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Paciorek AM, von Schacky CE, Foreman SC, Gassert FG, Gassert FT, Kirschke JS, Laugwitz KL, Geith T, Hadamitzky M, Nadjiri J. Automated assessment of cardiac pathologies on cardiac MRI using T1-mapping and late gadolinium phase sensitive inversion recovery sequences with deep learning. BMC Med Imaging 2024; 24:43. [PMID: 38350900 PMCID: PMC10865672 DOI: 10.1186/s12880-024-01217-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 01/30/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND A deep learning (DL) model that automatically detects cardiac pathologies on cardiac MRI may help streamline the diagnostic workflow. To develop a DL model to detect cardiac pathologies on cardiac MRI T1-mapping and late gadolinium phase sensitive inversion recovery (PSIR) sequences were used. METHODS Subjects in this study were either diagnosed with cardiac pathology (n = 137) including acute and chronic myocardial infarction, myocarditis, dilated cardiomyopathy, and hypertrophic cardiomyopathy or classified as normal (n = 63). Cardiac MR imaging included T1-mapping and PSIR sequences. Subjects were split 65/15/20% for training, validation, and hold-out testing. The DL models were based on an ImageNet pretrained DenseNet-161 and implemented using PyTorch and fastai. Data augmentation with random rotation and mixup was applied. Categorical cross entropy was used as the loss function with a cyclic learning rate (1e-3). DL models for both sequences were developed separately using similar training parameters. The final model was chosen based on its performance on the validation set. Gradient-weighted class activation maps (Grad-CAMs) visualized the decision-making process of the DL model. RESULTS The DL model achieved a sensitivity, specificity, and accuracy of 100%, 38%, and 88% on PSIR images and 78%, 54%, and 70% on T1-mapping images. Grad-CAMs demonstrated that the DL model focused its attention on myocardium and cardiac pathology when evaluating MR images. CONCLUSIONS The developed DL models were able to reliably detect cardiac pathologies on cardiac MR images. The diagnostic performance of T1 mapping alone is particularly of note since it does not require a contrast agent and can be acquired quickly.
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Affiliation(s)
- Aleksandra M Paciorek
- Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Claudio E von Schacky
- Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Sarah C Foreman
- Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Felix G Gassert
- Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Florian T Gassert
- Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Jan S Kirschke
- TUM-Neuroimaging Center, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Karl-Ludwig Laugwitz
- Department of Medicine I, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Tobias Geith
- Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Martin Hadamitzky
- Department of Radiology, German Heart Center Munich, Technical University of Munich, Lazarettstraße 36, 80636, Munich, Germany
| | - Jonathan Nadjiri
- Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
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Ziegler CM, Wagner F, Alleborn K, Geith T, Holzapfel BM, Heimkes B. Muscle forces acting on the greater trochanter lead to a dorsal warping of the apophyseal growth plate. J Anat 2024; 244:63-74. [PMID: 37694853 PMCID: PMC10734645 DOI: 10.1111/joa.13944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 07/17/2023] [Accepted: 08/01/2023] [Indexed: 09/12/2023] Open
Abstract
The apophyseal growth plate of the greater trochanter, unlike most other growth plates of the human body, exhibits a curved morphology that results in a divergent pattern resembling an open crocodile mouth on plain antero-posterior radiographs. To quantify the angular alignment of the growth plate and to draw conclusions about the function of the muscles surrounding it, we analyzed 57 MRI images of 51 children and adolescents aged 3-17 years and of six adults aged 18-52 years. We measured the angulation of the plate relative to the horizontal plane (AY angle) and the trajectories of the muscles attaching to the greater trochanter of the proximal femur. From anterior to posterior, the AY angle shows a decrease of 33.44°. In the anterior third, the cartilage is angled at a mean of 51.64°, and in the posterior third, the mean angulation is 18.6°. This indicates that the cartilage in the anterior region of the greater trochanteric apophysis is subject to more vertically oriented force vectors compared to the posterior region, as the growth plates align perpendicular to the force vectors acting on them. Combining the measured muscle trajectories with the physiological cross-sectional areas (PCSA) available from the literature revealed that, in addition to the known internal and external lateral traction ligament systems, a third, dorsally located traction ligament system exists that may be responsible for the dorsal deformation of the AY angle.
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Affiliation(s)
- Christian Max Ziegler
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), LMU University HospitalLudwig‐Maximilians‐Universität MünchenMunichGermany
| | - Ferdinand Wagner
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), LMU University HospitalLudwig‐Maximilians‐Universität MünchenMunichGermany
- Department of Pediatric Surgery, Dr. von Hauner Children's HospitalLudwig‐Maximilians‐University MunichMunichGermany
- Institute of Health and Biomedical Innovation, Queensland University of Technology (QUT)QueenslandBrisbaneAustralia
| | - Karoline Alleborn
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), LMU University HospitalLudwig‐Maximilians‐Universität MünchenMunichGermany
| | - Tobias Geith
- Department of Interventional RadiologyTechnical University of MunichMunichGermany
| | - Boris Michael Holzapfel
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), LMU University HospitalLudwig‐Maximilians‐Universität MünchenMunichGermany
- Institute of Health and Biomedical Innovation, Queensland University of Technology (QUT)QueenslandBrisbaneAustralia
| | - Bernhard Heimkes
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), LMU University HospitalLudwig‐Maximilians‐Universität MünchenMunichGermany
- Klinikum Dritter Orden, Department of Pediatric SurgeryPediatric Orthopedic and Neuroorthopaedic SectionMunichGermany
