECTIVES Presurgical identification and morphologic characterization of the peroneal perforator arteries (PPAs) are essential for osseomyocutaneous flap surgery. The aim of this study was to evaluate PPAs using time-of-flight (TOF) angiography in 7 T magnetic resonance imaging in comparison with dual-energy computed tomographic angiography (CTA). MATERIALS AND METHODS In this prospective study, TOF angiography and CTA of both lower legs were acquired before flap surgery from 07/2019 to 02/2020. Magnetic resonance imaging was performed using a dedicated 28-channel knee coil with an acquisition time of 9:55 minutes (voxel size: 0.4 × 0.4 × 0.8 mm). Computed tomographic angiography was acquired with a third-generation dual-source computed tomography on the same day. Virtual monoenergetic reconstructions at 40 keV photon energy served as the standard of reference for PPA identification and subtyping. Two independent readers assessed the image quality, quantity, length assessment, and classification according to surgical considerations of PPAs for TOF angiography and CTA. Both TOF angiography and CTA were used for presurgical flap design and were evaluated by an orofacial surgeon. RESULTS Ten patients (mean age, 59.9 ± 14.9 years; 7 men) were included. Time-of-flight angiography and CTA identified 53 and 51 PPAs in total, respectively. Time-of-flight angiography showed superior image quality (both readers, P < 0.05). Time-of-flight angiography enabled specific classification of PPA subtypes more often (53 vs 39; P < 0.05), and both readers reported higher diagnostic confidence for TOF angiography than CTA in all patients (interrater agreement κ = 0.8; P < 0.05). Regarding length assessment, PPAs were significantly more conspicuous with TOF angiography (TOF mean , 50 ± 11 mm; CTA mean , 40 ± 9 mm; P = 0.001). In comparison with CTA, TOF angiography prospectively changed the orofacial surgeon's final decision on the presurgical selected PPAs in 60% of cases. CONCLUSIONS Presurgical assessment of PPAs is feasible using TOF in 7 T magnetic resonance imaging. Moreover, TOF angiography was superior to CTA for classifying and identifying PPAs, which may facilitate the planning of reconstructive surgery.
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Affiliation(s)
| | | | - Manuel Weber
- Department of Oral and Maxillofacial Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Marco Kesting
- Department of Oral and Maxillofacial Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Armin M. Nagel
- From the Institute of Radiology, University Hospital Erlangen
- Division of Medical Physics in Radiology, German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - Wolfgang Wuest
- From the Institute of Radiology, University Hospital Erlangen
| | - Matthias S. May
- From the Institute of Radiology, University Hospital Erlangen
| | - Frank W. Roemer
- From the Institute of Radiology, University Hospital Erlangen
- Quantitative Imaging Center (QIC), Department of Radiology, Boston University School of Medicine, Massachusetts
| | - Michael Uder
- From the Institute of Radiology, University Hospital Erlangen
| | - Rafael Heiss
- From the Institute of Radiology, University Hospital Erlangen
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Heiss R, Tan L, Schmidt S, Regensburger AP, Ewert F, Mammadova D, Buehler A, Vogel-Claussen J, Voskrebenzev A, Rauh M, Rompel O, Nagel AM, Lévy S, Bickelhaupt S, May MS, Uder M, Metzler M, Trollmann R, Woelfle J, Wagner AL, Knieling F. Pulmonary Dysfunction after Pediatric COVID-19. Radiology 2023; 306:e221250. [PMID: 36125379 PMCID: PMC9513839 DOI: 10.1148/radiol.221250] [Citation(s) in RCA: 30] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Long COVID occurs at a lower frequency in children and adolescents than in adults. Morphologic and free-breathing phase-resolved functional low-field-strength MRI may help identify persistent pulmonary manifestations after SARS-CoV-2 infection. Purpose To characterize both morphologic and functional changes of lung parenchyma at low-field-strength MRI in children and adolescents with post-COVID-19 condition compared with healthy controls. Materials and Methods Between August and December 2021, a cross-sectional clinical trial using low-field-strength MRI was performed in children and adolescents from a single academic medical center. The primary outcome was the frequency of morphologic changes at MRI. Secondary outcomes included MRI-derived functional proton ventilation and perfusion parameters. Clinical symptoms, the duration from positive reverse transcriptase-polymerase chain reaction test result, and serologic parameters were compared with imaging results. Nonparametric tests for pairwise and corrected tests for groupwise comparisons were applied to assess differences in healthy controls, recovered participants, and those with long COVID. Results A total of 54 participants after COVID-19 infection (mean age, 11 years ± 3 [SD]; 30 boys [56%]) and nine healthy controls (mean age, 10 years ± 3; seven boys [78%]) were included: 29 (54%) in the COVID-19 group had recovered from infection and 25 (46%) were classified as having long COVID on the day of enrollment. Morphologic abnormality was identified in one recovered participant. Both ventilated and perfused lung parenchyma (ventilation-perfusion [V/Q] match) was higher in healthy controls (81% ± 6.1) compared with the recovered group (62% ± 19; P = .006) and the group with long COVID (60% ± 20; P = .003). V/Q match was lower in patients with time from COVID-19 infection to study participation of less than 180 days (63% ± 20; P = .03), 180-360 days (63% ± 18; P = .03), and 360 days (41% ± 12; P < .001) as compared with the never-infected healthy controls (81% ± 6.1). Conclusion Low-field-strength MRI showed persistent pulmonary dysfunction in children and adolescents who recovered from COVID-19 and those with long COVID. Clinical trial registration no. NCT04990531 © RSNA, 2022 Supplemental material is available for this article. See also the editorial by Paltiel in this issue.
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Affiliation(s)
- Rafael Heiss
- From the Institute of Radiology (R.H., S.S., O.R., A.M.N., S.L., S.B., M.S.M., M.U.), Department of Pediatrics and Adolescent Medicine (L.T., A.P.R., F.E., D.M., A.B., M.R., M.M., R.T., J.W., A.L.W., F.K.), Pediatric Experimental and Translational Imaging Laboratory (PETI_Lab), Department of Pediatrics and Adolescent Medicine (A.P.R., A.B., A.L.W., F.K.), and Center for Social Pediatrics (F.E., D.M., R.T., J.W., A.L.W., F.K.), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Loschgestr 15, Erlangen 91054, Germany; and Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany (J.V.C., A.V.)
| | - Lina Tan
- From the Institute of Radiology (R.H., S.S., O.R., A.M.N., S.L., S.B., M.S.M., M.U.), Department of Pediatrics and Adolescent Medicine (L.T., A.P.R., F.E., D.M., A.B., M.R., M.M., R.T., J.W., A.L.W., F.K.), Pediatric Experimental and Translational Imaging Laboratory (PETI_Lab), Department of Pediatrics and Adolescent Medicine (A.P.R., A.B., A.L.W., F.K.), and Center for Social Pediatrics (F.E., D.M., R.T., J.W., A.L.W., F.K.), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Loschgestr 15, Erlangen 91054, Germany; and Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany (J.V.C., A.V.)
| | - Sandy Schmidt
- From the Institute of Radiology (R.H., S.S., O.R., A.M.N., S.L., S.B., M.S.M., M.U.), Department of Pediatrics and Adolescent Medicine (L.T., A.P.R., F.E., D.M., A.B., M.R., M.M., R.T., J.W., A.L.W., F.K.), Pediatric Experimental and Translational Imaging Laboratory (PETI_Lab), Department of Pediatrics and Adolescent Medicine (A.P.R., A.B., A.L.W., F.K.), and Center for Social Pediatrics (F.E., D.M., R.T., J.W., A.L.W., F.K.), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Loschgestr 15, Erlangen 91054, Germany; and Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany (J.V.C., A.V.)
| | - Adrian P Regensburger
- From the Institute of Radiology (R.H., S.S., O.R., A.M.N., S.L., S.B., M.S.M., M.U.), Department of Pediatrics and Adolescent Medicine (L.T., A.P.R., F.E., D.M., A.B., M.R., M.M., R.T., J.W., A.L.W., F.K.), Pediatric Experimental and Translational Imaging Laboratory (PETI_Lab), Department of Pediatrics and Adolescent Medicine (A.P.R., A.B., A.L.W., F.K.), and Center for Social Pediatrics (F.E., D.M., R.T., J.W., A.L.W., F.K.), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Loschgestr 15, Erlangen 91054, Germany; and Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany (J.V.C., A.V.)
| | - Franziska Ewert
- From the Institute of Radiology (R.H., S.S., O.R., A.M.N., S.L., S.B., M.S.M., M.U.), Department of Pediatrics and Adolescent Medicine (L.T., A.P.R., F.E., D.M., A.B., M.R., M.M., R.T., J.W., A.L.W., F.K.), Pediatric Experimental and Translational Imaging Laboratory (PETI_Lab), Department of Pediatrics and Adolescent Medicine (A.P.R., A.B., A.L.W., F.K.), and Center for Social Pediatrics (F.E., D.M., R.T., J.W., A.L.W., F.K.), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Loschgestr 15, Erlangen 91054, Germany; and Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany (J.V.C., A.V.)
| | - Dilbar Mammadova
- From the Institute of Radiology (R.H., S.S., O.R., A.M.N., S.L., S.B., M.S.M., M.U.), Department of Pediatrics and Adolescent Medicine (L.T., A.P.R., F.E., D.M., A.B., M.R., M.M., R.T., J.W., A.L.W., F.K.), Pediatric Experimental and Translational Imaging Laboratory (PETI_Lab), Department of Pediatrics and Adolescent Medicine (A.P.R., A.B., A.L.W., F.K.), and Center for Social Pediatrics (F.E., D.M., R.T., J.W., A.L.W., F.K.), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Loschgestr 15, Erlangen 91054, Germany; and Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany (J.V.C., A.V.)
| | - Adrian Buehler
- From the Institute of Radiology (R.H., S.S., O.R., A.M.N., S.L., S.B., M.S.M., M.U.), Department of Pediatrics and Adolescent Medicine (L.T., A.P.R., F.E., D.M., A.B., M.R., M.M., R.T., J.W., A.L.W., F.K.), Pediatric Experimental and Translational Imaging Laboratory (PETI_Lab), Department of Pediatrics and Adolescent Medicine (A.P.R., A.B., A.L.W., F.K.), and Center for Social Pediatrics (F.E., D.M., R.T., J.W., A.L.W., F.K.), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Loschgestr 15, Erlangen 91054, Germany; and Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany (J.V.C., A.V.)
| | - Jens Vogel-Claussen
- From the Institute of Radiology (R.H., S.S., O.R., A.M.N., S.L., S.B., M.S.M., M.U.), Department of Pediatrics and Adolescent Medicine (L.T., A.P.R., F.E., D.M., A.B., M.R., M.M., R.T., J.W., A.L.W., F.K.), Pediatric Experimental and Translational Imaging Laboratory (PETI_Lab), Department of Pediatrics and Adolescent Medicine (A.P.R., A.B., A.L.W., F.K.), and Center for Social Pediatrics (F.E., D.M., R.T., J.W., A.L.W., F.K.), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Loschgestr 15, Erlangen 91054, Germany; and Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany (J.V.C., A.V.)
| | - Andreas Voskrebenzev
- From the Institute of Radiology (R.H., S.S., O.R., A.M.N., S.L., S.B., M.S.M., M.U.), Department of Pediatrics and Adolescent Medicine (L.T., A.P.R., F.E., D.M., A.B., M.R., M.M., R.T., J.W., A.L.W., F.K.), Pediatric Experimental and Translational Imaging Laboratory (PETI_Lab), Department of Pediatrics and Adolescent Medicine (A.P.R., A.B., A.L.W., F.K.), and Center for Social Pediatrics (F.E., D.M., R.T., J.W., A.L.W., F.K.), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Loschgestr 15, Erlangen 91054, Germany; and Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany (J.V.C., A.V.)
| | - Manfred Rauh
- From the Institute of Radiology (R.H., S.S., O.R., A.M.N., S.L., S.B., M.S.M., M.U.), Department of Pediatrics and Adolescent Medicine (L.T., A.P.R., F.E., D.M., A.B., M.R., M.M., R.T., J.W., A.L.W., F.K.), Pediatric Experimental and Translational Imaging Laboratory (PETI_Lab), Department of Pediatrics and Adolescent Medicine (A.P.R., A.B., A.L.W., F.K.), and Center for Social Pediatrics (F.E., D.M., R.T., J.W., A.L.W., F.K.), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Loschgestr 15, Erlangen 91054, Germany; and Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany (J.V.C., A.V.)
| | - Oliver Rompel
- From the Institute of Radiology (R.H., S.S., O.R., A.M.N., S.L., S.B., M.S.M., M.U.), Department of Pediatrics and Adolescent Medicine (L.T., A.P.R., F.E., D.M., A.B., M.R., M.M., R.T., J.W., A.L.W., F.K.), Pediatric Experimental and Translational Imaging Laboratory (PETI_Lab), Department of Pediatrics and Adolescent Medicine (A.P.R., A.B., A.L.W., F.K.), and Center for Social Pediatrics (F.E., D.M., R.T., J.W., A.L.W., F.K.), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Loschgestr 15, Erlangen 91054, Germany; and Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany (J.V.C., A.V.)
| | - Armin M Nagel
- From the Institute of Radiology (R.H., S.S., O.R., A.M.N., S.L., S.B., M.S.M., M.U.), Department of Pediatrics and Adolescent Medicine (L.T., A.P.R., F.E., D.M., A.B., M.R., M.M., R.T., J.W., A.L.W., F.K.), Pediatric Experimental and Translational Imaging Laboratory (PETI_Lab), Department of Pediatrics and Adolescent Medicine (A.P.R., A.B., A.L.W., F.K.), and Center for Social Pediatrics (F.E., D.M., R.T., J.W., A.L.W., F.K.), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Loschgestr 15, Erlangen 91054, Germany; and Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany (J.V.C., A.V.)
| | - Simon Lévy
- From the Institute of Radiology (R.H., S.S., O.R., A.M.N., S.L., S.B., M.S.M., M.U.), Department of Pediatrics and Adolescent Medicine (L.T., A.P.R., F.E., D.M., A.B., M.R., M.M., R.T., J.W., A.L.W., F.K.), Pediatric Experimental and Translational Imaging Laboratory (PETI_Lab), Department of Pediatrics and Adolescent Medicine (A.P.R., A.B., A.L.W., F.K.), and Center for Social Pediatrics (F.E., D.M., R.T., J.W., A.L.W., F.K.), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Loschgestr 15, Erlangen 91054, Germany; and Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany (J.V.C., A.V.)
| | - Sebastian Bickelhaupt
- From the Institute of Radiology (R.H., S.S., O.R., A.M.N., S.L., S.B., M.S.M., M.U.), Department of Pediatrics and Adolescent Medicine (L.T., A.P.R., F.E., D.M., A.B., M.R., M.M., R.T., J.W., A.L.W., F.K.), Pediatric Experimental and Translational Imaging Laboratory (PETI_Lab), Department of Pediatrics and Adolescent Medicine (A.P.R., A.B., A.L.W., F.K.), and Center for Social Pediatrics (F.E., D.M., R.T., J.W., A.L.W., F.K.), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Loschgestr 15, Erlangen 91054, Germany; and Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany (J.V.C., A.V.)
| | - Matthias S May
- From the Institute of Radiology (R.H., S.S., O.R., A.M.N., S.L., S.B., M.S.M., M.U.), Department of Pediatrics and Adolescent Medicine (L.T., A.P.R., F.E., D.M., A.B., M.R., M.M., R.T., J.W., A.L.W., F.K.), Pediatric Experimental and Translational Imaging Laboratory (PETI_Lab), Department of Pediatrics and Adolescent Medicine (A.P.R., A.B., A.L.W., F.K.), and Center for Social Pediatrics (F.E., D.M., R.T., J.W., A.L.W., F.K.), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Loschgestr 15, Erlangen 91054, Germany; and Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany (J.V.C., A.V.)
