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Stoevesandt D, Ludwig C, Mauz-Körholz C, Körholz D, Hasenclever D, McCarten K, Flerlage JE, Kurch L, Wohlgemuth WA, Landman-Parker J, Wallace WH, Fosså A, Vordermark D, Karlén J, Cepelová M, Klekawka T, Attarbaschi A, Hraskova A, Uyttebroeck A, Beishuizen A, Dieckmann K, Leblanc T, Daw S, Steglich J. Pulmonary lesions in early response assessment in pediatric Hodgkin lymphoma: prevalence and possible implications for initial staging. Pediatr Radiol 2024; 54:725-736. [PMID: 38296856 PMCID: PMC11056341 DOI: 10.1007/s00247-024-05859-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 01/11/2024] [Accepted: 01/12/2024] [Indexed: 02/02/2024]
Abstract
BACKGROUND Disseminated pulmonary involvement in pediatric Hodgkin lymphoma (pHL) is indicative of Ann Arbor stage IV disease. During staging, it is necessary to assess for coexistence of non-malignant lung lesions due to infection representing background noise to avoid erroneously upstaging with therapy intensification. OBJECTIVE This study attempts to describe new lung lesions detected on interim staging computed tomography (CT) scans after two cycles of vincristine, etoposide, prednisolone, doxorubicin in a prospective clinical trial. Based on the hypothesis that these new lung lesions are not part of the underlying malignancy but are epiphenomena, the aim is to analyze their size, number, and pattern to help distinguish true lung metastases from benign lung lesions on initial staging. MATERIALS AND METHODS A retrospective analysis of the EuroNet-PHL-C1 trial re-evaluated the staging and interim lung CT scans of 1,300 pediatric patients with HL. Newly developed lung lesions during chemotherapy were classified according to the current Fleischner glossary of terms for thoracic imaging. Patients with new lung lesions found at early response assessment (ERA) were additionally assessed and compared to response seen in hilar and mediastinal lymph nodes. RESULTS Of 1,300 patients at ERA, 119 (9.2%) had new pulmonary lesions not originally detectable at diagnosis. The phenomenon occurred regardless of initial lung involvement or whether a patient relapsed. In the latter group, new lung lesions on ERA regressed by the time of relapse staging. New lung lesions on ERA in patients without relapse were detected in 102 (7.8%) patients. Pulmonary nodules were recorded in 72 (5.5%) patients, the majority (97%) being<10 mm. Consolidations, ground-glass opacities, and parenchymal bands were less common. CONCLUSION New nodules on interim staging are common, mostly measure less than 10 mm in diameter and usually require no further action because they are most likely non-malignant. Since it must be assumed that benign and malignant lung lesions coexist on initial staging, this benign background noise needs to be distinguished from lung metastases to avoid upstaging to stage IV disease. Raising the cut-off size for lung nodules to ≥ 10 mm might achieve the reduction of overtreatment but needs to be further evaluated with survival data. In contrast to the staging criteria of EuroNet-PHL-C1 and C2, our data suggest that the number of lesions present at initial staging may be less important.
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Affiliation(s)
- Dietrich Stoevesandt
- Department of Radiology, University Hospital Halle, Ernst-Grube-Straße 40, 06120, Halle/Salle, Germany.
| | - Christiane Ludwig
- Department of Internal Medicine, University Hospital Halle, Halle/Saale, Germany
| | - Christine Mauz-Körholz
- Department of Pediatric Hematology and Oncology, University Hospital Giessen-Marburg, Giessen, Germany
- Medical Faculty of the Martin-Luther-University of Halle-Wittenberg, Halle/Saale, Germany
| | - Dieter Körholz
- Department of Pediatric Hematology and Oncology, University Hospital Giessen-Marburg, Giessen, Germany
| | - Dirk Hasenclever
- Institute of Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
| | - Kathleen McCarten
- Diagnostic Imaging and Pediatrics, Warren Alpert Medical School, Brown University, Providence, RI, USA
- Pediatric Radiology, IROCRI (Imaging and Radiation Oncology Core - Rhode Island), Lincoln, RI, USA
| | - Jamie E Flerlage
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Lars Kurch
- Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany
| | - Walter A Wohlgemuth
- Department of Radiology, University Hospital Halle, Ernst-Grube-Straße 40, 06120, Halle/Salle, Germany
| | | | - William H Wallace
- Department of Paediatric Haematology and Oncology, Royal Hospital for Children and Young People and University of Edinburgh, Edinburgh, UK
| | - Alexander Fosså
- Department of Medical Oncology and Radiotherapy, Oslo University Hospital, Oslo, Norway
| | - Dirk Vordermark
- Department of Radiation Oncology, Medical Faculty of the Martin-Luther-University, Halle (Saale), Germany
| | - Jonas Karlén
- Karolinska University Hospital, Astrid Lindgrens Children's Hospital, Stockholm, Sweden
| | - Michaela Cepelová
- Department of Pediatric Hematology and Oncology, University Hospital Motol and Second Medical Faculty of Charles University, Prague, Czech Republic
| | - Tomasz Klekawka
- Department of Pediatric Oncology and Hematology, University Children's Hospital of Krakow, Kraków, Poland
| | - Andishe Attarbaschi
- Department of Pediatric Hematology and Oncology, St. Anna Children's Hospital, Medical University of Vienna, Vienna, Austria and St. Anna Children's Cancer Research Institute, Vienna, Austria
| | - Andrea Hraskova
- Department of Pediatric Hematology and Oncology, University Children's Hospital, Bratislava, Slovakia
| | - Anne Uyttebroeck
- Department of Pediatric Hematology and Oncology, University Hospitals Leuven, Louvain, Belgium
| | - Auke Beishuizen
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Karin Dieckmann
- Department of Radio-Oncology, Medical University Vienna, Vienna, Austria
| | - Thierry Leblanc
- Service d'Hématologie Et d'Immunologie Pédiatrique, Hôpital Robert-Debré, Paris, France
| | - Stephen Daw
- Department of Pediatric Hematology and Oncology, University College London Hospitals, London, UK
| | - Jonas Steglich
- Department of Radiology, University Hospital Halle, Ernst-Grube-Straße 40, 06120, Halle/Salle, Germany
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Loeser JH, Kisser U, Dießel L, von der Heydt S, Bidakov O, Loberg C, Wohlgemuth WA. Interdisciplinary Treatment of Macroglossia Due to a Microcystic Lymphatic Malformation with Bleomycin Electrosclerotherapy Followed by Partial Resection. Cardiovasc Intervent Radiol 2024:10.1007/s00270-024-03693-1. [PMID: 38691122 DOI: 10.1007/s00270-024-03693-1] [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] [Received: 09/06/2023] [Accepted: 02/22/2024] [Indexed: 05/03/2024]
Affiliation(s)
- J H Loeser
- Clinic and Polyclinic of Radiology, University Hospital Halle (Saale), Ernst-Grube-Straße 40, 06120, Halle Saale, Germany.
| | - U Kisser
- Clinic and Polyclinic of ENT, University Hospital Halle (Saale), Ernst-Grube-Straße 40, 06120, Halle Saale, Germany
| | - L Dießel
- Clinic and Polyclinic of Pathology, University Hospital Halle (Saale), Ernst-Grube-Straße 40, 06120, Halle Saale, Germany
| | - S von der Heydt
- Clinic and Polyclinic of Radiology, University Hospital Halle (Saale), Ernst-Grube-Straße 40, 06120, Halle Saale, Germany
| | - O Bidakov
- Clinic and Polyclinic of Radiology, University Hospital Halle (Saale), Ernst-Grube-Straße 40, 06120, Halle Saale, Germany
| | - C Loberg
- Clinic and Polyclinic of Radiology, University Hospital Halle (Saale), Ernst-Grube-Straße 40, 06120, Halle Saale, Germany
| | - W A Wohlgemuth
- Clinic and Polyclinic of Radiology, University Hospital Halle (Saale), Ernst-Grube-Straße 40, 06120, Halle Saale, Germany
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3
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Schmidt VF, Cangir Ö, Meyer L, Goldann C, Hengst S, Brill R, von der Heydt S, Waner M, Puhr-Westerheide D, Öcal O, Ümütlü MR, Mansour N, Rudolph J, Sint A, Obereisenbuchner F, Häberle B, Ricke J, Seidensticker M, Wohlgemuth WA, Wildgruber M. Outcome of bleomycin electrosclerotherapy of slow-flow malformations in adults and children. Eur Radiol 2024:10.1007/s00330-024-10723-6. [PMID: 38627287 DOI: 10.1007/s00330-024-10723-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 02/19/2024] [Accepted: 03/01/2024] [Indexed: 04/20/2024]
Abstract
OBJECTIVES To evaluate the safety and clinical outcome of bleomycin electrosclerotherapy (BEST) for treating extracranial slow-flow malformations. METHODS In this retrospective investigation of a multicenter cohort presenting symptomatic slow-flow malformations, patient records were analyzed with respect to procedural details and complications. A treatment-specific, patient-reported questionnaire was additionally evaluated, obtained 3-12 months after the last treatment, to assess the subjective outcomes, including mobility, aesthetic aspects, and pain, as well as the occurrence of postprocedural skin hyperpigmentation. All outcome parameters were compared according to patients' age. RESULTS Overall, 325 BEST treatments were performed in 233 patients after intralesional and/or intravenous bleomycin injection. The total complication rate was 10.2% (33/325), including 29/352 (8.9%) major complications. Patient-reported mobility decreased in 10/133 (8.8%), was stable in 30/113 (26.5%), improved in 48/113 (42.5%), and was rated symptom-free in 25/113 (22.1%) patients. Aesthetic aspects were rated impaired compared to baseline in 19/113 (16.8%), stable in 21/133 (18.6%), improved in 62/113 (54.9%), and perfect in 11/133 (9.7%) patients. Postprocedural skin hyperpigmentation occurred in 78/113 (69%) patients, remaining unchanged in 24/78 (30.8%), reduced in 51/78 (65.5%), and completely resolved in 3/78 (3.8%) patients. The median VAS pain scale was 4.0 (0-10) preprocedural and 2.0 (0-9) postprocedural. Children/adolescents performed significantly better in all parameters compared to adults (≥ 16 years) (mobility, p = 0.011; aesthetic aspects, p < 0.001; pain, p < 0.001). CONCLUSIONS BEST is effective for treating slow-flow vascular malformations, with few but potentially significant major complications. Regarding patient-reported outcomes, children seem to benefit better compared to older patients, suggesting that BEST should not be restricted to adults. CLINICAL RELEVANCE STATEMENT Bleomycin electrosclerotherapy is a safe and effective approach and therapy should not be restricted to adults due to good clinical outcomes in children.
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Affiliation(s)
- Vanessa F Schmidt
- Department of Radiology, LMU University Hospital, LMU Munich, München, Germany.
- Interdisziplinäres Zentrum für Gefäßanomalien (IZGA), LMU University Hospital, LMU Munich, München, Germany.