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Nadjiri J, Waggershauser T, Mühlmann M, Ehmer U, Geisler F, Mayr U, Geith T, Paprottka PM. Transjugular intrahepatic portosystemic shunt creation (TIPS) in the angio-CT-a hybrid intervention with image fusion. Eur Radiol 2023; 33:7380-7387. [PMID: 37284864 PMCID: PMC10598145 DOI: 10.1007/s00330-023-09793-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 04/20/2023] [Accepted: 05/14/2023] [Indexed: 06/08/2023]
Abstract
OBJECTIVE For transjugular intrahepatic portosystemic shunt (TIPS) creation, ultrasound guidance for portal vein puncture is strongly recommended. However, outside regular hours of service, a skilled sonographer might be lacking. Hybrid intervention suites combine CT imaging with conventional angiography allowing to project 3D information into the conventional 2D imaging and further CT-fluoroscopic puncture of the portal vein. The purpose of this study was to assess whether TIPS using angio-CT facilitates the procedure for a single interventional radiologist. METHODS All TIPS procedures from 2021 and 2022 which took place outside regular working hours were included (n = 20). Ten TIPS procedures were performed with just fluoroscopy guidance and ten procedures using angio-CT. For the angio-CT TIPS, a contrast-enhanced CT was performed on the angiography table. From the CT, a 3D volume was created using virtual rendering technique (VRT). The VRT was blended with the conventional angiography image onto the live monitor and used as guidance for the TIPS needle. Fluoroscopy time, area dose product, and interventional time were assessed. RESULTS Hybrid intervention with angio-CT did lead to a significantly shorter fluoroscopy time and interventional time (p = 0.034 for both). Mean radiation exposure was significantly reduced, too (p = 0.04). Furthermore, the mortality rate was lower in patients who underwent the hybrid TIPS (0% vs 33%). CONCLUSION TIPS procedure in angio-CT performed by only one interventional radiologist is quicker and reduces radiation exposure for the interventionalist compared to mere fluoroscopy guidance. The results further indicate increased safety using angio-CT. CLINICAL RELEVANCE STATEMENT This study aimed to evaluate the feasibility of using angio-CT in TIPS procedures during non-standard working hours. Results indicated that the use of angio-CT significantly reduced fluoroscopy time, interventional time, and radiation exposure, while also leading to improved patient outcomes. KEY POINTS • Image guiding such as ultrasound is recommended for transjugular intrahepatic portosystemic shunt creation but might be not available for emergency cases outside of regular working hours. • Transjugular intrahepatic portosystemic shunt creation using an angio-CT with image fusion is feasible for only one physician under emergency settings and results in lower radiation exposure and faster procedures. • Transjugular intrahepatic portosystemic shunt creation using an angio-CT with image fusion seems to be safer than using mere fluoroscopy guidance.
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Affiliation(s)
- Jonathan Nadjiri
- Department of Interventional Radiology, School of Medicine, University Hospital Klinikum Rechts Der Isar TUM, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany.
| | - Tobias Waggershauser
- Department of Interventional Radiology, School of Medicine, University Hospital Klinikum Rechts Der Isar TUM, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Marc Mühlmann
- Department of Interventional Radiology, School of Medicine, University Hospital Klinikum Rechts Der Isar TUM, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Ursula Ehmer
- Department of Medicine II, School of Medicine, Technical University of Munich, University Hospital Klinikum Rechts Der Isar, Munich, Germany
| | - Fabian Geisler
- Department of Medicine II, School of Medicine, Technical University of Munich, University Hospital Klinikum Rechts Der Isar, Munich, Germany
| | - Ulrich Mayr
- Department of Medicine II, School of Medicine, Technical University of Munich, University Hospital Klinikum Rechts Der Isar, Munich, Germany
| | - Tobias Geith
- Department of Interventional Radiology, School of Medicine, University Hospital Klinikum Rechts Der Isar TUM, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Philipp M Paprottka
- Department of Interventional Radiology, School of Medicine, University Hospital Klinikum Rechts Der Isar TUM, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
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Nadjiri J, Geith T, Mühlmann M, Waggershauser T, Paprottka PM. Safety of sheathless vascular access using braided 4 F selective catheters for common body interventions - a retrospective study. CVIR Endovasc 2023; 6:6. [PMID: 36795179 PMCID: PMC9935754 DOI: 10.1186/s42155-023-00350-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 01/23/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Besides other factors, complication rate of transarterial interventions depends on the size of the vascular access. Therefore, the vascular access is mostly chosen as small as possible while still allowing all planned parts of the intervention. This retrospective analysis is to evaluate the safety and feasibility of sheathless arterial interventions for a broad spectrum of interventions in daily practice. METHODS All sheathless interventions using a 4 F main catheter between May 2018 and September 2021 were included in the evaluation. Additionally, intervention parameters such as type of catheter, use of microcatheter and required change of main catheters were assessed. Information about the use about sheathless approach and catheters were obtained from the material registration system. All catheters were braided. RESULTS 503 sheathless interventions with 4 F catheters from the groin were documented. The spectrum comprised bleeding embolization, diagnostic angiographies, arterial DOTA-TATE-therapy, uterine fibroid embolization, transarterial chemotherapy, transarterial radioembolization and others. In 31 cases (6 %) a change of the main catheter was required. In 381 cases (76 %) a microcatheter was utilized. No clinically relevant adverse events were observed (grade 2 or higher [CIRSE AE-classification]). None of the cases later required conversion to a sheath-based intervention. CONCLUSIONS Sheathless interventions with a 4 F braided catheter from the groin are safe and feasible. It allows for a broad spectrum of interventions in daily practice.
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Affiliation(s)
- Jonathan Nadjiri
- Department of Interventional Radiology, School of medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, DE, Germany.
