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Schreiber LM, Lohr D, Baltes S, Vogel U, Elabyad IA, Bille M, Reiter T, Kosmala A, Gassenmaier T, Stefanescu MR, Kollmann A, Aures J, Schnitter F, Pali M, Ueda Y, Williams T, Christa M, Hofmann U, Bauer W, Gerull B, Zernecke A, Ergün S, Terekhov M. Ultra-high field cardiac MRI in large animals and humans for translational cardiovascular research. Front Cardiovasc Med 2023; 10:1068390. [PMID: 37255709 PMCID: PMC10225557 DOI: 10.3389/fcvm.2023.1068390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 04/04/2023] [Indexed: 06/01/2023] Open
Abstract
A key step in translational cardiovascular research is the use of large animal models to better understand normal and abnormal physiology, to test drugs or interventions, or to perform studies which would be considered unethical in human subjects. Ultrahigh field magnetic resonance imaging (UHF-MRI) at 7 T field strength is becoming increasingly available for imaging of the heart and, when compared to clinically established field strengths, promises better image quality and image information content, more precise functional analysis, potentially new image contrasts, and as all in-vivo imaging techniques, a reduction of the number of animals per study because of the possibility to scan every animal repeatedly. We present here a solution to the dual use problem of whole-body UHF-MRI systems, which are typically installed in clinical environments, to both UHF-MRI in large animals and humans. Moreover, we provide evidence that in such a research infrastructure UHF-MRI, and ideally combined with a standard small-bore UHF-MRI system, can contribute to a variety of spatial scales in translational cardiovascular research: from cardiac organoids, Zebra fish and rodent hearts to large animal models such as pigs and humans. We present pilot data from serial CINE, late gadolinium enhancement, and susceptibility weighted UHF-MRI in a myocardial infarction model over eight weeks. In 14 pigs which were delivered from a breeding facility in a national SARS-CoV-2 hotspot, we found no infection in the incoming pigs. Human scanning using CINE and phase contrast flow measurements provided good image quality of the left and right ventricle. Agreement of functional analysis between CINE and phase contrast MRI was excellent. MRI in arrested hearts or excised vascular tissue for MRI-based histologic imaging, structural imaging of myofiber and vascular smooth muscle cell architecture using high-resolution diffusion tensor imaging, and UHF-MRI for monitoring free radicals as a surrogate for MRI of reactive oxygen species in studies of oxidative stress are demonstrated. We conclude that UHF-MRI has the potential to become an important precision imaging modality in translational cardiovascular research.
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Affiliation(s)
- Laura M. Schreiber
- Department of Cardiovascular Imaging and Chair of Molecular and Cellular Imaging, Comprehensive Heart Failure Center Wuerzburg (CHFC), University Hospital Wuerzburg, Wuerzburg, Germany
| | - David Lohr
- Department of Cardiovascular Imaging and Chair of Molecular and Cellular Imaging, Comprehensive Heart Failure Center Wuerzburg (CHFC), University Hospital Wuerzburg, Wuerzburg, Germany
| | - Steffen Baltes
- Department of Cardiovascular Imaging and Chair of Molecular and Cellular Imaging, Comprehensive Heart Failure Center Wuerzburg (CHFC), University Hospital Wuerzburg, Wuerzburg, Germany
| | - Ulrich Vogel
- Institute for Hygiene and Microbiology, University of Wuerzburg, Wuerzburg, Germany
| | - Ibrahim A. Elabyad
- Department of Cardiovascular Imaging and Chair of Molecular and Cellular Imaging, Comprehensive Heart Failure Center Wuerzburg (CHFC), University Hospital Wuerzburg, Wuerzburg, Germany
| | - Maya Bille
- Department of Cardiovascular Imaging and Chair of Molecular and Cellular Imaging, Comprehensive Heart Failure Center Wuerzburg (CHFC), University Hospital Wuerzburg, Wuerzburg, Germany
| | - Theresa Reiter
- Department of Cardiovascular Imaging and Chair of Molecular and Cellular Imaging, Comprehensive Heart Failure Center Wuerzburg (CHFC), University Hospital Wuerzburg, Wuerzburg, Germany
- Department of Internal Medicine I/Cardiology, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Aleksander Kosmala
- Department of Cardiovascular Imaging and Chair of Molecular and Cellular Imaging, Comprehensive Heart Failure Center Wuerzburg (CHFC), University Hospital Wuerzburg, Wuerzburg, Germany
- Department of Radiology, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Tobias Gassenmaier
- Department of Cardiovascular Imaging and Chair of Molecular and Cellular Imaging, Comprehensive Heart Failure Center Wuerzburg (CHFC), University Hospital Wuerzburg, Wuerzburg, Germany
- Department of Radiology, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Maria R. Stefanescu
- Department of Cardiovascular Imaging and Chair of Molecular and Cellular Imaging, Comprehensive Heart Failure Center Wuerzburg (CHFC), University Hospital Wuerzburg, Wuerzburg, Germany
| | - Alena Kollmann
- Department of Cardiovascular Imaging and Chair of Molecular and Cellular Imaging, Comprehensive Heart Failure Center Wuerzburg (CHFC), University Hospital Wuerzburg, Wuerzburg, Germany
| | - Julia Aures
- Department of Cardiovascular Imaging and Chair of Molecular and Cellular Imaging, Comprehensive Heart Failure Center Wuerzburg (CHFC), University Hospital Wuerzburg, Wuerzburg, Germany
| | - Florian Schnitter
- Department of Internal Medicine I/Cardiology, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Mihaela Pali
- Department of Cardiovascular Imaging and Chair of Molecular and Cellular Imaging, Comprehensive Heart Failure Center Wuerzburg (CHFC), University Hospital Wuerzburg, Wuerzburg, Germany
| | - Yuichiro Ueda
- Institute of Anatomy and Cell Biology, Julius-Maximilians-University, Wuerzburg, Germany
| | - Tatiana Williams
- Department of Cardiovascular Genetics, Comprehensive Heart Failure Center Wuerzburg, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Martin Christa
- Department of Internal Medicine I/Cardiology, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Ulrich Hofmann
- Department of Internal Medicine I/Cardiology, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Wolfgang Bauer
- Department of Internal Medicine I/Cardiology, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Brenda Gerull
- Department of Internal Medicine I/Cardiology, University Hospital Wuerzburg, Wuerzburg, Germany
- Department of Cardiovascular Genetics, Comprehensive Heart Failure Center Wuerzburg, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Alma Zernecke
- Institute of Experimental Biomedicine, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Süleyman Ergün
- Institute of Anatomy and Cell Biology, Julius-Maximilians-University, Wuerzburg, Germany
| | - Maxim Terekhov
- Department of Cardiovascular Imaging and Chair of Molecular and Cellular Imaging, Comprehensive Heart Failure Center Wuerzburg (CHFC), University Hospital Wuerzburg, Wuerzburg, Germany
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Traub J, Schürmann P, Schmitt D, Gassenmaier T, Fette G, Frantz S, Störk S, Beyersdorf N, Boivin-Jahns V, Jahns R, Hofmann U, Frey A. Features of metabolic syndrome and inflammation independently affect left ventricular function early after first myocardial infarction. Int J Cardiol 2023; 370:43-50. [PMID: 36306955 DOI: 10.1016/j.ijcard.2022.10.142] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 10/13/2022] [Accepted: 10/19/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND A high body mass index (BMI) is often associated with metabolic syndrome, which is accompanied by systemic low-grade chronic inflammation. Here, we analyzed whether BMI, other components of metabolic syndrome, and/or inflammatory markers correlate with left ventricular geometry, function, and infarct size as assessed by serial cardiac magnetic resonance imaging (MRI) after a first (clinically evident) ST-elevation MI (STEMI). METHODS Within the Etiology, Titre-Course, and effect on Survival (ETiCS) study, cardiac MRI conducted 7-9 days and 12 months after MI enabled longitudinal characterization of patients with a first STEMI along with serial routine blood counts and multiplex cytokine measurements. RESULTS Of 91 locally included STEMI patients, 47% were overweight (25 kg/m2 < BMI < 30 kg/m2) and 24% were obese (BMI ≥ 30 kg/m2). No patient died during 12 months of follow-up. Left ventricular ejection fraction (LVEF), measured 7-9 days after STEMI, was significantly lower in overweight (49.5 ± 7.1%) and obese (45.8 ± 12.0%) patients than in the normal weight group (56.2 ± 7.7%). Along with BMI (T = -3.8; p < 0.001), hemoglobin A1c (HbA1c; T = -3.1; p = 0.004) and peak C-reactive protein (T = -2.6; p = 0.013) emerged as independent predictors of worse LVEF 7-9 days post MI (R2 = 0.45). Only peak C-reactive protein (T = -4.4; p < 0.001), but not parameters of the metabolic syndrome, predicted worse LVEF 12 months after STEMI (R2 = 0.20). CONCLUSION Both BMI and HbA1c correlated negatively with LVEF only early, but not late after STEMI. Peak CRP evolved as strongest predictor of cardiac function at all time points independent of the metabolic syndrome.
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Affiliation(s)
- Jan Traub
- Department of Internal Medicine I, University Hospital Würzburg, Germany; Comprehensive Heart Failure Center, University and University Hospital Würzburg, Germany; Interdisciplinary Center for Clinical Research, University Würzburg, Germany.