| | - Özlem Cangir
- Department of Pediatric Surgery, Center for Vascular Malformations, Klinikum Barnim GmbH, Werner Forssmann Hospital, Eberswalde, Germany
| | - Lutz Meyer
- Department of Pediatric Surgery, Center for Vascular Malformations, Klinikum Barnim GmbH, Werner Forssmann Hospital, Eberswalde, Germany
| | - Constantin Goldann
- Clinic and Policlinic of Radiology, Martin-Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Susanne Hengst
- Department of Radiology, Center for Vascular Malformations, Klinikum Barnim GmbH, Werner Forssmann Hospital, Eberswalde, Germany
| | - Richard Brill
- Clinic and Policlinic of Radiology, Martin-Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Susanne von der Heydt
- Clinic and Policlinic of Radiology, Martin-Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Milton Waner
- Vascular Birthmark Institute of New York, New York, NY, USA
| | | | - Osman Öcal
- Department of Radiology, LMU University Hospital, LMU Munich, München, Germany
| | | | - Nabeel Mansour
- Department of Radiology, LMU University Hospital, LMU Munich, München, Germany
| | - Jan Rudolph
- Department of Radiology, LMU University Hospital, LMU Munich, München, Germany
| | - Alena Sint
- Department of Radiology, LMU University Hospital, LMU Munich, München, Germany
- Interdisziplinäres Zentrum für Gefäßanomalien (IZGA), LMU University Hospital, LMU Munich, München, Germany
| | - Florian Obereisenbuchner
- Department of Radiology, LMU University Hospital, LMU Munich, München, Germany
- Interdisziplinäres Zentrum für Gefäßanomalien (IZGA), LMU University Hospital, LMU Munich, München, Germany
| | - Beate Häberle
- Interdisziplinäres Zentrum für Gefäßanomalien (IZGA), LMU University Hospital, LMU Munich, München, Germany
- Department for Pediatric Surgery, LMU University Hospital, LMU Munich, München, Germany
| | - Jens Ricke
- Department of Radiology, LMU University Hospital, LMU Munich, München, Germany
- Interdisziplinäres Zentrum für Gefäßanomalien (IZGA), LMU University Hospital, LMU Munich, München, Germany
| | - Max Seidensticker
- Department of Radiology, LMU University Hospital, LMU Munich, München, Germany
- Interdisziplinäres Zentrum für Gefäßanomalien (IZGA), LMU University Hospital, LMU Munich, München, Germany
| | - Walter A Wohlgemuth
- Clinic and Policlinic of Radiology, Martin-Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Moritz Wildgruber
- Department of Radiology, LMU University Hospital, LMU Munich, München, Germany
- Interdisziplinäres Zentrum für Gefäßanomalien (IZGA), LMU University Hospital, LMU Munich, München, Germany
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4
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Schmidt VF, Kapp FG, Goldann C, Huthmann L, Cucuruz B, Brill R, Vielsmeier V, Seebauer CT, Michel AJ, Seidensticker M, Uller W, Weiß JBW, Sint A, Häberle B, Haehl J, Wagner A, Cordes J, Holm A, Schanze D, Ricke J, Kimm MA, Wohlgemuth WA, Zenker M, Wildgruber M. Extracranial Vascular Anomalies Driven by RAS/MAPK Variants: Spectrum and Genotype-Phenotype Correlations. J Am Heart Assoc 2024; 13:e033287. [PMID: 38563363 DOI: 10.1161/jaha.123.033287] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 03/05/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND We aimed to correlate alterations in the rat sarcoma virus (RAS)/mitogen-activated protein kinase pathway in vascular anomalies to the clinical phenotype for improved patient and treatment stratification. METHODS AND RESULTS This retrospective multicenter cohort study included 29 patients with extracranial vascular anomalies containing mosaic pathogenic variants (PVs) in genes of the RAS/mitogen-activated protein kinase pathway. Tissue samples were collected during invasive treatment or clinically indicated biopsies. PVs were detected by the targeted sequencing of panels of genes known to be associated with vascular anomalies, performed using DNA from affected tissue. Subgroup analyses were performed according to the affected genes with regard to phenotypic characteristics in a descriptive manner. Twenty-five vascular malformations, 3 vascular tumors, and 1 patient with both a vascular malformation and vascular tumor presented the following distribution of PVs in genes: Kirsten rat sarcoma viral oncogene (n=10), neuroblastoma ras viral oncogene homolog (n=1), Harvey rat sarcoma viral oncogene homolog (n=5), V-Raf murine sarcoma viral oncogene homolog B (n=8), and mitogen-activated protein kinase kinase 1 (n=5). Patients with RAS PVs had advanced disease stages according to the Schobinger classification (stage 3-4: RAS, 9/13 versus non-RAS, 3/11) and more frequent progression after treatment (RAS, 10/13 versus non-RAS, 2/11). Lesions with Kirsten rat sarcoma viral oncogene PVs infiltrated more tissue layers compared with the other PVs including other RAS PVs (multiple tissue layers: Kirsten rat sarcoma viral oncogene, 8/10 versus other PVs, 6/19). CONCLUSIONS This comparison of patients with various PVs in genes of the RAS/MAPK pathway provides potential associations with certain morphological and clinical phenotypes. RAS variants were associated with more aggressive phenotypes, generating preliminary data and hypothesis for future larger studies.
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Affiliation(s)
- Vanessa F Schmidt
- Department of Radiology LMU University Hospital, LMU Munich München Germany
- Interdisziplinäres Zentrum für Gefäßanomalien (IZGA) LMU University Hospital, LMU Munich München Germany
| | - Friedrich G Kapp
- Division of Pediatric Hematology and Oncology, Department of Pediatric and Adolescent Medicine University Medical Center Freiburg, University of Freiburg Germany
| | - Constantin Goldann
- Clinic and Policlinic of Radiology Martin-Luther University Halle-Wittenberg Halle (Saale) Germany
| | - Linda Huthmann
- Clinic and Policlinic of Radiology Martin-Luther University Halle-Wittenberg Halle (Saale) Germany
| | - Beatrix Cucuruz
- Clinic and Policlinic of Radiology Martin-Luther University Halle-Wittenberg Halle (Saale) Germany
| | - Richard Brill
- Clinic and Policlinic of Radiology Martin-Luther University Halle-Wittenberg Halle (Saale) Germany
| | - Veronika Vielsmeier
- Department of Otorhinolaryngology Regensburg University Medical Center Regensburg Germany
| | - Caroline T Seebauer
- Department of Otorhinolaryngology Regensburg University Medical Center Regensburg Germany
| | - Armin-Johannes Michel
- Department of Pediatric and Adolescent Surgery Paracelsus Medical University Hospital Salzburg Austria
| | - Max Seidensticker
- Department of Radiology LMU University Hospital, LMU Munich München Germany
- Interdisziplinäres Zentrum für Gefäßanomalien (IZGA) LMU University Hospital, LMU Munich München Germany
| | - Wibke Uller
- Department of Diagnostic and Interventional Radiology University of Freiburg Medical Centre, Medical Faculty of the University of Freiburg Freiburg Germany
| | - Jakob B W Weiß
- Department of Plastic and Hand Surgery University of Freiburg Medical Centre, Medical Faculty of the University of Freiburg Freiburg Germany
| | - Alena Sint
- Department of Radiology LMU University Hospital, LMU Munich München Germany
- Interdisziplinäres Zentrum für Gefäßanomalien (IZGA) LMU University Hospital, LMU Munich München Germany
| | - Beate Häberle
- Interdisziplinäres Zentrum für Gefäßanomalien (IZGA) LMU University Hospital, LMU Munich München Germany
- Department of Pediatric Surgery, Dr. von Hauner Children's Hospital LMU University Hospital, LMU Munich München Germany
| | - Julia Haehl
- Interdisziplinäres Zentrum für Gefäßanomalien (IZGA) LMU University Hospital, LMU Munich München Germany
- Department of Pediatric Surgery, Dr. von Hauner Children's Hospital LMU University Hospital, LMU Munich München Germany
| | - Alexandra Wagner
- Interdisziplinäres Zentrum für Gefäßanomalien (IZGA) LMU University Hospital, LMU Munich München Germany
- Department of Pediatric Surgery, Dr. von Hauner Children's Hospital LMU University Hospital, LMU Munich München Germany
| | - Johanna Cordes
- Division of Pediatric Hematology and Oncology, Department of Pediatric and Adolescent Medicine University Medical Center Freiburg, University of Freiburg Germany
| | - Annegret Holm
- Division of Pediatric Hematology and Oncology, Department of Pediatric and Adolescent Medicine University Medical Center Freiburg, University of Freiburg Germany
| | - Denny Schanze
- Institute of Human Genetics, University Hospital Magdeburg Magdeburg Germany
| | - Jens Ricke
- Department of Radiology LMU University Hospital, LMU Munich München Germany
- Interdisziplinäres Zentrum für Gefäßanomalien (IZGA) LMU University Hospital, LMU Munich München Germany
| | - Melanie A Kimm
- Department of Radiology LMU University Hospital, LMU Munich München Germany
- Interdisziplinäres Zentrum für Gefäßanomalien (IZGA) LMU University Hospital, LMU Munich München Germany
| | - Walter A Wohlgemuth
- Clinic and Policlinic of Radiology Martin-Luther University Halle-Wittenberg Halle (Saale) Germany
| | - Martin Zenker
- Institute of Human Genetics, University Hospital Magdeburg Magdeburg Germany
| | - Moritz Wildgruber
- Department of Radiology LMU University Hospital, LMU Munich München Germany
- Interdisziplinäres Zentrum für Gefäßanomalien (IZGA) LMU University Hospital, LMU Munich München Germany
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5
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Brinkmann F, Friedrichs A, Behrens GM, Behrens P, Berner R, Caliebe A, Denkinger CM, Giesbrecht K, Gussew A, Hoffmann AT, Hojenski L, Hovardovska O, Dopfer-Jablonka A, Kaasch AJ, Kobbe R, Kraus M, Lindner A, Maier C, Mitrov L, Nauck M, de Miranda SN, Scherer M, Schmiedel Y, Stahl D, Timmesfeld N, Toepfner N, Vehreschild J, Wohlgemuth WA, Petersmann A, Vehreschild MJGT. Prevalence of infectious diseases, immunity to vaccine-preventable diseases and chronic medical conditions among Ukrainian refugees in Germany - A cross sectional study from the German Network University Medicine (NUM). J Infect Public Health 2024; 17:642-649. [PMID: 38458134 DOI: 10.1016/j.jiph.2024.02.003] [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: 08/21/2023] [Revised: 01/26/2024] [Accepted: 02/05/2024] [Indexed: 03/10/2024] Open
Abstract
BACKGROUND Vulnerability to infectious diseases in refugees is dependent on country of origin, flight routes, and conditions. Information on specific medical needs of different groups of refugees is lacking. We assessed the prevalence of infectious diseases, immunity to vaccine-preventable diseases, and chronic medical conditions in children, adolescents, and adult refugees from Ukraine who arrived in Germany in 2022. METHODS Using different media, we recruited Ukrainian refugees at 13 sites between 9-12/2022. An antigen test for acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) infection, serologies for a range of vaccine-preventable diseases, as well as interferon gamma release assays (IGRAs) for tuberculosis (TB), and SARS-CoV-2 were performed. We assessed personal and family history of chronic medical conditions, infectious diseases, vaccination status, and conditions during migration. RESULTS Overall, 1793 refugees (1401 adults and 392 children/adolescents) were included. Most participants were females (n = 1307; 72·3%) and from Eastern or Southern Ukraine. TB IGRA was positive in 13% (n = 184) of the adults and in 2% (n = 7) of the children. Serology-based immunological response was insufficient in approximately 21% (360/1793) of the participants for measles, 32% (572/1793) for diphtheria, and 74% (1289/1793) for hepatitis B. CONCLUSIONS We show evidence of low serological response to vaccine-preventable infections and increased LTBI prevalence in Ukrainian refugees. These findings should be integrated into guidelines for screening and treatment of infectious diseases in migrants and refugees in Germany and Europe. Furthermore, low immunity for vaccine-preventable diseases in Ukrainians independent of their refugee status, calls for tailor-made communication efforts.
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Affiliation(s)
- Folke Brinkmann
- University Children's Hospital, Katholisches Klinikum Bochum, Ruhr-University Bochum, Bochum, Germany
| | - Anette Friedrichs
- Department of Internal Medicine I, Infectious Diseases, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Georg Mn Behrens
- Department of Rheumatology and Immunology, Hannover Medical School, Hannover, Germany; German Center for Infection Research, Site Hannover-Braunschweig, Hannover, Germany
| | - Pia Behrens
- Goethe University Frankfurt, University Hospital Frankfurt, Department of Internal Medicine, Infectious Diseases, Frankfurt am Main, Germany
| | - Reinhard Berner
- Department of Pediatrics, Faculty of Medicine and University Hospital Carl Gustav Carus, Dresden University of Technology, Dresden, Germany
| | - Amke Caliebe
- Institute of Medical Informatics and Statistics, Kiel University and University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Claudia M Denkinger
- Division of Infectious Disease and Tropical Medicine, Heidelberg University Hospital, Heidelberg, Germany; German Centre for Infection Research, partner site Heidelberg, Germany
| | - Katharina Giesbrecht
- Goethe University Frankfurt, University Hospital Frankfurt, Department of Internal Medicine, Infectious Diseases, Frankfurt am Main, Germany
| | - Alexander Gussew
- Clinic and Policlinic of Radiology, University Medical Clinic Halle, Halle (Saale), Germany
| | - Anna Theresa Hoffmann
- University Children's Hospital, Katholisches Klinikum Bochum, Ruhr-University Bochum, Bochum, Germany
| | - Leonhard Hojenski
- Department of Internal Medicine I, Infectious Diseases, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Olga Hovardovska
- Department of Epidemiology, Helmholtz Centre for Infection Research Braunschweig, Germany; German Centre for Infection Research, TI BBD, Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - Alexandra Dopfer-Jablonka
- Department of Rheumatology and Immunology, Hannover Medical School, Hannover, Germany; German Center for Infection Research, Site Hannover-Braunschweig, Hannover, Germany
| | - Achim J Kaasch
- Institute of Medical Microbiology and Hospital Hygiene, Faculty of Medicine, Otto-von-Guericke-University Magdeburg
| | - Robin Kobbe
- Institute for Infection Research and Vaccine Development (IIRVD), University Medical Centre Hamburg-Eppendorf, Hamburg, Germany; Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Monika Kraus
- Institute of Epidemiology, Helmholtz Zentrum München, Munich, Germany
| | - Andreas Lindner
- Charité - Universitätsmedizin Berlin, Charité Center for Global Health, Institute of International Health, Berlin, Germany
| | - Christoph Maier
- University Children's Hospital, Katholisches Klinikum Bochum, Ruhr-University Bochum, Bochum, Germany
| | - Lazar Mitrov
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Germany
| | - Matthias Nauck
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine of Greifswald, Greifswald, Germany; DZHK (German Centre for Cardiovacsular Research), Partner Site Greifswald, University Medicine, Greifswald, Germany
| | - Susana Nunes de Miranda
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Germany
| | - Margarete Scherer
- Goethe University Frankfurt, University Hospital Frankfurt, Department II of Internal Medicine, Hematology/Oncology, Frankfurt am Main, Germany
| | - Yvonne Schmiedel
- Department of Internal Medicine I, Infectious Diseases, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Dana Stahl
- Trusted Third Party of the University Medicine Greifswald, Greifswald, Germany
| | - Nina Timmesfeld
- Department of Medical Informatics, Biometry and Epidemiology, Ruhr University Bochum, Germany
| | - Nicole Toepfner
- Department of Pediatrics, Faculty of Medicine and University Hospital Carl Gustav Carus, Dresden University of Technology, Dresden, Germany
| | - Janne Vehreschild
- DZHK (German Centre for Cardiovacsular Research), Partner Site Greifswald, University Medicine, Greifswald, Germany
| | - Walter A Wohlgemuth
- Clinic and Policlinic of Radiology, University Medical Clinic Halle, Halle (Saale), Germany
| | - Astrid Petersmann
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine of Greifswald, Greifswald, Germany; Institute for Clinical Chemistry and Laboratory Medicine, University Medicine Oldenburg, Oldenburg, Germany
| | - Maria J G T Vehreschild
- Goethe University Frankfurt, University Hospital Frankfurt, Department of Internal Medicine, Infectious Diseases, Frankfurt am Main, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Frankfurt am Main, Germany.