| | - Tobias Geith
- grid.6936.a0000000123222966Department of Interventional Radiology, School of medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675 Munich, DE Germany
| | - Marc Mühlmann
- grid.6936.a0000000123222966Department of Interventional Radiology, School of medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675 Munich, DE Germany
| | - Tobias Waggershauser
- grid.6936.a0000000123222966Department of Interventional Radiology, School of medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675 Munich, DE Germany
| | - Philipp M. Paprottka
- grid.6936.a0000000123222966Department of Interventional Radiology, School of medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675 Munich, DE Germany
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Erber BM, Reidler P, Goller SS, Ricke J, Dürr HR, Klein A, Lindner L, Di Gioia D, Geith T, Baur-Melnyk A, Armbruster M. Impact of Dynamic Contrast Enhanced and Diffusion-Weighted MR Imaging on Detection of Early Local Recurrence of Soft Tissue Sarcoma. J Magn Reson Imaging 2023; 57:622-630. [PMID: 35582900 DOI: 10.1002/jmri.28236] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 05/03/2022] [Accepted: 05/05/2022] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Diagnosis of residual or recurrent tumor in soft-tissue sarcomas (STS) is a differential diagnostic challenge since post-therapeutic changes impede diagnosis. PURPOSE To evaluate the diagnostic accuracy of quantitative dynamic contrast enhanced (DCE)-MRI and diffusion-weighted imaging (DWI) to detect local recurrence of STS of the limb. STUDY TYPE Prospective. POPULATION A totalof 64 consecutive patients with primary STS of the limbs were prospectively included 3-6 months after surgery between January 2016 and July 2021. FIELD STRENGTH/SEQUENCE A 1.5 T; axial DWI echo-planar imaging sequences and DCE-MRI using a 3D T1-weighted spoiled gradient-echo sequence. ASSESSMENT The quantitative DCE-MRI parameters relative plasma flow (rPF) and relative mean transit time (rMTT) were calculated and ADC mapping was used to quantify diffusion restriction. Regions of interest of tumor growth and postoperative changes were drawn in consensus by two experts for diffusion and perfusion analysis. An additional morphological assessment was done by three independent and blinded radiologists. STATISTICAL TEST Unpaired t-test, ROC-analysis, and a logistic regression model were applied. Interobserver reliability was calculated using Fleiss kappa statistics. A P value of 0.05 was considered statistically significant. RESULTS A total of 11 patients turned out to have local recurrence. rPF was significantly higher in cases of local recurrence when compared to cases without local recurrence (61.1-4.5) while rMTT was slightly and significantly lower in local recurrence. ROC-analysis showed an area under the curve (AUC) of 0.95 (SEM ± 0.05) for rPF while a three-factor multivariate logistic regression model showed a high diagnostic accuracy of rPF (R2 = 0.71). Compared with morphological assessment, rPF had a distinct higher specificity and true positive value in detection of LR. DATA CONCLUSION DCE-MRI is a promising additional method to differentiate local recurrence from benign postoperative changes in STS of the limb. Especially specificity in detection of LR is increased compared to morphological assessment. EVIDENCE LEVEL 1 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Bernd M Erber
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Paul Reidler
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Sophia S Goller
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Jens Ricke
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Hans R Dürr
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany
| | - Alexander Klein
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany
| | - Lars Lindner
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
| | - Dorit Di Gioia
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
| | - Tobias Geith
- Department of Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Andrea Baur-Melnyk
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Marco Armbruster
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
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Geith T, Paprottka PM. [Imaging of intrahepatic cholangiocarcinoma : Reliable diagnosis according to the new S3 guideline]. Radiologe 2022; 62:205-209. [PMID: 35029722 DOI: 10.1007/s00117-021-00961-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2021] [Indexed: 10/19/2022]
Abstract
The S3 guideline on hepatocellular carcinoma has been expanded to include malignant biliary carcinoma (synonym cholangiocarcinoma [CCA]). Magnetic resonance imaging (MRI) with additional magnetic resonance cholangiopancreatography (MRCP) is the imaging modality of choice to evaluate local findings. Use of gadolinium ethoxybenzyl diethylenetriamine penta-acetic acid (Gd-EOB-DTPA)-based contrast agent increases its diagnostic value. Histologic confirmation is always required when diagnosing intrahepatic CCA (iCCA) because using imaging alone there is a risk of confusion with HCC subtypes.
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Affiliation(s)
- Tobias Geith
- Interventionelle Radiologie, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Str. 22, 81675, München, Deutschland.
| | - Philipp M Paprottka
- Interventionelle Radiologie, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Str. 22, 81675, München, Deutschland
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Nadjiri J, Kierse A, Sendlbeck M, Janssen A, Geith T, Waggershauser T, Paprottka PM. Efficacy of ultrasound assisted catheter-directed thrombolysis compared to catheter-directed thrombolysis in vitro. Acta Radiol 2021; 64:119-124. [PMID: 34866428 DOI: 10.1177/02841851211061440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Catheter-directed thrombolysis (CDT) is an effective and safe endovascular method used in critical limb ischemia and many other thromboembolic events. Ultrasound-assisted catheter-directed thrombolysis (US-CDT) is an emerging technique considered to accelerate thrombolysis and therefore is supposed to improve outcome. PURPOSE To evaluate the efficacy of US-CDT in comparison to standard CDT in vitro. MATERIAL AND METHODS A total of 69 sets of human venous blood were evaluated, each comprising a tube just treated with CDT, a tube treated with US-CDT, and a control tube. All tubes were kept under physiological conditions. Except for the controls, in all tubes 5 mg of tissue-type plasminogen activator was administered over the predetermined treatment interval. Thrombus mass was weighted at the end of the lysis intervals at 6 h or 24 h, respectively. RESULTS CDT led to a mean thrombus reduction of 32% and ultrasound-assisted lysis led to a mean thrombus reduction of 41% (P < 0.001 for both). Thrombus reduction was significantly higher after US-CDT compared to CDT (P = 0.001). The better efficacy of US-CDT was mostly already apparent at early phases during thrombolysis and did further mildly increase over time (r = 0.24; P = 0.047). CONCLUSION In vitro US-CDT is significantly superior to standard CDT; this effect is apparent at an early timepoint of lysis and slightly further increases over time.