| | - Paula Schürmann
- Department of Internal Medicine I, University Hospital Würzburg, Germany; Comprehensive Heart Failure Center, University and University Hospital Würzburg, Germany
| | - Dominik Schmitt
- Department of Internal Medicine I, University Hospital Würzburg, Germany
| | - Tobias Gassenmaier
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Germany
| | - Georg Fette
- Data Integration Center, University Hospital Würzburg, Germany
| | - Stefan Frantz
- Department of Internal Medicine I, University Hospital Würzburg, Germany; Comprehensive Heart Failure Center, University and University Hospital Würzburg, Germany
| | - Stefan Störk
- Department of Internal Medicine I, University Hospital Würzburg, Germany; Comprehensive Heart Failure Center, University and University Hospital Würzburg, Germany
| | - Niklas Beyersdorf
- Institute for Virology and Immunobiology, University of Würzburg, Germany
| | - Valérie Boivin-Jahns
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Germany; Department of Pharmacology and Toxicology, University of Würzburg, Germany
| | - Roland Jahns
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Germany; Interdisciplinary Bank of Biomaterials and Data Würzburg, University Hospital and University Würzburg, Germany
| | - Ulrich Hofmann
- Department of Internal Medicine I, University Hospital Würzburg, Germany; Comprehensive Heart Failure Center, University and University Hospital Würzburg, Germany
| | - Anna Frey
- Department of Internal Medicine I, University Hospital Würzburg, Germany; Comprehensive Heart Failure Center, University and University Hospital Würzburg, Germany
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Toggweiler S, Brinkert M, Wolfrum M, Moccetti F, Stämpfli SF, De Boeck BWL, Magarzo G, Gassenmaier T, Attinger-Toller A, Bossard M, Fornaro J, Buhmann R, Cuculi F, Kobza R. Paravalvular Leak After Implantation of the ACURATE neo and the ACURATE neo2 Transcatheter Heart Valve. Cardiovasc Revasc Med 2022; 45:37-43. [PMID: 35902306 DOI: 10.1016/j.carrev.2022.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 07/21/2022] [Indexed: 01/04/2023]
Affiliation(s)
| | - Miriam Brinkert
- Department of Cardiology, Kantonsspital Aarau, Aarau, Switzerland
| | - Mathias Wolfrum
- Heart Center Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland
| | | | - Simon F Stämpfli
- Heart Center Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Bart W L De Boeck
- Heart Center Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland; Department of Radiology, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Getulio Magarzo
- Heart Center Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland
| | | | | | - Matthias Bossard
- Heart Center Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Jürgen Fornaro
- Department of Radiology, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Ralf Buhmann
- Department of Radiology, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Florim Cuculi
- Heart Center Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Richard Kobza
- Heart Center Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland
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Klingenberg R, Holtkamp F, Grün D, Frey A, Jahns V, Jahns R, Gassenmaier T, Hamm CW, Frantz S, Keller T. Use of serial changes in biomarkers vs. baseline levels to predict left ventricular remodelling after STEMI. ESC Heart Fail 2022; 10:432-441. [PMID: 36271665 PMCID: PMC9871716 DOI: 10.1002/ehf2.14204] [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: 05/26/2022] [Revised: 09/01/2022] [Accepted: 10/02/2022] [Indexed: 01/29/2023] Open
Abstract
AIMS Cellular communication network factor 1 (CCN1) is an independent predictor of MACE after ACS and elevated levels correlated with infarct size after STEMI. We compared the prognostic accuracy of baseline levels of CCN1, NT-proBNP, hsTnT, and ST2 and changes in levels over time to predict the development of structural and functional alterations typical of LV remodelling. METHODS Serial 3-T cMRI scans were performed to determine LVEF, LVEDV, LVESV, infarct size, and relative infarct size, which were correlated with serial measurements of the four biomarkers. The prognostic significance of these biomarkers was assessed by multiple logistic regression analysis by examining their performance in predicting dichotomized cardiac MRI values 12 months after STEMI based on their median. For each biomarker three models were created using baseline (BL), the Δ value (BL to 6 months), and the two values together as predictors. All models were adjusted for age and renal function. Receiver operator curves were plotted with area under the curve (AUC) to discriminate the prognostic accuracy of individual biomarkers for MRI-based structural or functional changes. RESULTS A total of 44 predominantly male patients (88.6%) from the ETiCS (Etiology, Titre-Course, and Survival) study were identified at a mean age of 55.5 ± 11.5 (SD) years treated by successful percutaneous coronary intervention (97.7%) at a rate of 95.5% stent implantation within a median pain-to-balloon time of 260 min (IQR 124-591). Biomarkers hsTnT and ST2 were identified as strong predictors (AUC > 0.7) of LVEDV and LVEF. BL measurement to predict LVEF [hsTnT: AUC 0.870 (95% CI: 0.756-0.983), ST2: AUC 0.763 (95% CI: 0.615-0.911)] and the Δ value BL-6M [hsTnT: AUC 0.870 (95% CI: 0.756-0.983), ST2: AUC 0.809 (95% CI: 0.679-0.939)] showed a high prognostic value without a significant difference for the comparison of the BL model vs. the Δ-value model (BL-6M) for hsTnT (P = 1) and ST2 (P = 0.304). The combined model that included baseline and Δ value as predictors was not able to improve the ability to predict LVEF [hsTnT: AUC 0.891 (0.791-0.992), P = 0.444; ST2: AUC 0.778 (0.638-0.918), P = 0.799]. Baseline levels of CCN1 were closely associated with LVEDV at 12 months [AUC 0.708 (95% CI: 0.551-0.865)] and infarct size [AUC 0.703 (95% CI: 0.534-0.872)]. CONCLUSIONS Baseline biomarker levels of hsTnT and ST2 were the strongest predictors of LVEF and LVEDV at 12 months after STEMI. The association of CCN1 with LVEDV and infarct size warrants further study into the underlying pathophysiology of this novel biomarker.
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Affiliation(s)
- Roland Klingenberg
- Department of CardiologyKerckhoff Heart and Thorax Center, and Campus of the Justus Liebig University of GiessenGiessenGermany,DZHK (German Center for Cardiovascular Research), partner site Rhine‐MainBad NauheimGermany
| | - Franziska Holtkamp
- Department of CardiologyKerckhoff Heart and Thorax Center, and Campus of the Justus Liebig University of GiessenGiessenGermany,DZHK (German Center for Cardiovascular Research), partner site Rhine‐MainBad NauheimGermany,Department of Internal Medicine I, CardiologyJustus‐Liebig‐UniversityGießenGermany
| | - Dimitri Grün
- Department of Internal Medicine I, CardiologyJustus‐Liebig‐UniversityGießenGermany
| | - Anna Frey
- Comprehensive Heart Failure Center (DZHI)University Hospital WürzburgWürzburgGermany,Department of Internal Medicine IUniversity Hospital WürzburgWürzburgGermany
| | - Valérie Jahns
- Comprehensive Heart Failure Center (DZHI)University Hospital WürzburgWürzburgGermany,Department of Pharmacology and ToxicologyUniversity Hospital WürzburgWürzburgGermany
| | - Roland Jahns
- Comprehensive Heart Failure Center (DZHI)University Hospital WürzburgWürzburgGermany,Interdisciplinary Bank of Biomaterials and Data Würzburg (IBDW)University and University Hospital WürzburgWürzburgGermany
| | - Tobias Gassenmaier
- Comprehensive Heart Failure Center (DZHI)University Hospital WürzburgWürzburgGermany,Institute of RadiologyUniversity Hospital WürzburgWürzburgGermany
| | - Christian W. Hamm
- Department of CardiologyKerckhoff Heart and Thorax Center, and Campus of the Justus Liebig University of GiessenGiessenGermany,DZHK (German Center for Cardiovascular Research), partner site Rhine‐MainBad NauheimGermany,Department of Internal Medicine I, CardiologyJustus‐Liebig‐UniversityGießenGermany
| | - Stefan Frantz
- Comprehensive Heart Failure Center (DZHI)University Hospital WürzburgWürzburgGermany,Department of Internal Medicine IUniversity Hospital WürzburgWürzburgGermany
| | - Till Keller
- Department of CardiologyKerckhoff Heart and Thorax Center, and Campus of the Justus Liebig University of GiessenGiessenGermany,DZHK (German Center for Cardiovascular Research), partner site Rhine‐MainBad NauheimGermany,Department of Internal Medicine I, CardiologyJustus‐Liebig‐UniversityGießenGermany
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Luetkens K, Gassenmaier T, Kunz A, Gietzen HC, Huflage H, Bley AT, Schmitt R, Grunz PJ. Stellenwert der intravenös kontrastverstärkten MRT für die Diagnose von zentralen und peripheren TFCC-Läsionen. ROFO-FORTSCHR RONTG 2022. [DOI: 10.1055/s-0042-1749925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- K Luetkens
- Uniklinikum Würzburg, Radiologie, Würzburg
| | - T Gassenmaier
- Institut für Diagnostische und Interventionelle Radiologie, Uniklinik Würzburg, Würzburg
| | - A Kunz
- Institut für Diagnostische und Interventionelle Radiologie, Uniklinik Würzburg, Wuerzburg
| | - H C Gietzen
- Institut für Diagnostische und Interventionelle Radiologie, Uniklinik Würzburg, Würzburg
| | - H Huflage
- Institut für Diagnostische und Interventionelle Radiologie, Uniklinik Würzburg, Würzburg
| | - A T Bley
- Institut für Diagnostische und Interventionelle Radiologie, Uniklinik Würzburg, Würzburg
| | - R Schmitt
- Institut für Diagnostische und Interventionelle Radiologie, Uniklinik Würzburg, Würzburg
| | - P J Grunz
- Institut für Diagnostische und Interventionelle Radiologie, Uniklinik Würzburg, Würzburg
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Kunz A, Luetkens K, Huflage H, Bley T, Gassenmaier T, Grunz PJ. Zinn-Filter-Einsatz in der Kegelstrahl-CT-Bildgebung des Extremitätenskeletts mit einem multifunktionalen Roboter-Röntgensystem. ROFO-FORTSCHR RONTG 2022. [DOI: 10.1055/s-0042-1749928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- A Kunz
- Universitätsklinikum Würzburg, Inst. f. Diagn. u. Interv. Radiologie, Würzburg
| | - K Luetkens
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Würzburg, Würzburg
| | - H Huflage
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Würzburg, Würzburg
| | - T Bley
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Würzburg, Würzburg
| | - T Gassenmaier
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Würzburg, Würzburg
| | - P J Grunz
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Würzburg, Würzburg
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Holtkamp F, Gruen D, Frey A, Jahns V, Jahns R, Gassenmaier T, Hamm C, Frantz S, Keller T, Klingenberg R. Does a 6-month change in circulating biomarkers improve the prognostic power of baseline values for predicting cardiac MRI pathologies in patients with STEMI? Atherosclerosis 2022. [DOI: 10.1016/j.atherosclerosis.2022.06.221] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Luetkens KS, Huflage H, Kunz AS, Ritschl L, Herbst M, Kappler S, Ergün S, Goertz L, Pennig L, Bley TA, Gassenmaier T, Grunz JP. The effect of tin prefiltration on extremity cone-beam CT imaging with a twin robotic X-ray system. Radiography (Lond) 2021; 28:433-439. [PMID: 34716089 DOI: 10.1016/j.radi.2021.10.009] [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: 05/30/2021] [Revised: 08/13/2021] [Accepted: 10/09/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION While tin prefiltration is established in various CT applications, its value in extremity cone-beam CT relative to optimized spectra has not been thoroughly assessed thus far. This study aims to investigate the effect of tin filters in extremity cone-beam CT with a twin-robotic X-ray system. METHODS Wrist, elbow and ankle joints of two cadaveric specimens were examined in a laboratory setup with different combinations of prefiltration (copper, tin), tube voltage and current-time product. Image quality was assessed subjectively by five radiologists with Fleiss' kappa being computed to measure interrater agreement. To provide a semiquantitative criterion for image quality, contrast-to-noise ratios (CNR) were compared for standardized regions of interest. Volume CT dose indices were calculated for a 16 cm polymethylmethacrylate phantom. RESULTS Radiation dose ranged from 17.4 mGy in the clinical standard protocol without tin filter to as low as 0.7 mGy with tin prefiltration. Image quality ratings and CNR for tin-filtered scans with 100 kV were lower than for 80 kV studies with copper prefiltration despite higher dose (11.2 and 5.6 vs. 4.5 mGy; p < 0.001). No difference was ascertained between 100 kV scans with tin filtration and 60 kV copper-filtered scans with 75% dose reduction (subjective: p = 0.101; CNR: p = 0.706). Fleiss' kappa of 0.597 (95% confidence interval 0.567-0.626; p < 0.001) indicated moderate interrater agreement. CONCLUSION Considerable dose reduction is feasible with tin prefiltration, however, the twin-robotic X-ray system's low-dose potential for extremity 3D imaging is maximized with a dedicated low-kilovolt scan protocol in situations without extensive beam-hardening artifacts. IMPLICATIONS FOR PRACTICE Low-kilovolt imaging with copper prefiltration provides a superior trade-off between dose reduction and image quality compared to tin-filtered cone-beam CT scan protocols with higher tube voltage.