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Graf S, Wohlgemuth WA, Deistung A. Incorporating a-priori information in deep learning models for quantitative susceptibility mapping via adaptive convolution. Front Neurosci 2024; 18:1366165. [PMID: 38529264 PMCID: PMC10962327 DOI: 10.3389/fnins.2024.1366165] [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: 01/05/2024] [Accepted: 02/20/2024] [Indexed: 03/27/2024] Open
Abstract
Quantitative susceptibility mapping (QSM) has attracted considerable interest for tissue characterization (e.g., iron and calcium accumulation, myelination, venous vasculature) in the human brain and relies on extensive data processing of gradient-echo MRI phase images. While deep learning-based field-to-susceptibility inversion has shown great potential, the acquisition parameters applied in clinical settings such as image resolution or image orientation with respect to the magnetic field have not been fully accounted for. Furthermore, the lack of comprehensive training data covering a wide range of acquisition parameters further limits the current QSM deep learning approaches. Here, we propose the integration of a priori information of imaging parameters into convolutional neural networks with our approach, adaptive convolution, that learns the mapping between the additional presented information (acquisition parameters) and the changes in the phase images associated with these varying acquisition parameters. By associating a-priori information with the network parameters itself, the optimal set of convolution weights is selected based on data-specific attributes, leading to generalizability towards changes in acquisition parameters. Moreover, we demonstrate the feasibility of pre-training on synthetic data and transfer learning to clinical brain data to achieve substantial improvements in the computation of susceptibility maps. The adaptive convolution 3D U-Net demonstrated generalizability in acquisition parameters on synthetic and in-vivo data and outperformed models lacking adaptive convolution or transfer learning. Further experiments demonstrate the impact of the side information on the adaptive model and assessed susceptibility map computation on simulated pathologic data sets and measured phase data.
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Affiliation(s)
- Simon Graf
- University Clinic and Polyclinic for Radiology, University Hospital Halle (Saale), Halle, Germany
- Halle MR Imaging Core Facility, Medical Faculty, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Walter A. Wohlgemuth
- University Clinic and Polyclinic for Radiology, University Hospital Halle (Saale), Halle, Germany
- Halle MR Imaging Core Facility, Medical Faculty, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Andreas Deistung
- University Clinic and Polyclinic for Radiology, University Hospital Halle (Saale), Halle, Germany
- Halle MR Imaging Core Facility, Medical Faculty, Martin-Luther-University Halle-Wittenberg, Halle, Germany
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7
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Damm M, Efremov L, Jalal M, Nadeem N, Dober J, Michl P, Wohlgemuth WA, Wadsley J, Hopper AD, Krug S, Rosendahl J. Body composition parameters predict survival in pancreatic cancer-A retrospective multicenter analysis. United European Gastroenterol J 2023; 11:998-1009. [PMID: 37987099 PMCID: PMC10720684 DOI: 10.1002/ueg2.12489] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 07/31/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND Parameters to adapt individual treatment strategies for patients with pancreatic ductal adenocarcinoma (PDAC) are urgently needed. The present study aimed to evaluate body composition parameters as predictors of overall survival (OS) in PDAC patients. METHODS Measurements of body composition parameters were performed on computed tomography scans at diagnosis. Height-standardized and Body Mass Index- and sex-adjusted regression formulas deriving cut-offs from a healthy population were used. The Kaplan-Meier method with the log-rank test was performed for survival analysis. Independent prognostic factors were identified with uni- and multivariable Cox regression analyses. RESULTS In total, 354 patients were analyzed. In a multivariable Cox model, besides tumor stage and resection status, only myosteatosis (HR 1.53; 95% CI 1.10-2.14, p = 0.01) was an independent prognostic factor of OS among body composition parameters. Subgroup analyses revealed that the prognostic impact of myosteatosis was higher in patients ≤68 years of age, with advanced tumor stages and patients without curative intended resection. CONCLUSIONS The analysis of one of the largest Caucasian cohorts to date, demonstrated myosteatosis to be an independent prognostic factor of OS in PDAC. To improve outcomes, prospective trials aiming to investigate the utility of an early assessment of myosteatosis with subsequent intervention by dieticians, sports medicine physicians, and physiotherapists are warranted.
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Affiliation(s)
- Marko Damm
- Department of Internal Medicine I, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Ljupcho Efremov
- Institute for Medical Epidemiology, Biometrics and Informatics (IMEBI), Interdisciplinary Center for Health Sciences, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
- Department of Radiation Oncology, Martin-Luther-University, Halle (Saale), Germany
| | - Mustafa Jalal
- Academic Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield, UK
| | - Nabeegh Nadeem
- Academic Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield, UK
| | - Johannes Dober
- Department of Radiology, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Patrick Michl
- Department of Internal Medicine I, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
- Department of Internal Medicine IV, University Hospital Heidelberg, Heidelberg, Germany
| | - Walter A Wohlgemuth
- Department of Radiology, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | | | - Andrew D Hopper
- Department of Infection and Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Sebastian Krug
- Department of Internal Medicine I, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
- Department of Internal Medicine IV, University Hospital Heidelberg, Heidelberg, Germany
| | - Jonas Rosendahl
- Department of Internal Medicine I, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
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Slawig A, Rothe M, Deistung A, Bohndorf K, Brill R, Graf S, Weng AM, Wohlgemuth WA, Gussew A. Ultra-short echo time (UTE) MR imaging: A brief review on technical considerations and clinical applications. ROFO-FORTSCHR RONTG 2023. [PMID: 37995735 DOI: 10.1055/a-2193-1379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2023]
Abstract
BACKGROUND With the availability of MRI sequences with ultrashort echo times (UTE sequences), a signal can be gained from tissue, which was formerly only indirectly accessible. While already extensively employed in various research settings, the widespread transition of UTE imaging to clinical practice is just starting. METHODS Based on a systematic literature search as well as knowledge gained through annual participation in conferences dedicated to advances in MRI, this review aims to give a brief overview of technical considerations and challenges of UTE imaging and summarizes the major areas of application of UTE imaging. RESULTS UTE is already employed in clinical practice for structural lung imaging as well as the characterization of tissue composition and its alterations in selected musculoskeletal, cardiovascular, or neurodegenerative diseases. In specific contexts it can replace CT examinations with ionizing radiation and is especially attractive for pediatric patients and longitudinal monitoring of disease progression and treatment. CONCLUSION UTE imaging provides an interesting and very valuable tool for various clinical purposes and promises a multitude of new insights into tissue properties. While some challenges remain, ongoing adoption in the clinical routine can be expected, as UTE approaches provide a new contrast and capture a signal in tissue formerly invisible on MR imaging. KEY POINTS · UTE imaging gains relevance in clinical settings. · UTE imaging is employed for the characterization of tissue composition and its alterations in selected musculoskeletal, cardiovascular, or neurodegenerative diseases. · UTE imaging is employed in the clinical routine for structural lung imaging. · UTE imaging promises a multitude of new insights into tissue properties.
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Affiliation(s)
- Anne Slawig
- University Clinic and Outpatient Clinic for Radiology, University Hospital Halle, Germany
- Halle MR Imaging Core Facility, Medical faculty, Martin Luther University Halle Wittenberg, Halle, Germany
| | - Maik Rothe
- University Clinic and Outpatient Clinic for Radiology, University Hospital Halle, Germany
- Halle MR Imaging Core Facility, Medical faculty, Martin Luther University Halle Wittenberg, Halle, Germany
| | - Andreas Deistung
- University Clinic and Outpatient Clinic for Radiology, University Hospital Halle, Germany
- Halle MR Imaging Core Facility, Medical faculty, Martin Luther University Halle Wittenberg, Halle, Germany
| | - Klaus Bohndorf
- University Clinic and Outpatient Clinic for Radiology, University Hospital Halle, Germany
| | - Richard Brill
- University Clinic and Outpatient Clinic for Radiology, University Hospital Halle, Germany
| | - Simon Graf
- University Clinic and Outpatient Clinic for Radiology, University Hospital Halle, Germany
- Halle MR Imaging Core Facility, Medical faculty, Martin Luther University Halle Wittenberg, Halle, Germany
| | - Andreas Max Weng
- Department of Diagnostic and Interventional Radiology, University Hospital Wurzburg, Wurzburg, Germany
| | - Walter A Wohlgemuth
- University Clinic and Outpatient Clinic for Radiology, University Hospital Halle, Germany
- Halle MR Imaging Core Facility, Medical faculty, Martin Luther University Halle Wittenberg, Halle, Germany
| | - Alexander Gussew
- University Clinic and Outpatient Clinic for Radiology, University Hospital Halle, Germany
- Halle MR Imaging Core Facility, Medical faculty, Martin Luther University Halle Wittenberg, Halle, Germany
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9
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Muir T, Bertino G, Groselj A, Ratnam L, Kis E, Odili J, McCafferty I, Wohlgemuth WA, Cemazar M, Krt A, Bosnjak M, Zanasi A, Battista M, de Terlizzi F, Campana LG, Sersa G. Bleomycin electrosclerotherapy (BEST) for the treatment of vascular malformations. An International Network for Sharing Practices on Electrochemotherapy (InspECT) study group report. Radiol Oncol 2023; 57:141-149. [PMID: 37341196 DOI: 10.2478/raon-2023-0029] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 06/03/2023] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND Biomedical applications of electroporation are expanding out of the field of oncology into vaccination, treatment of arrhythmias and now in the treatment of vascular malformations. Bleomycin is a widely used sclerosing agent in the treatment of various vascular malformations. The application of electric pulses in addition to bleomycin enhances the effectiveness of the drug, as demonstrated by electrochemotherapy, which utilizes bleomycin in the treatment of tumors. The same principle is used in bleomycin electrosclerotherapy (BEST). The approach seems to be effective in the treatment of low-flow (venous and lymphatic) and, potentially, even high-flow (arteriovenous) malformations. Although there are only a few published reports to date, the surgical community is interested, and an increasing number of centers are applying BEST in the treatment of vascular malformations. Within the International Network for Sharing Practices on Electrochemotherapy (InspECT) consortium, a dedicated working group has been constituted to develop standard operating procedures for BEST and foster clinical trials. CONCLUSIONS By treatment standardization and successful completion of clinical trials demonstrating the effectiveness and safety of the approach, higher quality data and better clinical outcomes may be achieved.