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Affiliation(s)
- Jonathan Nadjiri
- Department of Interventional Radiology, Klinikum rechts der Isar of the Technical University of Munich, Munich, Germany
| | - Anna Kierse
- Department of Interventional Radiology, Klinikum rechts der Isar of the Technical University of Munich, Munich, Germany
| | - Melanie Sendlbeck
- Department of Interventional Radiology, Klinikum rechts der Isar of the Technical University of Munich, Munich, Germany
| | - Agnes Janssen
- Department of Interventional Radiology, Klinikum rechts der Isar of the Technical University of Munich, Munich, Germany
| | - Tobias Geith
- Department of Interventional Radiology, Klinikum rechts der Isar of the Technical University of Munich, Munich, Germany
| | - Tobias Waggershauser
- Department of Interventional Radiology, Klinikum rechts der Isar of the Technical University of Munich, Munich, Germany
| | - Philipp M Paprottka
- Department of Interventional Radiology, Klinikum rechts der Isar of the Technical University of Munich, Munich, Germany
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Horng A, Stroebel J, Geith T, Milz S, Pacureanu A, Yang Y, Cloetens P, Lovric G, Mittone A, Bravin A, Coan P. Multiscale X-ray phase contrast imaging of human cartilage for investigating osteoarthritis formation. J Biomed Sci 2021; 28:42. [PMID: 34098949 PMCID: PMC8182937 DOI: 10.1186/s12929-021-00739-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [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: 01/09/2021] [Accepted: 06/01/2021] [Indexed: 12/14/2022] Open
Abstract
Background The evolution of cartilage degeneration is still not fully understood, partly due to its thinness, low radio-opacity and therefore lack of adequately resolving imaging techniques. X-ray phase-contrast imaging (X-PCI) offers increased sensitivity with respect to standard radiography and CT allowing an enhanced visibility of adjoining, low density structures with an almost histological image resolution. This study examined the feasibility of X-PCI for high-resolution (sub-) micrometer analysis of different stages in tissue degeneration of human cartilage samples and compare it to histology and transmission electron microscopy. Methods Ten 10%-formalin preserved healthy and moderately degenerated osteochondral samples, post-mortem extracted from human knee joints, were examined using four different X-PCI tomographic set-ups using synchrotron radiation the European Synchrotron Radiation Facility (France) and the Swiss Light Source (Switzerland). Volumetric datasets were acquired with voxel sizes between 0.7 × 0.7 × 0.7 and 0.1 × 0.1 × 0.1 µm3. Data were reconstructed by a filtered back-projection algorithm, post-processed by ImageJ, the WEKA machine learning pixel classification tool and VGStudio max. For correlation, osteochondral samples were processed for histology and transmission electron microscopy. Results X-PCI provides a three-dimensional visualization of healthy and moderately degenerated cartilage samples down to a (sub-)cellular level with good correlation to histologic and transmission electron microscopy images. X-PCI is able to resolve the three layers and the architectural organization of cartilage including changes in chondrocyte cell morphology, chondrocyte subgroup distribution and (re-)organization as well as its subtle matrix structures. Conclusions X-PCI captures comprehensive cartilage tissue transformation in its environment and might serve as a tissue-preserving, staining-free and volumetric virtual histology tool for examining and chronicling cartilage behavior in basic research/laboratory experiments of cartilage disease evolution.
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Affiliation(s)
- Annie Horng
- Department of Clinical Radiology, Faculty of Medicine, Ludwig-Maximilians-University, Marchioninistr. 15, 81377, Munich, Germany.,RZM - Radiologisches Zentrum Munich-Pasing, Pippinger Str. 25, 81245, Munich, Germany
| | - Johannes Stroebel
- Department of Medical Physics, Faculty of Physics, Ludwig-Maximilians-University Munich, Am Coulombwall 1, 85748, Garching, Germany
| | - Tobias Geith
- Department of Interventional Radiology, Klinikum Rechts der Isar of the Technical University of Munich, Munich, Germany
| | - Stefan Milz
- Faculty of Medicine, Anatomische Anstalt, Neuroanatomy, Ludwig Maximilians University, Munich, Germany
| | | | - Yang Yang
- European Synchrotron Radiation Facility, Grenoble, France.,National Synchrotron Light Source II, Brookhaven National Laboratory, Upton, NY, 11973, USA
| | - Peter Cloetens
- European Synchrotron Radiation Facility, Grenoble, France
| | - Goran Lovric
- Paul Scherrer Institute (Swiss Light Source), Villigen, Switzerland
| | | | - Alberto Bravin
- European Synchrotron Radiation Facility, Grenoble, France
| | - Paola Coan
- Department of Clinical Radiology, Faculty of Medicine, Ludwig-Maximilians-University, Marchioninistr. 15, 81377, Munich, Germany. .,Department of Medical Physics, Faculty of Physics, Ludwig-Maximilians-University Munich, Am Coulombwall 1, 85748, Garching, Germany.
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Geith T, Stellwag AC, E Müller P, Reiser M, Baur-Melnyk A. Is bone marrow edema syndrome a precursor of hip or knee osteonecrosis? Results of 49 patients and review of the literature. ACTA ACUST UNITED AC 2021; 26:355-362. [PMID: 32558648 DOI: 10.5152/dir.2020.19188] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
PURPOSE Diagnosis of bone marrow edema syndrome (BMES) can be challenging. There is sometimes uncertainty about the correct diagnosis of BMES on morphologic magnetic resonance imaging (MRI), since subchondral findings like lines and spots can be misinterpreted as "beginning" or "possible" avascular osteonecrosis (AVN). The aim of our study was to systematically assess the temporal course of BMES from first diagnosis on MRI until the end of clinical symptoms and the full disappearance of bone marrow edema (BME) to determine whether subchondral lines and spots detected in these patients can develop into osteonecrosis. METHODS In a combined retrospective and prospective study, we retrieved serial MRI scans of hips and knees with BME from the hospital database. According to clinical and imaging data, all patients with degenerative, infectious/inflammatory, rheumatic, neoplastic conditions and those showing typical osteonecrosis were excluded. We collected all available MRI examinations from first detection of BME until its disappearance. In case edema had not fully resolved in the last available MRI scan, we performed an MRI with an additional dynamic contrast-enhanced (DCE-MRI) sequence. For each MRI scan, we recorded the severity of edema, the presence of subchondral hypointense lines and the presence of subchondral focal hypointense zones on T1-weighted images by two independent readers. The DCE-MRI scans were used to calculate parameter maps to assess the perfusion characteristics. RESULTS The study comprised 49 patients aged 22-71 years. In total, 171 morphologic and 5 DCE-MRI scans were evaluated. In 44 patients (89.8%), the BMES completely healed without remnants. In 18 of 49 patients (36.7%), a subchondral line was present in the first MRI exam. Nine patients (18.4%) developed a subchondral line within 1-5 months after the first MRI. In total, 27 out of 49 patients (55.1%) had subchondral lines (12 knees, 15 hips) during the timeframe of the study. All subchondral lines disappeared in the timeframe of the study. Subchondral focal hypointense zones were present in 14 out of 49 patients (28.6%): in 9 cases, subchondral focal hypointense zones disappeared after a median of 5.5 months (range, 1-85 months), while in 5 cases, subchondral focal lesions persisted until the end of the study (up to more than 85 months) without edema in the surrounding bone. All persisting subchondral focal lesions were hyperperfused. These 5 patients had associated meniscal lesions. CONCLUSION Our study shows that subchondral lines and spots found in patients with BMES do not develop into AVN. Subchondral lines, which resemble subchondral insufficiency fractures, are associated with BMES. Subchondral focal T1-hypointense zones do not represent AVN; most probably these areas represent reparative processes within the subchondral bone, where tensile and shear force overload is present due to altered biomechanics.