| | - Michael Uder
- From the Institute of Radiology (R.H., S.S., O.R., A.M.N., S.L., S.B., M.S.M., M.U.), Department of Pediatrics and Adolescent Medicine (L.T., A.P.R., F.E., D.M., A.B., M.R., M.M., R.T., J.W., A.L.W., F.K.), Pediatric Experimental and Translational Imaging Laboratory (PETI_Lab), Department of Pediatrics and Adolescent Medicine (A.P.R., A.B., A.L.W., F.K.), and Center for Social Pediatrics (F.E., D.M., R.T., J.W., A.L.W., F.K.), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Loschgestr 15, Erlangen 91054, Germany; and Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany (J.V.C., A.V.)
| | - Markus Metzler
- From the Institute of Radiology (R.H., S.S., O.R., A.M.N., S.L., S.B., M.S.M., M.U.), Department of Pediatrics and Adolescent Medicine (L.T., A.P.R., F.E., D.M., A.B., M.R., M.M., R.T., J.W., A.L.W., F.K.), Pediatric Experimental and Translational Imaging Laboratory (PETI_Lab), Department of Pediatrics and Adolescent Medicine (A.P.R., A.B., A.L.W., F.K.), and Center for Social Pediatrics (F.E., D.M., R.T., J.W., A.L.W., F.K.), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Loschgestr 15, Erlangen 91054, Germany; and Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany (J.V.C., A.V.)
| | - Regina Trollmann
- From the Institute of Radiology (R.H., S.S., O.R., A.M.N., S.L., S.B., M.S.M., M.U.), Department of Pediatrics and Adolescent Medicine (L.T., A.P.R., F.E., D.M., A.B., M.R., M.M., R.T., J.W., A.L.W., F.K.), Pediatric Experimental and Translational Imaging Laboratory (PETI_Lab), Department of Pediatrics and Adolescent Medicine (A.P.R., A.B., A.L.W., F.K.), and Center for Social Pediatrics (F.E., D.M., R.T., J.W., A.L.W., F.K.), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Loschgestr 15, Erlangen 91054, Germany; and Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany (J.V.C., A.V.)
| | - Joachim Woelfle
- From the Institute of Radiology (R.H., S.S., O.R., A.M.N., S.L., S.B., M.S.M., M.U.), Department of Pediatrics and Adolescent Medicine (L.T., A.P.R., F.E., D.M., A.B., M.R., M.M., R.T., J.W., A.L.W., F.K.), Pediatric Experimental and Translational Imaging Laboratory (PETI_Lab), Department of Pediatrics and Adolescent Medicine (A.P.R., A.B., A.L.W., F.K.), and Center for Social Pediatrics (F.E., D.M., R.T., J.W., A.L.W., F.K.), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Loschgestr 15, Erlangen 91054, Germany; and Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany (J.V.C., A.V.)
| | - Alexandra L Wagner
- From the Institute of Radiology (R.H., S.S., O.R., A.M.N., S.L., S.B., M.S.M., M.U.), Department of Pediatrics and Adolescent Medicine (L.T., A.P.R., F.E., D.M., A.B., M.R., M.M., R.T., J.W., A.L.W., F.K.), Pediatric Experimental and Translational Imaging Laboratory (PETI_Lab), Department of Pediatrics and Adolescent Medicine (A.P.R., A.B., A.L.W., F.K.), and Center for Social Pediatrics (F.E., D.M., R.T., J.W., A.L.W., F.K.), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Loschgestr 15, Erlangen 91054, Germany; and Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany (J.V.C., A.V.)
| | - Ferdinand Knieling
- From the Institute of Radiology (R.H., S.S., O.R., A.M.N., S.L., S.B., M.S.M., M.U.), Department of Pediatrics and Adolescent Medicine (L.T., A.P.R., F.E., D.M., A.B., M.R., M.M., R.T., J.W., A.L.W., F.K.), Pediatric Experimental and Translational Imaging Laboratory (PETI_Lab), Department of Pediatrics and Adolescent Medicine (A.P.R., A.B., A.L.W., F.K.), and Center for Social Pediatrics (F.E., D.M., R.T., J.W., A.L.W., F.K.), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Loschgestr 15, Erlangen 91054, Germany; and Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany (J.V.C., A.V.)
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8
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Kaemmerer AS, Alkhalaileh K, Suleiman MN, Kopp M, Hauer C, May MS, Uder M, Weyand M, Harig F. Pericardial tamponade, a diagnostic chameleon: from the historical perspectives to contemporary management. J Cardiothorac Surg 2023; 18:60. [PMID: 36739433 PMCID: PMC9898697 DOI: 10.1186/s13019-023-02174-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 01/28/2023] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Pericardial tamponade (PT) early after cardiac surgery is a challenging clinical entity, not infrequently misrecognized and often only detected late in its course. Because the clinical signs of pericardial tamponade can be very unspecific, a high degree of initial suspicion is required to establish the diagnosis. In addition to clinical examination the deployment of imaging techniques is almost always mandatory in order to avoid delays in diagnosis and to initiate any necessary interventions, such as pericardiocentesis or direct cardiac surgical interventions. After a brief overview of how knowledge of PT has developed throughout history, we report on an atypical life-threatening cardiac tamponade after cardiac surgery. A 74-year-old woman was admitted for elective biological aortic valve replacement and aorto-coronary-bypass grafting (left internal mammary artery to left anterior descending artery, single vein graft to right coronary artery). On the 10th postoperative day, the patient unexpectedly deteriorated. She rapidly developed epigastric pain radiating to the left upper abdomen, and features of low peripheral perfusion and shock. There were no clear signs of pericardial tamponade either clinically or echocardiographically. Therefore, for further differential diagnosis, a contrast-enhanced computed tomography scan was performed under clinical suspicion of acute abdomen. Unexpectedly, active bleeding distally from the right coronary anastomosis was revealed. While the patient was prepared for operative revision, she needed cardiopulmonary resuscitation, which was successful. Intraoperatively, the source of bleeding was located and surgically relieved. The subsequent postoperative course was uneventful. CONCLUSIONS In the first days after cardiac surgery, the occurrence of life-threatening situations, such as cardiac tamponade, must be expected. Especially if the symptoms are atypical, the entire diagnostic armamentarium must be applied to identify the origin of the complaints, which may be cardiac, but also non-cardiac. CENTRAL MESSAGE A high level of suspicion, immediate diagnostic confirmation, and rapid treatment are required to recognize and successfully treat such an emergency (Fig. 5). PERSPECTIVE Pericardial tamponade should always be considered as a complication of cardiac surgery, even when symptoms are atypical. The full range of diagnostic tools must be used to identify the origin of the complaints, which may be cardiac, but also non-cardiac (Fig. 5).
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Affiliation(s)
- Ann-Sophie Kaemmerer
- grid.5330.50000 0001 2107 3311Department of Cardiac Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Krankenhausstrasse 12, 91054 Erlangen, Germany
| | - Khaleel Alkhalaileh
- grid.5330.50000 0001 2107 3311Department of Cardiac Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Krankenhausstrasse 12, 91054 Erlangen, Germany
| | - Mathieu N. Suleiman
- grid.5330.50000 0001 2107 3311Department of Cardiac Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Krankenhausstrasse 12, 91054 Erlangen, Germany
| | - Markus Kopp
- grid.5330.50000 0001 2107 3311Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Christine Hauer
- grid.5330.50000 0001 2107 3311Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Matthias S. May
- grid.5330.50000 0001 2107 3311Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Michael Uder
- grid.5330.50000 0001 2107 3311Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Michael Weyand
- grid.5330.50000 0001 2107 3311Department of Cardiac Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Krankenhausstrasse 12, 91054 Erlangen, Germany
| | - Frank Harig
- grid.5330.50000 0001 2107 3311Department of Cardiac Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Krankenhausstrasse 12, 91054 Erlangen, Germany
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9
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Abstract
Governments of numerous countries implemented school closures to contain the COVID-19 pandemic. Several investigations have shown the negative impact of social-distancing policies and school closures on children worldwide. Recently, research also demonstrated adverse effects on adults' well-being. The development of children is strongly affected by their parent's emotional state. The present study aimed to examine parental stress levels caused by a short period of homeschooling in December 2020 in Germany. A structured survey was set up and distributed randomly via social media and parent associations. We observed a significant increase in stress and concerns. Family conflicts significantly increased, social isolation was feared, and powerlessness and helplessness ascended. Risk factors were parental education levels, parental working time, and teaching features like the frequency of feedback, correction, and accessibility.
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Affiliation(s)
- Isabelle May
- Department of Educational
Psychology and Research on Excellence, Friedrich-Alexander-Universität
Erlangen-Nürnberg (FAU), Nuremberg, Germany
| | - Sarah Awad
- Department of Educational
Psychology and Research on Excellence, Friedrich-Alexander-Universität
Erlangen-Nürnberg (FAU), Nuremberg, Germany
| | - Matthias S. May
- Medical Faculty, Friedrich-Alexander-Universität
Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Albert Ziegler
- Department of Educational
Psychology and Research on Excellence, Friedrich-Alexander-Universität
Erlangen-Nürnberg (FAU), Nuremberg, Germany
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10
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Kopp M, Roth JP, Geisler F, Daniel S, Ruettinger T, Treutlein C, Balbach EL, Heiss R, Wetzl M, El Amrani N, Cavallaro A, Uder M, May MS. Digitized and structured informed patient consent before contrast-enhanced computed tomography: feasibility and benefits in clinical routine. Insights Imaging 2022; 13:164. [PMID: 36219277 PMCID: PMC9554108 DOI: 10.1186/s13244-022-01304-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 09/24/2022] [Indexed: 11/24/2022] Open
Abstract
Background To evaluate the feasibility and benefits of digitized informed patient consent (D-IPC) for contrast-enhanced CT and compare digitized documentation with paper-based, conventional patient records (C-PR).
Methods We offered D-IPC to 2016 patients scheduled for a CT. We assessed patient history (e.g., CT examinations, malignant or cardiovascular diseases) and contraindications (red flags) for a CT (e.g., thyroid hyperfunction, allergies) using a tablet device. We evaluated the success rate of D-IPC and compared patient age between the subgroups of patients who were able or unable to complete D-IPC. We analyzed the prevalence of marked questions and red flags (RF). RF were compared with the documentation from C-PR. We estimated greenhouse gas (GHG) emissions for paperless workflow and provide a cost–benefit analysis. Results Overall, 84.4% of patients completed D-IPC. They were younger (median 61 years) than unsuccessful patients (65 years; p < 0.001). Patients who marked questions (21.7%) were older than patients without inquiries (median 63.9 vs 59.5 years; p < 0.001). The most prevalent RF was thyroid disease (23.8%). RF were considered critical for contrast-agent injection in 13.7%, requiring personalized preparation. The detection rate for RF documented with D-IPC was higher than for C-PR (n = 385 vs. 43). GHG emissions for tablet production are 80–90 times higher than for paper production. The estimated costs were slightly higher for D-IPC (+ 8.7%).
Conclusion D-IPC is feasible, but patient age is a relevant factor. Marked questions and RF help personalize IPC. The availability of patient history by D-IPC was superior compared to C-PR.
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Affiliation(s)
- Markus Kopp
- Departement of Radiology, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nuremberg, 91054, Erlangen, Germany.
| | - Jan Peter Roth
- Departement of Radiology, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nuremberg, 91054, Erlangen, Germany
| | - Frederik Geisler
- Departement of Radiology, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nuremberg, 91054, Erlangen, Germany
| | - Sascha Daniel
- Departement of Radiology, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nuremberg, 91054, Erlangen, Germany
| | - Theresa Ruettinger
- Departement of Radiology, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nuremberg, 91054, Erlangen, Germany
| | - Christoph Treutlein
- Departement of Radiology, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nuremberg, 91054, Erlangen, Germany
| | - Eva L Balbach
- Departement of Radiology, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nuremberg, 91054, Erlangen, Germany
| | - Rafael Heiss
- Departement of Radiology, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nuremberg, 91054, Erlangen, Germany
| | - Matthias Wetzl
- Departement of Radiology, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nuremberg, 91054, Erlangen, Germany
| | - Nouhayla El Amrani
- Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany.,Grenoble Alpes University, Grenoble, France
| | - Alexander Cavallaro
- Departement of Radiology, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nuremberg, 91054, Erlangen, Germany.,Imaging Science Institute, University Hospital Erlangen, Erlangen, Germany
| | - Michael Uder
- Departement of Radiology, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nuremberg, 91054, Erlangen, Germany.,Imaging Science Institute, University Hospital Erlangen, Erlangen, Germany
| | - Matthias S May
- Departement of Radiology, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nuremberg, 91054, Erlangen, Germany.,Imaging Science Institute, University Hospital Erlangen, Erlangen, Germany
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Meixner CR, Nagel AM, Höger SA, Gast LV, Wiesmueller M, Uder M, May MS, Hotfiel T, Heiss R. Muscle perfusion and the effect of compression garments in delayed-onset muscle soreness assessed with arterial spin labeling magnetic resonance imaging. Quant Imaging Med Surg 2022; 12:4462-4473. [PMID: 36060583 PMCID: PMC9403597 DOI: 10.21037/qims-21-1104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 06/15/2022] [Indexed: 11/06/2022]
Abstract
Background Methods Results Conclusions
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Affiliation(s)
- Christian R. Meixner
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Armin M. Nagel
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Svenja A. Höger
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Lena V. Gast
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Marco Wiesmueller
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Michael Uder
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Matthias S. May
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Thilo Hotfiel
- Department of Orthopedic Surgery, Friedrich-Alexander-Universität Erlangen-Nürenberg, Erlangen, Germany
- Center for Musculoskeletal Surgery Osnabrück (OZMC), Klinikum Osnabrück, Osnabrück, Germany
| | - Rafael Heiss
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
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12
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Frank K, Ströbel A, Ludolph I, Hauck T, May MS, Beier JP, Horch RE, Arkudas A. Improving the Safety of DIEP Flap Transplantation: Detailed Perforator Anatomy Study Using Preoperative CTA. J Pers Med 2022; 12:jpm12050701. [PMID: 35629124 PMCID: PMC9145001 DOI: 10.3390/jpm12050701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 04/13/2022] [Accepted: 04/23/2022] [Indexed: 12/24/2022] Open
Abstract
Background: Deep inferior epigastric perforator and muscle sparing transverse rectus abdominis muscle flaps are commonly used flaps for autologous breast reconstruction. CT-angiography allows to analyse the perforator course preoperatively. Our aim was to compare the different aspects of perforator anatomy in the most detailed study. Methods: CT-angiographies of 300 female patients with autologous breast reconstruction of 10 years were analysed regarding the anatomy of the deep inferior epigastric artery and every perforator. Results: Overall, 2260 perforators were included. We identified correlations regarding the DIEA branching point and number of perforators and their intramuscular course. The largest perforator emerged more often from the medial branch of the DIEA than the smaller perforators (70% (416/595) vs. 54% (878/1634), p < 0.001) and more often had a direct connection to the SIEV (large 67% (401/595) vs. small 39% (634/1634), p < 0.01). Medial row perforators were larger than the laterals (lateral 1.44 mm ± 0.43 (n = 941) vs. medial 1.58 mm ± 0.52 (n = 1304) (p < 0.001)). The larger and more medial the perforator, the more likely it was connected to the SIEV: perforators with direct connection to the SIEV had a diameter of 1.65 mm ± 0.53 (n = 1050), perforators with indirect connection had a diameter of 1.43 ± 0.43 (n = 1028), perforators without connection had a diameter of 1.31 mm ± 0.37 (n = 169) (p < 0.001). Medial perforators were more often directly connected to the SIEV than lateral perforators (medial 56% (723/1302) vs. lateral 35% (327/941), p < 0.001). A lateral perforator more often had a short intramuscular course than medial perforators (69% (554/800) vs. 45% (474/1055), p < 0.001), which was also more often observed in the case of a small perforator and a caudal exit of the rectus sheath. Conclusion: The largest perforator emerges more often from the medial branch of the DIEA and frequently has a direct connection to the SIEV, making medial row perforators ideal for DIEP flap transplantation.