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Affiliation(s)
- Tobian Muir
- Department of Reconstructive Plastic Surgery, James Cook University Hospital, Middlesbrough, United Kingdom
| | - Giulia Bertino
- Department of Otolaryngology Head Neck Surgery, University of Pavia, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo Foundation, Pavia, Italy
| | - Ales Groselj
- Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Lakshmi Ratnam
- Department of Interventional Radiology, St George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Erika Kis
- Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary
| | - Joy Odili
- Department of Plastic Surgery, St. Georges University Hospitals NHS Trust, London, United Kingdom
| | - Ian McCafferty
- Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, United Kingdom
| | - Walter A Wohlgemuth
- Universitätsklinik und Poliklinik für Radiologie, Universitätsmedizin Halle, Halle, Germany
| | - Maja Cemazar
- Department of Experimental Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
- Faculty of Health Sciences, University of Primorska, Slovenia
| | - Aljosa Krt
- Department of Otorhinolaryngology, Izola General Hospital, Izola, Slovenia
| | - Masa Bosnjak
- Department of Experimental Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | | | | | | | - Luca G Campana
- Department of Surgery, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Gregor Sersa
- Department of Experimental Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
- Faculty of Health Sciences, University of Ljubljana, Ljubljana, Slovenia
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10
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Guntau M, Cucuruz B, Brill R, Bidakov O, von der Heydt S, Deistung A, Wohlgemuth WA. Individualized treatment of congenital vascular malformations of the tongue. Clin Hemorheol Microcirc 2023; 83:421-429. [PMID: 36846994 DOI: 10.3233/ch-221683] [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: 02/23/2023]
Abstract
BACKGROUND/OBJECTIVE Oral malformations of the tongue are exceedingly rare. The aim of this study was to evaluate the effectiveness of individualized treatment for patients with vascular malformations of the tongue. METHODS This retrospective study is based on a consecutive local registry at a tertiary care Interdisciplinary Center for Vascular Anomalies. Patients with vascular malformations of the tongue were included. Indications for therapy of the vascular malformation were macroglossia with the impossibility to close the mouth, bleeding, recurrent infection and dysphagia. Size regression of the malformation (volume measurement) and symptom improvement were investigated. RESULTS Out of 971 consecutive patients with vascular malformations, 16 patients suffered from a vascular malformation of the tongue. Twelve patients had slow-flow malformations and 4 fast-flow malformations. Indications for interventions were bleeding (4/16, 25%), macroglossia (6/16, 37.5%), and recurrent infections (4/16, 25%). For two patients (2/16, 12.5%), there was no indication for intervention due to absence of symptoms. Four patients received sclerotherapy, 7 patients Bleomycin-electrosclerotherapy (BEST) and 3 patients embolization. Median follow-up was 16 months (IQR 7-35.5). In all patients, symptoms had decreased after two interventions at a median (IQR 1-3.75). Volume reduction of the malformation of the tongue was 13.3%(from median 27.9 cm3 to median 24.2 cm3, p = 0.0039), and even more pronounced when considering only patients with BEST (from 86 cm3 to 59.1 cm3, p = 0.001). CONCLUSION Symptoms of vascular malformations of the tongue are improved after a median of two interventions with significantly increased volume reduction after Bleomycin-electrosclerotherapy.
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Affiliation(s)
- Moritz Guntau
- Clinic and Policlinic of Radiology, University Hospital Halle (Saale), Halle (Saale), Germany
| | - Beatrix Cucuruz
- Clinic and Policlinic of Radiology, University Hospital Halle (Saale), Halle (Saale), Germany
| | - Richard Brill
- Clinic and Policlinic of Radiology, University Hospital Halle (Saale), Halle (Saale), Germany
| | - Oleksandr Bidakov
- Clinic and Policlinic of Radiology, University Hospital Halle (Saale), Halle (Saale), Germany
| | - Susane von der Heydt
- Clinic and Policlinic of Radiology, University Hospital Halle (Saale), Halle (Saale), Germany
| | - Andreas Deistung
- Clinic and Policlinic of Radiology, University Hospital Halle (Saale), Halle (Saale), Germany
| | - Walter A Wohlgemuth
- Clinic and Policlinic of Radiology, University Hospital Halle (Saale), Halle (Saale), Germany
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11
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Schmidt VF, Masthoff M, Vielsmeier V, Seebauer CT, Cangir Ö, Meyer L, Mükke A, Lang W, Schmid A, Sporns PB, Brill R, Wohlgemuth WA, da Silva NPB, Seidensticker M, Schinner R, Küppers J, Häberle B, Haubner F, Ricke J, Zenker M, Kimm MA, Wildgruber M. Clinical Outcome and Quality of Life of Multimodal Treatment of Extracranial Arteriovenous Malformations: The APOLLON Study Protocol. Cardiovasc Intervent Radiol 2023; 46:142-151. [PMID: 36261507 PMCID: PMC9810564 DOI: 10.1007/s00270-022-03296-8] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 09/30/2022] [Indexed: 01/11/2023]
Abstract
PURPOSE Arteriovenous malformations (AVMs) as rare diseases are diagnostically and therapeutically challenging. Due to the limited evidence regarding treatment outcome, prospective data are needed on how different treatment regimens affect outcome. The aims of this prospective trial are to determine effectiveness, safety, and clinical outcome of multimodal treatment in patients with extracranial AVMs. MATERIALS AND METHODS After clinical and magnetic resonance imaging (MRI)-based diagnosis and informed consent, 146 patients (> 4 years and < 70 years) undergoing multimodal therapy in tertiary care vascular anomalies centers will be included in this prospective observational trial. Treatment options include conservative management, medical therapy, minimally invasive image-guided procedures (embolization, sclerotherapy) and surgery as well as combinations of the latter. The primary outcome is the patient-reported QoL 6 months after completion of treatment using the short form-36 health survey version 2 (SF-36v2) and the corresponding short form-10 health survey (SF-10) for children. In addition, clinical presentation (physician-reported signs), MRI imaging (radiological assessment of devascularization), recurrence rate, and therapeutic safety will be analyzed. Further follow-up will be performed after 12, 24, and 36 months. Moreover, liquid biopsies are being obtained from peripheral blood at multiple time points to investigate potential biomarkers for therapy response and disease progression. DISCUSSION The APOLLON trial is a prospective, multicenter, observational open-label trial with unequal study groups to generate prospective evidence for multimodal treatment of AVMs. A multicenter design with the potential to assess larger populations will provide an increased understanding of multimodal therapy outcome in this orphan disease. TRIAL REGISTRATION German Clinical Trials Register (identification number: DRKS00021019) https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00021019 .
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Affiliation(s)
- Vanessa F. Schmidt
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Max Masthoff
- Clinic for Radiology, University Hospital Muenster, Muenster, Germany
| | - Veronika Vielsmeier
- Department of Otorhinolaryngology, University Hospital Regensburg, Regensburg, Germany
| | - Caroline T. Seebauer
- Department of Otorhinolaryngology, University Hospital Regensburg, Regensburg, Germany
| | - Özlem Cangir
- Department of Pediatric Surgery, Center for Vascular Malformations, Klinikum Barnim GmbH, Werner Forssmann Hospital, Eberswalde, Germany
| | - Lutz Meyer
- Department of Pediatric Surgery, Center for Vascular Malformations, Klinikum Barnim GmbH, Werner Forssmann Hospital, Eberswalde, Germany
| | - Antje Mükke
- Department of Vascular Surgery, University Hospital Erlangen, Erlangen, Germany
| | - Werner Lang
- Department of Vascular Surgery, University Hospital Erlangen, Erlangen, Germany
| | - Axel Schmid
- Department for Radiology, University Hospital Erlangen, Erlangen, Germany
| | - Peter B. Sporns
- Department of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | - Richard Brill
- Clinic and Policlinic of Diagnostic Radiology, Martin-Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Walter A. Wohlgemuth
- Clinic and Policlinic of Diagnostic Radiology, Martin-Luther University Halle-Wittenberg, Halle (Saale), Germany
| | | | - Max Seidensticker
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Regina Schinner
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Julia Küppers
- Department for Pediatric Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Beate Häberle
- Department for Pediatric Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Frank Haubner
- Department of Otorhinolaryngology, University Hospital, LMU Munich, Munich, Germany
| | - Jens Ricke
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Martin Zenker
- Institute for Human Genetics, Otto von Guericke University of Magdeburg, Magdeburg, Germany
| | - Melanie A. Kimm
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Moritz Wildgruber
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
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12
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Schramm D, Wohlgemuth WA, Guntau M, Wieprecht M, Deistung A, Bidakov O, Wildgruber M, Brill R, Cucuruz B. Development of hemodynamically relevant acquired arterio-venous fistulae in patients with venous malformations. Clin Hemorheol Microcirc 2022; 83:207-215. [PMID: 36565106 DOI: 10.3233/ch-221610] [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: 12/24/2022]
Abstract
BACKGROUND Venous malformations tend to retain their slow-flow behavior, even in progressive disease or regression following therapy. OBJECTIVE The aim of this study is to analyze the development of acquired hemodynamic relevant arterio-venous fistulae in patients with slow-flow malformations. METHODS This study is a retrospective analysis based on a consecutive local registry at a tertiary care Interdisciplinary Center for Vascular Anomalies. Patients with venous malformations and development of secondary arterio-venous fistulae were included. Indications for therapy of the vascular malformation were based on patients' symptoms and complications. The following endpoints were of clinical interest and were assessed: origin of development of arteriovenous fistula, development of secondary comorbidities as a result of the vascular malformation. For analysis we focused on descriptive statistics. RESULTS Out of 1213 consecutive patients with vascular malformations, in 6 patients perfusion changed from slow flow to arterio-venous fast-flow patterns. Four patients developed the fistula after local trauma in the area of the malformation, the other 2 patients developed the fistula due to progression of the disease and recurrent thrombophlebitis. These 2 patients had no trauma or interventions at the time of arterio-venous fistula development. CONCLUSIONS Acquired arterio-venous fast-flow fistula in patients with slow flow vascular malformation is very rare and might be a result of local trauma or the progression of the disease with recurrent thrombophlebitis. Specific evidence-based treatment options for these patients do not exist.
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Affiliation(s)
- D Schramm
- Department of Radiology, University Hospital Halle, Halle, Germany
| | - W A Wohlgemuth
- Department of Radiology, University Hospital Halle, Halle, Germany
| | - M Guntau
- Department of Radiology, University Hospital Halle, Halle, Germany
| | - M Wieprecht
- Department of Radiology, University Hospital Halle, Halle, Germany
| | - A Deistung
- Department of Radiology, University Hospital Halle, Halle, Germany
| | - O Bidakov
- Department of Radiology, University Hospital Halle, Halle, Germany
| | - M Wildgruber
- Department of Radiology, University Hospital Halle, Halle, Germany
| | - R Brill
- Department of Radiology, University Hospital Halle, Halle, Germany
| | - B Cucuruz
- Department of Radiology, University Hospital Halle, Halle, Germany
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13
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Schmidt VF, Masthoff M, Goldann C, Brill R, Sporns PB, Segger L, Schulze-Zachau V, Takes M, Köhler M, Deniz S, Öcal O, Mansour N, Ümütlü MR, Shemwetta MD, Baraka BM, Mbuguje EM, Naif AA, Ukweh O, Seidensticker M, Ricke J, Gebauer B, Wohlgemuth WA, Wildgruber M. Multicentered analysis of percutaneous sclerotherapies in venous malformations of the face. Front Med (Lausanne) 2022; 9:1066412. [PMID: 36582288 PMCID: PMC9792481 DOI: 10.3389/fmed.2022.1066412] [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: 10/10/2022] [Accepted: 11/28/2022] [Indexed: 12/15/2022] Open
Abstract
Objectives To evaluate the safety and outcome of image-guided sclerotherapy for treating venous malformations (VMs) of the face. Materials and methods A multicenter cohort of 68 patients with VMs primarily affecting the face was retrospectively investigated. In total, 142 image-guided sclerotherapies were performed using gelified ethanol and/or polidocanol. Clinical and imaging findings were assessed to evaluate clinical response, lesion size reduction, and complication rates. Sub-analyses of complication rates depending on type and injected volume of the sclerosant as well as of pediatric versus adult patient groups were conducted. Results Mean number of procedures per patient was 2.1 (±1.7) and mean follow-up consisted of 8.7 months (±6.8 months). Clinical response (n = 58) revealed a partial relief of symptoms in 70.7% (41/58), 13/58 patients (22.4%) presented symptom-free while only 4/58 patients (6.9%) reported no improvement. Post-treatment imaging (n = 52) revealed an overall objective response rate of 86.5% (45/52). The total complication rate was 10.6% (15/142) including 4.2% (7/142) major complications, mostly (14/15, 93.3%) resolved by conservative means. In one case, a mild facial palsy persisted over time. The complication rate in the gelified ethanol subgroup was significantly higher compared to polidocanol and to the combination of both sclerosants (23.5 vs. 6.0 vs. 8.3%, p = 0.01). No significant differences in complications between the pediatric and the adult subgroup were observed (12.1 vs. 9.2%, p = 0.57). Clinical response did not correlate with lesion size reduction on magnetic resonance imaging (MRI). Conclusion Image-guided sclerotherapy is effective for treating VMs of the face. Clinical response is not necessarily associated with size reduction on imaging. Despite the complex anatomy of this location, the procedures are safe for both adults and children.