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Affiliation(s)
- Tobias Geith
- Department of Interventional Radiology, Rechts der Isar Hospital, Technical University of Munich, Munich, Germany
| | - Ann-Cathrin Stellwag
- Department of Radiology, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Peter E Müller
- Department of Orthopedic Surgery, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Maximilian Reiser
- Department of Radiology, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Andrea Baur-Melnyk
- Department of Radiology, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
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Nadjiri J, Geith T, Waggershauser T, Heuser L, Morhard D, Bücker A, Paprottka PM. [Comparison of radiation exposure in common hepatic interventions : A retrospective analysis of DeGIR registry data]. Radiologe 2021; 61:80-86. [PMID: 32816049 PMCID: PMC7810650 DOI: 10.1007/s00117-020-00737-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Hintergrund Die transarterielle Chemoembolisation (TACE) oder auch Gallenganginterventionen stellen häufige Leberinterventionen dar. Ziel der Arbeit In dieser retrospektiven Studie soll die Strahlenexposition der Patienten mit einem hepatischen Eingriff in Abhängigkeit von Art und Feinziel der Intervention analysiert und verglichen werden. Material und Methoden Dies ist eine Analyse von 7003 DeGIR-Registerdatensätzen aus den Jahren 2016 bis 2018 für TACE und Gallenganginterventionen. Das Dosisflächenprodukt (DFP) und die Durchleuchtungszeit (DL) sowie die Interventionsart und das anatomisch definierte Feinziel der Interventionen wurden erfasst. Ergebnisse Insgesamt lagen Dosiswerte für 4985 durchgeführte TACE und 2018 Gallenganginterventionen vor. Bei Gallenganginterventionen lag der Median des DFP bei 2594 (Interquartilbereich [IQR] = 1174–5858) cGy*cm2. Bei der TACE betrug der Median des DFP 11.632 [IQR = 5530–22.800] cGy*cm2 und lag damit signifikant höher als bei Gallenganginterventionen (p < 0,0001). Gallengangeingriffe mit dem höchsten DFP sind Interventionen am Ductus hepaticus, während Eingriffe mit der längsten DL an der Hepatikusgabel stattfinden. Diskussion Die individuelle Strahlendosis für einen Patienten bei einer Leberintervention hängt weniger von der Komplexität des Eingriffs bzw. Durchleuchtungszeit ab, sondern von der Art des Eingriffs und vom Feinziel der Intervention. Die vorliegenden Dosisdaten können eine Hilfe sein, die Strahlenexposition bei einer Leberintervention bereits vor dem Eingriff grob abzuschätzen.
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Affiliation(s)
- Jonathan Nadjiri
- Sektion für Interventionelle Radiologie, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Straße 22, München, Deutschland.
| | - Tobias Geith
- Sektion für Interventionelle Radiologie, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Straße 22, München, Deutschland
| | - Tobias Waggershauser
- Sektion für Interventionelle Radiologie, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Straße 22, München, Deutschland
| | | | - Dominik Morhard
- Radiologie und Neuroradiologie, Leopoldina Krankenhaus Schweinfurt, Schweinfurt, Deutschland
| | - Arno Bücker
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum der Universität des Saarlandes, Homburg /Saar, Deutschland
| | - Philipp M Paprottka
- Sektion für Interventionelle Radiologie, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Straße 22, München, Deutschland
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Steger A, Bollwein C, Geith T, Ibrahim T. Endovascular rescue-stenting of a ruptured mycotic subclavian pseudoaneurysm caused by pulmonary aspergillosis. Eur Heart J 2019; 40:2520. [PMID: 31329847 DOI: 10.1093/eurheartj/ehz261] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Alexander Steger
- Klinik und Poliklinik für Innere Medizin I, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, Munich, Germany
| | - Christine Bollwein
- Institut für Pathologie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, Munich, Germany
| | - Tobias Geith
- Interventionelle Radiologie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, Munich, Germany
| | - Tareq Ibrahim
- Klinik und Poliklinik für Innere Medizin I, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, Munich, Germany
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Kraxenberger M, Schröder C, Geith T, Büttner A, von Schulze-Pellengahr C, Birkenmaier C, Müller PE, Jansson V, Wegener B. Fracture generation in human vertebrae under compression loading: The influence of pedicle preservation and bone mineral density on in vitro fracture behavior. Technol Health Care 2018; 26:155-163. [PMID: 29154300 DOI: 10.3233/thc-171086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Fractured vertebral bodies are a common and wide spread health issue. OBJECTIVE The purpose of this study was to develop a standardized method to experimentally generate compression fractures in vertebral bodies. The influence of the pedicles has been investigated with regards to the fracture behavior. The correlation between bone mineral density (BMD), the cause of fractures and the fracture behavior was investigated. METHODS Twenty-one fresh frozen human lumbar spines were examined for bone mineral density (BMD) by means of quantitative computed tomography (qCT). All soft tissue was removed, vertebrae were carefully separated from each other and the exposed cranial and caudal endplates were covered with a thin layer of resin to generate a plane and homogeneous surface. A total of 80 vertebral bodies were tested until fracture. RESULTS A good positive correlation was found between BMD, fracture compression force and stiffness of the vertebral body. No significant differences were found between the fractures generated in vertebral bodies with and without pedicles, respectively. CONCLUSIONS Our model represents a consolidation of already existing testing devices. The comparative measurement of the BMD and the fracture behavior shows validity. In contrast to other authors, the force was applied to the whole vertebral body. Furthermore the upper and lower plates were not parallelized and therefore the natural anatomic shape was imitated. Fracture behavior was not altered by removing the pedicles.