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Affiliation(s)
- Katharina Frank
- Laboratory for Tissue Engineering and Regenerative Medicine, Department of Plastic and Hand Surgery, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (K.F.); (I.L.); (T.H.); (J.P.B.); (R.E.H.)
| | - Armin Ströbel
- Center for Clinical Studies, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany;
| | - Ingo Ludolph
- Laboratory for Tissue Engineering and Regenerative Medicine, Department of Plastic and Hand Surgery, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (K.F.); (I.L.); (T.H.); (J.P.B.); (R.E.H.)
| | - Theresa Hauck
- Laboratory for Tissue Engineering and Regenerative Medicine, Department of Plastic and Hand Surgery, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (K.F.); (I.L.); (T.H.); (J.P.B.); (R.E.H.)
| | - Matthias S. May
- Department of Radiology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany;
| | - Justus P. Beier
- Laboratory for Tissue Engineering and Regenerative Medicine, Department of Plastic and Hand Surgery, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (K.F.); (I.L.); (T.H.); (J.P.B.); (R.E.H.)
- Department of Plastic Surgery, Hand Surgery–Burn Center, University Hospital RWTH Aachen, 52074 Aachen, Germany
| | - Raymund E. Horch
- Laboratory for Tissue Engineering and Regenerative Medicine, Department of Plastic and Hand Surgery, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (K.F.); (I.L.); (T.H.); (J.P.B.); (R.E.H.)
| | - Andreas Arkudas
- Laboratory for Tissue Engineering and Regenerative Medicine, Department of Plastic and Hand Surgery, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (K.F.); (I.L.); (T.H.); (J.P.B.); (R.E.H.)
- Correspondence:
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13
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Hinsen M, Heiss R, Nagel AM, Lévy S, Uder M, Bickelhaupt S, May MS. [Imaging of the lung using low-field magnetic resonance imaging]. Radiologe 2022; 62:418-428. [PMID: 35416476 PMCID: PMC9006515 DOI: 10.1007/s00117-022-00996-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2022] [Indexed: 12/04/2022]
Abstract
Hintergrund Die Untersuchung der Lunge mit der Magnetresonanztomographie (MRT) geht mit hohen Herausforderungen einher und konnte sich im klinischen Alltag bisher nicht durchsetzen. Aktuelle Entwicklungen der Niederfeld-MRT, in Kombination mit neuen computergestützten Aufnahme- und Auswertungsalgorithmen, versprechen neue Perspektiven für die bildgebende Diagnostik pulmonaler Erkrankungen. Ziel dieser Arbeit Diese Übersichtsarbeit soll ein Verständnis der physikalischen Vorteile der Niederfeld-MRT für die Lungenbildgebung vermitteln, einen Überblick über die spärlich vorhandenen Vorkenntnisse aus der Literatur bieten und erste Ergebnisse eines neu entwickelten Niederfeld-MRT präsentieren. Methoden Inhalte dieses Artikels basieren auf physikalischen Grundlagen, Recherchen in Literaturdatenbanken und eigenen Erfahrungen in der Lungenbildgebung mit einem modernen 0,55-T-MRT. Schlussfolgerung Die Niederfeld-MRT (< 1 T) kann technische und ökonomische Vorteile gegenüber höheren Feldstärken für die Lungenbildgebung haben. Die physikalischen Voraussetzungen sind aufgrund geringerer Suszeptibilitätseffekte, längerer transversaler Relaxationszeiten und niedrigerer spezifischer Absorptionsraten besonders für die Anatomie der Lunge vorteilhaft. Die geringeren Anschaffungs- und Betriebskosten haben zudem ein großes Potenzial, die Verfügbarkeit zu erhöhen und gleichzeitig die Nachhaltigkeit zu verbessern. Durch die Kombination moderner Sequenzen und computergestützter Auswertungen kann die morphologische Bildgebung um orts- und zeitaufgelöste funktionelle Untersuchungen der Lunge ohne Strahlenbelastung ergänzt werden. Sowohl für kritische Szenarien, wie Screening und engmaschiges Therapiemonitoring, als auch für besonders gefährdete Patientengruppen könnten Lücken geschlossen werden. Dazu gehören beispielsweise akute und chronische Lungenerkrankungen bei Kindern oder die Abklärung einer Lungenembolie bei Schwangeren.
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Affiliation(s)
- Maximilian Hinsen
- Radiologisches Institut, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Maximiliansplatz 3, 91054, Erlangen, Deutschland
| | - Rafael Heiss
- Radiologisches Institut, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Maximiliansplatz 3, 91054, Erlangen, Deutschland.,Imaging Science Institute, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - Armin M Nagel
- Radiologisches Institut, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Maximiliansplatz 3, 91054, Erlangen, Deutschland.,Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Deutschland
| | - Simon Lévy
- Radiologisches Institut, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Maximiliansplatz 3, 91054, Erlangen, Deutschland
| | - Michael Uder
- Radiologisches Institut, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Maximiliansplatz 3, 91054, Erlangen, Deutschland.,Imaging Science Institute, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - Sebastian Bickelhaupt
- Radiologisches Institut, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Maximiliansplatz 3, 91054, Erlangen, Deutschland
| | - Matthias S May
- Radiologisches Institut, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Maximiliansplatz 3, 91054, Erlangen, Deutschland. .,Imaging Science Institute, Universitätsklinikum Erlangen, Erlangen, Deutschland.
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14
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Pogarell T, May MS, Nagel AM, Uder M, Heiss R. [Imaging of the musculoskeletal system using low-field magnetic resonance imaging]. Radiologe 2022; 62:410-417. [PMID: 35416477 DOI: 10.1007/s00117-022-01000-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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Magnetic resonance imaging (MRI) plays a crucial role in musculoskeletal imaging. The high prevalence and pain-related suffering of patients pose a particular challenge concerning availability and turnover times, respectively. Low-field (≤ 1.0 T) MRI has the potential to fulfill these needs. However, during the past three decades, high field systems have increasingly replaced low field systems because of their limitations in image quality. Recent technological advancements in high-performance hard- and software promise musculoskeletal imaging with adequate quality at lower field strengths for several regions and indications. OBJECTIVES The goal is to provide insight into the advantages and disadvantages of low-field musculoskeletal imaging, discuss the current literature, and include our first experiences with a modern 0.55 T MRI. MATERIALS AND METHODS This review is based on research in various literature databases and our own musculoskeletal imaging experiences with a modern 0.55 T scanner. CONCLUSION Most publications pertaining to musculoskeletal imaging at low-field strength MRI are outdated, and studies regarding the diagnostic performance of modern low-field MRI systems are needed. These new systems may complement existing high-field systems and make MRI more accessible, even in low-income countries. From our own experience, modern low-field MRI seems to be adequate in musculoskeletal imaging, especially in acute injuries.
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Affiliation(s)
- Tobias Pogarell
- Radiologisches Institut, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Maximiliansplatz 3, 91054, Erlangen, Deutschland
| | - Matthias S May
- Radiologisches Institut, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Maximiliansplatz 3, 91054, Erlangen, Deutschland.,Imaging Science Institute, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - Armin M Nagel
- Radiologisches Institut, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Maximiliansplatz 3, 91054, Erlangen, Deutschland.,Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Deutschland
| | - Michael Uder
- Radiologisches Institut, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Maximiliansplatz 3, 91054, Erlangen, Deutschland.,Imaging Science Institute, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - Rafael Heiss
- Radiologisches Institut, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Maximiliansplatz 3, 91054, Erlangen, Deutschland. .,Imaging Science Institute, Universitätsklinikum Erlangen, Erlangen, Deutschland.
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Praël I, Wuest W, Heiss R, Wiesmueller M, Kopp M, Uder M, May MS. Dual-Energy Lung Perfusion in Portal Venous Phase CT-A Comparison with the Pulmonary Arterial Phase. Diagnostics (Basel) 2021; 11:diagnostics11111989. [PMID: 34829336 PMCID: PMC8620268 DOI: 10.3390/diagnostics11111989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 10/21/2021] [Indexed: 11/16/2022] Open
Abstract
Pulmonary arterial dual-energy (aDE) CT is an established technique for evaluating pulmonary perfusion blood volume (PBV). As DECT protocols are increasingly used for thoraco-abdominal CT, this study assessed image quality and clinical findings in portal–venous phase dual-energy (vDE) CT and compared it to aDE. In 95 patients, vDE-CT was performed using a dual-source scanner (70/Sn150 kV, 560/140 ref.mAs). Pulmonary triggered aDE-CT served as reference (n = 94). PBV was reconstructed using a dedicated algorithm. Mean relative attenuation was measured in the pulmonary trunk, aorta, and segmented lung parenchyma. A distribution ratio (DL) between vessels and parenchyma was calculated to assess the iodine uptake of the lung parenchyma. Subjective overall diagnostic image quality was assessed for PBV images on a five-point Likert scale. Image artifacts were classified into five groups based on scale rating and compared between vDE and aDE. Pathological findings were correlated with the anatomical image datasets. Mean relative attenuation of the lung parenchyma was comparable in both groups (vDE: 23 ± 6 HU and aDE: 22 ± 7 HU), but significantly lower in the vessels of vDE. Therefore, iodine uptake of the lung parenchyma was significantly higher in vDE (DL: 10% vs. 8%, p < 0.01). The subjective overall image quality of the PBV images was comparable (p = 0.5). Rotation and streak artifacts were found in most of the patients (>86%, both p > 0.6). Dual-source artifacts were found in only a few patients in both groups (vDE 5%, aDE 7%, p = 0.5). Recess and subpleural artifacts were increased in vDE (vDE 53/27%, aDE 24/7%, both p < 0.001). Pathological findings were found in 19% of the vDE patients and 59% of the aDE patients. Comparable objective and subjective image quality of lung perfusion can be obtained in vDE and aDE. Iodine uptake of the lung parenchyma is increased in vDE compared to aDE, suggesting an interstitial pooling effect. Knowledge of the different appearances of artifacts will aid in the interpretation of the images. Additional clinical information about the lung parenchyma can be provided by PBV evaluation in vDE.
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Affiliation(s)
- Isabelle Praël
- Department of Radiology, University Hospital Erlangen, 91054 Erlangen, Germany; (I.P.); (R.H.); (M.W.); (M.K.); (M.U.)
- Faculty of Medicine, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
| | - Wolfgang Wuest
- Imaging Science Institute Erlangen, 91054 Erlangen, Germany;
- Hospital Martha-Maria, 90491 Nürnberg, Germany
| | - Rafael Heiss
- Department of Radiology, University Hospital Erlangen, 91054 Erlangen, Germany; (I.P.); (R.H.); (M.W.); (M.K.); (M.U.)
| | - Marco Wiesmueller
- Department of Radiology, University Hospital Erlangen, 91054 Erlangen, Germany; (I.P.); (R.H.); (M.W.); (M.K.); (M.U.)
| | - Markus Kopp
- Department of Radiology, University Hospital Erlangen, 91054 Erlangen, Germany; (I.P.); (R.H.); (M.W.); (M.K.); (M.U.)
| | - Michael Uder
- Department of Radiology, University Hospital Erlangen, 91054 Erlangen, Germany; (I.P.); (R.H.); (M.W.); (M.K.); (M.U.)
- Imaging Science Institute Erlangen, 91054 Erlangen, Germany;
| | - Matthias S. May
- Department of Radiology, University Hospital Erlangen, 91054 Erlangen, Germany; (I.P.); (R.H.); (M.W.); (M.K.); (M.U.)
- Imaging Science Institute Erlangen, 91054 Erlangen, Germany;
- Correspondence:
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Hauck T, Arkudas A, Horch RE, Ströbel A, May MS, Binder J, Krautz C, Ludolph I. The third dimension in perforator mapping-Comparison of Cinematic Rendering and maximum intensity projection in abdominal-based autologous breast reconstruction. J Plast Reconstr Aesthet Surg 2021; 75:536-543. [PMID: 34756655 DOI: 10.1016/j.bjps.2021.09.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 09/19/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Cinematic Rendering (CR) is a recently introduced post-processing three-dimensional (3D) visualization imaging tool. The aim of this study was to assess its clinical value in the preoperative planning of deep inferior epigastric artery perforator (DIEP) or muscle-sparing transverse rectus abdominis myocutaneous (MS-TRAM) flaps, and to compare it with maximum intensity projection (MIP) images. The study presents the first application of CR for perforator mapping prior to autologous breast reconstruction. METHODS Two senior surgeons independently analyzed CR and MIP images based on computed tomography angiography (CTA) datasets of 20 patients in terms of vascular pedicle characteristics, the possibility to harvest a DIEP or MS-TRAM flap, and the side of the flap harvest. We calculated inter- and intra-observer agreement in order to examine the accordance of both image techniques. RESULTS We observed a good inter- and intra-observer agreement concerning the type of flap and the side of the flap harvest. However, the agreement on the pedicle characteristics varies depending on the considered variable. Both investigators identified a significantly higher number of perforators with MIP compared with CR (observer 1, p<0.0001 and observer 2, p<0.0385). CONCLUSION The current study serves as an explorative study, showing first experiences with CR in abdominal-based autologous breast reconstruction. In addition to MIP images, CR might improve the surgeon's understanding of the individual's anatomy. Future studies are required to compare CR with other 3D visualization tools and its possible effects on operative parameters.
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Affiliation(s)
- Theresa Hauck
- Department of Plastic and Hand Surgery and Laboratory for Tissue Engineering and Regenerative Medicine, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Germany.
| | - Andreas Arkudas
- Department of Plastic and Hand Surgery and Laboratory for Tissue Engineering and Regenerative Medicine, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Germany
| | - Raymund E Horch
- Department of Plastic and Hand Surgery and Laboratory for Tissue Engineering and Regenerative Medicine, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Germany
| | - Armin Ströbel
- Center for Clinical Studies, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU, Germany)
| | - Matthias S May
- Department of Radiology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Germany
| | - Johannes Binder
- Department of Surgery, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Germany
| | - Christian Krautz
- Department of Surgery, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Germany
| | - Ingo Ludolph
- Department of Plastic and Hand Surgery and Laboratory for Tissue Engineering and Regenerative Medicine, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Germany
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17
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Ellmann S, Nickel JM, Heiss R, El Amrani N, Wüst W, Rompel O, Rueffer A, Cesnjevar R, Dittrich S, Uder M, May MS. Prognostic Value of CTA-Derived Left Ventricular Mass in Neonates with Congenital Heart Disease. Diagnostics (Basel) 2021; 11:diagnostics11071215. [PMID: 34359298 PMCID: PMC8303678 DOI: 10.3390/diagnostics11071215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 07/01/2021] [Accepted: 07/02/2021] [Indexed: 12/19/2022] Open
Abstract
For therapeutic decisions regarding uni- or biventricular surgical repair in congenital heart disease (CHD), left ventricular mass (LVM) is an important factor. The aim of this retrospective study was to determine the LVM of infants with CHD in thoracic computed tomography angiographies (CTAs) and to evaluate its usefulness as a prognostic parameter, with special attention paid to hypoplastic left heart (HLH) patients. Manual segmentation of the left ventricular endo- and epicardial volumes was performed in CTAs of 132 infants. LVMs were determined from these volumes and normalized to body surface area. LVMs of patients with different types of CHD were compared to each other using analyses of variances (ANOVA). An LVM cutoff for discrimination between uni- and biventricular repair was determined using receiver operating characteristics. Survival rates were calculated using Kaplan–Meier statistics. Patients with a clinical diagnosis of an HLH had significantly lower mean LVM (21.88 g/m2) compared to patients without applicable disease (50.22 g/m2; p < 0.0001) and compared to other CHDs, including persistent truncus arteriosus, left ventricular outflow tract obstruction, transposition of the great arteries, pulmonary artery stenosis or atresia, and double-outlet right ventricle (all, p < 0.05). The LVM cutoff for uni- vs. biventricular surgery was 33.9 g/m2 (sensitivity: 82.3%; specificity: 73.7%; PPV: 94.9%). In a subanalysis of HLH patients, a sensitivity of 50.0%, specificity of 100%, PPV of 100%, and NPV of 83.3% was determined. Patient survival was not significantly different between the surgical approaches or between patients with LVM above or below the cutoff. LVM can be measured in chest CTA of newborns with CHD and can be used as a prognostic factor.