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Affiliation(s)
- K S Luetkens
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, Germany.
| | - H Huflage
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, Germany.
| | - A S Kunz
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, Germany.
| | - L Ritschl
- X-ray Products - Research & Development, Siemens Healthcare GmbH, Siemensstraße 1, 91301, Forchheim, Germany.
| | - M Herbst
- X-ray Products - Research & Development, Siemens Healthcare GmbH, Siemensstraße 1, 91301, Forchheim, Germany.
| | - S Kappler
- X-ray Products - Research & Development, Siemens Healthcare GmbH, Siemensstraße 1, 91301, Forchheim, Germany.
| | - S Ergün
- Institute of Anatomy and Cell Biology, University of Würzburg, Koellikerstraße 6, 97070 Würzburg, Germany.
| | - L Goertz
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937 Cologne, Germany.
| | - L Pennig
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937 Cologne, Germany.
| | - T A Bley
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, Germany.
| | - T Gassenmaier
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, Germany.
| | - J-P Grunz
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, Germany.
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Petritsch B, Petri N, Weng AM, Petersilka M, Allmendinger T, Bley TA, Gassenmaier T. Photon-Counting Computed Tomography for Coronary Stent Imaging: In Vitro Evaluation of 28 Coronary Stents. Invest Radiol 2021; 56:653-660. [PMID: 33867450 DOI: 10.1097/rli.0000000000000787] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [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: 10/21/2022]
Abstract
OBJECTIVES The aim of this study was to assess in-stent lumen visibility and quantitative image characteristics of different coronary stents using a novel photon-counting detector (PCD) computed tomography (CT) system in comparison to a state-of-the-art energy-integrating detector (EID) CT scanner. MATERIALS AND METHODS In this in vitro phantom study, 28 different coronary stents ranging from 2.25 to 4.5 mm lumen diameter were expanded into plastic tubes filled with contrast agent. Stent-containing plastic tubes were positioned in a custom-made emulsion-filled phantom, which was inserted into an anthropomorphic phantom simulating a medium-sized patient. Computed tomography scans were acquired parallel to the scanners' z axis using a novel cadmium telluride-based PCD CT system (SOMATOM CountPlus; Siemens Healthcare GmbH, Forchheim Germany), operating in 2 different modes (standard-resolution mode [SR] and ultra-high-resolution [UHR] mode), and a latest generation dual-source EID CT system (SOMATOM Force; Siemens Healthcare GmbH, Forchheim). CTDIvol-matched images were reconstructed with comparable convolution kernels and using the same reconstruction parameters. In-stent lumen visibility (in %), increase in in-stent attenuation (expressed as Δ in-stent CT attenuation), and image noise (in Hounsfield unit) were manually measured. Parts of the image analysis (in-stent lumen visibility) were additionally performed in an automated way. Differences were tested using Wilcoxon signed rank test. RESULTS The best in-stent lumen visibility was achieved with the PCD-UHR mode and the lowest noise levels with the PCD-SR mode. The median in-stent lumen visibility was significantly higher (P < 0.001) with PCD (SR, 66.7%; interquartile range [IQR], 63.3-72.3; UHR, 68.9%; IQR, 64.4-74.4) compared with EID (65.4%; IQR, 62.2-70.4). The Δ in-stent CT attenuation was significantly lower for PCD in both SR (78 HU; IQR, 46-108; P = 0.024) and UHR (85 HU; IQR, 59-113; P = 0.006) compared with EID (108 HU; IQR, 85-126). Image noise was significantly lower (P < 0.001) for PCD-SR (21 HU; IQR, 21-21) compared with EID images (25 HU; IQR, 24-25.0). CONCLUSIONS The PCD provides superior in-stent lumen visibility and quantitative image characteristics when compared with conventional EID.
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Affiliation(s)
| | - Nils Petri
- Internal Medicine I, University Hospital Würzburg, Würzburg
| | - Andreas M Weng
- From the Departments of Diagnostic and Interventional Radiology
| | | | | | - Thorsten A Bley
- From the Departments of Diagnostic and Interventional Radiology
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10
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Heidenreich JF, Gassenmaier T, Ankenbrand MJ, Bley TA, Wech T. Self-configuring nnU-net pipeline enables fully automatic infarct segmentation in late enhancement MRI after myocardial infarction. Eur J Radiol 2021; 141:109817. [PMID: 34144308 DOI: 10.1016/j.ejrad.2021.109817] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 08/24/2020] [Revised: 05/07/2021] [Accepted: 06/07/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To fully automatically derive quantitative parameters from late gadolinium enhancement (LGE) cardiac MR (CMR) in patients with myocardial infarction and to investigate if phase sensitive or magnitude reconstructions or a combination of both results in best segmentation accuracy. METHODS In this retrospective single center study, a convolutional neural network with a U-Net architecture with a self-configuring framework ("nnU-net") was trained for segmentation of left ventricular myocardium and infarct zone in LGE-CMR. A database of 170 examinations from 78 patients with history of myocardial infarction was assembled. Separate fitting of the model was performed, using phase sensitive inversion recovery, the magnitude reconstruction or both contrasts as input channels. Manual labelling served as ground truth. In a subset of 10 patients, the performance of the trained models was evaluated and quantitatively compared by determination of the Sørensen-Dice similarity coefficient (DSC) and volumes of the infarct zone compared with the manual ground truth using Pearson's r correlation and Bland-Altman analysis. RESULTS The model achieved high similarity coefficients for myocardium and scar tissue. No significant difference was observed between using PSIR, magnitude reconstruction or both contrasts as input (PSIR and MAG; mean DSC: 0.83 ± 0.03 for myocardium and 0.72 ± 0.08 for scars). A strong correlation for volumes of infarct zone was observed between manual and model-based approach (r = 0.96), with a significant underestimation of the volumes obtained from the neural network. CONCLUSION The self-configuring nnU-net achieves predictions with strong agreement compared to manual segmentation, proving the potential as a promising tool to provide fully automatic quantitative evaluation of LGE-CMR.
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Affiliation(s)
- Julius F Heidenreich
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Germany.
| | - Tobias Gassenmaier
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Germany
| | - Markus J Ankenbrand
- Department of Cellular and Molecular Imaging, Comprehensive Heart Failure Center, University Hospital Würzburg, Germany; Center for Computational and Theoretical Biology, University of Würzburg, Germany
| | - Thorsten A Bley
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Germany
| | - Tobias Wech
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Germany
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11
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Gietzen C, Luetkens K, Bley T, Gassenmaier T, Schmitt R, Grunz JP. Added Diagnostic Value of Radial Plane View for Evaluation of TFCC injury in CT Arthrography of the Wrist. Semin Musculoskelet Radiol 2021. [DOI: 10.1055/s-0041-1731574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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12
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Luetkens K, Laas S, Haßler S, Gassenmaier T, Christopoulos G, Schmitt R, Luitjens J, Grunz JP. Gadolinium-enhanced MRI of the Wrist for Injuries of the Triangular Fibrocartilage Complex. Semin Musculoskelet Radiol 2021. [DOI: 10.1055/s-0041-1731533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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13
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Huflage H, Pennig L, Gietzen C, Bley T, Gassenmaier T, Grunz JP. Prototype Cone-beam CT Scan Mode on a Multipurpose X-ray System: Image Quality in Cadaveric Elbow Scans Compared with Third-generation Dual-source CT. Semin Musculoskelet Radiol 2021. [DOI: 10.1055/s-0041-1731522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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14
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Grunz JP, Pennig L, Fieber T, Gietzen CH, Heidenreich JF, Huflage H, Gruschwitz P, Kuhl PJ, Petritsch B, Kosmala A, Bley TA, Gassenmaier T. Twin robotic x-ray system in small bone and joint trauma: impact of cone-beam computed tomography on treatment decisions. Eur Radiol 2020; 31:3600-3609. [PMID: 33280057 PMCID: PMC8128787 DOI: 10.1007/s00330-020-07563-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 07/11/2020] [Revised: 09/24/2020] [Accepted: 11/25/2020] [Indexed: 12/11/2022]
Abstract
Objectives Trauma evaluation of extremities can be challenging in conventional radiography. A multi-use x-ray system with cone-beam CT (CBCT) option facilitates ancillary 3-D imaging without repositioning. We assessed the clinical value of CBCT scans by analyzing the influence of additional findings on therapy. Methods Ninety-two patients underwent radiography and subsequent CBCT imaging with the twin robotic scanner (76 wrist/hand/finger and 16 ankle/foot/toe trauma scans). Reports by on-call radiologists before and after CBCT were compared regarding fracture detection, joint affliction, comminuted injuries, and diagnostic confidence. An orthopedic surgeon recommended therapy based on reported findings. Surgical reports (N = 52) and clinical follow-up (N = 85) were used as reference standard. Results CBCT detected more fractures (83/64 of 85), joint involvements (69/53 of 71), and multi-fragment situations (68/50 of 70) than radiography (all p < 0.001). Six fractures suspected in radiographs were ruled out by CBCT. Treatment changes based on additional information from CBCT were recommended in 29 patients (31.5%). While agreement between advised therapy before CBCT and actual treatment was moderate (κ = 0.41 [95% confidence interval 0.35–0.47]; p < 0.001), agreement after CBCT was almost perfect (κ = 0.88 [0.83–0.93]; p < 0.001). Diagnostic confidence increased considerably for CBCT studies (p < 0.001). Median effective dose for CBCT was 4.3 μSv [3.3–5.3 μSv] compared to 0.2 μSv [0.1–0.2 μSv] for radiography. Conclusions CBCT provides advantages for the evaluation of acute small bone and joint trauma by detecting and excluding extremity fractures and fracture-related findings more reliably than radiographs. Additional findings induced therapy change in one third of patients, suggesting substantial clinical impact. Key Points • With cone-beam CT, extremity fractures and fracture-related findings can be detected and ruled out more reliably than with conventional radiography. • Additional diagnostic information provided by cone-beam CT scans has substantial impact on therapy in small bone and joint trauma. • For distal extremity injury assessment, one-stop-shop imaging without repositioning is feasible with the twin robotic x-ray system.