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Affiliation(s)
- Vanessa F. Schmidt
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany,*Correspondence: Vanessa F. Schmidt,
| | - Max Masthoff
- Clinic for Radiology, Münster University Hospital, Münster, Germany
| | - Constantin Goldann
- Clinic and Policlinic of Radiology, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Richard Brill
- Clinic and Policlinic of Radiology, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Peter B. Sporns
- Department of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland,Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Laura Segger
- Department of Radiology, Charité – University Medicine Berlin, Berlin, Germany
| | - Victor Schulze-Zachau
- Department of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | - Martin Takes
- Department of Interventional Radiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | - Michael Köhler
- Clinic for Radiology, Münster University Hospital, Münster, Germany
| | - Sinan Deniz
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Osman Öcal
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Nabeel Mansour
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | | | - Mwivano Dunstan Shemwetta
- Department of Radiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Balowa Musa Baraka
- Department of Radiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Eric M. Mbuguje
- Department of Radiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Azza A. Naif
- Department of Radiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Ofonime Ukweh
- Department of Radiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania,Department of Radiology, University of Calabar, Calabar, Nigeria
| | - Max Seidensticker
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Jens Ricke
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Bernhard Gebauer
- Department of Radiology, Charité – University Medicine Berlin, Berlin, Germany
| | - Walter A. Wohlgemuth
- Clinic and Policlinic of Radiology, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Moritz Wildgruber
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
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14
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Korenblik R, van Zon JFJA, Olij B, Heil J, Dewulf MJL, Neumann UP, Olde Damink SWM, Binkert CA, Schadde E, van der Leij C, van Dam RM, van Baardewijk LJ, Barbier L, Binkert CA, Billingsley K, Björnsson B, Andorrà EC, Arslan B, Baclija I, Bemelmans MHA, Bent C, de Boer MT, Bokkers RPH, de Boo DW, Breen D, Breitenstein S, Bruners P, Cappelli A, Carling U, Robert MCI, Chan B, De Cobelli F, Choi J, Crawford M, Croagh D, van Dam RM, Deprez F, Detry O, Dewulf MJL, Díaz-Nieto R, Dili A, Erdmann JI, Font JC, Davis R, Delle M, Fernando R, Fisher O, Fouraschen SMG, Fretland ÅA, Fundora Y, Gelabert A, Gerard L, Gobardhan P, Gómez F, Guiliante F, Grünberger T, Grochola LF, Grünhagen DJ, Guitart J, Hagendoorn J, Heil J, Heise D, Herrero E, Hess G, Hilal MA, Hoffmann M, Iezzi R, Imani F, Inmutto N, James S, Borobia FJG, Jovine E, Kalil J, Kingham P, Kollmar O, Kleeff J, van der Leij C, Lopez-Ben S, Macdonald A, Meijerink M, Korenblik R, Lapisatepun W, Leclercq WKG, Lindsay R, Lucidi V, Madoff DC, Martel G, Mehrzad H, Menon K, Metrakos P, Modi S, Moelker A, Montanari N, Moragues JS, Navinés-López J, Neumann UP, Nguyen J, Peddu P, Primrose JN, Olde Damink SWM, Qu X, Raptis DA, Ratti F, Ryan S, Ridouani F, Rinkes IHMB, Rogan C, Ronellenfitsch U, Serenari M, Salik A, Sallemi C, Sandström P, Martin ES, Sarría L, Schadde E, Serrablo A, Settmacher U, Smits J, Smits MLJ, Snitzbauer A, Soonawalla Z, Sparrelid E, Spuentrup E, Stavrou GA, Sutcliffe R, Tancredi I, Tasse JC, Teichgräber U, Udupa V, Valenti DA, Vass D, Vogl TJ, Wang X, White S, De Wispelaere JF, Wohlgemuth WA, Yu D, Zijlstra IJAJ. Resectability of bilobar liver tumours after simultaneous portal and hepatic vein embolization versus portal vein embolization alone: meta-analysis. BJS Open 2022; 6:6844022. [PMID: 36437731 PMCID: PMC9702575 DOI: 10.1093/bjsopen/zrac141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 09/09/2022] [Accepted: 10/05/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Many patients with bi-lobar liver tumours are not eligible for liver resection due to an insufficient future liver remnant (FLR). To reduce the risk of posthepatectomy liver failure and the primary cause of death, regenerative procedures intent to increase the FLR before surgery. The aim of this systematic review is to provide an overview of the available literature and outcomes on the effectiveness of simultaneous portal and hepatic vein embolization (PVE/HVE) versus portal vein embolization (PVE) alone. METHODS A systematic literature search was conducted in PubMed, Web of Science, and Embase up to September 2022. The primary outcome was resectability and the secondary outcome was the FLR volume increase. RESULTS Eight studies comparing PVE/HVE with PVE and six retrospective PVE/HVE case series were included. Pooled resectability within the comparative studies was 75 per cent in the PVE group (n = 252) versus 87 per cent in the PVE/HVE group (n = 166, OR 1.92 (95% c.i., 1.13-3.25)) favouring PVE/HVE (P = 0.015). After PVE, FLR hypertrophy between 12 per cent and 48 per cent (after a median of 21-30 days) was observed, whereas growth between 36 per cent and 67 per cent was reported after PVE/HVE (after a median of 17-31 days). In the comparative studies, 90-day primary cause of death was similar between groups (2.5 per cent after PVE versus 2.2 per cent after PVE/HVE), but a higher 90-day primary cause of death was reported in single-arm PVE/HVE cohort studies (6.9 per cent, 12 of 175 patients). CONCLUSION Based on moderate/weak evidence, PVE/HVE seems to increase resectability of bi-lobar liver tumours with a comparable safety profile. Additionally, PVE/HVE resulted in faster and more pronounced hypertrophy compared with PVE alone.
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Affiliation(s)
- Remon Korenblik
- Correspondence to: R. K., Universiteigssingel 50 (room 5.452) 6229 ER Maastricht, The Netherlands (e-mail: ); R. M. v. D., Maastricht UMC+, Dept. of Surgery, Level 4, PO Box 5800, 6202 AZ Maastricht, The Netherlands (e-mail: )
| | - Jasper F J A van Zon
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Bram Olij
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands,GROW—Department of Surgery, School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands,Department of General, Visceral and Transplant Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Jan Heil
- Department of General, Visceral and Transplant Surgery, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Maxime J L Dewulf
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Ulf P Neumann
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands,Department of General, Visceral and Transplant Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Steven W M Olde Damink
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands,Department of General, Visceral and Transplant Surgery, University Hospital RWTH Aachen, Aachen, Germany,NUTRIM—Department of Surgery, School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Christoph A Binkert
- Department of Radiology, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Erik Schadde
- Department of General, Visceral and Transplant Surgery, Klinik Hirslanden, Zurich, Switzerland,Department of General, Visceral and Transplant Surgery, Hirslanden Klink St. Anna Luzern, Luzern, Switzerland
| | | | - Ronald M van Dam
- Correspondence to: R. K., Universiteigssingel 50 (room 5.452) 6229 ER Maastricht, The Netherlands (e-mail: ); R. M. v. D., Maastricht UMC+, Dept. of Surgery, Level 4, PO Box 5800, 6202 AZ Maastricht, The Netherlands (e-mail: )
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15
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Korenblik R, Olij B, Aldrighetti LA, Hilal MA, Ahle M, Arslan B, van Baardewijk LJ, Baclija I, Bent C, Bertrand CL, Björnsson B, de Boer MT, de Boer SW, Bokkers RPH, Rinkes IHMB, Breitenstein S, Bruijnen RCG, Bruners P, Büchler MW, Camacho JC, Cappelli A, Carling U, Chan BKY, Chang DH, Choi J, Font JC, Crawford M, Croagh D, Cugat E, Davis R, De Boo DW, De Cobelli F, De Wispelaere JF, van Delden OM, Delle M, Detry O, Díaz-Nieto R, Dili A, Erdmann JI, Fisher O, Fondevila C, Fretland Å, Borobia FG, Gelabert A, Gérard L, Giuliante F, Gobardhan PD, Gómez F, Grünberger T, Grünhagen DJ, Guitart J, Hagendoorn J, Heil J, Heise D, Herrero E, Hess GF, Hoffmann MH, Iezzi R, Imani F, Nguyen J, Jovine E, Kalff JC, Kazemier G, Kingham TP, Kleeff J, Kollmar O, Leclercq WKG, Ben SL, Lucidi V, MacDonald A, Madoff DC, Manekeller S, Martel G, Mehrabi A, Mehrzad H, Meijerink MR, Menon K, Metrakos P, Meyer C, Moelker A, Modi S, Montanari N, Navines J, Neumann UP, Peddu P, Primrose JN, Qu X, Raptis D, Ratti F, Ridouani F, Rogan C, Ronellenfitsch U, Ryan S, Sallemi C, Moragues JS, Sandström P, Sarriá L, Schnitzbauer A, Serenari M, Serrablo A, Smits MLJ, Sparrelid E, Spüntrup E, Stavrou GA, Sutcliffe RP, Tancredi I, Tasse JC, Udupa V, Valenti D, Fundora Y, Vogl TJ, Wang X, White SA, Wohlgemuth WA, Yu D, Zijlstra IAJ, Binkert CA, Bemelmans MHA, van der Leij C, Schadde E, van Dam RM. Dragon 1 Protocol Manuscript: Training, Accreditation, Implementation and Safety Evaluation of Portal and Hepatic Vein Embolization (PVE/HVE) to Accelerate Future Liver Remnant (FLR) Hypertrophy. Cardiovasc Intervent Radiol 2022; 45:1391-1398. [PMID: 35790566 PMCID: PMC9458562 DOI: 10.1007/s00270-022-03176-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 05/08/2022] [Indexed: 12/02/2022]
Abstract
STUDY PURPOSE The DRAGON 1 trial aims to assess training, implementation, safety and feasibility of combined portal- and hepatic-vein embolization (PVE/HVE) to accelerate future liver remnant (FLR) hypertrophy in patients with borderline resectable colorectal cancer liver metastases. METHODS The DRAGON 1 trial is a worldwide multicenter prospective single arm trial. The primary endpoint is a composite of the safety of PVE/HVE, 90-day mortality, and one year accrual monitoring of each participating center. Secondary endpoints include: feasibility of resection, the used PVE and HVE techniques, FLR-hypertrophy, liver function (subset of centers), overall survival, and disease-free survival. All complications after the PVE/HVE procedure are documented. Liver volumes will be measured at week 1 and if applicable at week 3 and 6 after PVE/HVE and follow-up visits will be held at 1, 3, 6, and 12 months after the resection. RESULTS Not applicable. CONCLUSION DRAGON 1 is a prospective trial to assess the safety and feasibility of PVE/HVE. Participating study centers will be trained, and procedures standardized using Work Instructions (WI) to prepare for the DRAGON 2 randomized controlled trial. Outcomes should reveal the accrual potential of centers, safety profile of combined PVE/HVE and the effect of FLR-hypertrophy induction by PVE/HVE in patients with CRLM and a small FLR. TRIAL REGISTRATION Clinicaltrials.gov: NCT04272931 (February 17, 2020). Toestingonline.nl: NL71535.068.19 (September 20, 2019).
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Affiliation(s)
- R Korenblik
- GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht Universiteitssingel 40 room 5.452, 6229 ET, Maastricht, The Netherlands.
