Income is associated with hippocampal/amygdala and education with cingulate cortex grey matter volume

Income and education are both elements of a person’s socioeconomic status, which is predictive of a broad range of life outcomes. The brain’s gray matter volume (GMV) is influenced by socioeconomic status and mediators related to an unhealthy life style. We here investigated two independent general population samples comprising 2838 participants (all investigated with the same MRI-scanner) with regard to the association of indicators of the socioeconomic status and gray matter volume. Voxel-based morphometry without prior hypotheses revealed that years of education were positively associated with GMV in the anterior cingulate cortex and net-equivalent income with gray matter volume in the hippocampus/amygdala region. Analyses of possible mediators (alcohol, cigarettes, body mass index (BMI), stress) revealed that the relationship between income and GMV in the hippocampus/amygdala region was partly mediated by self-reported stressors, and the association of years of education with GMV in the anterior cingulate cortex by BMI. These results corrected for whole brain effects (and therefore not restricted to certain brain areas) do now offer possibilities for more detailed hypotheses-driven approaches.

Physically active life style is associated with increased grey matter brain volume in a medial parieto-frontal network

To examine the association between the amount of sports activity performed during leisure time and gray matter volume (GMV) of the brain we investigated differences in GMV in a large cohort study of community-dwelling older adults. 967 individuals indicated their average weekly sports activity via a questionnaire, and underwent high resolution T1-weighted structural imaging of the brain. We used voxel based morphometry (CAT 12) in a region of interest approach for (1) comparing participants with higher versus lower sports activity (median split) and (2) calculating a linear regression on GMV and sports activity. We carefully corrected for other factors known to have an impact on GMV (sex, age, total brain volume, education, cigarettes and alcohol consumption, body mass index) and excluded pathology (history of psychiatric or neurological disease; visual inspection of brain scans). Those participants who spend more time performing sports activity per week (median split with > 1 h/week) showed higher GMV in the dorsomedial frontal lobe, the superior parietal lobe, and the precuneus/cuneus area. When splitting participants by their median (55.5 years) into two groups we found a stronger protective effect of sports against age related GMV decline for the older part of the cohort. Overall, a more active lifestyle was associated with increased GMV in areas associated with self-awareness and working memory. These cohort data support data on the protective role of sports activity for the GMV.

Subinternship in Radiology - A Practical Start to the Specialization?

Purpose: To identify factors influencing medical students to choose radiology in the four-month clinical elective in the final year of medical school following radiology subinternships. Materials and Methods: A subsample of medical students in a nationwide German online survey evaluated a subinternship in radiology (19 items). They were divided into four groups: Students who could imagine doing a clinical elective in radiology in the practical year based on their experiences during the subinternship ("yes, based on subinternship"), students who could not ("no, based on subinternship") and students who had made this decision prior to the subinternship ("yes, prior to subinternship" and "no, prior to subinternship"). Results: 94 medical students evaluated a radiology subinternship (54.4 % females). Based on their experiences during the subinternship, 54 students (57.4 %) intended to do a final year clinical elective in radiology, 39 of them (41.5 %) being encouraged by the subinternship. 40 (42.6 %) reported having a negative attitude towards a clinical elective in radiology, 16 of them (17.0 %) having made this decision based on their subinternship experience. Groups did not differ regarding gender (p = 0.396) and age (p = 0.853). Students motivated to do a final year clinical elective in radiology experienced excellent academic teaching (p = 0.001) and practical involvement (p = 0.003), achieved their learning goals more often (p = 0.001), were better integrated into the team (p = 0.001), and acquired more practical skills (p = 0.003). Overall satisfaction was higher in these groups (p = 0.001). Conclusion: Satisfaction with a radiology subinternship is crucial for motivating medical students to do a final year clinical elective in radiology. A structured subinternship and continuous mentoring should be targeted to keep students connected to radiology. Key Points: • Radiology subinternships influence further interest in the specialization.• The quality and structure of teaching critically influence student satisfaction.• Team integration and practical involvement positively affect the attitude towards a specialization. Citation Format: • Kasch R, Wirkner J, Hosten N et al. Subinternship in Radiology - A Practical Start to the Specialization? Fortschr Röntgenstr 2016; 188: 1024 - 1030.