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Affiliation(s)
- Michael Kraxenberger
- Department of Orthopedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich - Campus Grosshadern, Munich, Germany
| | - Christian Schröder
- Department of Orthopedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich - Campus Grosshadern, Munich, Germany
| | - Tobias Geith
- Institute for Clinical Radiology, University Hospital, LMU Munich - Campus Grosshadern, Munich, Germany
| | - Andreas Büttner
- Institute of Forensic Medicine, University Medical Center, Rostock, Germany
| | | | - Christof Birkenmaier
- Department of Orthopedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich - Campus Grosshadern, Munich, Germany
| | - Peter E Müller
- Department of Orthopedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich - Campus Grosshadern, Munich, Germany
| | - Volkmar Jansson
- Department of Orthopedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich - Campus Grosshadern, Munich, Germany
| | - Bernd Wegener
- Department of Orthopedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich - Campus Grosshadern, Munich, Germany
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Abstract
The bone marrow basically consists of red blood-forming bone marrow and yellow fat. In the skeleton, there is an age-dependent distribution of these two parts. In the context of medical interventions or therapies, bone marrow changes can occur, whereby the normal bone marrow can basically be replaced by fat, edema, or fibrosis/sclerosis. Here, specific signal intensities and patterns are shown in imaging. After irradiation therapies, edematous changes, hemorrhages, and osteoradionecroses are observed. Likewise, insufficiency fractures, impairment of the growth gaps, or the development of tumors is possible. In patients on dialysis, deposit of protein in the bone marrow is possible in the case of the so-called amyloidosis osteoarthropathy. Postoperative bone marrow edema, insufficiency fractures, or osteonecrosis can be observed after arthroscopy. Changes in the distribution of fat markers and blood-forming bone marrow can be observed after stem cell transplants. In the therapy with cortisone, insufficiency fractures and osteonecroses are possible. Depending on their effect on the hematopoietic system, chemotherapyies can first lead to edematous changes and then to fatty bone marrow, which is reversible after therapy. Angiogenesis inhibitors in combination with other chemotherapeutic agents often lead to mixed images of stimulated and fatty bone marrow.
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Affiliation(s)
- T Geith
- Klinik und Poliklinik für Radiologie, Klinikum der Universität München, Marchioninistraße 15, 81375, München, Deutschland.
| | - A-C Stellwag
- Klinik und Poliklinik für Radiologie, Klinikum der Universität München, Marchioninistraße 15, 81375, München, Deutschland
| | - A Baur-Melnyk
- Klinik und Poliklinik für Radiologie, Klinikum der Universität München, Marchioninistraße 15, 81375, München, Deutschland
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Horng A, Geith T, Brun E, Mittone A, Gasilov S, Adam-Neumair S, Bravin A, Reiser M, Coan P. Cartilage Imaging using HR Propagation-Based Phase-contrast CT in a Guinea Pig Knee Joint Model of Different Age Groups. Semin Musculoskelet Radiol 2017. [DOI: 10.1055/s-0037-1600894] [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: 10/20/2022]
Affiliation(s)
- Annie Horng
- Radiologisches Zentrum München-Pasing, Munich, Germany
| | - Tobias Geith
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany
| | - Emmanuel Brun
- European Synchrotron Radiation Facility, Grenoble, France
| | | | - Sergei Gasilov
- European Synchrotron Radiation Facility, Grenoble, France
| | - Silvia Adam-Neumair
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany
| | - Alberto Bravin
- European Synchrotron Radiation Facility, Grenoble, France
| | | | - Paolo Coan
- Radiologisches Zentrum München-Pasing, Munich, Germany
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Dietrich O, Geith T, Reiser MF, Baur-Melnyk A. Diffusion imaging of the vertebral bone marrow. NMR Biomed 2017; 30:e3333. [PMID: 26114411 DOI: 10.1002/nbm.3333] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Revised: 04/27/2015] [Accepted: 05/04/2015] [Indexed: 06/04/2023]
Abstract
Diffusion-weighted MRI (DWI) of the vertebral bone marrow is a clinically important tool for the characterization of bone-marrow pathologies and, in particular, for the differentiation of benign (osteoporotic) and malignant vertebral compression fractures. DWI of the vertebral bone marrow is, however, complicated by some unique MR and tissue properties of vertebral bone marrow. Due to both the spongy microstructure of the trabecular bone and the proximity of the lungs, soft tissue, or large vessels, substantial magnetic susceptibility variations occur, which severely reduce the magnetic field homogeneity as well as the transverse relaxation time T*2 , and thus complicate MRI in particular with echoplanar imaging (EPI) techniques. Therefore, alternative diffusion-weighting pulse sequence types such as single-shot fast-spin-echo sequences or segmented EPI techniques became important alternatives for quantitative DWI of the vertebral bone marrow. This review first describes pulse sequence types that are particularly important for DWI of the vertebral bone marrow. Then, data from 24 studies that made diffusion measurements of normal vertebral bone marrow are reviewed; summarizing all results, the apparent diffusion coefficient (ADC) of normal vertebral bone marrow is typically found to be between 0.2 and 0.6 × 10-3 mm2 /s. Finally, DWI of vertebral compression fractures is discussed. Numerous studies demonstrate significantly greater ADCs in osteoporotic fractures (typically between 1.2 and 2.0 × 10-3 mm2 /s) than in malignant fractures or lesions (typically 0.7-1.3 × 10-3 mm2 /s). Alternatively, several studies used the (qualitative) image contrast of diffusion-weighted acquisitions for differentiation of lesion etiology: a very good lesion differentiation can be achieved, particularly with diffusion-weighted steady-state free precession sequences, which depict malignant lesions as hyperintense relative to normal-appearing vertebral bone marrow, in contrast to hypointense or isointense osteoporotic lesions. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Olaf Dietrich