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.
| | - B Olij
- GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht Universiteitssingel 40 room 5.452, 6229 ET, Maastricht, The Netherlands
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | | | - M Abu Hilal
- Department of Surgery, Fondazione Poliambulanza, Brescia, Italy
| | - M Ahle
- Deparment of Radiology, University Hospital, Linköping, Sweden
| | - B Arslan
- Department of Radiology, Rush University Medical Center, Chicago, USA
| | - L J van Baardewijk
- Department of Radiology, Maxima Medisch Centrum, Eindhoven, The Netherlands
| | - I Baclija
- Department of Radiology, Clinic Favoriten, Vienna, Austria
| | - C Bent
- Department of Radiology, Bournemouth and Christuchurch, The Royal Bournemouth and Christchurch Hospitals, Bournemouth and Christuchurch, UK
| | - C L Bertrand
- Department of Surgery, CHU UCLouvain Namur, Namur, Belgium
| | - B Björnsson
- Department of Surgery, Biomedical and Clinical Sciences, Linköping University Hospital, Linköping, Sweden
| | - M T de Boer
- Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - S W de Boer
- Deparment of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - R P H Bokkers
- Department of Radiology, University Medical Center Groningen, Groningen, The Netherlands
| | - I H M Borel Rinkes
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - S Breitenstein
- Department of General and Visceral Surgery, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - R C G Bruijnen
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - P Bruners
- Department of Radiology, University Hospital Aachen, Aachen, Germany
| | - M W Büchler
- Department of Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - J C Camacho
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - A Cappelli
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - U Carling
- Department of Radiology, University Hospital Oslo, Oslo, Norway
| | - B K Y Chan
- Department of Surgery, Aintree University Hospitals NHS, Liverpool, UK
| | - D H Chang
- Department of Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - J Choi
- Department of Surgery, Western Health Footscray, Footscray, Australia
| | - J Codina Font
- Department of Radiology, University Hospital Dr. Josep Trueta de Girona, Girona, Spain
| | - M Crawford
- Department of Surgery, Royal Prince Alfred Hospital, Camperdown, Australia
| | - D Croagh
- Department of Surgery, Monash Health, Clayton, Australia
| | - E Cugat
- Department of Surgery, University Hospital Germans Trias I Pujol, Badalona, Spain
| | - R Davis
- Department of Radiology, Aintree University Hospitals NHS, Liverpool, UK
| | - D W De Boo
- Department of Radiology, Monash Health, Clayton, Australia
| | - F De Cobelli
- Department of Radiology, Ospedale San Raffaele, Milan, Italy
| | | | - O M van Delden
- Department of Radiology, Amsterdam University Medical Centers Location AMC, Amsterdam, The Netherlands
| | - M Delle
- Department of Radiology, Karolinska University Hospital, Stockholm, Sweden
| | - O Detry
- Department of Surgery, CHU de Liège, Liège, Belgium
| | - R Díaz-Nieto
- Department of Surgery, Aintree University Hospitals NHS, Liverpool, UK
| | - A Dili
- Department of Surgery, CHU UCLouvain Namur, Namur, Belgium
| | - J I Erdmann
- Department of Surgery, Amsterdam University Medical Centers Location AMC, Amsterdam, The Netherlands
| | - O Fisher
- Department of Surgery, Royal Prince Alfred Hospital, Camperdown, Australia
| | - C Fondevila
- Department of Surgery, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Å Fretland
- Department of Surgery, University Hospital Oslo, Oslo, Norway
| | - F Garcia Borobia
- Department of Surgery, Hospital Parc Taulí de Sabadell, Sabadell, Spain
| | - A Gelabert
- Department of Radiology, Hospital Parc Taulí de Sabadell, Sabadell, Spain
- Department of Radiology, University Hospital Mútua Terassa, Terassa, Spain
| | - L Gérard
- Department of Radiology, CHU de Liège, Liège, Belgium
| | - F Giuliante
- Department of Surgery, Gemelli University Hospital Rome, Rome, Italy
| | - P D Gobardhan
- Department of Surgery, Amphia, Breda, The Netherlands
| | - F Gómez
- Department of Radiology, Hospital Clínic de Barcelona, Barcelona, Spain
| | - T Grünberger
- Department of Surgery, HPB Center Vienna Health Network, Clinic Favoriten, Vienna, Austria
| | - D J Grünhagen
- Department of Surgery, Erasmus Medisch Centrum, Rotterdam, The Netherlands
| | - J Guitart
- Department of Radiology, University Hospital Mútua Terassa, Terassa, Spain
| | - J Hagendoorn
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - J Heil
- Department of Surgery, University Hospital Frankfurt, Frankfurt, Germany
| | - D Heise
- Department of General, Visceral and Transplant Surgery, University Hospital Aachen, Aachen, Germany
| | - E Herrero
- Department of Surgery, University Hospital Mútua Terassa, Terassa, Spain
| | - G F Hess
- Department of Surgery, Clarunis University Hospital, Basel, Switzerland
| | - M H Hoffmann
- Department of Radiology, St. Clara Spital, Basel, Switzerland
| | - R Iezzi
- Department of Radiology, Gemelli University Hospital, Rome, Italy
| | - F Imani
- Department of Radiology, Amphia, Breda, The Netherlands
| | - J Nguyen
- Department of Radiology, Western Health Footscray, Footscray, Australia
| | - E Jovine
- Department of Surgery, Ospedale Maggiore di Bologna, Bologna, Italy
| | - J C Kalff
- Department of Surgery, University Hospital Bonn, Bonn, Germany
| | - G Kazemier
- Department of Surgery, Amsterdam University Medical Centers Location VU, Amsterdam, The Netherlands
| | - T P Kingham
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA
| | - J Kleeff
- Department of Surgery, University Hospital Halle (Saale), Halle, Germany
| | - O Kollmar
- Department of Surgery, Clarunis University Hospital, Basel, Switzerland
| | - W K G Leclercq
- Department of Surgery, Maxima Medisch Centrum, Eindhoven, The Netherlands
| | - S Lopez Ben
- Department of Surgery, University Hospital Dr. Josep Trueta de Girona, Girona, Spain
| | - V Lucidi
- Department of Surgery, Hôpital Erasme, Brussels, Belgium
| | - A MacDonald
- Department of Radiology, Oxford University Hospital NHS, Oxford, UK
| | - D C Madoff
- Department of Radiology, Yale School of Medicine, New Haven, USA
| | - S Manekeller
- Department of Surgery, University Hospital Bonn, Bonn, Germany
| | - G Martel
- Department of Surgery, The Ottawa Hospital, Ottawa, Canada
| | - A Mehrabi
- Department of Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - H Mehrzad
- Department of Radiology, Queen Elizabeth Hospital Birmingham NHS, Birmingham, UK
| | - M R Meijerink
- Department of Radiology, Amsterdam University Medical Centers Location VU, Amsterdam, The Netherlands
| | - K Menon
- Department of Surgery, King's College Hospital NHS, London, UK
| | - P Metrakos
- Department of Surgery, McGill University Health Centre, Montréal, Canada
| | - C Meyer
- Department of Radiology, University Hospital Bonn, Bonn, Germany
| | - A Moelker
- Department of Radiology and Nuclear Medicine, Erasmus Medisch Centrum, Rotterdam, The Netherlands
| | - S Modi
- Department of Radiology, University Hospital Southampton NHS, Southampton, UK
| | - N Montanari
- Department of Radiology, Ospedale Maggiore Di Bologna, Bologna, Italy
| | - J Navines
- Department of Surgery, University Hospital Germans Trias I Pujol, Badalona, Spain
| | - U P Neumann
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of General, Visceral and Transplant Surgery, University Hospital Aachen, Aachen, Germany
| | - P Peddu
- Department of Radiology, King's College Hospital NHS, London, UK
| | - J N Primrose
- Department of Surgery, University Hospital Southampton NHS, Southampton, UK
| | - X Qu
- Department of Radiology, Zhongshan Hospital, Fundan University, Shanghai, China
| | - D Raptis
- Department of Surgery, Royal Free Hospital NHS, London, UK
| | - F Ratti
- Department of Surgery, Ospedale San Raffaele, Milan, Italy
| | - F Ridouani
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - C Rogan
- Department of Radiology, Royal Prince Alfred Hospital, Camperdown, Australia
| | - U Ronellenfitsch
- Department of Surgery, University Hospital Halle (Saale), Halle, Germany
| | - S Ryan
- Department of Radiology, The Ottawa Hospital, Ottawa, Canada
| | - C Sallemi
- Department of Radiology, Fondazione Poliambulanza, Brescia, Italy
| | - J Sampere Moragues
- Department of Radiology, University Hospital Germans Trias I Pujol, Badalona, Spain
| | - P Sandström
- Department of Surgery, Biomedical and Clinical Sciences, Linköping University Hospital, Linköping, Sweden
| | - L Sarriá
- Department of Radiology, University Hospital Miguel Servet, Saragossa, Spain
| | - A Schnitzbauer
- Department of Surgery, University Hospital Frankfurt, Frankfurt, Germany
| | - M Serenari
- Department of Surgery, General Surgery and Transplant Unit, IRCCS Azienda Ospedaliero- Universitaria di Bologna, Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - A Serrablo
- Department of Surgery, University Hospital Miguel Servet, Saragossa, Spain
| | - M L J Smits
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - E Sparrelid
- Department of Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - E Spüntrup
- Department of Radiology, Klinikum Saarbrücken gGmbH, Saarbrücken, Germany
| | - G A Stavrou
- Department of Surgery, Klinikum Saarbrücken gGmbH, Saarbrücken, Germany
| | - R P Sutcliffe
- Department of Surgery, Queen Elizabeth Hospital Birmingham NHS, Birmingham, UK
| | - I Tancredi
- Department of Radiology, Hôpital Erasme, Brussels, Belgium
| | - J C Tasse
- Department of Radiology, Rush University Medical Center, Chicago, USA
| | - V Udupa
- Department of Surgery, Oxford University Hospital NHS, Oxford, UK
| | - D Valenti
- Department of Radiology, McGill University Health Centre, Montréal, Canada
| | - Y Fundora
- Department of Surgery, Hospital Clínic de Barcelona, Barcelona, Spain
| | - T J Vogl
- Department of Radiology, University Hosptital Frankfurt, Frankfurt, Germany
| | - X Wang
- Department of Surgery, Zhongshan Hospital, Fundan University, Shanghai, China
| | - S A White
- Department of Surgery, Newcastle Upon Tyne Hospitals NHS, Newcastle upon Tyne, UK
| | - W A Wohlgemuth
- Department of Radiology, University Hospital Halle (Saale), Halle, Germany
| | - D Yu
- Department of Radiology, Royal Free Hospital NHS, London, UK
| | - I A J Zijlstra
- Department of Radiology, Amsterdam University Medical Centers Location VU, Amsterdam, The Netherlands
| | - C A Binkert
- Department of Radiology, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - M H A Bemelmans
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of General, Visceral and Transplant Surgery, University Hospital Aachen, Aachen, Germany
| | - C van der Leij
- Deparment of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - E Schadde
- Department of General and Visceral Surgery, Cantonal Hospital Winterthur, Winterthur, Switzerland
- Department of Surgery, Rush University Medical Center Chicago, Chicago, USA
| | - R M van Dam
- GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht Universiteitssingel 40 room 5.452, 6229 ET, Maastricht, The Netherlands.
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.
- Department of General, Visceral and Transplant Surgery, University Hospital Aachen, Aachen, Germany.
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Schmidt VF, Masthoff M, Goldann C, Ehrl D, Deniz S, Öcal O, Seidensticker M, Ricke J, Köhler M, Brill R, Wohlgemuth WA, Wildgruber M. Image-guided embolization of arteriovenous malformations of the hand using Ethylene-vinyl Alcohol Copolymer. Diagn Interv Radiol 2022; 28:486-494. [PMID: 36218151 DOI: 10.5152/dir.2022.21644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE This study aimed to evaluate the safety and outcome of image-guided embolization for treating arteriovenous malformations (AVMs) of the hand using ethylene-vinyl alcohol copolymer (EVOH). METHODS A retrospective, multicenter cohort of 15 patients with AVMs of the hand treated with 35 imageguided embolotherapies using EVOH was investigated. Clinical history, symptomatology, and imaging findings were assessed to evaluate clinical outcome (symptom-free, partial relief of pain, no improvement of pain, and clinical progression despite embolization), lesion devascularization (total, 100%; near-total, 90%-99%; substantial, 70%-90%; partial, 30%-70%; and failure, 0%-30%), and peri- and postprocedural complication rates (major complications classified according to CIRSE guidelines). Substratification analysis was performed with respect to the involvement of different anatomical compartments and the injected volume of the embolic agent. RESULTS Patients were treated for pain (93.3%), skin ulceration (46.7%), and local bleeding (33.3%). The mean number of embolotherapies was 2.3 (±1.1) in 3 patients, a planned surgical resection was conducted after embolization. Clinical outcome after a median follow-up of 18 months revealed an overall response of 11/15 patients (73.3%). Imaging at last follow-up revealed 70%- 99% reduced vascularization in 12/15 patients (80%) including 2 patients (13.3%) with a neartotal devascularization of 90%-99%. Peri- and postprocedural complications occurred in 8.5% and 31.5%, respectively, including 17.1% major complications, in 1 case requiring a previously unplanned resection. Involvement of the finger was associated with increased rates of persistent symptoms compared to the other groups (P=.049). No significant difference between the embolic agent volume injected and complication rates was found (P=.372). CONCLUSION Image-guided embolization using EVOH-based liquid embolic agents is effective for treating AVMs of the hand in the mid-term.