Wie schreibe ich eine gute Übersichtsarbeit?

Übersichtsarbeiten stellen einen wichtigen Teil medizinischer Literatur dar und ermöglichen dem Leser innerhalb kurzer Zeit einen umfassenden Überblick über ein bestimmtes Thema zu bekommen. In der Radiologie und der Nuklearmedizin haben Übersichtsarbeiten oft einen erzählenden/narrativen Charakter und somit ein hohes Maß an Subjektivität. Diese Subjektivität ist letztlich ausschlaggebend dafür, dass narrative Übersichtsarbeiten bei der Erstellung wissenschaftlicher Leitlinien nicht berücksichtigt werden.

Ziel dieser Arbeit ist es, die Kriterien für die Erstellung einer systematischen Übersichtsarbeit zu beleuchten und den Leser so bei der Erstellung einer systematischen und strukturierten Übersichtsarbeit zu unterstützen.

Feasibility of gadoxetate disodium-enhanced MR cholangiography in chronic cholestatic biliary disease

AIM

To investigate the feasibility of gadoxetate disodium-enhanced magnetic resonance (MR) cholangiography in chronic obstructive cholestatic biliary disease in the clinical setting.

MATERIALS AND METHODS

Twenty-three patients with dilated bile duct trees and ten volunteers underwent gadoxetate disodium-enhanced liver MR cholangiography and were enrolled in the present retrospective study. Gadoxetate disodium was given in a standardized manner as a bolus injection at a dose of 0.25 mmol/kg of body weight (0.1 ml/kg). Region of interest-based measurement of mean enhancement of the dilated bile ducts was performed in series before gadoxetate disodium administration and during hepatobiliary phases.

RESULTS

Direct comparison of mean bile duct enhancement during hepatobiliary phases in the clinical imaging window between healthy volunteers [4.7 ± 2.2 arbitrary units (au)] and patients with dilated bile ducts (0.1 ± 0.3 au) revealed significantly lower or absent enhancement in dilated bile ducts (p = 0.001).

CONCLUSION

Standard clinical gadoxetate disodium-enhanced MR cholangiography is not a reliable technique for the evaluation of the biliary trees, because of altered biliary gadoxetate disodium elimination in patients with chronic obstructive biliary diseases.

[Endovascular treatment of acute ischemic stroke under conscious sedation compared to general anesthesia - safety, feasibility and clinical and radiological outcome]

PURPOSE

Vessel recanalization is an important predictor of clinical outcome in the treatment of acute ischemic stroke. Endovascular therapies are used with increasing frequency. There is no general agreement on the policy of anesthesia during endovascular therapy, ranging from general anesthesia (GA) to local anesthesia at the puncture site with conscious sedation (CS) as needed. The aim of the study was to evaluate the safety and feasibility and radiological and clinical outcome of endovascular stroke therapy under CS.

MATERIALS AND METHODS

We retrospectively included all patients with acute ischemic stroke who were treated with endovascular therapy over a five-year period. Data was evaluated with respect to type of sedation, conversion from CS to GA, recanalization rate, infarct volume and peri- and post-procedural complications.

RESULTS

There was a technical failure in 7 patients. Of the remaining 124 patients (mean age 68.8 ± 14.6 years), 65 were female (52 %). The site of occlusion was located in the anterior circulation in 94 patients (76 %) and in the posterior circulation in 30 cases (24 %). 105 patients (85 %) were treated under CS and 16 cases (13 %) primarily under GA. In 3 cases (2 %) peri-procedural conversion to GA was necessary. Primary intra-arterial thrombolysis, mechanical recanalization only, and combination therapy were performed in 60 (48 %), 27 (22 %) and 37 (30 %) patients, respectively. There were no significant differences for recanalization rate and complications between GA and CS. The mean procedure time was significantly shorter in patients treated under CS (p < 0.01).

CONCLUSION

Endovascular stroke therapy with CS is feasible, can be performed safely and is faster than with GA.

[Diffusion-weighted MRI - how many B-values are necessary?]