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Affiliation(s)
- Stephan Ellmann
- Department of Radiology, University Hospital Erlangen, Maximiliansplatz 3, 91054 Erlangen, Germany; (J.-M.N.); (R.H.); (N.E.A.); (O.R.); (M.U.); (M.S.M.)
- Correspondence:
| | - Julie-Marie Nickel
- Department of Radiology, University Hospital Erlangen, Maximiliansplatz 3, 91054 Erlangen, Germany; (J.-M.N.); (R.H.); (N.E.A.); (O.R.); (M.U.); (M.S.M.)
| | - Rafael Heiss
- Department of Radiology, University Hospital Erlangen, Maximiliansplatz 3, 91054 Erlangen, Germany; (J.-M.N.); (R.H.); (N.E.A.); (O.R.); (M.U.); (M.S.M.)
- Imaging Science Institute Erlangen, Ulmenweg 18, 91054 Erlangen, Germany;
| | - Nouhayla El Amrani
- Department of Radiology, University Hospital Erlangen, Maximiliansplatz 3, 91054 Erlangen, Germany; (J.-M.N.); (R.H.); (N.E.A.); (O.R.); (M.U.); (M.S.M.)
| | - Wolfgang Wüst
- Imaging Science Institute Erlangen, Ulmenweg 18, 91054 Erlangen, Germany;
- Department of Radiology, Martha Maria Hospital Nuremberg, 90491 Nuremberg, Germany
| | - Oliver Rompel
- Department of Radiology, University Hospital Erlangen, Maximiliansplatz 3, 91054 Erlangen, Germany; (J.-M.N.); (R.H.); (N.E.A.); (O.R.); (M.U.); (M.S.M.)
| | - Andre Rueffer
- Department of Pediatric Cardiac Surgery, University Hospital Hamburg Eppendorf, 20246 Hamburg, Germany;
| | - Robert Cesnjevar
- Department of Pediatric Cardiac Surgery, University Hospital Erlangen, Loschgestraße 15, 91054 Erlangen, Germany;
| | - Sven Dittrich
- Department of Pediatric Cardiology, University Hospital Erlangen, Loschgestraße 15, 91054 Erlangen, Germany;
| | - Michael Uder
- Department of Radiology, University Hospital Erlangen, Maximiliansplatz 3, 91054 Erlangen, Germany; (J.-M.N.); (R.H.); (N.E.A.); (O.R.); (M.U.); (M.S.M.)
- Imaging Science Institute Erlangen, Ulmenweg 18, 91054 Erlangen, Germany;
| | - Matthias S. May
- Department of Radiology, University Hospital Erlangen, Maximiliansplatz 3, 91054 Erlangen, Germany; (J.-M.N.); (R.H.); (N.E.A.); (O.R.); (M.U.); (M.S.M.)
- Imaging Science Institute Erlangen, Ulmenweg 18, 91054 Erlangen, Germany;
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18
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Wiesmueller M, Wuest W, May MS, Ellmann S, Heiss R, Saake M, Janka R, Uder M, Laun FB. Comparison of Readout-Segmented Echo-Planar Imaging and Single-Shot TSE DWI for Cholesteatoma Diagnostics. AJNR Am J Neuroradiol 2021; 42:1305-1312. [PMID: 33926901 DOI: 10.3174/ajnr.a7112] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 01/23/2021] [Indexed: 01/18/2023]
Abstract
BACKGROUND AND PURPOSE The high diagnostic value of DWI for cholesteatoma diagnostics is undisputed. This study compares the diagnostic value of readout-segmented echo-planar DWI and single-shot TSE DWI for cholesteatoma diagnostics. MATERIALS AND METHODS Thirty patients with newly suspected cholesteatoma were examined with a dedicated protocol, including readout-segmented echo-planar DWI and single-shot TSE DWI at 1.5T. Acquisition parameters of both diffusion-weighted sequences were as follows: b=1000 s/mm,2 axial and coronal section orientations, and section thickness of 3 mm. Image quality was evaluated by 2 readers on a 5-point Likert scale with respect to lesion conspicuity, the presence of susceptibility artifacts mimicking cholesteatomas, and overall subjective image quality. Sensitivity and specificity were calculated using histology results as the gold standard. RESULTS Twenty-five cases of histologically confirmed cholesteatomas were included in the study group. Lesion conspicuity was higher and fewer artifacts were found when using TSE DWI (both P < .001). The overall subjective image quality, however, was better with readout-segmented DWI. For TSE DWI, the sensitivity for readers 1 and 2 was 92% (95% CI, 74%-99%) and 88% (95% CI, 69%-97%), respectively, while the specificity for both readers was 80% (95% CI, 28%-99%). For readout-segmented DWI, the sensitivity for readers 1 and 2 was 76% (95% CI, 55%-91%) and 68% (95% CI, 46%-85%), while the specificity for both readers was 60% (95% CI, 15%-95%). CONCLUSIONS The use of TSE DWI is advisable for cholesteatoma diagnostics and preferable over readout-segmented DWI.
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Affiliation(s)
- M Wiesmueller
- From the Institute of Radiology (M.W., W.W., M.S.M., S.E., R.H., M.S., R.J., M.U., F.B.L.) .,Image Science Institute (M.W., W.W., M.S.M., R.H., M.S., R.J., M.U.), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - W Wuest
- From the Institute of Radiology (M.W., W.W., M.S.M., S.E., R.H., M.S., R.J., M.U., F.B.L.).,Image Science Institute (M.W., W.W., M.S.M., R.H., M.S., R.J., M.U.), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - M S May
- From the Institute of Radiology (M.W., W.W., M.S.M., S.E., R.H., M.S., R.J., M.U., F.B.L.).,Image Science Institute (M.W., W.W., M.S.M., R.H., M.S., R.J., M.U.), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - S Ellmann
- From the Institute of Radiology (M.W., W.W., M.S.M., S.E., R.H., M.S., R.J., M.U., F.B.L.)
| | - R Heiss
- From the Institute of Radiology (M.W., W.W., M.S.M., S.E., R.H., M.S., R.J., M.U., F.B.L.).,Image Science Institute (M.W., W.W., M.S.M., R.H., M.S., R.J., M.U.), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - M Saake
- From the Institute of Radiology (M.W., W.W., M.S.M., S.E., R.H., M.S., R.J., M.U., F.B.L.).,Image Science Institute (M.W., W.W., M.S.M., R.H., M.S., R.J., M.U.), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - R Janka
- From the Institute of Radiology (M.W., W.W., M.S.M., S.E., R.H., M.S., R.J., M.U., F.B.L.).,Image Science Institute (M.W., W.W., M.S.M., R.H., M.S., R.J., M.U.), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - M Uder
- From the Institute of Radiology (M.W., W.W., M.S.M., S.E., R.H., M.S., R.J., M.U., F.B.L.).,Image Science Institute (M.W., W.W., M.S.M., R.H., M.S., R.J., M.U.), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - F B Laun
- From the Institute of Radiology (M.W., W.W., M.S.M., S.E., R.H., M.S., R.J., M.U., F.B.L.)
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Kopp M, Wetzl M, Geissler F, Roth JP, Wallner R, Hoefler D, Faby S, Allmendinger T, Amarteifio P, Wuest W, Cavallaro A, Uder M, May MS. Structured Digital Self-Assessment of Patient Anamnesis Prior to Computed Tomography: Performance Evaluation and Added Value. J Med Syst 2021; 45:30. [PMID: 33511485 PMCID: PMC7843739 DOI: 10.1007/s10916-020-01690-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 12/01/2020] [Indexed: 01/02/2023]
Abstract
The aim of this study was to evaluate the performance of a tablet-based, digitized structured self-assessment (DSSA) of patient anamnesis (PA) prior to computed tomography (CT). Of the 317 patients consecutively referred for CT, the majority (n = 294) was able to complete the tablet-based questionnaire, which consisted of 67 items covering social anamnesis, lifestyle factors (e.g., tobacco abuse), medical history (e.g., kidney diseases), current symptoms, and the usability of the system. Patients were able to mark unclear questions for a subsequent discussion with the radiologist. Critical issues for the CT examination were structured and automatically highlighted as “red flags” (RFs) in order to improve patient interaction. RFs and marked questions were highly prevalent (69.5% and 26%). Missing creatinine values (33.3%), kidney diseases (14.4%), thyroid diseases (10.6%), metformin (5.5%), claustrophobia (4.1%), allergic reactions to contrast agents (2.4%), and pathological TSH values (2.0%) were highlighted most frequently as RFs. Patient feedback regarding the comprehensibility of the questionnaire and the tablet usability was mainly positive (90.9%; 86.2%). With advanced age, however, patients provided more negative feedback for both (p = 0.007; p = 0.039). The time effort was less than 20 min for 85.1% of patients, and faster patients were significantly younger (p = 0.046). Overall, the DSSA of PA prior to CT shows a high success rate and is well accepted by most patients. RFs and marked questions were common and helped to focus patients’ interactions and reporting towards decisive aspects.
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Affiliation(s)
- M Kopp
- Departement of Radiology, University Hospital Erlangen, 91054, Erlangen, Germany.
| | - M Wetzl
- Departement of Radiology, University Hospital Erlangen, 91054, Erlangen, Germany
| | - F Geissler
- Departement of Radiology, University Hospital Erlangen, 91054, Erlangen, Germany
| | - J P Roth
- Departement of Radiology, University Hospital Erlangen, 91054, Erlangen, Germany
| | - R Wallner
- e.Bavarian Health GmbH, Erlangen, Germany.,Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - D Hoefler
- e.Bavarian Health GmbH, Erlangen, Germany.,Siemens Healthcare GmbH, Forchheim, Germany
| | - S Faby
- Siemens Healthcare GmbH, Forchheim, Germany
| | | | - P Amarteifio
- Siemens Healthcare GmbH, Forchheim, Germany.,Imaging Science Institute, Erlangen, Germany
| | - W Wuest
- Departement of Radiology, University Hospital Erlangen, 91054, Erlangen, Germany.,Imaging Science Institute, Erlangen, Germany
| | - A Cavallaro
- Departement of Radiology, University Hospital Erlangen, 91054, Erlangen, Germany.,Imaging Science Institute, Erlangen, Germany
| | - M Uder
- Departement of Radiology, University Hospital Erlangen, 91054, Erlangen, Germany.,Imaging Science Institute, Erlangen, Germany
| | - M S May
- Departement of Radiology, University Hospital Erlangen, 91054, Erlangen, Germany.,Imaging Science Institute, Erlangen, Germany
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Wuest W, May MS, Wiesmueller M, Uder M, Schmid A. Effect of long term CPAP therapy on cardiac parameters assessed with cardiac MRI. Int J Cardiovasc Imaging 2020; 37:613-621. [PMID: 32926309 PMCID: PMC8423704 DOI: 10.1007/s10554-020-02024-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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 09/09/2020] [Indexed: 11/16/2022]
Abstract
The obstructive sleep apnoea syndrome (OSAS) is a disorder with a high prevalence and is associated with an elevated cardiovascular risk and increased morbidity and mortality. For longitudinal studies and functional analysis cardiac MRI is regarded as the gold standard. Aim of this study was to evaluate the long-term effect of continuous positive airway pressure (CPAP) therapy on cardiac functional parameters with cardiac Magnetic Resonance Imaging (cMRI). 54 patients with OSAS (mean apnea hypopnea index-AHI: 31) were prospectively enrolled in this study and cMRI was performed before and after 7 months of CPAP therapy. Data were acquired on a 1.5 T MRI and right and left ventricular cardiac function were analysed. CPAP treatment was considered compliant when used ≥ 4 h per night. 24-h blood pressure was measured at baseline and follow up. 33 patients could be assigned to the compliance group. Left ventricular stroke volume (LV SV) and right ventricular ejection fraction (RV EF) improved significantly with CPAP therapy (LV SV from 93 ± 19 to 99 ± 20 ml, p = 0.02; RV EF from 50 ± 6 to 52 ± 6%, p = 0.04). All other cardiac parameters did not change significantly while mean systolic and diastolic blood pressure improved significantly (p < 0.01). 21 patients were assigned to the non-compliance group and were considered as a control group. There were no relevant differences in cardiac parameters between baseline and follow up examination in these patients. CPAP therapy seems to improve LV SV, RV EF, systolic and diastolic blood pressure in OSAS patients, but reproducibility of our results need to be confirmed in a larger patient population.
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Affiliation(s)
- W Wuest
- Radioloical Institute, Friedrich-Alexander-University-Erlangen-Nuremberg, Maximiliansplatz 1, 91054, Erlangen, Germany.
| | - M S May
- Radioloical Institute, Friedrich-Alexander-University-Erlangen-Nuremberg, Maximiliansplatz 1, 91054, Erlangen, Germany
| | - M Wiesmueller
- Radioloical Institute, Friedrich-Alexander-University-Erlangen-Nuremberg, Maximiliansplatz 1, 91054, Erlangen, Germany
| | - M Uder
- Radioloical Institute, Friedrich-Alexander-University-Erlangen-Nuremberg, Maximiliansplatz 1, 91054, Erlangen, Germany
| | - A Schmid
- Radioloical Institute, Friedrich-Alexander-University-Erlangen-Nuremberg, Maximiliansplatz 1, 91054, Erlangen, Germany
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21
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Wetzl M, May MS, Weinmann D, Hammon M, Treutlein C, Zeilinger M, Kiefer A, Trollmann R, Woelfle J, Uder M, Rompel O. Dual-source computed tomography of the lung with spectral shaping and advanced iterative reconstruction: potential for maximum radiation dose reduction. Pediatr Radiol 2020; 50:1240-1248. [PMID: 32556576 PMCID: PMC7398955 DOI: 10.1007/s00247-020-04714-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 03/06/2020] [Accepted: 05/12/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Radiation dose at CT should be as low as possible without compromising diagnostic quality. OBJECTIVE To assess the potential for maximum dose reduction of pediatric lung dual-source CT with spectral shaping and advanced iterative reconstruction (ADMIRE). MATERIALS AND METHODS We retrospectively analyzed dual-source CT acquisitions in a full-dose group (FD: 100 kV, 64 reference mAs) and in three groups with spectral shaping and differing reference mAs values (Sn: 100 kV, 96/64/32 reference mAs), each group consisting of 16 patients (age mean 11.5 years, standard deviation 4.8 years, median 12.8 years, range 1.3-18 years). Advanced iterative reconstruction of images was performed with different strengths (FD: ADMIRE Level 2; Sn: ADMIRE Levels 2, 3 and 4). We analyzed dose parameters and measured noise. Diagnostic confidence and detectability of lung lesions as well as anatomical structures were assessed using a Likert scale (from 1 [unacceptable] to 4 [fully acceptable]). RESULTS Compared to full dose, effective dose was reduced to 16.7% in the Sn 96 group, 11.1% in Sn64, and 5.5% in Sn32 (P<0.001). Noise values of Sn64ADM4 did not statistically differ from those in FDADM2 (45.7 vs. 38.9 Hounsfield units [HU]; P=0.132), whereas noise was significantly higher in Sn32ADM4 compared to Sn64ADM4 (61.5 HU; P<0.001). A Likert score >3 was reached in Sn64ADM4 regarding diagnostic confidence (3.2) and detectability of lung lesions (3.3). For detectability of most anatomical structures, no significant differences were found between FDAM2 and Sn64ADM4 (P≥0.05). CONCLUSION In pediatric lung dual-source CT, spectral shaping together with ADMIRE 4 enable radiation dose reduction to about 10% of a full-dose protocol while maintaining an acceptable diagnostic quality.