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Affiliation(s)
- Vanessa F Schmidt
- Department of Radiology, University Hospital, LMU Munich, München, Germany
| | - Max Masthoff
- Clinic of Radiology, University Hospital Muenster, Muenster, Germany
| | - Constantin Goldann
- Clinic and Policlinic of Radiology, Martin-Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Denis Ehrl
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | - Sinan Deniz
- Department of Radiology, University Hospital, LMU Munich, München, Germany
| | - Osman Öcal
- Department of Radiology, University Hospital, LMU Munich, München, Germany
| | - Max Seidensticker
- Department of Radiology, University Hospital, LMU Munich, München, Germany
| | - Jens Ricke
- Department of Radiology, University Hospital, LMU Munich, München, Germany
| | - Michael Köhler
- Clinic of Radiology, University Hospital Muenster, Muenster, Germany
| | - Richard Brill
- Clinic and Policlinic of Radiology, Martin-Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Walter A Wohlgemuth
- Clinic and Policlinic of Radiology, Martin-Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Moritz Wildgruber
- Department of Radiology, University Hospital, LMU Munich, München, Germany
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17
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Müller-Wille R, Wildgruber M, Wohlgemuth WA. Interventionelle Behandlungsoptionen bei vaskulären Malformationen. Phlebologie 2022. [DOI: 10.1055/a-1808-2566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Zusammenfassung
Klassifikation von vaskulären Malformationen Während Hämangiome zu den vaskulären Tumoren zählen, sind vaskuläre Malformationen angeboren und bilden sich von selbst nicht zurück. Sie werden nach der ISSVA-Klassifikation unterschieden.
Indikation zur Therapie Ziele der Therapie von Gefäßmalformationen sind die Linderung der Symptome, der Organerhalt und die Verhinderung von Krankheitsprogress und Komplikationen.
Nichtinvasive Therapieoptionen Die Kompressionstherapie sowie physiotherapeutische Maßnahmen zählen zu den wichtigsten konservativen Therapieoptionen.
Invasive Therapieoptionen Die chirurgische Resektion, die oberflächliche Lasertherapie und die interventionelle Therapie stellen die invasiven Therapieoptionen dar. Für die Behandlung symptomatischer Gefäßmalformationen stehen mittlerweile zahlreiche minimalinvasive interventionelle Verfahren zur Verfügung. Slow-Flow-Malformationen können relativ komplikationsarm mittels perkutaner Sklerotherapie behandelt werden, die zu einem zeitversetzten entzündlichen Verschluss der Läsion führt. Dysplastische Venen wie die Marginalvene können mittels endoluminaler Verfahren erfolgreich verödet werden. Die zumeist Katheter-gesteuerten Embolisationsverfahren mittels Flüssigembolisaten, Plugs und Coils erlauben den Verschluss von Fast-Flow-Gefäßmalformationen.
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Affiliation(s)
| | - Moritz Wildgruber
- Klinik und Poliklinik für Radiologie, Klinikum der Ludwig-Maximilians-Universität München
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18
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Schmidt VF, Masthoff M, Brill R, Sporns PB, Köhler M, Schulze-Zachau V, Takes M, Ehrl D, Puhr-Westerheide D, Kunz WG, Shemwetta MD, Mbuguje EM, Naif AA, Sarkar A, Ricke J, Seidensticker M, Wohlgemuth WA, Wildgruber M. Image-Guided Embolotherapy of Arteriovenous Malformations of the Face. Cardiovasc Intervent Radiol 2022; 45:992-1000. [PMID: 35655034 PMCID: PMC9226106 DOI: 10.1007/s00270-022-03169-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 05/05/2022] [Indexed: 12/16/2022]
Abstract
Purpose To evaluate the safety and outcome of image-guided embolotherapy of extracranial arteriovenous malformations (AVMs) primarily affecting the face. Materials and Methods A multicenter cohort of 28 patients presenting with AVMs primarily affecting the face was retrospectively investigated. Fifty image-guided embolotherapies were performed, mostly using ethylene–vinyl alcohol copolymer-based embolic agents. Clinical and imaging findings were assessed to evaluate response during follow-up (symptom-free, partial relief of symptoms, no improvement, and progression despite embolization), lesion devascularization (total, 100%; substantial, 76–99%; partial, 51–75%; failure, < 50%; and progression), and complication rates (classified according to the CIRSE guidelines). Sub-analyses regarding clinical outcome (n = 24) were performed comparing patients with (n = 12) or without (n = 12) subsequent surgical resection after embolotherapy. Results The median number of embolotherapy sessions was 2.0 (range, 1–4). Clinical outcome after a mean follow-up of 12.4 months (± 13.3; n = 24) revealed a therapy response in 21/24 patients (87.5%). Imaging showed total devascularization in 14/24 patients (58.3%), including the 12 patients with subsequent surgery and 2 additional patients with embolotherapy only. Substantial devascularization (76–99%) was assessed in 7/24 patients (29.2%), and partial devascularization (51–75%) in 3/24 patients (12.5%). Complications occurred during/after 12/50 procedures (24.0%), including 18.0% major complications. Patients with subsequent surgical resections were more often symptom-free at the last follow-up compared to the group having undergone embolotherapy only (p = 0.006). Conclusion Image-guided embolotherapy is safe and effective for treating extracranial AVMs of the face. Subsequent surgical resections after embolization may substantially improve patients’ clinical outcome, emphasizing the need for multimodal therapeutic concepts. Level of Evidence Level 4, Retrospective study. Supplementary Information The online version contains supplementary material available at 10.1007/s00270-022-03169-0.
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Affiliation(s)
- Vanessa F Schmidt
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany.
| | - Max Masthoff
- Clinic for Radiology, University Hospital Muenster, Muenster, Germany
| | - Richard Brill
- Clinic and Policlinic of Radiology, Martin-Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Peter B Sporns
- Department of Neuroradiology, Clinic for Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | - Michael Köhler
- Clinic for Radiology, University Hospital Muenster, Muenster, Germany
| | - Victor Schulze-Zachau
- Department of Neuroradiology, Clinic for Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | - Martin Takes
- Department of Neuroradiology, Clinic for Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | - Denis Ehrl
- Department of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Munich, Germany
| | | | - Wolfgang G Kunz
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Mwivano Dunstan Shemwetta
- Department of Radiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Eric M Mbuguje
- Department of Radiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Azza A Naif
- Department of Radiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Abizer Sarkar
- Department of Radiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Jens Ricke
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Max Seidensticker
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Walter A Wohlgemuth
- Clinic and Policlinic of Radiology, Martin-Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Moritz Wildgruber
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
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19
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Schmidt VF, Olivieri M, Häberle B, Masthoff M, Deniz S, Sporns PB, Wohlgemuth WA, Wildgruber M. Interventional Treatment Options in Children with Extracranial Vascular Malformations. Hamostaseologie 2022; 42:131-141. [PMID: 35263769 DOI: 10.1055/a-1728-5686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Extracranial vascular malformations vary greatly and belong to the complex field of orphan diseases and can involve all segments of the vascular tree: arteries, capillaries, and veins, and similarly the lymphatic system. The classification according to the International Society for the Study of Vascular Anomalies (ISSVA) represents an important guidance for selecting appropriate therapy. Although many of the principles of endovascular treatment, including image-guided sclerotherapy and embolization, are similar in adult and pediatric practice, there are some distinct differences regarding the treatment of vascular malformations of children. Thus, it is crucial to involve longer-term plan about managing these chronic diseases and their impact on a growing child. This review provides a detailed overview over the clinical presentation of venous, lymphatic, and arteriovenous malformations in children and emphasizes the specifics of their interventional treatment options, including distinct pediatric dose limitations and procedure-related side effects.
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Affiliation(s)
- Vanessa F Schmidt
- Department of Radiology, Ludwig Maximilian University Hospital, Munich, München, Germany
| | - Martin Olivieri
- Paediatric Thrombosis and Haemostasis Unit, Dr. von Hauner Children's Hospital Munich, Ludwig Maximilian University, Munich, Germany
| | - Beate Häberle
- Department for Pediatric Surgery, Ludwig Maximilian University Hospital, Munich, München, Germany
| | - Max Masthoff
- Clinic of Radiology, University Hospital Muenster, Muenster, Germany
| | - Sinan Deniz
- Department of Radiology, Ludwig Maximilian University Hospital, Munich, München, Germany
| | - Peter B Sporns
- Department of Neuroradiology, Clinic for Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland.,Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg - Eppendorf, Hamburg, Germany
| | - Walter A Wohlgemuth
- Clinic and Policlinic of Diagnostic Radiology, Martin-Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Moritz Wildgruber
- Department of Radiology, Ludwig Maximilian University Hospital, Munich, München, Germany
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20
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Luiken I, Eisenmann S, Garbe J, Sternby H, Verdonk RC, Dimova A, Ignatavicius P, Ilzarbe L, Koiva P, Penttilä AK, Regnér S, Dober J, Wohlgemuth WA, Brill R, Michl P, Rosendahl J, Damm M. Pleuropulmonary pathologies in the early phase of acute pancreatitis correlate with disease severity. PLoS One 2022; 17:e0263739. [PMID: 35130290 PMCID: PMC8820650 DOI: 10.1371/journal.pone.0263739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 01/25/2022] [Indexed: 12/12/2022] Open
Abstract
Background
Respiratory failure worsens the outcome of acute pancreatitis (AP) and underlying factors might be early detectable.
Aims
To evaluate the prevalence and prognostic relevance of early pleuropulmonary pathologies and pre-existing chronic lung diseases (CLD) in AP patients.
Methods
Multicentre retrospective cohort study. Caudal sections of the thorax derived from abdominal contrast enhanced computed tomography (CECT) performed in the early phase of AP were assessed. Independent predictors of severe AP were identified by binary logistic regression analysis. A one-year survival analysis using Kaplan-Meier curves and log rank test was performed.
Results
358 patients were analysed, finding pleuropulmonary pathologies in 81%. CECTs were performed with a median of 2 days (IQR 1–3) after admission. Multivariable analysis identified moderate to severe or bilateral pleural effusions (PEs) (OR = 4.16, 95%CI 2.05–8.45, p<0.001) and pre-existing CLD (OR = 2.93, 95%CI 1.17–7.32, p = 0.022) as independent predictors of severe AP. Log rank test showed a significantly worse one-year survival in patients with bilateral compared to unilateral PEs in a subgroup.
Conclusions
Increasing awareness of the prognostic impact of large and bilateral PEs and pre-existing CLD could facilitate the identification of patients at high risk for severe AP in the early phase and thus improve their prognosis.
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Affiliation(s)
- Ina Luiken
- Department of Internal Medicine I, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Stephan Eisenmann
- Department of Internal Medicine I, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Jakob Garbe
- Department of Internal Medicine I, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Hanna Sternby
- Department of Surgery, Institution of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Robert C. Verdonk
- Department of Gastroenterology, St. Antonius Ziekenhuis, Nieuwegein, The Netherlands
| | - Alexandra Dimova
- Department of Surgery, University Hospital for Emergency Medicine “Pirogov”, Sofia, Bulgaria
| | - Povilas Ignatavicius
- Department of Surgery, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Lucas Ilzarbe
- Department of Gastroenterology, Hospital del Mar, Barcelona, Spain
| | - Peeter Koiva
- Department of Gastroenterology, East Tallinn Central Hospital, Tallinn, Estonia
| | - Anne K. Penttilä
- Department of Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Sara Regnér
- Department of Surgery, Institution of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Johannes Dober
- Department of Radiology, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Walter A. Wohlgemuth
- Department of Radiology, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Richard Brill
- Department of Radiology, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Patrick Michl
- Department of Internal Medicine I, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Jonas Rosendahl
- Department of Internal Medicine I, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Marko Damm
- Department of Internal Medicine I, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
- * E-mail:
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21
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Cucuruz B, Koller M, Pfleiderer R, Geisthoff U, Meyer L, Kapp F, Lang W, Schmitz-Rixen T, Wohlgemuth WA. Towards a better treatment of patients with vascular malformations: certified interdisciplinary centers are mandatory. Z Evid Fortbild Qual Gesundhwes 2022; 168:1-7. [PMID: 35144912 DOI: 10.1016/j.zefq.2021.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 11/02/2021] [Accepted: 11/21/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Vascular anomalies are orphan diseases that occur in all age groups and range from purely aesthetic to potentially life-threatening conditions. This thesis paper outlines the typical conferring problems in patient management and possible structural solutions for a better patient treatment in the future. METHODS A multi-perspective author panel consisting of key stakeholders from the German Interdisciplinary Society of Vascular Anomalies and the German Society for Surgery defined problem areas and possible solutions including quality indicators as criteria for certified interdisciplinary Vascular Anomalies Centers (VAC). RESULTS According to the literature available, clearly defined nomenclature and nosological entities often remain unused in this field, and consented diagnostic and therapeutic evidence is rare. Expert opinions dominate and in some cases lead to disparate recommendations. Typical patient problems arise from this situation, exemplified in patient vignettes. Centralized and standardized patient treatment in interdisciplinary VAC may be a solution to this problem. These centers should agree on a set of general principles and quality indicators with an additional minimum set of structural and procedural criteria. DISCUSSION The present position paper outlines perspectives for implementing certified interdisciplinary VAC. There is a need for a comprehensive nomenclature, access to interdisciplinary treatment centers, more scientific evidence, and further education in this rare group of diseases. CONCLUSION Use of scientifically sound and patient-relevant criteria for certifying the interdisciplinary quality of VAC is expected to improve health care in Germany.