PURPOSE

Diffusion-weighted imaging (DWI) has become an important component in modern stroke imaging. This MR technique detects diffusion abnormalities, which can be quantified by computing apparent diffusion coefficient (ADC) maps. ADC values are typically calculated from a set of MR images obtained with varying degrees of diffusion weighting (b-values) using nonlinear regression. However, there is no agreement concerning the number of images needed for ADC calculation. The aim of our study was to determine how many b-values are necessary to reliably calculate ADC maps.

MATERIALS AND METHODS

In 100 consecutive patients with clinical signs of acute ischemic stroke, 6 identically oriented and centered diffusion data sets with different b-values were acquired. ROI analysis was performed for DWI-positive lesions, normal-appearing gray and white matter, CSF, and background noise. ADC values for each ROI were calculated using a nonlinear regression model. Additionally, the CNR and SNR were calculated for each ROI.

RESULTS

Acquisition time was 0:39 min for 2 b-values and up to 2:49 min for a sequence with 7 b-values. The mean ADC (× 10(-3) mm2/s) for ischemic lesions was 58.29, 58.47, 57.83, 57.81, 57.58 and 54.51 using 2, 3, 4, 5, 6, and 7 b-values. Ischemic lesions had significantly different mean ADC values only for high b-values (b = 2000 s/mm2).

CONCLUSION

ADC values can be reliably calculated using 2 b-values. Radiologists may use the more time-efficient 2-point method for reliably estimating ADC values and detecting ischemic lesions in the daily clinical routine.

Neurogenic heterotopic ossification: epidemiology and morphology on conventional radiographs in an early neurological rehabilitation population

OBJECTIVE

To retrospectively evaluate neurogenic heterotopic ossification in an early neurological rehabilitation population (phases B and C) with respect to epidemiology and morphology on conventional radiographs.

MATERIALS AND METHODS

Over a 4-year period, 1,463 patients treated at a clinic for early neurological rehabilitation were evaluated for clinical symptoms of neurogenic heterotopic ossification. In case of clinical suspicion, plain radiographs of the expected sites were obtained. If heterotopic ossification was detected, the initial and subsequent radiographs were retrospectively analyzed for sites, size, and morphology. Immature lesions were categorized as small (<10 mm) or large (10-100 mm).

RESULTS

The prevalence rate of neurogenic heterotopic ossification was 2.05%. The condition was most common in young male adults. The hip was the most common site accounting for more than half of the cases. Two or more ossifications were seen in 56.7% of the affected patients with approximately two-thirds showing bilateral symmetric involvement of corresponding joint regions. The size of ossifications strongly varied interindividually. Small immature lesions demonstrated less progression in size than large lesions during maturation (P < 0.05).

CONCLUSION

Standard radiographs, as a fast and inexpensive technique, allow the expected size progression of heterotopic ossifications during maturation to be estimated, which is relevant in terms of therapeutic decisions, patient mobilization, and neurological rehabilitation.

[Diagnosing neurovascular compression syndromes]

PURPOSE

Neurovascular compression syndromes are diseases caused by abnormal contact between a vessel loop and the root exit/entry zone of a cranial nerve. Compression can cause paroxysmal attacks of abnormal motor or sensory phenomena in the affected nerve.

MATERIALS AND METHODS

Review based on a selective analysis of the literature.

RESULTS

Neurovascular compression syndromes include well-established entities such as trigeminal neuralgia, facial hemispasm, vestibular paroxysmia and glossopharyngeus neuralgia but also cranial nerve disorders caused by compression due to an aneurysm, e. g., oculomotor nerve paresis caused by an aneurysm of the posterior communicating branch. An overview of neurovascular compression syndromes is given, outlining diagnostic procedures and the morphological imaging features of each syndrome as well as the changes seen after treatment are described.

CONCLUSION

Neurovascular compression syndromes are complex diseases. MR imaging plays an important role in the diagnostic workup of these diseases.

Percutaneous balloon kyphoplasty with the patient under intravenous analgesia and sedation: a feasibility study

BACKGROUND AND PURPOSE

Kyphoplasty is a minimally invasive procedure for the treatment of malignant or osteoporotic vertebral compression fractures, normally performed with the patient under general anesthesia. This may cause a therapeutic dilemma because these patients often have a very high risk for general anesthesia due to concomitant diseases. The aim of this study was to evaluate the safety and feasibility of percutaneous kyphoplasty by using IV anesthesia and sedation with midazolam and piritramide.