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Affiliation(s)
- Jan-Peter Grunz
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany.
| | - Lenhard Pennig
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Tabea Fieber
- Department of Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - Carsten Herbert Gietzen
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - Julius Frederik Heidenreich
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - Henner Huflage
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - Philipp Gruschwitz
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - Philipp Josef Kuhl
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - Bernhard Petritsch
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - Aleksander Kosmala
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - Thorsten Alexander Bley
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - Tobias Gassenmaier
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
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15
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Sagmeister F, Herrmann S, Gassenmaier T, Bernhardt P, Rasche V, Liebold A, Weidemann F, Brunner H, Beer M. Non-invasive determination of pressure recovery by cardiac MRI and echocardiography in patients with severe aortic stenosis: short and long-term outcome prediction. J Int Med Res 2020; 48:300060520954708. [PMID: 33076730 PMCID: PMC7592334 DOI: 10.1177/0300060520954708] [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] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To assess the influence of pressure recovery (PR)-corrected haemodynamic parameters on outcome in patients with aortic stenosis. METHODS Aortic stenosis severity parameters were corrected for PR (increase in static pressure due to decreasing dynamic pressure), assessed using transthoracic echocardiography (TTE) or cardiac magnetic resonance imaging (CMR), in patients with aortic stenosis. PR, indexed PR (iPR) and energy loss index (ELI) were determined. Factors that predicted all-cause mortality, and 9-month or 10-year New York Heart Association classification ≥2 were assessed using Cox proportional hazards regression. RESULTS A total of 25 patients, aged 68 ± 10 years, were included. PR was 17 ± 6 mmHg using CMR, and CMR correlated with TTE measurements. PR correction using CMR data reduced the AS-severity classification in 12-20% of patients, and correction using TTE data reduced the AS-severity classification in 16% of patients. Age (Wald 4.774) was a statistically significant predictor of all-cause mortality; effective orifice area (Wald 3.753) and ELI (Wald 3.772) almost reached significance. CONCLUSIONS PR determination may result in significant reclassification of aortic stenosis severity and may hold value in predicting all-cause mortality.
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Affiliation(s)
- Florian Sagmeister
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany.,Department of Diagnostic and Interventional Radiology, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Sebastian Herrmann
- Department of Medicine I, Division of Cardiology, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Tobias Gassenmaier
- Department of Diagnostic and Interventional Radiology, University Hospital Wuerzburg, Wuerzburg, Germany
| | | | - Volker Rasche
- Department of Medicine II, Cardiology, University Hospital Ulm, Ulm, Germany
| | - Andreas Liebold
- Department of Cardiac, Thoracic and Vascular Surgery, University Hospital Ulm, Ulm, Germany
| | - Frank Weidemann
- Department of Medicine I, Division of Cardiology, University Hospital Wuerzburg, Wuerzburg, Germany.,Department of Medicine I, Hospital Centre Vest, Recklinghausen, Germany
| | - Horst Brunner
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany
| | - Meinrad Beer
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany.,Department of Diagnostic and Interventional Radiology, University Hospital Wuerzburg, Wuerzburg, Germany
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16
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Grunz JP, Weng AM, Kunz AS, Veyhl-Wichmann M, Schmitt R, Gietzen CH, Pennig L, Herz S, Ergün S, Bley TA, Gassenmaier T. 3D cone-beam CT with a twin robotic x-ray system in elbow imaging: comparison of image quality to high-resolution multidetector CT. Eur Radiol Exp 2020; 4:52. [PMID: 32895778 PMCID: PMC7477066 DOI: 10.1186/s41747-020-00177-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 07/03/2020] [Indexed: 02/07/2023] Open
Abstract
Background Elbow imaging is challenging with conventional multidetector computed tomography (MDCT), while cone-beam CT (CBCT) provides superior options. We compared intra-individually CBCT versus MDCT image quality in cadaveric elbows. Methods A twin robotic x-ray system with new CBCT mode and a high-resolution clinical MDCT were compared in 16 cadaveric elbows. Both systems were operated with a dedicated low-dose (LD) protocol (equivalent volume CT dose index [CTDIvol(16 cm)] = 3.3 mGy) and a regular clinical scan dose (RD) protocol (CTDIvol(16 cm) = 13.8 mGy). Image quality was evaluated by two radiologists (R1 and R2) on a seven-point Likert scale, and estimation of signal intensity in cancellous bone was conducted. Wilcoxon signed-rank tests and intraclass correlation coefficient (ICC) statistics were used. Results The CBCT prototype provided superior subjective image quality compared to MDCT scans (for RD, p ≤ 0.004; for LD, p ≤ 0.001). Image quality was rated very good or excellent in 100% of the cases by both readers for RD CBCT, 100% (R1) and 93.8% (R2) for LD CBCT, 62.6% and 43.8% for RD MDCT, and 0.0% and 0.0% for LD MDCT. Single-measure ICC was 0.95 (95% confidence interval 0.91–0.97; p < 0.001). Software-based assessment supported subjective findings with less “undecided” pixels in CBCT than dose-equivalent MDCT (p < 0.001). No significant difference was found between LD CBCT and RD MDCT. Conclusions In cadaveric elbow studies, the tested cone-beam CT prototype delivered superior image quality compared to high-end multidetector CT and showed a potential for considerable dose reduction.
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Affiliation(s)
- Jan-Peter Grunz
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany.
| | - Andreas Max Weng
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - Andreas Steven Kunz
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - Maike Veyhl-Wichmann
- Institute of Anatomy and Cell Biology, University of Würzburg, Koellikerstraße 6, 97070, Würzburg, Germany
| | - Rainer Schmitt
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - Carsten Herbert Gietzen
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - Lenhard Pennig
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Stefan Herz
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - Süleyman Ergün
- Institute of Anatomy and Cell Biology, University of Würzburg, Koellikerstraße 6, 97070, Würzburg, Germany
| | - Thorsten Alexander Bley
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - Tobias Gassenmaier
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
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17
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Hock M, Terekhov M, Stefanescu MR, Lohr D, Herz S, Reiter T, Ankenbrand M, Kosmala A, Gassenmaier T, Juchem C, Schreiber LM. B 0 shimming of the human heart at 7T. Magn Reson Med 2020; 85:182-196. [PMID: 32700791 DOI: 10.1002/mrm.28423] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 02/14/2020] [Revised: 06/19/2020] [Accepted: 06/22/2020] [Indexed: 01/31/2023]
Abstract
PURPOSE Inhomogeneities of the static magnetic B0 field are a major limiting factor in cardiac MRI at ultrahigh field (≥ 7T), as they result in signal loss and image distortions. Different magnetic susceptibilities of the myocardium and surrounding tissue in combination with cardiac motion lead to strong spatio-temporal B0 -field inhomogeneities, and their homogenization (B0 shimming) is a prerequisite. Limitations of state-of-the-art shimming are described, regional B0 variations are measured, and a methodology for spherical harmonics shimming of the B0 field within the human myocardium is proposed. METHODS The spatial B0 -field distribution in the heart was analyzed as well as temporal B0 -field variations in the myocardium over the cardiac cycle. Different shim region-of-interest selections were compared, and hardware limitations of spherical harmonics B0 shimming were evaluated by calibration-based B0 -field modeling. The role of third-order spherical harmonics terms was analyzed as well as potential benefits from cardiac phase-specific shimming. RESULTS The strongest B0 -field inhomogeneities were observed in localized spots within the left-ventricular and right-ventricular myocardium and varied between systolic and diastolic cardiac phases. An anatomy-driven shim region-of-interest selection allowed for improved B0 -field homogeneity compared with a standard shim region-of-interest cuboid. Third-order spherical harmonics terms were demonstrated to be beneficial for shimming of these myocardial B0 -field inhomogeneities. Initial results from the in vivo implementation of a potential shim strategy were obtained. Simulated cardiac phase-specific shimming was performed, and a shim term-by-term analysis revealed periodic variations of required currents. CONCLUSION Challenges in state-of-the-art B0 shimming of the human heart at 7 T were described. Cardiac phase-specific shimming strategies were found to be superior to vendor-supplied shimming.
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Affiliation(s)
- Michael Hock
- Chair of Cellular and Molecular Imaging, Comprehensive Heart Failure Center (CHFC), University Hospital Wuerzburg, Wuerzburg, Germany
| | - Maxim Terekhov
- Chair of Cellular and Molecular Imaging, Comprehensive Heart Failure Center (CHFC), University Hospital Wuerzburg, Wuerzburg, Germany
| | - Maria Roxana Stefanescu
- Chair of Cellular and Molecular Imaging, Comprehensive Heart Failure Center (CHFC), University Hospital Wuerzburg, Wuerzburg, Germany
| | - David Lohr
- Chair of Cellular and Molecular Imaging, Comprehensive Heart Failure Center (CHFC), University Hospital Wuerzburg, Wuerzburg, Germany
| | - Stefan Herz
- Chair of Cellular and Molecular Imaging, Comprehensive Heart Failure Center (CHFC), University Hospital Wuerzburg, Wuerzburg, Germany.,Department of Diagnostic and Interventional Radiology, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Theresa Reiter
- Chair of Cellular and Molecular Imaging, Comprehensive Heart Failure Center (CHFC), University Hospital Wuerzburg, Wuerzburg, Germany.,Department of Internal Medicine I, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Markus Ankenbrand
- Chair of Cellular and Molecular Imaging, Comprehensive Heart Failure Center (CHFC), University Hospital Wuerzburg, Wuerzburg, Germany
| | - Aleksander Kosmala
- Chair of Cellular and Molecular Imaging, Comprehensive Heart Failure Center (CHFC), University Hospital Wuerzburg, Wuerzburg, Germany.,Department of Diagnostic and Interventional Radiology, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Tobias Gassenmaier
- Chair of Cellular and Molecular Imaging, Comprehensive Heart Failure Center (CHFC), University Hospital Wuerzburg, Wuerzburg, Germany.,Department of Diagnostic and Interventional Radiology, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Christoph Juchem
- Department of Biomedical Engineering, Columbia University, New York, New York, USA.,Department of Radiology, Columbia University, New York, New York, USA
| | - Laura Maria Schreiber
- Chair of Cellular and Molecular Imaging, Comprehensive Heart Failure Center (CHFC), University Hospital Wuerzburg, Wuerzburg, Germany
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18
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Frey A, Gassenmaier T, Hofmann U, Schmitt D, Fette G, Marx A, Herterich S, Boivin-Jahns V, Ertl G, Bley T, Frantz S, Jahns R, Störk S. Coagulation factor XIII activity predicts left ventricular remodelling after acute myocardial infarction. ESC Heart Fail 2020; 7:2354-2364. [PMID: 32548915 PMCID: PMC7524135 DOI: 10.1002/ehf2.12774] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 12/09/2019] [Revised: 04/21/2020] [Accepted: 05/07/2020] [Indexed: 11/11/2022] Open
Abstract
AIMS Acute myocardial infarction (MI) is the major cause of chronic heart failure. The activity of blood coagulation factor XIII (FXIIIa) plays an important role in rodents as a healing factor after MI, whereas its role in healing and remodelling processes in humans remains unclear. We prospectively evaluated the relevance of FXIIIa after acute MI as a potential early prognostic marker for adequate healing. METHODS AND RESULTS This monocentric prospective cohort study investigated cardiac remodelling in patients with ST-elevation MI and followed them up for 1 year. Serum FXIIIa was serially assessed during the first 9 days after MI and after 2, 6, and 12 months. Cardiac magnetic resonance imaging was performed within 4 days after MI (Scan 1), after 7 to 9 days (Scan 2), and after 12 months (Scan 3). The FXIII valine-to-leucine (V34L) single-nucleotide polymorphism rs5985 was genotyped. One hundred forty-six patients were investigated (mean age 58 ± 11 years, 13% women). Median FXIIIa was 118% (quartiles, 102-132%) and dropped to a trough on the second day after MI: 109% (98-109%; P < 0.001). FXIIIa recovered slowly over time, reaching the baseline level after 2 to 6 months and surpassed baseline levels only after 12 months: 124% (110-142%). The development of FXIIIa after MI was independent of the genotype. FXIIIa on Day 2 was strongly and inversely associated with the relative size of MI in Scan 1 (Spearman's ρ = -0.31; P = 0.01) and Scan 3 (ρ = -0.39; P < 0.01) and positively associated with left ventricular ejection fraction: ρ = 0.32 (P < 0.01) and ρ = 0.24 (P = 0.04), respectively. CONCLUSIONS FXIII activity after MI is highly dynamic, exhibiting a significant decline in the early healing period, with reconstitution 6 months later. Depressed FXIIIa early after MI predicted a greater size of MI and lower left ventricular ejection fraction after 1 year. The clinical relevance of these findings awaits to be tested in a randomized trial.