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Affiliation(s)
- Matthias Wetzl
- Department of Radiology, University Hospital Erlangen, Erlangen, Germany.
| | - Matthias S. May
- grid.411668.c0000 0000 9935 6525Department of Radiology, University Hospital Erlangen, Erlangen, Germany ,grid.411668.c0000 0000 9935 6525Imaging Science Institute, University Hospital Erlangen, Erlangen, Germany
| | - Daniel Weinmann
- grid.411668.c0000 0000 9935 6525Department of Radiology, University Hospital Erlangen, Erlangen, Germany
| | - Matthias Hammon
- grid.411668.c0000 0000 9935 6525Department of Radiology, University Hospital Erlangen, Erlangen, Germany
| | - Christoph Treutlein
- grid.411668.c0000 0000 9935 6525Department of Radiology, University Hospital Erlangen, Erlangen, Germany
| | - Martin Zeilinger
- grid.411668.c0000 0000 9935 6525Department of Radiology, University Hospital Erlangen, Erlangen, Germany
| | - Alexander Kiefer
- grid.411668.c0000 0000 9935 6525Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Erlangen, Germany
| | - Regina Trollmann
- grid.411668.c0000 0000 9935 6525Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Erlangen, Germany
| | - Joachim Woelfle
- grid.411668.c0000 0000 9935 6525Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Erlangen, Germany
| | - Michael Uder
- grid.411668.c0000 0000 9935 6525Department of Radiology, University Hospital Erlangen, Erlangen, Germany ,grid.411668.c0000 0000 9935 6525Imaging Science Institute, University Hospital Erlangen, Erlangen, Germany
| | - Oliver Rompel
- grid.411668.c0000 0000 9935 6525Department of Radiology, University Hospital Erlangen, Erlangen, Germany
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Treutlein C, Wiesmüller M, May MS, Heiss R, Hepp T, Uder M, Wuest W. Complete Free-breathing Adenosine Stress Cardiac MRI Using Compressed Sensing and Motion Correction: Comparison of Functional Parameters, Perfusion, and Late Enhancement with the Standard Breath-holding Examination. Radiol Cardiothorac Imaging 2019; 1:e180017. [PMID: 33778508 DOI: 10.1148/ryct.2019180017] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 04/30/2019] [Accepted: 05/23/2019] [Indexed: 12/28/2022]
Abstract
PURPOSE To compare free-breathing (FB) stress cardiac MRI examinations with the reference standard breath-holding (BH) examination. MATERIALS AND METHODS A total of 40 consecutive patients were enrolled prospectively and were examined with 3-T MRI. Functional imaging, perfusion, and late gadolinium enhancement (LGE) sequences were performed in BH and FB by using compressed sensing and in-line motion correction. Left ventricle (LV) and right ventricle (RV) functional parameters in BH and FB examinations were compared by using Bland-Altman plots and linear mixed models. Subjective image quality was assessed with a five-point scale (1 = nondiagnostic, 5 = very good). For perfusion and LGE imaging, diagnostic confidence was rated with a three-point scale (1 = low, 3 = high), and image quality was rated with a five-point scale (1 = nondiagnostic, 5 = very good). The Wilcoxon test was used to compare image quality and diagnostic confidence. RESULTS Bland-Altman plots showed good agreement for LV and RV functional parameters in BH and FB sequences. Subjective image quality was significantly better with the BH sequences in the LV (P < .01) but was comparable in the RV (P > .99). Scanning time was 218 seconds (range, 130-385 seconds) for cine BH and 16 seconds (range, 11-27 seconds) for cine FB. Extent of perfusion defects, LGE, and diagnostic confidence was comparable between groups. Scanning time was 371 seconds (range, 239-502 seconds) for the LGE BH sequence and 189 seconds (range, 122-286 seconds) for the LGE FB sequence. CONCLUSION FB adenosine stress cardiac MRI delivers diagnostic image quality and could represent an alternative for use in patients who are unable to meet the demands of multiple BHs and long examination times.© RSNA, 2019.
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Affiliation(s)
- Christoph Treutlein
- University of Erlangen, Radiological Institute, Maximiliansplatz 3, 91054 Erlangen, Germany (C.T., M.W., M.S.M., R.H., M.U., W.W.); Department of Medical Biometry, Informatics and Epidemiology, Faculty of Medicine, University of Bonn, Bonn, Germany (T.H.); and Institute of Medical Informatics, Biometry and Epidemiology, University of Erlangen-Nuremberg, Erlangen, Germany (T.H.)
| | - Marco Wiesmüller
- University of Erlangen, Radiological Institute, Maximiliansplatz 3, 91054 Erlangen, Germany (C.T., M.W., M.S.M., R.H., M.U., W.W.); Department of Medical Biometry, Informatics and Epidemiology, Faculty of Medicine, University of Bonn, Bonn, Germany (T.H.); and Institute of Medical Informatics, Biometry and Epidemiology, University of Erlangen-Nuremberg, Erlangen, Germany (T.H.)
| | - Matthias S May
- University of Erlangen, Radiological Institute, Maximiliansplatz 3, 91054 Erlangen, Germany (C.T., M.W., M.S.M., R.H., M.U., W.W.); Department of Medical Biometry, Informatics and Epidemiology, Faculty of Medicine, University of Bonn, Bonn, Germany (T.H.); and Institute of Medical Informatics, Biometry and Epidemiology, University of Erlangen-Nuremberg, Erlangen, Germany (T.H.)
| | - Rafael Heiss
- University of Erlangen, Radiological Institute, Maximiliansplatz 3, 91054 Erlangen, Germany (C.T., M.W., M.S.M., R.H., M.U., W.W.); Department of Medical Biometry, Informatics and Epidemiology, Faculty of Medicine, University of Bonn, Bonn, Germany (T.H.); and Institute of Medical Informatics, Biometry and Epidemiology, University of Erlangen-Nuremberg, Erlangen, Germany (T.H.)
| | - Tobias Hepp
- University of Erlangen, Radiological Institute, Maximiliansplatz 3, 91054 Erlangen, Germany (C.T., M.W., M.S.M., R.H., M.U., W.W.); Department of Medical Biometry, Informatics and Epidemiology, Faculty of Medicine, University of Bonn, Bonn, Germany (T.H.); and Institute of Medical Informatics, Biometry and Epidemiology, University of Erlangen-Nuremberg, Erlangen, Germany (T.H.)
| | - Michael Uder
- University of Erlangen, Radiological Institute, Maximiliansplatz 3, 91054 Erlangen, Germany (C.T., M.W., M.S.M., R.H., M.U., W.W.); Department of Medical Biometry, Informatics and Epidemiology, Faculty of Medicine, University of Bonn, Bonn, Germany (T.H.); and Institute of Medical Informatics, Biometry and Epidemiology, University of Erlangen-Nuremberg, Erlangen, Germany (T.H.)
| | - Wolfgang Wuest
- University of Erlangen, Radiological Institute, Maximiliansplatz 3, 91054 Erlangen, Germany (C.T., M.W., M.S.M., R.H., M.U., W.W.); Department of Medical Biometry, Informatics and Epidemiology, Faculty of Medicine, University of Bonn, Bonn, Germany (T.H.); and Institute of Medical Informatics, Biometry and Epidemiology, University of Erlangen-Nuremberg, Erlangen, Germany (T.H.)
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23
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Nau D, Wuest W, Rompel O, Hammon M, Gloeckler M, Toka O, Dittrich S, Rueffer A, Cesnjevar R, Lell MM, Uder M, May MS. Evaluation of ventricular septal defects using high pitch computed tomography angiography of the chest in children with complex congenital heart defects below one year of age. J Cardiovasc Comput Tomogr 2019; 13:226-233. [DOI: 10.1016/j.jcct.2019.01.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 01/14/2019] [Accepted: 01/31/2019] [Indexed: 01/08/2023]
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24
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Heiss R, Hotfiel T, Kellermann M, May MS, Wuest W, Janka R, Nagel AM, Uder M, Hammon M. Effect of Compression Garments on the Development of Edema and Soreness in Delayed-Onset Muscle Soreness (DOMS). J Sports Sci Med 2018; 17:392-401. [PMID: 30116112 PMCID: PMC6090402] [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: 02/09/2018] [Accepted: 05/30/2018] [Indexed: 06/08/2023]
Abstract
Delayed-onset muscle soreness (DOMS), an ultrastructural muscle injury, is one of the most common reasons for impaired muscle performance. The purpose of this study was to investigate the influence of sport compression garments on the development of exercise-induced intramuscular edema in the context of DOMS. DOMS was induced in 15 healthy participants. The participants performed a standardized eccentric exercise of the calf muscles. Magnetic resonance imaging (MRI) was performed at baseline and 60h after exercise (T2-weighted signal intensity and T2 relaxation time was evaluated in each compartment and the intramuscular edema in the medial head of the gastrocnemius muscle was segmented). After the exercise, a conventional compression garment (18-21 mmHg) was placed on one randomized calf for 60h. The level of muscle soreness was evaluated using a visual analogue pain scale. T2-weighted signal intensity, T2 relaxation time and intramuscular edema showed a significant interaction for time with increased signal intensities/intramuscular edema in the medial head of the gastrocnemius muscle at follow-up compared to baseline. No significant main effect for compression or interaction between time and limb occurred. Further, no significant differences in the soleus muscle and the lateral head of the gastrocnemius muscle were noted between limbs or over time. After exercise, there was significantly increased muscle soreness in both lower legs in resting condition and when going downstairs and a decreased range of motion in the ankle joint. No significant difference was observed between the compressed and the non-compressed calf. Our results indicate that wearing conventional compression garments after DOMS has been induced has no significant effect on the development of muscle edema, muscle soreness, range of motion and calf circumference.
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Affiliation(s)
- Rafael Heiss
- Department of Radiology, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nuremberg, Erlangen, Germany
| | - Thilo Hotfiel
- Division of Orthopedic Rheumatology, Department of Orthopedic Surgery, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Marion Kellermann
- Division of Orthopedic Rheumatology, Department of Orthopedic Surgery, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Matthias S May
- Department of Radiology, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nuremberg, Erlangen, Germany
| | - Wolfgang Wuest
- Department of Radiology, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nuremberg, Erlangen, Germany
| | - Rolf Janka
- Department of Radiology, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nuremberg, Erlangen, Germany
| | - Armin M Nagel
- Department of Radiology, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nuremberg, Erlangen, Germany
| | - Michael Uder
- Department of Radiology, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nuremberg, Erlangen, Germany
| | - Matthias Hammon
- Department of Radiology, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nuremberg, Erlangen, Germany
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Scharf M, Oezdemir D, Schmid A, Kemmler W, von Stengel S, May MS, Uder M, Lell MM. Myocardial adaption to HI(R)T in previously untrained men with a randomized, longitudinal cardiac MR imaging study (Physical adaptions in Untrained on Strength and Heart trial, PUSH-trial). PLoS One 2017; 12:e0189204. [PMID: 29216285 PMCID: PMC5720775 DOI: 10.1371/journal.pone.0189204] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Accepted: 11/16/2017] [Indexed: 01/19/2023] Open
Abstract
Objective Although musculoskeletal effects in resistance training are well described, little is known about structural and functional cardiac adaption in formerly untrained subjects. We prospectively evaluated whether short term high intensity (resistance) training (HI(R)T) induces detectable morphologic cardiac changes in previously untrained men in a randomized controlled magnetic resonance imaging (MRI) study. Materials and methods 80 untrained middle-aged men were randomly assigned to a HI(R)T-group (n = 40; 43.5±5.9 years) or an inactive control group (n = 40; 42.0±6.3 years). HI(R)T comprised 22 weeks of training focusing on a single-set to failure protocol in 2–3 sessions/week, each with 10–13 exercises addressing main muscle groups. Repetitions were decreased from 8–10 to 3–5 during study period. Before and after HI(R)T all subjects underwent physiologic examination and cardiac MRI (cine imaging, tagging). Results Indexed left (LV) and right ventricular (RV) volume (LV: 76.8±15.6 to 78.7±14.8 ml/m2; RV: 77.0±15.5 to 78.7±15.1 ml/m2) and mass (LV: 55.5±9.7 to 57.0±8.8 g/m2; RV: 14.6±3.0 to 15.0±2.9 g/m2) significantly increased with HI(R)T (all p<0.001). Mean LV and RV remodeling indices of HI(R)T-group did not alter with training (0.73g/mL and 0.19g/mL, respectively [p = 0.96 and p = 0.87]), indicating balanced cardiac adaption. Indexed LV (48.4±11.1 to 50.8±11.0 ml/m2) and RV (48.5±11.0 to 50.6±10.7 ml/m2) stroke volume significantly increased with HI(R)T (p<0.001). Myocardial strain and strain rates did not change following resistance exercise. Left atrial volume at end systole slightly increased after HI(R)T (36.2±7.9 to 37.0±8.4 ml/m2, p = 0.411), the ratio to end-diastolic LV volume at baseline and post-training was unchanged (0.47 vs. 0.47, p = 0.79). Conclusion 22 weeks of HI(R)T lead to measurable, physiological changes in cardiac atrial and ventricular morphologic characteristics and function in previously untrained men. Trial regristration The PUSH-trial is registered at the US National Institutes of Health (ClinicalTrials.gov), NCT01766791.