- Josef Lissner Laboratory for Biomedical Imaging, Institute for Clinical Radiology, Ludwig Maximilian University Hospital Munich, Germany
| | - Tobias Geith
- Institute for Clinical Radiology, Ludwig Maximilian University Hospital Munich, Germany
| | - Maximilian F Reiser
- Josef Lissner Laboratory for Biomedical Imaging, Institute for Clinical Radiology, Ludwig Maximilian University Hospital Munich, Germany
- Institute for Clinical Radiology, Ludwig Maximilian University Hospital Munich, Germany
| | - Andrea Baur-Melnyk
- Institute for Clinical Radiology, Ludwig Maximilian University Hospital Munich, Germany
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Geith T, Niethammer T, Milz S, Dietrich O, Reiser M, Baur-Melnyk A. Transient Bone Marrow Edema Syndrome versus Osteonecrosis: Perfusion Patterns at Dynamic Contrast-enhanced MR Imaging with High Temporal Resolution Can Allow Differentiation. Radiology 2016; 283:478-485. [PMID: 27905865 DOI: 10.1148/radiol.2016152665] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Purpose To prospectively evaluate the perfusion patterns at quantitative dynamic contrast material-enhanced (DCE) magnetic resonance (MR) imaging of transient bone marrow edema syndrome (TBMES) and avascular osteonecrosis. Materials and Methods Institutional review board approval and written informed consent were obtained. Thirty-two patients (21 men, 11 women; mean age, 48 years; 26 hips, 10 knees) underwent conventional MR imaging and a dynamic contrast-enhanced three-dimensional spoiled gradient-echo sequence at 3 T. Parameter maps for mean transit time (MTT) and plasma flow (PF) were evaluated qualitatively and quantitatively. Differences in perfusion patterns were analyzed by using the Fisher exact test. Regions of interest were drawn in areas of high PF and long MTT on each parametric map. Mean, median, standard deviation, minimum, and maximum values were determined. TBMES and osteonecrosis were compared statistically by using the Mann-Whitney U and Wilcoxon signed-rank tests, with a P value of less than .05 considered indicative of a significant difference. Results Nineteen joints with TBMES and 17 joints with osteonecrosis were evaluated. TBMES joints showed a subchondral elongated area of high PF and low MTT that was surrounded by an area of long MTT and low PF. Osteonecrosis joints showed a subchondral area with low or no detectable PF and MTT adjacent to the joint surface, which was surrounded by a rim of high PF and intermediate MTT. Patterns for TBMES and osteonecrosis did not overlap. A significant difference (P < .001) in PF in the immediate subchondral area was found between TBMES and osteonecrosis; in joints with osteonecrosis, this was comparable to background noise, and therefore, could not be quantified. In the circumscribed rim of high PF and intermediate MTT, which was only found in joints with osteonecrosis, mean ± standard deviation PF was 18.9 mL/100 mL per minute ± 11.0 and mean MTT was 213.3 seconds ± 56.8. No significant difference between TBMES and osteonecrosis was found for MTT (P = .09) and PF (P = .75) in the surrounding area. Conclusion Parameter maps derived at dynamic contrast-enhanced MR imaging with high temporal resolution can allow differentiation of osteonecrosis from TBMES in hip and knee joints. © RSNA, 2016 Online supplemental material is available for this article.
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Affiliation(s)
- Tobias Geith
- From the Departments of Clinical Radiology (T.G., O.D., M.R., A.B.M.), Orthopedic Surgery (T.N.), and the Anatomical Institute (S.M.), Ludwig-Maximilians University Munich, Campus Grosshadern, Marchioninistrasse 15, 81377 Munich, Germany
| | - Thomas Niethammer
- From the Departments of Clinical Radiology (T.G., O.D., M.R., A.B.M.), Orthopedic Surgery (T.N.), and the Anatomical Institute (S.M.), Ludwig-Maximilians University Munich, Campus Grosshadern, Marchioninistrasse 15, 81377 Munich, Germany
| | - Stefan Milz
- From the Departments of Clinical Radiology (T.G., O.D., M.R., A.B.M.), Orthopedic Surgery (T.N.), and the Anatomical Institute (S.M.), Ludwig-Maximilians University Munich, Campus Grosshadern, Marchioninistrasse 15, 81377 Munich, Germany
| | - Olaf Dietrich
- From the Departments of Clinical Radiology (T.G., O.D., M.R., A.B.M.), Orthopedic Surgery (T.N.), and the Anatomical Institute (S.M.), Ludwig-Maximilians University Munich, Campus Grosshadern, Marchioninistrasse 15, 81377 Munich, Germany
| | - Maximilian Reiser
- From the Departments of Clinical Radiology (T.G., O.D., M.R., A.B.M.), Orthopedic Surgery (T.N.), and the Anatomical Institute (S.M.), Ludwig-Maximilians University Munich, Campus Grosshadern, Marchioninistrasse 15, 81377 Munich, Germany
| | - Andrea Baur-Melnyk
- From the Departments of Clinical Radiology (T.G., O.D., M.R., A.B.M.), Orthopedic Surgery (T.N.), and the Anatomical Institute (S.M.), Ludwig-Maximilians University Munich, Campus Grosshadern, Marchioninistrasse 15, 81377 Munich, Germany
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Gasilov S, Mittone A, Horng A, Geith T, Bravin A, Baumbach T, Coan P. Hard X-ray index of refraction tomography of a whole rabbit knee joint: A feasibility study. Phys Med 2016; 32:1785-1789. [PMID: 27793538 DOI: 10.1016/j.ejmp.2016.10.001] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 09/30/2016] [Accepted: 10/01/2016] [Indexed: 10/20/2022] Open
Abstract
We report results of the computed tomography reconstruction of the index of refraction in a whole rabbit knee joint examined at the photon energy of 51keV. Refraction based images make it possible to delineate the bone, cartilage, and soft tissues without adjusting the contrast window width and level. Density variations, which are related to tissue composition and are not visible in absorption X-ray images, are detected in the obtained refraction based images. We discuss why refraction-based images provide better detectability of low contrast features than absorption images.