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Affiliation(s)
- Anna Frey
- Comprehensive Heart Failure Center Würzburg, University Hospital Würzburg, Würzburg, Germany.,Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Tobias Gassenmaier
- Comprehensive Heart Failure Center Würzburg, University Hospital Würzburg, Würzburg, Germany.,Institute of Radiology, University Hospital Würzburg, Würzburg, Germany
| | - Ulrich Hofmann
- Comprehensive Heart Failure Center Würzburg, University Hospital Würzburg, Würzburg, Germany.,Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Dominik Schmitt
- Comprehensive Heart Failure Center Würzburg, University Hospital Würzburg, Würzburg, Germany.,Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Georg Fette
- Comprehensive Heart Failure Center Würzburg, University Hospital Würzburg, Würzburg, Germany.,Department for Artificial Intelligence and Applied Computer Science, University of Würzburg, Würzburg, Germany
| | - Almuth Marx
- Comprehensive Heart Failure Center Würzburg, University Hospital Würzburg, Würzburg, Germany
| | - Sabine Herterich
- Division of Laboratory Medicine, University Hospital Würzburg, Würzburg, Germany
| | - Valérie Boivin-Jahns
- Comprehensive Heart Failure Center Würzburg, University Hospital Würzburg, Würzburg, Germany.,Department of Pharmacology and Toxicology, University of Würzburg, Würzburg, Germany
| | - Georg Ertl
- Comprehensive Heart Failure Center Würzburg, University Hospital Würzburg, Würzburg, Germany.,Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Thorsten Bley
- Comprehensive Heart Failure Center Würzburg, University Hospital Würzburg, Würzburg, Germany.,Institute of Radiology, University Hospital Würzburg, Würzburg, Germany
| | - Stefan Frantz
- Comprehensive Heart Failure Center Würzburg, University Hospital Würzburg, Würzburg, Germany.,Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Roland Jahns
- Comprehensive Heart Failure Center Würzburg, University Hospital Würzburg, Würzburg, Germany.,Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany.,Interdisciplinary Bank of Biomaterials and Data Würzburg, University Hospital Würzburg, Würzburg, Germany
| | - Stefan Störk
- Comprehensive Heart Failure Center Würzburg, University Hospital Würzburg, Würzburg, Germany.,Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
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Grunz JP, Gietzen CH, Luetkens K, Wagner M, Kalb K, Bley TA, Lehmkuhl L, van Schoonhoven J, Gassenmaier T, Schmitt R. The importance of radial multiplanar reconstructions for assessment of triangular fibrocartilage complex injury in CT arthrography of the wrist. BMC Musculoskelet Disord 2020; 21:286. [PMID: 32381000 PMCID: PMC7206688 DOI: 10.1186/s12891-020-03321-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 03/24/2020] [Accepted: 04/29/2020] [Indexed: 12/30/2022] Open
Abstract
Background Triangular fibrocartilage complex (TFCC) lesions commonly cause ulnar-sided wrist pain and instability of the distal radioulnar joint. Due to its triangular shape, discontinuity of the TFCC is oftentimes difficult to visualize in radiological standard planes. Radial multiplanar reconstructions (MPR) may have the potential to simplify diagnosis in CT wrist arthrography. The objective of this study was to assess diagnostic advantages provided by radial MPR over standard planes for TFCC lesions in CT arthrography. Methods One hundred six patients (49 women, 57 men; mean age 44.2 ± 15.8 years) underwent CT imaging after wrist arthrography. Two radiologists (R1, R2) retrospectively analyzed three randomized datasets for each CT arthrography. One set contained axial, coronal and sagittal planes (MPRStandard), while the other two included an additional radial reconstruction with the rotating center either atop the ulnar styloid (MPRStyloid) or in the ulnar fovea (MPRFovea). Readers evaluated TFCC differentiability and condition. Suspected lesions were categorized using Palmer’s and Atzei’s classification and diagnostic confidence was stated on a five-point Likert scale. Results Compared to standard planes, differentiability of the superficial and deep TFCC layer was superior in radial reconstructions (R1/R2; MPRFovea: p < 0.001; MPRStyloid: p ≤ 0.007). Palmer and Atzei lesions were present in 86.8% (92/106) and 52.8% (56/106) of patients, respectively. Specificity, sensitivity and accuracy for central Palmer lesions did not differ in radial and standard MPR. For peripheral Atzei lesions, sensitivity (MPRStandard 78.6%/80.4%, MPRStyloid 94.6%/94.6%, MPRFovea 91.1%/89.3%) and accuracy (MPRStandard 86.8%/86.8%, MPRStyloid 96.2%/96.2%, MPRFovea 94.3%/93.4%) improved with additional styloid-centered (p = 0.004/0.008) and fovea-centered (p = 0.039/0.125) reconstructions. No substantial difference was observed between both radial MPR (p = 0.688/0.250). Interrater agreement was almost perfect for each dataset (κStandard = 0.876, κStyloid = 0.894, κFovea = 0.949). Diagnostic confidence increased with addition of either radial MPR (p < 0.001). Conclusions Ancillary radial planes improve accuracy and diagnostic confidence for detection of peripheral TFCC lesions in CT arthrography of the wrist.
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Affiliation(s)
- Jan-Peter Grunz
- Department of Diagnostic and Interventional Radiology, Rhön-Klinikum Campus Bad Neustadt, Von-Guttenberg-Str. 11, 97616, Bad Neustadt an der Saale, Germany. .,Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany.
| | - Carsten Herbert Gietzen
- Department of Diagnostic and Interventional Radiology, Rhön-Klinikum Campus Bad Neustadt, Von-Guttenberg-Str. 11, 97616, Bad Neustadt an der Saale, Germany.,Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| | - Karsten Luetkens
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| | - Matthias Wagner
- Department of Diagnostic and Interventional Radiology, Rhön-Klinikum Campus Bad Neustadt, Von-Guttenberg-Str. 11, 97616, Bad Neustadt an der Saale, Germany
| | - Karlheinz Kalb
- Department of Hand Surgery, Rhön-Klinikum Campus Bad Neustadt, Von-Guttenberg-Str. 11, 97616, Bad Neustadt an der Saale, Germany
| | - Thorsten Alexander Bley
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| | - Lukas Lehmkuhl
- Department of Diagnostic and Interventional Radiology, Rhön-Klinikum Campus Bad Neustadt, Von-Guttenberg-Str. 11, 97616, Bad Neustadt an der Saale, Germany
| | - Jörg van Schoonhoven
- Department of Hand Surgery, Rhön-Klinikum Campus Bad Neustadt, Von-Guttenberg-Str. 11, 97616, Bad Neustadt an der Saale, Germany
| | - Tobias Gassenmaier
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| | - Rainer Schmitt
- Department of Diagnostic and Interventional Radiology, Rhön-Klinikum Campus Bad Neustadt, Von-Guttenberg-Str. 11, 97616, Bad Neustadt an der Saale, Germany.,Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
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Kippnich M, Schorscher N, Kredel M, Markus C, Eden L, Gassenmaier T, Lock J, Wurmb T. Dual-room twin-CT scanner in multiple trauma care: first results after implementation in a level one trauma centre. Eur J Trauma Emerg Surg 2020; 47:1847-1852. [PMID: 32335685 PMCID: PMC7223892 DOI: 10.1007/s00068-020-01374-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 04/10/2020] [Indexed: 11/24/2022]
Abstract
Purpose The trauma centre of the Wuerzburg University Hospital has integrated a pioneering dual-room twin-CT scanner in a multiple trauma pathway. For concurrent treatment of two trauma patients, two carbon CT examination and intervention tables are positioned head to head with one sliding CT-Gantry in the middle. The focus of this study is the process of trauma care with the time to CT (tCT) and the time to operation (tOR) as quality indicator. Methods All patients with suspected multiple trauma, who required emergency surgery and who were initially diagnosed by the CT trauma protocol between 05/2018 and 12/2018 were included. Data relating to time spans (tCT and tOR), severity of injury and outcome was obtained. Results 110 of the 589 screened trauma patients had surgery immediately after finishing primary assessment in the ER. The ISS was 17 (9–34) (median and interquartile range, IQR). tCT was 15 (11–19) minutes (median and IQR) and tOR was 96.5 (75–119) minutes (median and IQR). In the first 30 days, seven patients died (6.4%) including two within the first 24 h (2%). There were two ICU days (1–6) (median and IQR) and one (0–1) (median and IQR) ventilator day. Conclusion The twin-CT technology is a fascinating tool to organize high-quality trauma care for two multiple trauma patients simultaneously.