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Affiliation(s)
- Michael Scharf
- Department of Radiology, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Bavaria, Germany
- * E-mail:
| | - Derya Oezdemir
- Department of Radiology, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Bavaria, Germany
| | - Axel Schmid
- Department of Radiology, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Bavaria, Germany
| | - Wolfgang Kemmler
- Department of Medical Physics, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Bavaria, Germany
| | - Simon von Stengel
- Department of Medical Physics, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Bavaria, Germany
| | - Matthias S. May
- Department of Radiology, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Bavaria, Germany
| | - Michael Uder
- Department of Radiology, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Bavaria, Germany
| | - Michael M. Lell
- Department of Radiology and Nuclear Medicine, Hospital of Nuremberg, Paracelsus Medical University, Nuremberg, Bavaria, Germany
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26
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May MS, Brand M, Lell MM, Sedlmair M, Allmendinger T, Uder M, Wuest W. Radiation dose reduction in parasinus CT by spectral shaping. Neuroradiology 2017; 59:169-176. [PMID: 28091696 DOI: 10.1007/s00234-016-1780-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 12/25/2016] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Spectral shaping aims to narrow the X-ray spectrum of clinical CT. The aim of this study was to determine the image quality and the extent of radiation dose reduction that can be achieved by tin prefiltration for parasinus CT. METHODS All scans were performed with a third generation dual-source CT scanner. A study protocol was designed using 100 kV tube voltage with tin prefiltration (200 mAs) that provides image noise levels comparable to a low-dose reference protocol using 100 kV without spectral shaping (25 mAs). One hundred consecutive patients were prospectively enrolled and randomly assigned to the study or control group. All patients signed written informed consent. The study protocol was approved by the local Institutional Review Board and applies to the HIPAA. Subjective and objective image quality (attenuation values, image noise, and contrast-to-noise ratio (CNR)) were assessed. Radiation exposure was assessed as volumetric CT dose index, and effective dose was estimated. Mann-Whitney U test was performed for radiation exposure and for image noise comparison. RESULTS All scans were of diagnostic image quality. Image noise in air, in the retrobulbar fat, and in the eye globe was comparable between both groups (all p > 0.05). CNReye globe/air did not differ significantly between both groups (p = 0.7). Radiation exposure (1.7 vs. 2.1 mGy, p < 0.01) and effective dose (0.055 vs. 0.066 mSv, p < 0.01) were significantly reduced in the study group. CONCLUSION Radiation dose can be further reduced by 17% for low-dose parasinus CT by tin prefiltration maintaining diagnostic image quality.
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Affiliation(s)
- Matthias S May
- Department of Radiology, University Hospital Erlangen, Maximiliansplatz 1, 91054, Erlangen, Germany
| | - Michael Brand
- Department of Radiology, University Hospital Erlangen, Maximiliansplatz 1, 91054, Erlangen, Germany
| | - Michael M Lell
- Department of Radiology, University Hospital Erlangen, Maximiliansplatz 1, 91054, Erlangen, Germany
| | | | | | - Michael Uder
- Department of Radiology, University Hospital Erlangen, Maximiliansplatz 1, 91054, Erlangen, Germany
| | - Wolfgang Wuest
- Department of Radiology, University Hospital Erlangen, Maximiliansplatz 1, 91054, Erlangen, Germany.
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Lell MM, Scharf M, Eller A, Wuest W, Allmendinger T, Fuchs F, Achenbach S, Uder M, May MS. Feasibility of Respiratory-gated High-pitch Spiral CT:: Free-breathing Inspiratory Image Quality. Acad Radiol 2016; 23:406-12. [PMID: 26853970 DOI: 10.1016/j.acra.2015.12.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 12/29/2015] [Accepted: 12/29/2015] [Indexed: 01/16/2023]
Abstract
RATIONALE AND OBJECTIVES This study aimed to develop and implement a respiratory-gated setup for dual-source computed tomography (CT) at high pitch to examine patients in a reproducible inspiratory phase. MATERIALS AND METHODS Twenty-one patients underwent free-breathing respiratory-gated chest CT using a high-pitch scan mode no more than 6 months after inspiratory breath-held nongated CT, which serves as reference. Scan parameters were as follows: pitch = 3.4, 128 × 0.6 mm collimation, 0.28 s gantry rotation time, and 150 ref.mAs per tube at 120 kV. The examinations were triggered using the tidal wave provided by a respiratory-gating system as input signal. Image quality was assessed focusing on artifacts and delineation of the anatomical and pathological structures. Lung volumes were measured on both free-breathing and reference examinations. RESULTS All examinations were performed without complications. Image quality was high with both protocols. Significantly less motion artifacts were recorded with the high-pitch mode compared to the reference (P = 0.02). Most of the artifacts were located in the peripheral parts of the lower lobes for the study group and in the central part of the left lower lobe for the reference. Average total lung volume was 4.5 ± 1.5 L in respiratory-gated examinations and 5.8 ± 0.9 L in examinations with breath-hold in inspiration. CONCLUSIONS High-pitch chest CT scanning during free breathing minimizes motion artifacts, improving image quality in patients with limited breath-holding abilities. To assure scanning in an inspiratory phase, data acquisition should be triggered with a respiratory-gating system.
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Rompel O, Janka R, May MS, Glöckler M, Cesnjevar R, Dittrich S, Lell MM, Uder M, Hammon M. Cardiac MRI in Children and Adolescents Who Have Undergone Surgical Repair of Right-Sided Congenital Heart Disease: Automated Left Ventricular Volumes and Function Analysis and Effects of Different Manual Adjustments. ROFO-FORTSCHR RONTG 2015; 187:1099-107. [PMID: 26327669 DOI: 10.1055/s-0035-1553418] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE To evaluate automated segmentation and the effects of different manual adjustments regarding left ventricular parameter quantification in cardiac magnetic resonance (MR) data on children and adolescents who have undergone surgical repair of right-sided congenital heart disease (CHD). MATERIALS AND METHODS Dedicated software (syngo.via, Siemens AG) was used to automatically segment and/or manually adjust the end-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV), myocardial mass (MM) and ejection fraction (EF) before/after manual apex/base adjustment (ADJ-step 1) and after manual apex/base/myocardial contour adjustment (ADJ-step 2; reference standard). MR data of 40 patients (13.1 ± 3. y, 4 - 17 y) with repaired CHD with decreased pulmonary blood flow (CHD-DPBF) were evaluated. Intra- and inter-rater reliability was determined for 10 randomly selected patients. RESULTS The software correctly detected the left ventricle in 38/40 (95%) patients. EDV after automated segmentation: 119.1 ± 44.0 ml; after ADJ-step 1: 115.8 ± 9.5 ml; after ADJ-step 2: 116.2 ± 39.4 ml. The corresponding results for ESV were 52.0 ± 18.5/49.6 ± 6.9/49.7 ± 16.4 ml; for SV 67.1 ± 28.5/66.2 ± 25.4/66.5 ± 25. ml; for EF 55.5 ± 7.3/56.7 ± 6.6/56.7 ± 6.3%; for MM 83.7 ± 35.9/76.2 ± 8.3/74.6 ± 27.2 g. Significant differences were found for ESV/MM/EF comparing the automated segmentation results with these after ADJ-step 1 and ADJ-step 2. No significant differences were found when comparing all results of ADJ-step 1 and ADJ-step 2 or when comparing EDV/SV results. Intra- and inter-rater reliability was excellent. The mean time effort was 63.4 ± 6.9 s for the automated segmentation, 74.2 ± 8.9 s for ADJ-step 1 and 269.5 ± 39.4 s for ADJ-step 2. CONCLUSION Automated left ventricular volumes and function analysis in children and adolescents with surgically treated CHD proved to be feasible with excellent intra- and inter-rater reliability. Automated segmentation with manual apex/base adjustment provided clinically acceptable results. KEY POINTS Automated left ventricular volume and function analysis in children and adolescents with surgically treated right-sided heart disease is feasible with excellent intra- and inter-rater reliability. Automated segmentation with manual apex/base adjustment provides clinically acceptable results. Additional manual myocardial contour adjustment does not significantly improve the results.
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Affiliation(s)
- O Rompel
- Department of Radiology, University Hospital Erlangen, Germany
| | - R Janka
- Department of Radiology, University Hospital Erlangen, Germany
| | - M S May
- Department of Radiology, University Hospital Erlangen, Germany
| | - M Glöckler
- Department of Pediatric Cardiology, University Hospital Erlangen, Germany
| | - R Cesnjevar
- Department of Pediatric Cardiac Surgery, University Hospital Erlangen, Germany
| | - S Dittrich
- Department of Pediatric Cardiology, University Hospital Erlangen, Germany
| | - M M Lell
- Department of Radiology, University Hospital Erlangen, Germany
| | - M Uder
- Department of Radiology, University Hospital Erlangen, Germany
| | - M Hammon
- Department of Radiology, University Hospital Erlangen, Germany
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Wuest W, May MS, Brand M, Bayerl N, Krauss A, Uder M, Lell M. Improved Image Quality in Head and Neck CT Using a 3D Iterative Approach to Reduce Metal Artifact. AJNR Am J Neuroradiol 2015; 36:1988-93. [PMID: 26272971 DOI: 10.3174/ajnr.a4386] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Accepted: 02/09/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND AND PURPOSE Metal artifacts from dental fillings and other devices degrade image quality and may compromise the detection and evaluation of lesions in the oral cavity and oropharynx by CT. The aim of this study was to evaluate the effect of iterative metal artifact reduction on CT of the oral cavity and oropharynx. MATERIALS AND METHODS Data from 50 consecutive patients with metal artifacts from dental hardware were reconstructed with standard filtered back-projection, linear interpolation metal artifact reduction (LIMAR), and iterative metal artifact reduction. The image quality of sections that contained metal was analyzed for the severity of artifacts and diagnostic value. RESULTS A total of 455 sections (mean ± standard deviation, 9.1 ± 4.1 sections per patient) contained metal and were evaluated with each reconstruction method. Sections without metal were not affected by the algorithms and demonstrated image quality identical to each other. Of these sections, 38% were considered nondiagnostic with filtered back-projection, 31% with LIMAR, and only 7% with iterative metal artifact reduction. Thirty-three percent of the sections had poor image quality with filtered back-projection, 46% with LIMAR, and 10% with iterative metal artifact reduction. Thirteen percent of the sections with filtered back-projection, 17% with LIMAR, and 22% with iterative metal artifact reduction were of moderate image quality, 16% of the sections with filtered back-projection, 5% with LIMAR, and 30% with iterative metal artifact reduction were of good image quality, and 1% of the sections with LIMAR and 31% with iterative metal artifact reduction were of excellent image quality. CONCLUSIONS Iterative metal artifact reduction yields the highest image quality in comparison with filtered back-projection and linear interpolation metal artifact reduction in patients with metal hardware in the head and neck area.
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Affiliation(s)
- W Wuest
- From the Radiological Institute (W.W., M.S.M., M.B., N.B., M.U., M.L.), Friedrich-Alexander-University-Erlangen-Nuremberg, Erlangen, Germany
| | - M S May
- From the Radiological Institute (W.W., M.S.M., M.B., N.B., M.U., M.L.), Friedrich-Alexander-University-Erlangen-Nuremberg, Erlangen, Germany
| | - M Brand
- From the Radiological Institute (W.W., M.S.M., M.B., N.B., M.U., M.L.), Friedrich-Alexander-University-Erlangen-Nuremberg, Erlangen, Germany
| | - N Bayerl
- From the Radiological Institute (W.W., M.S.M., M.B., N.B., M.U., M.L.), Friedrich-Alexander-University-Erlangen-Nuremberg, Erlangen, Germany
| | - A Krauss
- Medical Imaging (A.K.), Siemens Healthcare, Erlangen, Germany
| | - M Uder
- From the Radiological Institute (W.W., M.S.M., M.B., N.B., M.U., M.L.), Friedrich-Alexander-University-Erlangen-Nuremberg, Erlangen, Germany
| | - M Lell
- From the Radiological Institute (W.W., M.S.M., M.B., N.B., M.U., M.L.), Friedrich-Alexander-University-Erlangen-Nuremberg, Erlangen, Germany
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Brand M, Ellmann S, Sommer M, May MS, Eller A, Wuest W, Engert C, Achenbach S, Kuefner MA, Baeuerle T, Lell M, Uder M. Influence of Cardiac MR Imaging on DNA Double-Strand Breaks in Human Blood Lymphocytes. Radiology 2015. [PMID: 26225451 DOI: 10.1148/radiol.2015150555] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To evaluate the ability of magnetic resonance (MR) imaging to induce deoxyribonucleic acid (DNA) damage in patients who underwent cardiac MR imaging in daily routine by using γ-H2AX immunofluorescence microscopy. MATERIALS AND METHODS This study complies with the Declaration of Helsinki and was performed according to local ethics committee approval. Informed patient consent was obtained. Blood samples from 45 patients (13 women, 32 men; mean age, 50.3 years [age range, 20-89 years]) were obtained before and after contrast agent-enhanced cardiac MR imaging. MR imaging-induced double-strand breaks (DSBs) were quantified in isolated blood lymphocytes by using immunofluorescence microscopy after staining the phosphorylated histone variant γ-H2AX. Twenty-nine patients were examined with a myocarditis protocol (group A), 10 patients with a stress-testing protocol (group B), and six patients with flow measurements and angiography (group C). Paired t test was performed to compare excess foci before and after MR imaging. RESULTS The mean baseline DSB level before MR imaging and 5 minutes after MR imaging was, respectively, 0.116 DSB per cell ± 0.019 (standard deviation) and 0.117 DSB per cell ± 0.019 (P = .71). There was also no significant difference in DSBs in these subgroups (group A: DSB per cell before and after MR imaging, respectively, 0.114 and 0.114, P = .91; group B: DSB per cell before and after MR imaging, respectively, 0.123 and 0.124, P = .78; group C: DSB per cell before and after MR imaging, respectively, 0.114 and 0.115, P = .36). CONCLUSION By using γ-H2AX immunofluorescence microscopy, no DNA DSBs were detected after cardiac MR imaging.
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Affiliation(s)
- Michael Brand
- From the Department of Radiology, University Hospital Erlangen-Nuremberg, Maximiliansplatz 1, D-91054 Erlangen, Germany (M.B., S.E., M.S., M.S.M., A.E., W.W., C.E., M.A.K., T.B., M.L., M.U.); and Department of Cardiology, University Hospital Erlangen-Nuremberg, Erlangen, Germany (S.A.)
| | - Stephan Ellmann
- From the Department of Radiology, University Hospital Erlangen-Nuremberg, Maximiliansplatz 1, D-91054 Erlangen, Germany (M.B., S.E., M.S., M.S.M., A.E., W.W., C.E., M.A.K., T.B., M.L., M.U.); and Department of Cardiology, University Hospital Erlangen-Nuremberg, Erlangen, Germany (S.A.)
| | - Matthias Sommer
- From the Department of Radiology, University Hospital Erlangen-Nuremberg, Maximiliansplatz 1, D-91054 Erlangen, Germany (M.B., S.E., M.S., M.S.M., A.E., W.W., C.E., M.A.K., T.B., M.L., M.U.); and Department of Cardiology, University Hospital Erlangen-Nuremberg, Erlangen, Germany (S.A.)
| | - Matthias S May
- From the Department of Radiology, University Hospital Erlangen-Nuremberg, Maximiliansplatz 1, D-91054 Erlangen, Germany (M.B., S.E., M.S., M.S.M., A.E., W.W., C.E., M.A.K., T.B., M.L., M.U.); and Department of Cardiology, University Hospital Erlangen-Nuremberg, Erlangen, Germany (S.A.)
| | - Achim Eller
- From the Department of Radiology, University Hospital Erlangen-Nuremberg, Maximiliansplatz 1, D-91054 Erlangen, Germany (M.B., S.E., M.S., M.S.M., A.E., W.W., C.E., M.A.K., T.B., M.L., M.U.); and Department of Cardiology, University Hospital Erlangen-Nuremberg, Erlangen, Germany (S.A.)
| | - Wolfgang Wuest
- From the Department of Radiology, University Hospital Erlangen-Nuremberg, Maximiliansplatz 1, D-91054 Erlangen, Germany (M.B., S.E., M.S., M.S.M., A.E., W.W., C.E., M.A.K., T.B., M.L., M.U.); and Department of Cardiology, University Hospital Erlangen-Nuremberg, Erlangen, Germany (S.A.)
| | - Christina Engert
- From the Department of Radiology, University Hospital Erlangen-Nuremberg, Maximiliansplatz 1, D-91054 Erlangen, Germany (M.B., S.E., M.S., M.S.M., A.E., W.W., C.E., M.A.K., T.B., M.L., M.U.); and Department of Cardiology, University Hospital Erlangen-Nuremberg, Erlangen, Germany (S.A.)
| | - Stephan Achenbach
- From the Department of Radiology, University Hospital Erlangen-Nuremberg, Maximiliansplatz 1, D-91054 Erlangen, Germany (M.B., S.E., M.S., M.S.M., A.E., W.W., C.E., M.A.K., T.B., M.L., M.U.); and Department of Cardiology, University Hospital Erlangen-Nuremberg, Erlangen, Germany (S.A.)
| | - Michael A Kuefner
- From the Department of Radiology, University Hospital Erlangen-Nuremberg, Maximiliansplatz 1, D-91054 Erlangen, Germany (M.B., S.E., M.S., M.S.M., A.E., W.W., C.E., M.A.K., T.B., M.L., M.U.); and Department of Cardiology, University Hospital Erlangen-Nuremberg, Erlangen, Germany (S.A.)
| | - Tobias Baeuerle
- From the Department of Radiology, University Hospital Erlangen-Nuremberg, Maximiliansplatz 1, D-91054 Erlangen, Germany (M.B., S.E., M.S., M.S.M., A.E., W.W., C.E., M.A.K., T.B., M.L., M.U.); and Department of Cardiology, University Hospital Erlangen-Nuremberg, Erlangen, Germany (S.A.)
| | - Michael Lell
- From the Department of Radiology, University Hospital Erlangen-Nuremberg, Maximiliansplatz 1, D-91054 Erlangen, Germany (M.B., S.E., M.S., M.S.M., A.E., W.W., C.E., M.A.K., T.B., M.L., M.U.); and Department of Cardiology, University Hospital Erlangen-Nuremberg, Erlangen, Germany (S.A.)
| | - Michael Uder
- From the Department of Radiology, University Hospital Erlangen-Nuremberg, Maximiliansplatz 1, D-91054 Erlangen, Germany (M.B., S.E., M.S., M.S.M., A.E., W.W., C.E., M.A.K., T.B., M.L., M.U.); and Department of Cardiology, University Hospital Erlangen-Nuremberg, Erlangen, Germany (S.A.)