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Affiliation(s)
- S Gasilov
- Institute for Beam Physics and Technology, Karlsruhe Institute for Technology, Eggenstein 76344, Germany; Department of Physics, Ludwig Maximilians University, Garching 85748, Germany.
| | - A Mittone
- European Synchrotron Radiation Facility, Grenoble 38043, France; Department of Physics, Ludwig Maximilians University, Garching 85748, Germany
| | - A Horng
- Institute for Clinical Radiology, Ludwig-Maximilians-University, Munich 81377, Germany
| | - T Geith
- Institute for Clinical Radiology, Ludwig-Maximilians-University, Munich 81377, Germany
| | - A Bravin
- European Synchrotron Radiation Facility, Grenoble 38043, France
| | - T Baumbach
- Institute for Photon Science and Synchrotron Radiation, Karlsruhe Institute for Technology, Eggenstein 76344, Germany; Laboratory for Application of Synchrotron Radiation, Karlsruhe Institute for Technology, Eggenstein 76344, Germany
| | - P Coan
- Institute for Clinical Radiology, Ludwig-Maximilians-University, Munich 81377, Germany; Department of Physics, Ludwig Maximilians University, Garching 85748, Germany
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Strobl FF, Azam H, Schwarz JB, Paprottka PM, Geith T, Abdel-Rahman S, Zilles B, Lindner LH, Reiser MF, Trumm CG. CT fluoroscopy-guided closed-tip catheter placement before regional hyperthermia treatment of soft tissue sarcomas: 5-Year experience in 35 consecutive patients. Int J Hyperthermia 2015; 32:151-8. [DOI: 10.3109/02656736.2015.1107761] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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Gasilov S, Mittone A, Horng A, Bravin A, Baumbach T, Geith T, Reiser M, Coan P. Boundary value problem for phase retrieval from unidirectional X-ray differential phase images. Opt Express 2015; 23:13294-13308. [PMID: 26074580 DOI: 10.1364/oe.23.013294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The phase retrieval problem can be reduced to the second order partial differential equation. In order to retrieve the absolute values of the X-ray phase and to minimize the reconstruction artifacts we defined the mixed inhomogeneous boundary condition using available a priori information about the sample. Finite element technique was used to solve the boundary value problem. The approach is validated on numerical and experimental phantoms. In order to demonstrate a possible application of the method, we have processed an entire tomographic set of differential phase images and estimated the magnitude of the refractive index decrement for some tissues inside complex biomedical samples.
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Abstract
OBJECTIVES This article discusses the morphological criteria for the differentiation between acute osteoporotic and metastatic vertebral body fractures and new imaging methods, such as diffusion-weighted and chemical shift magnetic resonance imaging (MRI) are presented. BACKGROUND The differential diagnostics of osteoporotic and metastatic vertebral body fractures can be difficult in some cases. Both entities normally occur without adequate trauma and predominantly in elderly patients. IMAGING Conventional X-ray examination is the initial imaging method of choice but is not able to reliably differentiate between the osteoporotic or metastatic etiology of a fracture. Computed tomography (CT) clearly depicts osseous destruction in metastatic fractures but lacks specificity. Magnetic resonance imaging (MRI) shows a higher sensitivity and specificity in differentiating osteoporotic and metastatic fractures. DIFFERENTIAL DIAGNOSTICS The combination CT and MRI allows an accurate diagnosis with respect to an osteoprorotic or metastatic etiology in most of cases but bone marrow edema in acute fractures sometimes leads to ambiguous results and differential diagnostic problems.
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Affiliation(s)
- T Geith
- Institut für Klinische Radiologie, Klinikum der Ludwig-Maximilians-Universität, Campus Großhadern, Marchioninistr. 15, 81377, München, Deutschland,
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Horng A, Brun E, Mittone A, Gasilov S, Weber L, Geith T, Adam-Neumair S, Auweter SD, Bravin A, Reiser MF, Coan P. Cartilage and Soft Tissue Imaging Using X-rays. Invest Radiol 2014; 49:627-34. [DOI: 10.1097/rli.0000000000000063] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Geith T, Amarie S, Milz S, Bamberg F, Keilmann F. Visualisation of methacrylate-embedded human bone sections by infrared nanoscopy. J Biophotonics 2014; 7:418-424. [PMID: 23420621 DOI: 10.1002/jbio.201200172] [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] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Revised: 09/19/2012] [Accepted: 10/11/2012] [Indexed: 06/01/2023]
Abstract
A recently developed ultra-resolving near-field infrared nanoscope is applied to investigate methyl methacrylate embedded, un-decalcified human bone sections. Results show detail at a resolution of 30 nm. Specific contrasting of mineral components is enabled by choosing an appropriate infrared wavelength, here 9.47 μm, in the phosphate vibrational band. The method is surface-sensitive, probing to a depth of about 30 nm into the surface. The obtained infrared images are presented in direct comparison with optical and electron micrographs of the identical specimen. Lamellar bone organization, peri-cellular mineral deposition, and regional differences in mineral content are clearly detectable. Individual fibrils are resolved. - Infrared nanoscopy requires just standard hard tissue preparation techniques combined with section surface polishing. It can be integrated into existing laboratory environments without impeding subsequent routine staining and evaluation methods.
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Affiliation(s)
- Tobias Geith
- Department of Clinical Radiology, Ludwig-Maximilians-University, Großhadern Campus, 81377 München, Germany
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Horng A, Brun E, Mittone A, Gasilov S, Weber L, Geith T, Adam-Neumair S, Bravin A, Reiser M, Coan P. Phasenkontrast-CT als neue Röntgentechnik zur Darstellung von Knorpel und Weichgewebe des Kniegelenkes im Vergleich zu konventionellen klinischen Techniken. ROFO-FORTSCHR RONTG 2014. [DOI: 10.1055/s-0034-1372790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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