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Affiliation(s)
- Maximilian Kippnich
- Department of Anesthesia and Critical Care, Subsection Emergency- and Disaster Relief Medicine, University Hospital of Wuerzburg, Oberduerrbacherstrasse 6, 97080, Würzburg, Germany.
| | - Nora Schorscher
- Department of Anesthesia and Critical Care, Subsection Emergency- and Disaster Relief Medicine, University Hospital of Wuerzburg, Oberduerrbacherstrasse 6, 97080, Würzburg, Germany
| | - Markus Kredel
- Department of Anesthesia and Critical Care, University Hospital of Wuerzburg, Würzburg, Germany
| | - Christian Markus
- Department of Anesthesia and Critical Care, University Hospital of Wuerzburg, Würzburg, Germany
| | - Lars Eden
- Department of Trauma Surgery, University Hospital of Wuerzburg, Würzburg, Germany
| | - Tobias Gassenmaier
- Department of Diagnostic and Interventional Radiology, University Hospital of Wuerzburg, Würzburg, Germany
| | - Johann Lock
- Department of General and Visceral Surgery, University Hospital of Wuerzburg, Würzburg, Germany
| | - Thomas Wurmb
- Department of Anesthesia and Critical Care, Subsection Emergency- and Disaster Relief Medicine, University Hospital of Wuerzburg, Oberduerrbacherstrasse 6, 97080, Würzburg, Germany
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Grunz JP, Kunz AS, Gietzen CH, Weng AM, Veyhl-Wichmann M, Ergün S, Schmitt R, Bley TA, Gassenmaier T. 3D cone-beam CT of the ankle using a novel twin robotic X-ray system: Assessment of image quality and radiation dose. Eur J Radiol 2019; 119:108659. [DOI: 10.1016/j.ejrad.2019.108659] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 09/03/2019] [Accepted: 09/04/2019] [Indexed: 12/29/2022]
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Petri N, Ertel B, Gassenmaier T, Lengenfelder B, Bley TA, Voelker W. “Blind” pericardiocentesis: A comparison of different puncture directions. Catheter Cardiovasc Interv 2018; 92:E327-E332. [DOI: 10.1002/ccd.27601] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 02/15/2018] [Accepted: 02/25/2018] [Indexed: 11/09/2022]
Affiliation(s)
- Nils Petri
- Department of Internal Medicine I; University Hospital Würzburg; Würzburg Germany
| | - Babett Ertel
- Department of Internal Medicine I; University Hospital Würzburg; Würzburg Germany
| | - Tobias Gassenmaier
- Department of Diagnostic and Interventional Radiology; University Hospital of Würzburg; Würzburg Germany
| | - Björn Lengenfelder
- Department of Internal Medicine I; University Hospital Würzburg; Würzburg Germany
| | - Thorsten A. Bley
- Department of Diagnostic and Interventional Radiology; University Hospital of Würzburg; Würzburg Germany
| | - Wolfram Voelker
- Department of Internal Medicine I; University Hospital Würzburg; Würzburg Germany
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Petri N, Ertel B, Gassenmaier T, Lengenfelder B, Bley T, Voelker W. TCT-525 “Blind” Pericardiocentesis - A Comparison of Different Puncture Directions. J Am Coll Cardiol 2017. [DOI: 10.1016/j.jacc.2017.09.696] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Petri N, Ertel B, Gassenmaier T, Lengenfelder B, Bley T, Voelker W. P4321Blind pericardiocentesis: A comparison of different puncture techniques. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p4321] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Petritsch B, Kosmala A, Weng AM, Krauss B, Heidemeier A, Wagner R, Heintel TM, Gassenmaier T, Bley TA. Vertebral Compression Fractures: Third-Generation Dual-Energy CT for Detection of Bone Marrow Edema at Visual and Quantitative Analyses. Radiology 2017; 284:161-168. [DOI: 10.1148/radiol.2017162165] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Bernhard Petritsch
- From the Departments of Diagnostic and Interventional Radiology (B.P., A.K., A.M.W., A.H., T.G., T.A.B.) and Trauma, Hand, Plastic and Reconstructive Surgery (R.W., T.M.H.), University Hospital Würzburg, Oberdürrbacher Str 6, D-97080 Würzburg, Germany; Imaging and Therapy Division, Siemens Healthcare, Forchheim, Germany (B.K.)
| | - Aleksander Kosmala
- From the Departments of Diagnostic and Interventional Radiology (B.P., A.K., A.M.W., A.H., T.G., T.A.B.) and Trauma, Hand, Plastic and Reconstructive Surgery (R.W., T.M.H.), University Hospital Würzburg, Oberdürrbacher Str 6, D-97080 Würzburg, Germany; Imaging and Therapy Division, Siemens Healthcare, Forchheim, Germany (B.K.)
| | - Andreas M. Weng
- From the Departments of Diagnostic and Interventional Radiology (B.P., A.K., A.M.W., A.H., T.G., T.A.B.) and Trauma, Hand, Plastic and Reconstructive Surgery (R.W., T.M.H.), University Hospital Würzburg, Oberdürrbacher Str 6, D-97080 Würzburg, Germany; Imaging and Therapy Division, Siemens Healthcare, Forchheim, Germany (B.K.)
| | - Bernhard Krauss
- From the Departments of Diagnostic and Interventional Radiology (B.P., A.K., A.M.W., A.H., T.G., T.A.B.) and Trauma, Hand, Plastic and Reconstructive Surgery (R.W., T.M.H.), University Hospital Würzburg, Oberdürrbacher Str 6, D-97080 Würzburg, Germany; Imaging and Therapy Division, Siemens Healthcare, Forchheim, Germany (B.K.)
| | - Anke Heidemeier
- From the Departments of Diagnostic and Interventional Radiology (B.P., A.K., A.M.W., A.H., T.G., T.A.B.) and Trauma, Hand, Plastic and Reconstructive Surgery (R.W., T.M.H.), University Hospital Würzburg, Oberdürrbacher Str 6, D-97080 Würzburg, Germany; Imaging and Therapy Division, Siemens Healthcare, Forchheim, Germany (B.K.)
| | - Richard Wagner
- From the Departments of Diagnostic and Interventional Radiology (B.P., A.K., A.M.W., A.H., T.G., T.A.B.) and Trauma, Hand, Plastic and Reconstructive Surgery (R.W., T.M.H.), University Hospital Würzburg, Oberdürrbacher Str 6, D-97080 Würzburg, Germany; Imaging and Therapy Division, Siemens Healthcare, Forchheim, Germany (B.K.)
| | - Timo M. Heintel
- From the Departments of Diagnostic and Interventional Radiology (B.P., A.K., A.M.W., A.H., T.G., T.A.B.) and Trauma, Hand, Plastic and Reconstructive Surgery (R.W., T.M.H.), University Hospital Würzburg, Oberdürrbacher Str 6, D-97080 Würzburg, Germany; Imaging and Therapy Division, Siemens Healthcare, Forchheim, Germany (B.K.)
| | - Tobias Gassenmaier
- From the Departments of Diagnostic and Interventional Radiology (B.P., A.K., A.M.W., A.H., T.G., T.A.B.) and Trauma, Hand, Plastic and Reconstructive Surgery (R.W., T.M.H.), University Hospital Würzburg, Oberdürrbacher Str 6, D-97080 Würzburg, Germany; Imaging and Therapy Division, Siemens Healthcare, Forchheim, Germany (B.K.)
| | - Thorsten A. Bley
- From the Departments of Diagnostic and Interventional Radiology (B.P., A.K., A.M.W., A.H., T.G., T.A.B.) and Trauma, Hand, Plastic and Reconstructive Surgery (R.W., T.M.H.), University Hospital Würzburg, Oberdürrbacher Str 6, D-97080 Würzburg, Germany; Imaging and Therapy Division, Siemens Healthcare, Forchheim, Germany (B.K.)
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Gassenmaier T, Allmendinger T, Kunz AS, Veyhl-Wichmann M, Ergün S, Bley TA, Petritsch B. In vitro evaluation of a new iterative reconstruction algorithm for dose reduction in coronary artery calcium scoring. Acta Radiol Open 2017; 6:2058460117710682. [PMID: 28607763 PMCID: PMC5453409 DOI: 10.1177/2058460117710682] [Citation(s) in RCA: 2] [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: 11/28/2016] [Accepted: 04/27/2017] [Indexed: 11/17/2022] Open
Abstract
Background Coronary artery calcium (CAC) scoring is a widespread tool for cardiac risk assessment in asymptomatic patients and accompanying possible adverse effects, i.e. radiation exposure, should be as low as reasonably achievable. Purpose To evaluate a new iterative reconstruction (IR) algorithm for dose reduction of in vitro coronary artery calcium scoring at different tube currents. Material and Methods An anthropomorphic calcium scoring phantom was scanned in different configurations simulating slim, average-sized, and large patients. A standard calcium scoring protocol was performed on a third-generation dual-source CT at 120 kVp tube voltage. Reference tube current was 80 mAs as standard and stepwise reduced to 60, 40, 20, and 10 mAs. Images were reconstructed with weighted filtered back projection (wFBP) and a new version of an established IR kernel at different strength levels. Calcifications were quantified calculating Agatston and volume scores. Subjective image quality was visualized with scans of an ex vivo human heart. Results In general, Agatston and volume scores remained relatively stable between 80 and 40 mAs and increased at lower tube currents, particularly in the medium and large phantom. IR reduced this effect, as both Agatston and volume scores decreased with increasing levels of IR compared to wFBP (P < 0.001). Depending on selected parameters, radiation dose could be lowered by up to 86% in the large size phantom when selecting a reference tube current of 10 mAs with resulting Agatston levels close to the reference settings. Conclusion New iterative reconstruction kernels may allow for reduction in tube current for established Agatston scoring protocols and consequently for substantial reduction in radiation exposure.