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Hell MM, Achenbach S, Schuhbaeck A, Klinghammer L, May MS, Marwan M. CT-based analysis of pericoronary adipose tissue density: Relation to cardiovascular risk factors and epicardial adipose tissue volume. J Cardiovasc Comput Tomogr 2015; 10:52-60. [PMID: 26256553 DOI: 10.1016/j.jcct.2015.07.011] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 07/07/2015] [Accepted: 07/24/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND Pericoronary adipose tissue (PCAT) can promote atherosclerosis. Metabolically active and inactive PCAT may display different CT densities. However, CT density could be influenced by partial volume effects and image interpolation. OBJECTIVE To investigate whether PCAT density values in CT displays differences that are larger than those attributable to interpolation and partial volume effects, which would manifest themselves through the relationship between PCAT density and distance from the contrast-enhanced coronary lumen. METHODS PCAT density analysis was performed (417 non-atherosclerotic segments, 63 patients) using dual-source CT with a threshold-based measurement method. Changes in PCAT density values depending on distance from the contrast-enhanced coronary lumen and the influence of cardiovascular risk profile were analyzed. RESULTS Mean PCAT density was -78.1 ± 5.6 HU. PCAT density decreased from proximal to distal segments in the LAD (-78.0 ± 7.3 vs. -82.4 ± 7.7 HU; p < 0.001). PCAT density was higher close to the lumen compared to more peripheral locations (-76.0 ± 6.7 vs. -78.5 ± 5.4 HU; p < 0.001). Decreasing PCAT density was significantly associated with higher epicardial adipose tissue (EAT) volume and body mass index. There was a trend of lower PCAT values with a family history of coronary artery disease. CONCLUSION CT-measured attenuation of PCAT is influenced by EAT volume and body mass index. A decrease of PCAT attenuation with increasing distance from the vessel and from proximal to distal segments may suggest variations in CT density of PCAT due to partial volume effects and image interpolation rather than solely due to differences in tissue composition or metabolic activity.
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Affiliation(s)
- Michaela M Hell
- Department of Cardiology, University of Erlangen, Ulmenweg 18, 91054 Erlangen, Germany.
| | - Stephan Achenbach
- Department of Cardiology, University of Erlangen, Ulmenweg 18, 91054 Erlangen, Germany
| | - Annika Schuhbaeck
- Department of Cardiology, University of Erlangen, Ulmenweg 18, 91054 Erlangen, Germany
| | - Lutz Klinghammer
- Department of Cardiology, University of Erlangen, Ulmenweg 18, 91054 Erlangen, Germany
| | - Matthias S May
- Department of Radiology, University of Erlangen, Maximiliansplatz 1, 91054 Erlangen, Germany
| | - Mohamed Marwan
- Department of Cardiology, University of Erlangen, Ulmenweg 18, 91054 Erlangen, Germany
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Scharf M, Schmid A, Kemmler W, von Stengel S, May MS, Wuest W, Achenbach S, Uder M, Lell MM. Myocardial adaptation to high-intensity (interval) training in previously untrained men with a longitudinal cardiovascular magnetic resonance imaging study (Running Study and Heart Trial). Circ Cardiovasc Imaging 2015; 8:CIRCIMAGING.114.002566. [PMID: 25873721 DOI: 10.1161/circimaging.114.002566] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND To prospectively evaluate whether short-term high-intensity (interval) training (HI(I)T) induces detectable morphological cardiac changes in previously untrained men in cardiovascular magnetic resonance imaging. METHODS AND RESULTS Eighty-four untrained volunteers were randomly assigned to a HI(I)T group (n=42; 44.1±4.7 years) or an inactive control group (n=42; 42.3±5.6 years). HI(I)T focused on interval runs (intensity: 95%-105% of individually calculated heart rate at the anaerobic threshold). Before and after 16 weeks, all subjects underwent physiological examination, stepwise treadmill test with blood lactate analysis, and contrast-enhanced cardiovascular magnetic resonance imaging (cine, tagging, and delayed enhancement). Indexed left ventricular (LV) and right ventricular (RV) volume (LV, 77.1±8.5-83.9±8.6; RV, 80.5±8.5-86.6±8.1) and mass (LV, 58.2±6.4-63.4±8.1; RV, 14.8±1.7-16.1±2.1) significantly increased with HI(I)T. Changes in LV and RV morphological parameters with HI(I)T were highly correlated with an increase in maximal aerobic capacity (VO2max) and a decrease in blood lactate concentration at the anaerobic threshold. Mean LV and RV remodeling index of HI(I)T group did not alter with training (0.76 ±0.09 and 0.24±0.10 g/mL, respectively [P=0.97 and P=0.72]), indicating balanced cardiac adaptation. Myocardial circumferential strain decreased after HI(I)T within all 6 basal segments (anteroseptal, P=0.01 and anterolateral, P<0.001). There was no late gadolinium enhancement in any of the participants before or post HI(I)T. CONCLUSIONS Sixteen weeks of HI(I)T lead to measurable changes in cardiac atrial and ventricular morphology and function in previously untrained men. This correlates with improvements in parameters of endurance capacity. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01406730.
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Affiliation(s)
- Michael Scharf
- From the Departments of Radiology (M.S., A.S., M.S.M., W.W., M.U., M.M.L.), Medical Physics (W.K., S.v.S.), and Cardiology (S.A.), Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Axel Schmid
- From the Departments of Radiology (M.S., A.S., M.S.M., W.W., M.U., M.M.L.), Medical Physics (W.K., S.v.S.), and Cardiology (S.A.), Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Wolfgang Kemmler
- From the Departments of Radiology (M.S., A.S., M.S.M., W.W., M.U., M.M.L.), Medical Physics (W.K., S.v.S.), and Cardiology (S.A.), Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Simon von Stengel
- From the Departments of Radiology (M.S., A.S., M.S.M., W.W., M.U., M.M.L.), Medical Physics (W.K., S.v.S.), and Cardiology (S.A.), Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Matthias S May
- From the Departments of Radiology (M.S., A.S., M.S.M., W.W., M.U., M.M.L.), Medical Physics (W.K., S.v.S.), and Cardiology (S.A.), Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Wolfgang Wuest
- From the Departments of Radiology (M.S., A.S., M.S.M., W.W., M.U., M.M.L.), Medical Physics (W.K., S.v.S.), and Cardiology (S.A.), Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Stephan Achenbach
- From the Departments of Radiology (M.S., A.S., M.S.M., W.W., M.U., M.M.L.), Medical Physics (W.K., S.v.S.), and Cardiology (S.A.), Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Michael Uder
- From the Departments of Radiology (M.S., A.S., M.S.M., W.W., M.U., M.M.L.), Medical Physics (W.K., S.v.S.), and Cardiology (S.A.), Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Michael M Lell
- From the Departments of Radiology (M.S., A.S., M.S.M., W.W., M.U., M.M.L.), Medical Physics (W.K., S.v.S.), and Cardiology (S.A.), Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany.
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Wuest W, Lell M, May MS, Saake M, Kuwert T, Uder M, Linke R. Thoracic non-osseous lesions in cancer patients detected in low-dose CT images acquired as part of skeletal SPECT/CT examinations. Nuklearmedizin 2015; 54:173-7. [PMID: 26165684 DOI: 10.3413/nukmed-0721-15-02] [Citation(s) in RCA: 3] [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: 02/04/2015] [Accepted: 06/28/2015] [Indexed: 12/21/2022]
Abstract
AIM Hybrid single-photon emission tomographic (SPECT) and X-ray computed tomography (CT) systems are increasingly used in oncologic imaging. With SPECT/CT not only the thoracic spine but also the surrounding soft tissue needs to be evaluated for pathological findings. The purpose of this study was to assess the prevalence of non-osseous findings detectable on low-dose CT datasets from patients studied by thoracic 99mTc-dicarboxypropane diphosphonate (DPD)-SPECT/CT. PATIENTS, METHODS 119 consecutive oncologic patients (81 breast cancer, 38 with other cancer) who underwent DPD-SPECT CT of the thoracic region were included in this study. Non-osseous findings on CT were classified as either probably benign or suspicious. Suspicious findings were correlated with retrievable previous imaging and if performed with follow up imaging (MRI, CT with contrast medium, Ultrasound) or biopsy results. RESULTS In 80/119 (67%) patients no imaging was performed before SPECT/CT. Only 7/119 subjects (6%) had no other lesions than bone lesions. In 101/119 (85%) patients lesions found on SPECT/CT images were rated as benign and in 65/119 (55%) patients as suspicious. In 8/119 (7%) patients with previously unknown suspicious lesions on SPECT/CT images suspicious findings were confirmed by biopsy. CONCLUSION 7% of patients referred to SPECT/CT of the thoracic spine for staging of malignant disease had previously unknown suspicious non-osseous lesions detectable on the low-dose CT images which were confirmed by biopsy. This could be especially relevant for cancer entities like breast and prostate, in which no thorax-CT is routinely intended for staging.
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Affiliation(s)
- W Wuest
- Wolfgang Wuest, MD, Radiological Institute, Friedrich-Alexander-University-Erlangen-Nuremberg, Maximiliansplatz 1, 91054 Erlangen, Germany, Tel. +49/(0)91 31/854 55 07, Fax +49/(0)91 31/853 60 68, E-mail:
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Kramer M, Ellmann S, Allmendinger T, Eller A, Kammerer F, May MS, Baigger JF, Uder M, Lell MM. Computed Tomography Angiography of Carotid Arteries and Vertebrobasilar System: A Simulation Study for Radiation Dose Reduction. Medicine (Baltimore) 2015; 94:e1058. [PMID: 26131822 PMCID: PMC4504529 DOI: 10.1097/md.0000000000001058] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Computed tomography angiography (CTA) of carotid arteries and vertebrobasilar system is a standardized procedure with excellent image quality, but radiation exposure remains a matter of concern. The aim of this study is to examine to what extent radiation dose can be lowered in relation to a standard protocol by simulating examinations with lower tube currents applying a dedicated software.Lower tube current was simulated by a dedicated noise insertion and reconstruction software (ReconCT). In a phantom study, true scans were performed with different dose protocols and compared to the results of simulated dose reductions of the same degree, respectively. In a patient study, 30 CTAs of supra-aortic vessels were reconstructed at a level of 100%, 75%, 50%, and 25% of the initial dose. Objective and subjective image analyses were performed.No significant noise differences between true scans and simulated scans of mimicked contrasted vessels were found. In the patient study, the quality scores of the 4 dose groups differed statistically significant; this difference vanished for the comparison of the 100% and 75% datasets after dichotomization into the categories of diagnostic and nondiagnostic image quality (P = .50).This study suggests an easy-to-implement method of simulating CTAs of carotid arteries and vertebrobasilar system with lower tube current for dose reduction by artificially adding noise to the original raw data. Lowering the radiation dose in a moderate extent to 75% of the original dose levels does not significantly alter the diagnostic image quality.
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Brand M, Sommer M, Ellmann S, Wuest W, May MS, Eller A, Vogt S, Lell MM, Kuefner MA, Uder M. Influence of Different Antioxidants on X-Ray Induced DNA Double-Strand Breaks (DSBs) Using γ-H2AX Immunofluorescence Microscopy in a Preliminary Study. PLoS One 2015; 10:e0127142. [PMID: 25996998 PMCID: PMC4440758 DOI: 10.1371/journal.pone.0127142] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 04/13/2015] [Indexed: 11/19/2022] Open
Abstract
Background Radiation exposure occurs in X-ray guided interventional procedures or computed tomography (CT) and γ-H2AX-foci are recognized to represent DNA double-strand breaks (DSBs) as a biomarker for radiation induced damage. Antioxidants may reduce the induction of γ-H2AX-foci by binding free radicals. The aim of this study was to establish a dose-effect relationship and a time-effect relationship for the individual antioxidants on DSBs in human blood lymphocytes. Materials and Methods Blood samples from volunteers were irradiated with 10 mGy before and after pre-incubation with different antioxidants (zinc, trolox, lipoic acid, ß-carotene, selenium, vitamin E, vitamin C, N-acetyl-L-cysteine (NAC) and Q 10). Thereby, different pre-incubation times, concentrations and combinations of drugs were evaluated. For assessment of DSBs, lymphocytes were stained against the phosphorylated histone variant γ-H2AX. Results For zinc, trolox and lipoic acid regardless of concentration or pre-incubation time, no significant decrease of γ-H2AX-foci was found. However, ß-carotene (15%), selenium (14%), vitamin E (12%), vitamin C (25%), NAC (43%) and Q 10 (18%) led to a significant reduction of γ-H2AX-foci at a pre-incubation time of 1 hour. The combination of different antioxidants did not have an additive effect. Conclusion Antioxidants administered prior to irradiation demonstrated the potential to reduce γ-H2AX-foci in blood lymphocytes.