MATERIALS AND METHODS

From June 2007 to June 2009, we prospectively included 133 patients (77 women, 56 men; mean age, 69.18 ± 11.45 years) who were referred for BKP. Kyphoplasty was always performed under fluoroscopic guidance with a biplane angiographic system by using a transpedicular or extrapedicular approach. The individual anesthesia risk was assessed by using the ASA criteria. All procedures were performed with the patient under IV anesthesia and sedation with fractionated administration of midazolam and piritramide. Pain was assessed before and after treatment by using a VAS.

RESULTS

Ninety-nine patients (74.4%) had a significantly increased risk for general anesthesia (ASA score, ≥ 3). A total of 162 kyphoplasty procedures were performed. The mean amounts of midazolam and piritramide used were 11.3 ± 4.38 mg and 11.8 ± 3.98 mg, respectively. No complications related to IV anesthesia and sedation occurred. Periprocedural pain management was rated as sufficient, and all patients would undergo the procedure again.

CONCLUSIONS

Percutaneous BKP with the patient under IV anesthesia and sedation with midazolam and piritramide is a safe and feasible method for treating vertebral compression fractures in patients with an increased risk for general anesthesia.

[Medical and legal aspects of teleradiology in Germany]

In teleradiology, imaging data are transferred over a distance. This service is provided for the purpose of consulting or teleradiological reading in the narrower sense. Once a justification has been proposed in the latter, the examination is performed under the responsibility of a radiologist who is not present on site. The need for teleradiology services often derives from sparsely populated areas, a shortage of doctors, or the need for cost-efficient provision of radiological examinations. The providers and recipients of teleradiology services enter into an agreement specifying conditions for data transfer. The German ionizing radiation (medical exposure) regulations demand that the teleradiologist holds radiation protection qualifications and is able to reach the examination site within 45 - 60 minutes. In Germany, teleradiology services are still limited to nights, weekends, and vacations, although the German regulations allow an expansion under certain circumstances. Efforts to fundamentally change radiology in favor of teleradiology are putting the status of a radiological medical act as well as current teaching models at risk, thereby indirectly sustaining physician shortage. Transnational teleradiology services offer the possibility of cost reduction, taking advantage of out-of-hour reading and wage fluctuation. At the same time, such services are associated with deficits in quality and availability of personnel as well as the quality of medical services. In the long-term teleradiology concepts will fundamentally change radiology. Smaller radiology units will concentrate on daily business and fast reporting. Larger units also providing academic teaching can use teleradiology networks to offer specialized readings.

Ex-vivo human lung tumor model: use for temperature measurements during thermal ablation of NSCLC

PURPOSE

In the present study we used an ex-vivo human lung cancer model to compare temperature diffusion during thermal ablation using one laser fiber to that of a two-fiber approach. Furthermore, we examined whether there was a difference between temperature diffusion in normal lung tissue and tumor tissue during laser ablation.

MATERIALS AND METHODS

48 resected lung specimens containing non-small cell lung cancer were connected to a perfusion/ventilation apparatus and treated with 1 (22 specimens, group 1) or, in a second experiment, with 1 (13 specimens, group 2) or 2 (13 specimens, group 3) laser fibers. During tumor ablation, temperatures were measured interstitially every 5 sec. Laser ablation was followed by the taking of samples of 13 specimens for histological examination. For comparison we performed laser ablation in 7 specimens with normal lung tissue.

RESULTS

Laser treatment and temperature control were technically feasible in all samples. Thirty min after starting laser ablation with 1 fiber, a temperature of 61 ± 17 °C was achieved in group 1 at a distance of 10 mm from the laser fiber and a temperature of 74 ± 11 °C was achieved in group 2 (p = 0.1). In the middle between two active laser fibers placed 20 mm apart, a temperature of 93 ± 7 °C was achieved. The temperature reached in normal lung tissue after 20 min of laser ablation was 77 ± 15 °C at a distance of 10 mm from the laser fiber.

CONCLUSION

The ex-vivo model allowed performance of laser-induced thermal ablation in the perfused and ventilated lung. The use of two laser fibers increases the achieved temperatures significantly (p < 0.05). Temperatures reached in normal lung tissue were as high as in tumor tissue (p = 0.24).