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Affiliation(s)
- Tobias Gassenmaier
- Department of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Würzburg, Germany
| | | | - Andreas S Kunz
- Department of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Würzburg, Germany
| | - Maike Veyhl-Wichmann
- Institute of Anatomy and Cell Biology, University of Würzburg, Würzburg, Germany
| | - Süleyman Ergün
- Institute of Anatomy and Cell Biology, University of Würzburg, Würzburg, Germany
| | - Thorsten A Bley
- Department of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Würzburg, Germany
| | - Bernhard Petritsch
- Department of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Würzburg, Germany
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Petritsch B, Kosmala A, Gassenmaier T, Weng AM, Veldhoen S, Kunz AS, Bley TA. Diagnosis of Pulmonary Artery Embolism: Comparison of Single-Source CT and 3rd Generation Dual-Source CT using a Dual-Energy Protocol Regarding Image Quality and Radiation Dose. ROFO-FORTSCHR RONTG 2017; 189:527-536. [PMID: 28445908 DOI: 10.1055/s-0043-103089] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Purpose To compare radiation dose, subjective and objective image quality of 3 rd generation dual-source CT (DSCT) and dual-energy CT (DECT) with conventional 64-slice single-source CT (SSCT) for pulmonary CTA. Materials and Methods 180 pulmonary CTA studies were performed in three patient cohorts of 60 patients each. Group 1: conventional SSCT 120 kV (ref.); group 2: single-energy DSCT 100 kV (ref.); group 3: DECT 90/Sn150 kV. CTDIvol, DLP, effective radiation dose were reported, and CT attenuation (HU) was measured on three central and peripheral levels. The signal-to-noise-ratio (SNR) and contrast-to-noise-ratio (CNR) were calculated. Two readers assessed subjective image quality according to a five-point scale. Results Mean CTDIvol and DLP were significantly lower in the dual-energy group compared to the SSCT group (p < 0.001 [CTDIvol]; p < 0.001 [DLP]) and the DSCT group (p = 0.003 [CTDIvol]; p = 0.003 [DLP]), respectively. The effective dose in the DECT group was 2.79 ± 0.95 mSv and significantly smaller than in the SSCT group (4.60 ± 1.68 mSv, p < 0.001) and the DSCT group (4.24 ± 2.69 mSv, p = 0.003). The SNR and CNR were significantly higher in the DSCT group (p < 0.001). Subjective image quality did not differ significantly among the three protocols and was rated good to excellent in 75 % (135/180) of cases with an inter-observer agreement of 80 %. Conclusion Dual-energy pulmonary CTA protocols of 3 rd generation dual-source scanners allow for significant reduction of radiation dose while providing excellent image quality and potential additional information by means of perfusion maps. Key Points: · Dual-energy CT with 90/Sn150 kV configuration allows for significant dose reduction in pulmonary CTA.. · Subjective image quality was similar among the three evaluated CT-protocols (64-slice SSCT, single-energy DSCT, 90/Sn150 kV DECT) and was rated good to excellent in 75% of cases.. · Dual-energy CT provides potential additional information by means of iodine distribution maps.. Citation Format · Petritsch B, Kosmala A, Gassenmaier T et al. Diagnosis of Pulmonary Artery Embolism: Comparison of Single-Source CT and 3rd Generation Dual-Source CT using a Dual-Energy Protocol Regarding Image Quality and Radiation Dose. Fortschr Röntgenstr 2017; 189: 527 - 536.
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Gassenmaier T, Kunz A, Kosmala A, Bley T, Petritsch B. Strahlenexposition des koronaren Calciums-Scorings und der koronaren CT-Angiografie mit einem 3. Generations Dual-Source CT in einem unselektionierten Patientenkollektiv. ROFO-FORTSCHR RONTG 2017. [DOI: 10.1055/s-0037-1600235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- T Gassenmaier
- Universitätsklinikum Würzburg, Institut für diagnostische und interventionelle Radiologie, Würzburg
| | - A Kunz
- Universitätsklinikum Würzburg, Institut für diagnostische und interventionelle Radiologie, Würzburg
| | - A Kosmala
- Universitätsklinikum Würzburg, Institut für diagnostische und interventionelle Radiologie, Würzburg
| | - T Bley
- Universitätsklinikum Würzburg, Institut für diagnostische und interventionelle Radiologie, Würzburg
| | - B Petritsch
- Universitätsklinikum Würzburg, Institut für diagnostische und interventionelle Radiologie, Würzburg
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Petri N, Gassenmaier T, Allmendinger T, Flohr T, Voelker W, Bley TA. Influence of cardiac motion on stent lumen visualization in third generation dual-source CT employing a pulsatile heart model. Br J Radiol 2017; 90:20160616. [DOI: 10.1259/bjr.20160616] [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: 11/05/2022] Open
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Petritsch B, Köstler H, Weng AM, Horn M, Gassenmaier T, Kunz AS, Weidemann F, Wanner C, Bley TA, Beer M. Myocardial lipid content in Fabry disease: a combined 1H-MR spectroscopy and MR imaging study at 3 Tesla. BMC Cardiovasc Disord 2016; 16:205. [PMID: 27793097 PMCID: PMC5084400 DOI: 10.1186/s12872-016-0382-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 10/22/2016] [Indexed: 04/11/2023] Open
Abstract
BACKGROUND Fabry disease is characterized by a progressive deposition of sphingolipids in different organ systems, whereby cardiac involvement leads to death. We hypothesize that lysosomal storage of sphingolipids in the heart as occurring in Fabry disease does not reflect in higher cardiac lipid concentrations detectable by 1H magnetic resonance spectroscopy (MRS) at 3 Tesla. METHODS Myocardial lipid content was quantified in vivo by 1H-MRS in 30 patients (12 male, 18 female; 18 patients treated with enzyme replacement therapy) with genetically proven Fabry disease and in 30 healthy controls. The study protocol combined 1H-MRS with cardiac cine imaging and LGE MRI in a single examination. RESULTS Myocardial lipid content was not significantly elevated in Fabry disease (p = 0.225). Left ventricular (LV) mass was significantly higher in patients suffering from Fabry disease compared to controls (p = 0.019). Comparison of patients without signs of myocardial fibrosis in MRI (LGE negative; n = 12) to patients with signs of fibrosis (LGE positive; n = 18) revealed similar myocardial lipid content in both groups (p > 0.05), while the latter showed a trend towards elevated LV mass (p = 0.076). CONCLUSIONS This study demonstrates the potential of lipid metabolic investigation embedded in a comprehensive examination of cardiac morphology and function in Fabry disease. There was no evidence that lysosomal storage of sphingolipids influences cardiac lipid content as measured by 1H-MRS. Finally, the authors share the opinion that a comprehensive cardiac examination including three subsections (LGE; 1H-MRS; T1 mapping), could hold the highest potential for the final assessment of early and late myocardial changes in Fabry disease.
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Affiliation(s)
- B Petritsch
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany.
| | - H Köstler
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany.,University of Würzburg, Comprehensive Heart Failure Center, 97080, Würzburg, Germany
| | - A M Weng
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - M Horn
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - T Gassenmaier
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - A S Kunz
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - F Weidemann
- University of Würzburg, Comprehensive Heart Failure Center, 97080, Würzburg, Germany.,Department of Internal Medicine II/Cardiology, Katharinen-Hospital Unna, Obere Husemannstr.2, 59423, Unna, Germany
| | - C Wanner
- Department of Internal Medicine I, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - T A Bley
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - M Beer
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany
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Gassenmaier T, Petri N, Allmendinger T, Flohr T, Weng AM, Kunz AS, Petritsch B, Voelker W, Bley TA. In Vitro Comparison of Second- and Third-generation Dual-source CT for Coronary Stent Visualization at Different Tube Potentials. Acad Radiol 2016; 23:961-8. [PMID: 27236611 DOI: 10.1016/j.acra.2016.03.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Revised: 11/14/2015] [Accepted: 03/14/2016] [Indexed: 12/22/2022]
Abstract
RATIONALE AND OBJECTIVES The study aimed to evaluate in vitro stent lumen visibility of coronary stents in a second- and third-generation dual-source computed tomography (CT) system at 100 and 120 kVp tube potential. MATERIALS AND METHODS Twenty-six coronary stents ranging from 2.25 to 4.0 mm in diameter were implanted in a coronary vessel phantom. Scans were performed at 100 and 120 kVp tube potential. Evaluation was performed using a medium-sharp kernel in both systems (B46f in the second-generation and Bv49 in the third-generation model) and a sharp (Bv59) convolution kernel optimized for vascular imaging in the third-generation CT. RESULTS The median visible stent lumen diameter in the second-generation system was higher at 120 kVp with a median of 62.0% compared to 56.3% at 100 kVp (P < 0.001). The median visible diameter in the third-generation system was significantly higher applying the Bv49 kernel with 66.7% at 120 kVp and 61.1% at 100 kVp (both P < 0.001). When applying the Bv59 kernel, visible stent lumen further increased to 69.3% at 120 kVp and 66.7% at 100 kVp. Additionally, stent lumen was assessed using full width at half maximum, resulting in a comparable increase in luminal diameter at corresponding tube potential. CONCLUSIONS Third-generation dual-source CT provides superior stent lumen visibility at equivalent tube potential and at reduced tube potential of 100 kVp when compared to 120 kVp in a second-generation system, at least when manually assessed.
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Affiliation(s)
- Tobias Gassenmaier
- Department of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Oberdürrbacher Str. 6, 97080 Würzburg, Germany.
| | - Nils Petri
- Department of Internal Medicine I, University Hospital of Würzburg, Würzburg, Germany
| | | | | | - Andreas M Weng
- Department of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Oberdürrbacher Str. 6, 97080 Würzburg, Germany
| | - Andreas S Kunz
- Department of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Oberdürrbacher Str. 6, 97080 Würzburg, Germany
| | - Bernhard Petritsch
- Department of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Oberdürrbacher Str. 6, 97080 Würzburg, Germany
| | - Wolfram Voelker
- Department of Internal Medicine I, University Hospital of Würzburg, Würzburg, Germany
| | - Thorsten A Bley
- Department of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Oberdürrbacher Str. 6, 97080 Würzburg, Germany
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Petritsch B, Köstler H, Gassenmaier T, Kunz AS, Bley TA, Horn M. An investigation into potential gender-specific differences in myocardial triglyceride content assessed by 1H-Magnetic Resonance Spectroscopy at 3Tesla. J Int Med Res 2016; 44:585-91. [PMID: 27091860 PMCID: PMC5536690 DOI: 10.1177/0300060515603884] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 08/10/2015] [Indexed: 12/04/2022] Open
Abstract
Objective Over the past decade, myocardial triglyceride content has become an accepted biomarker for chronic metabolic and cardiac disease. The purpose of this study was to use proton (hydrogen 1)-magnetic resonance spectroscopy (1H-MRS) at 3Tesla (3 T) field strength to assess potential gender-related differences in myocardial triglyceride content in healthy individuals. Methods Cardiac MR imaging was performed to enable accurate voxel placement and obtain functional and morphological information. Double triggered (i.e., ECG and respiratory motion gating) 1H-MRS was used to quantify myocardial triglyceride levels for each gender. Two-sample t-test and Mann-Whitney U-test were used for statistical analyses. Results In total, 40 healthy volunteers (22 male, 18 female; aged >18 years and age matched) were included in the study. Median myocardial triglyceride content was 0.28% (interquartile range [IQR] 0.17–0.42%) in male and 0.24% (IQR 0.14–0.45%) in female participants, and no statistically significant difference was observed between the genders. Furthermore, no gender-specific difference in ejection fraction was observed, although on average, male participants presented with a higher mean ± SD left ventricular mass (136.3 ± 25.2 g) than female participants (103.9 ± 16.1 g). Conclusions The study showed that 1H-MRS is a capable, noninvasive tool for acquisition of myocardial triglyceride metabolites. Myocardial triglyceride concentration was shown to be unrelated to gender in this group of healthy volunteers.