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Affiliation(s)
- Michael Brand
- Department of Radiology, University Hospital Erlangen-Nuremberg, Erlangen, Germany
- * E-mail:
| | - Matthias Sommer
- Department of Radiology, University Hospital Erlangen-Nuremberg, Erlangen, Germany
| | - Stephan Ellmann
- Department of Radiology, University Hospital Erlangen-Nuremberg, Erlangen, Germany
| | - Wolfgang Wuest
- Department of Radiology, University Hospital Erlangen-Nuremberg, Erlangen, Germany
| | - Matthias S. May
- Department of Radiology, University Hospital Erlangen-Nuremberg, Erlangen, Germany
| | - Achim Eller
- Department of Radiology, University Hospital Erlangen-Nuremberg, Erlangen, Germany
| | - Sabine Vogt
- Department of Radiology, University Hospital Erlangen-Nuremberg, Erlangen, Germany
| | - Michael M. Lell
- Department of Radiology, University Hospital Erlangen-Nuremberg, Erlangen, Germany
| | - Michael A. Kuefner
- Department of Radiology, University Hospital Erlangen-Nuremberg, Erlangen, Germany
| | - Michael Uder
- Department of Radiology, University Hospital Erlangen-Nuremberg, Erlangen, Germany
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Lell MM, May MS, Brand M, Eller A, Buder T, Hofmann E, Uder M, Wuest W. Imaging the Parasinus Region with a Third-Generation Dual-Source CT and the Effect of Tin Filtration on Image Quality and Radiation Dose. AJNR Am J Neuroradiol 2015; 36:1225-30. [PMID: 25814658 DOI: 10.3174/ajnr.a4270] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Accepted: 12/14/2014] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND PURPOSE CT is the imaging technique of choice in the evaluation of midface trauma or inflammatory disease. We performed a systematic evaluation of scan protocols to optimize image quality and radiation exposure on third-generation dual-source CT. MATERIALS AND METHODS CT protocols with different tube voltage (70-150 kV), current (25-300 reference mAs), prefiltration, pitch value, and rotation time were systematically evaluated. All images were reconstructed with iterative reconstruction (Advanced Modeled Iterative Reconstruction, level 2). To individually compare results with otherwise identical factors, we obtained all scans on a frozen human head. Conebeam CT was performed for image quality and dose comparison with multidetector row CT. Delineation of important anatomic structures and incidental pathologic conditions in the cadaver head was evaluated. RESULTS One hundred kilovolts with tin prefiltration demonstrated the best compromise between dose and image quality. The most dose-effective combination for trauma imaging was Sn100 kV/250 mAs (volume CT dose index, 2.02 mGy), and for preoperative sinus surgery planning, Sn100 kV/150 mAs (volume CT dose index, 1.22 mGy). "Sn" indicates an additional prefiltration of the x-ray beam with a tin filter to constrict the energy spectrum. Exclusion of sinonasal disease was possible with even a lower dose by using Sn100 kV/25 mAs (volume CT dose index, 0.2 mGy). CONCLUSIONS High image quality at very low dose levels can be achieved by using a Sn100-kV protocol with iterative reconstruction. The effective dose is comparable with that of conventional radiography, and the high image quality at even lower radiation exposure favors multidetector row CT over conebeam CT.
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Affiliation(s)
- M M Lell
- From the Departments of Radiology (M.M.L., M.S.M., M.B., A.E., M.U., W.W.) Imaging Science Institute (M.M.L., M.U.), University Erlangen, Erlangen, Germany.
| | - M S May
- From the Departments of Radiology (M.M.L., M.S.M., M.B., A.E., M.U., W.W.)
| | - M Brand
- From the Departments of Radiology (M.M.L., M.S.M., M.B., A.E., M.U., W.W.)
| | - A Eller
- From the Departments of Radiology (M.M.L., M.S.M., M.B., A.E., M.U., W.W.)
| | - T Buder
- Department I (T.B.), Institute of Anatomy
| | - E Hofmann
- Orthodontics and Orofacial Orthopedics (E.H.)
| | - M Uder
- From the Departments of Radiology (M.M.L., M.S.M., M.B., A.E., M.U., W.W.) Imaging Science Institute (M.M.L., M.U.), University Erlangen, Erlangen, Germany
| | - W Wuest
- From the Departments of Radiology (M.M.L., M.S.M., M.B., A.E., M.U., W.W.)
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May MS, Kramer MR, Eller A, Wuest W, Scharf M, Brand M, Saake M, Schmidt B, Uder M, Lell MM. Automated tube voltage adaptation in head and neck computed tomography between 120 and 100 kV: effects on image quality and radiation dose. Neuroradiology 2014; 56:797-803. [DOI: 10.1007/s00234-014-1393-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Accepted: 06/11/2014] [Indexed: 01/02/2023]
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Wuest W, May MS, Scharf M, Layritz C, Eisentopf J, Ropers D, Pflederer T, Uder M, Achenbach S, Lell MM. Stent evaluation in low-dose coronary CT angiography: Effect of different iterative reconstruction settings. J Cardiovasc Comput Tomogr 2013; 7:319-25. [DOI: 10.1016/j.jcct.2013.08.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Revised: 08/09/2013] [Accepted: 08/16/2013] [Indexed: 11/30/2022]
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Abstract
The potential risks of radiation exposure associated with computed tomography (CT) imaging are reason for ongoing concern for both medical staff and patients. Radiation dose reduction is, according to the as low as reasonably achievable principle, an important issue in clinical routine, research and development. The complex interaction of preparation, examination and post-processing provides a high potential for optimization on the one hand but on the other a high risk for errors. The radiologist is responsible for the quality of the CT examination which requires specialized and up-to-date knowledge. Most of the techniques for radiation dose reduction are independent of the system and manufacturer. The basic principle should be radiation dose optimization without loss of diagnostic image quality rather than just reduction.
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Affiliation(s)
- M S May
- Radiologisches Institut, Universitätsklinikum Erlangen, Maximiliansplatz 1, 91054, Erlangen, Deutschland.
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Eller A, May MS, Scharf M, Schmid A, Kuefner M, Uder M, Lell MM. Attenuation-Based Automatic Kilovolt Selection in Abdominal Computed Tomography. Invest Radiol 2012; 47:559-65. [DOI: 10.1097/rli.0b013e318260c5d6] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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May MS, Brand M, Wuest W, Anders K, Kuwert T, Prante O, Schmidt D, Maschauer S, Semelka RC, Uder M, Kuefner MA. Induction and repair of DNA double-strand breaks in blood lymphocytes of patients undergoing 18F-FDG PET/CT examinations. Eur J Nucl Med Mol Imaging 2012; 39:1712-9. [DOI: 10.1007/s00259-012-2201-1] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Accepted: 07/16/2012] [Indexed: 11/29/2022]
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May MS, Deak P, Kuettner A, Lell MM, Wuest W, Scharf M, Keller AK, Häberle L, Achenbach S, Seltmann M, Uder M, Kalender WA. Radiation dose considerations by intra-individual Monte Carlo simulations in dual source spiral coronary computed tomography angiography with electrocardiogram-triggered tube current modulation and adaptive pitch. Eur Radiol 2011; 22:569-78. [PMID: 21984448 DOI: 10.1007/s00330-011-2300-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2011] [Revised: 09/09/2011] [Accepted: 09/13/2011] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To evaluate radiation dose levels in patients undergoing spiral coronary computed tomography angiography (CTA) on a dual-source system in clinical routine. METHODS Coronary CTA was performed for 56 patients with electrocardiogram-triggered tube current modulation (TCM) and heart-rate (HR) dependent pitch adaptation. Individual Monte Carlo (MC) simulations were performed for dose assessment. Retrospective simulations with constant tube current (CTC) served as reference. Lung tissue was segmented and used for organ and effective dose (ED) calculation. RESULTS Estimates for mean relative ED was 7.1 ± 2.1 mSv/100 mAs for TCM and 12.5 ± 5.3 mSv/100 mAs for CTC (P < 0.001). Relative dose reduction at low HR (≤60 bpm) was highest (49 ± 5%) compared to intermediate (60-70 bpm, 33 ± 12%) and high HR (>70 bpm, 29 ± 12%). However lowest ED is achieved at high HR (5.2 ± 1.5 mSv/100 mAs), compared with intermediate (6.7 ± 1.6 mSv/100 mAs) and low (8.3 ± 2.1 mSv/100 mAs) HR when automated pitch adaptation is applied. CONCLUSIONS Radiation dose savings up to 52% are achievable by TCM at low and regular HR. However lowest ED is attained at high HR by pitch adaptation despite inferior radiation dose reduction by TCM. KEY POINTS • Monte Carlo simulations allow for individual radiation dose calculations. • ECG-triggered tube current modulation (TCM) can effectively reduce radiation dose. • Slow and regular heart rates allow for highest dose reductions by TCM. • Adaptive pitch accounts for lowest radiation dose at high heart rates. • Women receive higher effective dose than men undergoing spiral coronary CT-angiography.
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Affiliation(s)
- Matthias S May
- Department of Radiology, University of Erlangen, Maximiliansplatz 1, 91054 Erlangen, Germany.
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Scharf M, Bink R, May MS, Hentschke C, Achenbach S, Uder M, Lell MM. High-Pitch Thoracic CT With Simultaneous Assessment of Coronary Arteries. JACC Cardiovasc Imaging 2011; 4:602-9. [DOI: 10.1016/j.jcmg.2011.02.014] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2010] [Revised: 02/16/2011] [Accepted: 02/23/2011] [Indexed: 11/29/2022]
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Zeuner R, Loehberg CR, Häberle L, Jud SM, Klingsiek P, Hein A, Bayer CM, Rauh C, Uder M, Cavallaro A, May MS, Adamietz B, Schulz-Wendtland R, Wittenberg T, Wagner F, Beckmann MW, Fasching PA, Heusinger K. Mammografische Dichte als Risikofaktor für die Entstehung eines Mammakarzinoms – Ergebnisse einer deutschen Fall-Kontroll-Studie. Geburtshilfe Frauenheilkd 2011. [DOI: 10.1055/s-0031-1278623] [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] Open
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May MS, Wardell WM, Lasagna L. New drug development during and after a period of regulatory change: clinical research activity of major United States pharmaceutical firms, 1958 to 1979. Clin Pharmacol Ther 1983; 33:691-700. [PMID: 6851401 DOI: 10.1038/clpt.1983.95] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The 1962 drug amendments fundamentally changed the way in which U.S. pharmaceutical firms could test new drugs in man and receive New Drug Application (NDA) approval. Although it is well known that the amendments and associated events caused a profound decline in the annual number of new drugs receiving NDA approval, the amendments' effects on clinical research into new chemical entities (NCEs) have not been investigated because data were unavailable. To study this we requested drug development information dating back to 1958 from most major United States-owned pharmaceutical firms and obtained complete responses from nine. The results showed that the introduction rate of NCEs into human testing dropped sharply in the early 1960s and declined substantially thereafter. The number of NCEs entering human testing fell from a mean of 89 a year in 1958-1962, to 35 a year in 1963-1972 (a reduction of 61%), and to 17 a year in the last 5 years of the survey, 1975-1979--an overall reduction of 81%. The number of NDA approvals received by these firms fell sharply by 49% in the early 1960s and more slowly for 10 years thereafter, from the mid-1960s to the mid-1970s. In the case of self-originated NCEs, the size of this later fall was 71%. Causes of these changes in NCE flow include the amendments and the events that prompted them; changes in scientific philosophy, standards, and state of the art; and economic factors.
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Wardell WM, May MS, Trimble AG. New drug development by United States pharmaceutical firms with analyses of trends in the acquisition and origin of drug candidates, 1963-1979. Clin Pharmacol Ther 1982; 32:407-17. [PMID: 7116754 DOI: 10.1038/clpt.1982.181] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
The average number of self-originated new chemical entities (NCEs) first tested in man by 39 United States-owned pharmaceutical firms in the 3-year period from 1977 to 1979 was 26 a year, approximately half the number investigated annually in the previous decade. Investigational New Drug (IND) Exemption filings on self-originated NCEs, but not those on acquired NCEs, were also comparatively low. Consequently, the contribution of self-originated NCEs to total IND filings fell from 81% in 1963 through 1975 to 68% in 1976 through 1979. (There was a similar decline, from 78% to 61%, in the proportion of compounds synthesized in the United States.) The relative increase in IND filings on acquired NCEs was greatest for smaller firms. By the late 1970s acquired NCEs accounted for almost 50% of the INDs filed by smaller firms, but only 10% to 25% of those filed by large and medium-sized firms. The importance of NCEs acquired from abroad has increased since the mid-1970s. The number of INDs filed on Japanese-originated NCEs rose from approximately one a year in 1963 through 1975 to an average of 3.5 a year in 1976 through 1979. Initial clinical testing of self-originated drugs abroad, which increased sharply in the early 1970s to reach a peak of 36% in 1976, declined to approximately 21% in 1977 through 1979. Self-originated drugs approved in 1977-1979 spent an average of 6 years in United States clinical testing and 2 in regulatory review, a total of 8 years from IND filing to NDA approval. The percentage of IND filings on self-originated NCEs that received New Drug Application (NDA) approval after 8 years or more was 9% overall, although ultimate success rates will be higher. There was a higher success rate for anti-infective drugs (17%) than for other pharmacologic categories (7%). For acquired NCEs, the overall approval rate was much larger (28%).
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Schlagman S, Hattman S, May MS, Berger L. In vivo methylation by Escherichia coli K-12 mec+ deoxyribonucleic acid-cytosine methylase protects against in vitro cleavage by the RII restriction endonuclease (R. Eco RII). J Bacteriol 1976; 126:990-6. [PMID: 770462 PMCID: PMC233238 DOI: 10.1128/jb.126.2.990-996.1976] [Citation(s) in RCA: 60] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
We have analyzed the susceptibility of the deoxyribonucleic acid (DNA) of phage fd replicative form (RF) and of Escherichia coli to in vitro cleavage by purified RII restriction endonuclease (R. Eco RII). The results are summarized as follows: (i) fd, mec- RFI, isolated from infected E. coli K-12 mec- bacteria (a mutant strain lacking DNA-cytosine methylase activity), is cleaved into at least two fragments, whereas fd. mec+ RFI, isolated from the parental mec+ strain, is not cleaved. (ii) E. coli mec- DNA is extensively degraded, whereas mec+ DNA-cytosine methylase acts as an RII modification enzyme.
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Abstract
Phages lambda and fd were propagated in Escherichia coli strains that have either host K-12 or the N-3 R-factor deoxyribonucleic acid-cytosine methylase activity. Pyrimidine tracts containing 3H-labeled 5-methylcytosine (MeC) were analyzed; in all cases, the major methylated sequence was 5' ... C-MeC-T ... 3'.
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Abstract
Deoxyribonucleic acid (DNA)-cytosine methylation specified by the wild-type Escherichia coli K 12 mec+ gene and by the N-3 drug resistance (R) factor was studied in vivo and in vitro. Phage lambda and fd were propagated in the presence of L-[methyl-3H]methionine in various host bacteria. The in vivo labeled DNA was isolated from purified phage and depurinated by formic acid-diphenylamine treatment. The resulting pyrimidine oligonucleotide tracts were separated according to size and base composition by chromatography on diethylaminoethyl-cellulose in 7 M urea at pH 5.5 and 3.5, respectively. The distribution of labeled 5-methylcytosine in DNA pyrimidine tracts was identical for phage grown in mec+ and mec minus (N-3) cells. For phage lambda the major 5-methylcytosine containing tract was the tripyrimidine, C2T; for both fd-mec minus (N-3) DNA and fd-mec+DNA, C2T was the sole 5-methylcytosine-containing tract. When various lambda DNAs were methylated to saturation in vitro by crude extracts from mec+ and mec minus (N-3) cells, the extent of cytosine methylation was the same. This is in contrast to in vivo methylation where lambda-mec minus (N-3) DNA contains twice as many 5-methylcytosines per genome as lambda-mec+ DNA. Therefore, we suggest that the K12 met+ cytosine methylase and the N-3 plasmid modification methylase are capable of recognizing the same nucleotide sequences, but that the in vivo methylation rate is lower in mec+ cells.
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