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Affiliation(s)
- Bernhard Petritsch
- Department of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Würzburg, Germany
| | - Herbert Köstler
- Department of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Würzburg, Germany
| | - Tobias Gassenmaier
- Department of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Würzburg, Germany
| | - Andreas S Kunz
- Department of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Würzburg, Germany
| | - Thorsten A Bley
- Department of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Würzburg, Germany
| | - Michael Horn
- Department of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Würzburg, Germany
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Petritsch B, Gassenmaier T, Kunz AS, Donhauser J, Goltz JP, Bley TA, Horn M. Age Dependency of Myocardial Triglyceride Content: A 3T High-Field 1H-MR Spectroscopy Study. ROFO-FORTSCHR RONTG 2015; 187:1016-21. [PMID: 26230138 DOI: 10.1055/s-0035-1553350] [Citation(s) in RCA: 4] [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] [Indexed: 10/23/2022]
Abstract
PURPOSE The role of myocardial triglyceride (mTG) content in the aging human heart is not entirely understood. The aim of this study was to measure concentrations of mTG content from healthy volunteers and to determine the association between age, mTG content and systolic heart function. Furthermore, the technical stability of the (1)H-magnetic resonance spectroscopy ((1)H-MRS) and the reliability of peak evaluation at 3 T were evaluated. MATERIALS AND METHODS The total study population of 47 healthy volunteers was divided into 4 age classes, according to the age of the subjects (1(st) cohort 20 - 29 years (yrs.), n = 20; 2(nd) cohort 30 - 39 yrs., n = 10; 3(rd) cohort 40 - 49 yrs., n = 9; 4(th) cohort 50 - 60 yrs., n = 8). Cardiac MRI and double triggered (1)H-MRS of the myocardium were consecutively performed using a 3 T scanner. Each participant underwent spectroscopic measurements twice in the same investigation. RESULTS mTG content increases with age. The correlation of age and mTG is minimal (r = 0.48; p < 0.001). The following age-averaged mTG content values expressed as % of mTG signal compared to the water signal were determined for each cohort: 1(st) cohort 0.25 % (± 0.17); 2(nd) cohort 0.48 % (± 0.30); 3(rd) cohort 0.48 % (± 0.18); 4(th) cohort 0.77 % (± 0.70). There was no significant correlation (r = 0.04; p = n.s.) between LV mass and mTG content in healthy volunteers. Within our cohorts, no effects of age or mTG content on systolic heart function were seen (r = - 0.01; p = n.s.). The intraclass correlation coefficient of spectroscopic measurements was high (r = 0.965; p < 0.001). CONCLUSION Myocardial TG content increases with age. The normal age-dependent concentration ranges of myocardial lipid metabolites reported in this study may be helpful for the correction of acquired (1)H-MRS data in patients when evaluating metabolic and cardiovascular diseases in future magnetic resonance spectroscopy studies.
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Affiliation(s)
- B Petritsch
- Institute of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Würzburg, Germany
| | - T Gassenmaier
- Institute of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Würzburg, Germany
| | - A S Kunz
- Institute of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Würzburg, Germany
| | - J Donhauser
- Institute of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Würzburg, Germany
| | - J P Goltz
- Clinic for Radiology and Nuclear Medicine, University Hospital of Schleswig-Holstein, Campus Lübeck, Germany
| | - T A Bley
- Institute of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Würzburg, Germany
| | - M Horn
- Institute of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Würzburg, Germany
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Gassenmaier T, Petritsch B, Kunz AS, Gkaniatsas S, Gaudron PD, Weidemann F, Nordbeck P, Beer M. Long term evolution of magnetic resonance imaging characteristics in a case of atypical left lateral wall hypertrophic cardiomyopathy. World J Cardiol 2015; 7:357-360. [PMID: 26131341 PMCID: PMC4478571 DOI: 10.4330/wjc.v7.i6.357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Revised: 02/25/2015] [Accepted: 04/07/2015] [Indexed: 02/06/2023] Open
Abstract
We are reporting a long-time magnetic resonance imaging (MRI) follow-up in a rare case of cardiac left lateral wall hypertrophy. Hypertrophic cardiomyopathy (HCM) is the most common genetic cardiovascular disorder and a significant cause of sudden cardiac death. Cardiac magnetic resonance (CMR) imaging can be a valuable tool for assessment of detailed information on size, localization, and tissue characteristics of hypertrophied myocardium. However, there is still little knowledge of long-term evolution of HCM as visualized by magnetic resonance imaging. Recently, our group reported a case of left lateral wall HCM as a rare variant of the more common forms, such as septal HCM, or apical HCM. As we now retrieved an old cardiac MRI acquired in this patient more than 20 years ago, we are able to provide the thrilling experience of an ultra-long MRI follow-up presentation in this rare case of left lateral wall hypertrophy. Furthermore, this case outlines the tremendous improvements in imaging quality within the last two decades of CMR imaging.
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Veldhoen S, Sauer A, Gassenmaier T, Petritsch B, Herz S, Blanke P, Derlin T, Bley TA, Wirth C. Contrast-enhanced voiding urosonography phantom study: intravenous iodinated and gadolinium-based contrast agents may cause false-negative results in assessment of vesicoureteral reflux in children. Pediatr Radiol 2015; 45:862-71. [PMID: 25655368 DOI: 10.1007/s00247-014-3243-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Revised: 10/13/2014] [Accepted: 11/12/2014] [Indexed: 12/14/2022]
Abstract
BACKGROUND Contrast-enhanced voiding urosonography (ce-VUS) is commonly requested simultaneously to other diagnostic imaging necessitating intravenous contrast agents. To date there is limited knowldedge about intravesical interactions between different types of contrast agents. OBJECTIVE To assess the effect of excreted intravenous iodinated and gadolinium-based contrast agents on the intravesical distribution of ultrasound contrast within contrast-enhanced voiding urosonography. MATERIALS AND METHODS Iodinated (iomeprol, iopamidol) and gadolinium-based (gadoterate meglumine) contrast agents were diluted to bladder concentration and injected into balloons filled with saline solution. CT scans were performed to assess the contrast distribution in these phantoms. Regions of interest were placed at the top and bottom side of each balloon and Hounsfield units (HU) were measured. Three other balloons were filled with saline solution and contrast media likewise. The ultrasound contrast agent sulphur hexafluoride was added and its distribution was assessed using sonography. RESULTS MDCT scans showed a separation of two liquid layers in all bladder phantoms with the contrast layers located at the bottom and the saline solution at the top. Significant differences of the HU measurements at the top and bottom side were observed (P < 0.001-0.007). Following injection of ultrasound contrast agent, US showed its distribution exclusively among the saline solution. CONCLUSIONS False-negative results of contrast-enhanced voiding urosonography may occur if it is performed shortly after imaging procedures requiring intravenous contrast.
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Affiliation(s)
- Simon Veldhoen
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany,
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Veldhoen S, Sauer A, Gassenmaier T, Petritsch B, Herz S, Blanke P, Bley T, Wirth C. Die Miktionsurosonografie zum Ausschluss des vesikorenalen Reflux: Intravenöse Röntgen- und MRT-Kontrastmittel können falsch-negative Ergebnisse verursachen. Eine Phantomstudie. ROFO-FORTSCHR RONTG 2015. [DOI: 10.1055/s-0035-1551133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Sauer S, Goltz JP, Gassenmaier T, Kunz AS, Bley TA, Klein D, Petritsch B. Partial segmental thrombosis of the corpus cavernosum (PSTCC) diagnosed by contrast-enhanced ultrasound: a case report. BMC Urol 2014; 14:100. [PMID: 25515840 PMCID: PMC4289566 DOI: 10.1186/1471-2490-14-100] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 12/11/2014] [Indexed: 11/23/2022] Open
Abstract
Background Partial segmental thrombosis of the corpus cavernosum (PSTCC) is a rare disease predominantly occurring in young men. Cardinal symptoms are pain and perineal swelling. Although several risk factors are described in the literature, the exact etiology of penile thrombosis remains unclear in most cases. MRI or ultrasound (US) is usually used for diagnosing this condition. Case presentation We report a case of penile thrombosis after left-sided varicocele ligature in a young patient. The diagnosis was established using contrast-enhanced ultrasound (CEUS) and was confirmed by contrast-enhanced magnetic resonance imaging (ceMRI). Successful conservative treatment consisted of systemic anticoagulation using low molecular weight heparin and acetylsalicylic acid. Conclusion PSTCC is a rare condition in young men and appears with massive pain and perineal swelling. In case of suspected PSTCC utilization of CEUS may be of diagnostic benefit.
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Affiliation(s)
| | | | | | | | | | | | - Bernhard Petritsch
- University Hospital Würzburg, Institute of Diagnostic and Interventional Radiology, Oberdürrbacher Str, 6, 97080 Würzburg, Germany.
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Gkaniatsas S, Gaudron PD, Gassenmaier T, Beer M, Weidemann F, Nordbeck P. Atypical hypertrophic cardiomyopathy of the left lateral wall leading to ventricular tachycardia. Eur Heart J 2013; 35:548. [PMID: 24132188 DOI: 10.1093/eurheartj/eht412] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Spyridon Gkaniatsas
- Department of Internal Medicine I, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
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Gassenmaier T, Gorski A, Aleksic I, Deubner N, Weidemann F, Beer M. Impact of cardiac magnet resonance imaging on management of ventricular septal rupture after acute myocardial infarction. World J Cardiol 2013; 5:151-153. [PMID: 23710303 PMCID: PMC3663130 DOI: 10.4330/wjc.v5.i5.151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Revised: 04/03/2013] [Accepted: 04/29/2013] [Indexed: 02/06/2023] Open
Abstract
A 74-year-old man was admitted to the cardiac catheterization laboratory with acute myocardial infarction. After successful angioplasty and stent implantation into the right coronary artery, he developed cardiogenic shock the following day. Echocardiography showed ventricular septal rupture. Cardiac magnet resonance imaging (MRI) was performed on the critically ill patient and provided detailed information on size and localization of the ruptured septum by the use of fast MRI sequences. Moreover, the MRI revealed that the ventricular septal rupture was within the myocardial infarction area, which was substantially larger than the rupture. As the patient’s condition worsened, he was intubated and had intra-aortic balloon pump implanted, and extracorporeal membrane oxygenation was initiated. During the following days, the patient’s situation improved, and surgical correction of the ventricular septal defect could successfully be performed. To the best of our knowledge, this case report is the first description of postinfarction ventricular septal rupture by the use of cardiac MRI in an intensive care patient with cardiogenic shock and subsequent successful surgical repair.
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Gassenmaier T, Buchner S, Birner C, Jungbauer CG, Resch M, Debl K, Endemann DH, Riegger GA, Lehn P, Schmitz G, Luchner A. High-sensitive Troponin I in acute cardiac conditions: Implications of baseline and sequential measurements for diagnosis of myocardial infarction. Atherosclerosis 2012; 222:116-22. [DOI: 10.1016/j.atherosclerosis.2012.02.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2011] [Revised: 02/02/2012] [Accepted: 02/03/2012] [Indexed: 10/14/2022]
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Kissling G, Gassenmaier T, Wendt-Gallitelli MF, Jacob R. Pressure-volume relations, elastic modulus, and contractile behaviour of the hypertrophied left ventricle of rats with Goldblatt II hypertension. Pflugers Arch 1977; 369:213-21. [PMID: 142962 DOI: 10.1007/bf00582187] [Citation(s) in RCA: 43] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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