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Affiliation(s)
- Beatrix Cucuruz
- University Clinic and Policlinic of Radiology at the Martin-Luther-Universität Halle-Wittenberg, Halle, Germany
| | - Michael Koller
- Center for Clinical Studies, University Hospital Regensburg, Regensburg, Germany
| | - Ronja Pfleiderer
- German Interdisciplinary Society for Vascular Anomalies e.V., Halle, Germany
| | - Urban Geisthoff
- Department of Otorhinolaryngology, Head and Neck Surgery, Marburg University Hospital, Marburg, Germany
| | - Lutz Meyer
- Center for Vascular Malformations Eberswalde (ZVM), Werner Forßmann Hospital, Eberswalde, Germany
| | - Friedrich Kapp
- Department of Pediatric Hematology and Oncology, University Medical Center Freiburg, Freiburg, Germany
| | - Werner Lang
- Vascular Surgery, University Hospital Erlangen, Erlangen, Germany
| | - Thomas Schmitz-Rixen
- Institute for Transfusion Medicine and Immunohaematology Frankfurt/Main, Frankfurt/Main, Germany
| | - Walter A Wohlgemuth
- University Clinic and Policlinic of Radiology at the Martin-Luther-Universität Halle-Wittenberg, Halle, Germany.
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22
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Schmidt VF, Masthoff M, Czihal M, Cucuruz B, Häberle B, Brill R, Wohlgemuth WA, Wildgruber M. Imaging of peripheral vascular malformations - current concepts and future perspectives. Mol Cell Pediatr 2021; 8:19. [PMID: 34874510 PMCID: PMC8651875 DOI: 10.1186/s40348-021-00132-w] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 11/25/2021] [Indexed: 12/17/2022] Open
Abstract
Vascular Malformations belong to the spectrum of orphan diseases and can involve all segments of the vascular tree: arteries, capillaries, and veins, and similarly the lymphatic vasculature. The classification according to the International Society for the Study of Vascular Anomalies (ISSVA) is of major importance to guide proper treatment. Imaging plays a crucial role to classify vascular malformations according to their dominant vessel type, anatomical extension, and flow pattern. Several imaging concepts including color-coded Duplex ultrasound/contrast-enhanced ultrasound (CDUS/CEUS), 4D computed tomography angiography (CTA), magnetic resonance imaging (MRI) including dynamic contrast-enhanced MR-angiography (DCE-MRA), and conventional arterial and venous angiography are established in the current clinical routine. Besides the very heterogenous phenotypes of vascular malformations, molecular and genetic profiling has recently offered an advanced understanding of the pathogenesis and progression of these lesions. As distinct molecular subtypes may be suitable for targeted therapies, capturing certain patterns by means of molecular imaging could enhance non-invasive diagnostics of vascular malformations. This review provides an overview of subtype-specific imaging and established imaging modalities, as well as future perspectives of novel functional and molecular imaging approaches. We highlight recent pioneering imaging studies including thermography, positron emission tomography (PET), and multispectral optoacoustic tomography (MSOT), which have successfully targeted specific biomarkers of vascular malformations.
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Affiliation(s)
- Vanessa F Schmidt
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Max Masthoff
- Clinic for Radiology, University Hospital Muenster, Muenster, Germany
| | - Michael Czihal
- Angiology Division, Department for Medicine IV, University Hospital, LMU Munich, Munich, Germany
| | - Beatrix Cucuruz
- Clinic and Policlinic of Radiology, Martin-Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Beate Häberle
- Department for Pediatric Surgery, Dr. von Haunersches Kinderspital, University Hospital, LMU Munich, Munich, Germany
| | - Richard Brill
- Clinic and Policlinic of Radiology, Martin-Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Walter A Wohlgemuth
- Clinic and Policlinic of Radiology, Martin-Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Moritz Wildgruber
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany. .,Clinic for Radiology, University Hospital Muenster, Muenster, Germany.
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23
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Pein U, Fritz A, Markau S, Wohlgemuth WA, Girndt M. [Contrast media use in kidney disease - clinical practice recommendations]. Dtsch Med Wochenschr 2021; 146:1489-1495. [PMID: 34741294 DOI: 10.1055/a-1640-4503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Contrast media use in patients with renal disease regularly ensures discussions in everyday clinical practice. Both X-ray and MRI contrast media are predominantly eliminated by the kidneys and therefore closely linked to kidney function. Risk stratification prior to contrast media use in patients with pre-existing renal dysfunction should be based on eGFR-determination. Patients with an eGFR ≥ 30 ml/min require an individual risk assessment. In patients with advanced renal insufficiency ensuring euvolemia is crucial. Currently, there is no evidence for any other preventive approach. Therefore, no further specific procedures preventing contrast-associated kidney injury are recommended. Timing of contrast media injection and dialysis sessions in patients with end stage renal disease is necessary only after MRI contrast media use. Independently, acute kidney injury requires a patient individual decision.
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Affiliation(s)
- Ulrich Pein
- Universitätsklinik und Poliklinik für Innere Medizin II, Universitätsklinikum Halle (Saale)
| | - Annekathrin Fritz
- Universitätsklinik und Poliklinik für Innere Medizin II, Universitätsklinikum Halle (Saale)
| | - Silke Markau
- Universitätsklinik und Poliklinik für Innere Medizin II, Universitätsklinikum Halle (Saale)
| | - Walter A Wohlgemuth
- Department für Strahlenmedizin, Universitätsklinik und Poliklinik für Radiologie, Universitätsklinikum Halle (Saale)
| | - Matthias Girndt
- Universitätsklinik und Poliklinik für Innere Medizin II, Universitätsklinikum Halle (Saale)
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24
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Helm M, Goldann C, Hammer S, Platz Batista da Silva N, Wildgruber M, Deistung A, Gussew A, Wohlgemuth WA, Uller W, Brill R. Vascular malformations of the female and male genitalia: type and distribution patterns revealed by magnetic resonance imaging. Clin Exp Dermatol 2021; 47:43-49. [PMID: 34236712 DOI: 10.1111/ced.14830] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Vascular malformations of the genitalia often go undetected in clinical examination. These vascular malformations can cause a variety of clinical symptoms such as swelling, pain and bleeding. AIM To characterize the distribution patterns of genital vascular malformations using magnetic resonance imaging (MRI) and to correlate these patterns with clinical findings in order to guide diagnostic decisions. METHODS A retrospective analysis of MRIs of the pelvis and legs in 370 patients with vascular malformation was performed to determine the involvement of the internal and external genitalia. RESULTS In 71 patients (19%), genital involvement could be identified by MRI. Of these, 11.3% (8 of 71) presented with internal involvement, 36.6% (26 of 71) with external involvement and 52.1% (37 of 71) with both internal and external involvement. Over half (57.1%) of the 49 patients with visible external genital signs detected during a clinical examination had additional internal genital involvement. CONCLUSIONS Genital involvement is a common finding in patients with vascular malformation of the legs and/or pelvis. Based on our data, we recommend MRI of the legs and pelvic region in patients with externally visible signs of a vascular malformation of the external genitalia in order to exclude additional internal involvement.
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Affiliation(s)
- M Helm
- Department of Radiology and Polyclinic of Radiology, University Hospital Halle (Saale), Halle (Saale), Germany
| | - C Goldann
- Department of Radiology and Polyclinic of Radiology, University Hospital Halle (Saale), Halle (Saale), Germany
| | - S Hammer
- Department of Radiology, University Regensburg, Regensburg, Germany
| | | | - M Wildgruber
- Department of Radiology, University Hospital Ludwig-Maximilians-Universität, Campus Großhadern, Munich, Germany
| | - A Deistung
- Department of Radiology and Polyclinic of Radiology, University Hospital Halle (Saale), Halle (Saale), Germany
| | - A Gussew
- Department of Radiology and Polyclinic of Radiology, University Hospital Halle (Saale), Halle (Saale), Germany
| | - W A Wohlgemuth
- Department of Radiology and Polyclinic of Radiology, University Hospital Halle (Saale), Halle (Saale), Germany
| | - W Uller
- Department of Radiology, University of Freiburg, Freiburg, Germany
| | - R Brill
- Department of Radiology and Polyclinic of Radiology, University Hospital Halle (Saale), Halle (Saale), Germany
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25
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Schmidt VF, Wieland I, Wohlgemuth WA, Ricke J, Wildgruber M, Zenker M. Mosaic RASopathy due to KRAS variant G12D with segmental overgrowth and associated peripheral vascular malformations. Am J Med Genet A 2021; 185:3122-3128. [PMID: 34114335 DOI: 10.1002/ajmg.a.62386] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 05/11/2021] [Accepted: 05/27/2021] [Indexed: 01/19/2023]
Abstract
Oncogenic RAS variants lead to constitutive overactivation and increased signal transduction into downstream pathways. They are found as somatic driver events in various types of human cancer. In a somatic mosaic status, the same RAS variants have been associated with a wide spectrum of focal or segmental tissue dysplasia and overgrowth including various types of congenital nevi, vascular malformations, and other changes (mosaic RASopathies). We present a 3-year-old male patient with segmental overgrowth of the subcutaneous fatty tissue of the right lower extremity with colocalized arteriovenous and capillary malformations and dysplastic draining veins in combination with talipes equinovarus of the right foot. In tissue biopsies of the affected extremity, we identified a mosaic KRAS variant, c.35G>A (p.Gly12Asp), while this variant was absent in the DNA extracted from a biopsy of the normal extremity. This report provides further evidence for the wide clinical and phenotypic variability associated with mosaic KRAS variants. The described pattern confirms that the combination of segmental overgrowth and vascular anomalies in the form of arteriovenous and capillary malformations is a possible manifestation of a mosaic RASopathy. The accurate genetic diagnosis is crucial for molecular-targeted therapy, which might be a future therapeutic target for mosaic RASopathies.
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Affiliation(s)
| | - Ilse Wieland
- Institute of Human Genetics, University Hospital Magdeburg, Magdeburg, Germany
| | - Walter A Wohlgemuth
- Department of Radiology, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Jens Ricke
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Moritz Wildgruber
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Martin Zenker
- Institute of Human Genetics, University Hospital Magdeburg, Magdeburg, Germany
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Stoevesandt D, Jahn P, Watzke S, Wohlgemuth WA, Behr D, Buhtz C, Faber I, Enger S, Schwarz K, Brill R. Comparison of Acceptance and Knowledge Transfer in Patient Information Before an MRI Exam Administered by Humanoid Robot Versus a Tablet Computer: A Randomized Controlled Study. ROFO-FORTSCHR RONTG 2021; 193:947-954. [PMID: 34111898 DOI: 10.1055/a-1382-8482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE To investigate whether a humanoid robot in a clinical radiological setting is accepted as a source of information in conversations before MRI examinations of patients. In addition, the usability and the information transfer were compared with a tablet. METHODS Patients were randomly assigned to a robot or tablet group with their consent prior to MRI. The usability of both devices was compared with the extended System Usability Scale (SUS) and the information transfer with a knowledge query. Reasons for refusal were collected by a non-responder questionnaire. RESULTS At the University Hospital Halle 117 patients were included for participation. There was no statistically significant difference in gender and age. Of 18 non-responders, 4 refused to participate partly because of the robot; for another 3 the reason could not be clarified. The usability according to SUS score was different with statistical significance between the groups in the mean comparison and was one step higher for the tablet on the adjective scale. There was no statistically significant difference in knowledge transfer. On average, 8.41 of 9 questions were answered correctly. CONCLUSION This study is the first application, in a clinical radiological setting, of a humanoid robot interacting with patients. Tablet and robot are suitable for information transfer in the context of MRI. In comparison to studies in which the willingness to interact with a robot in the health care sector was investigated, the willingness is significantly higher in the present study. This could be explained by the fact that it was a concrete use case that was understandable to the participants and not a hypothetical scenario. Thus, potentially high acceptance for further specific areas of application of robots in radiology can be assumed. The higher level of usability perceived in the tablet group can be explained by the fact that here the interface represents a form of operation that has been established for years in all population groups. More frequent exposure to robots could also improve the response in the future. KEY POINTS · patients accept humanoid robots in clinical radiologic situations. · at present they can only convey information as well as an inexpensive tablet. · future systems can relieve the burden on personnel.. CITATION FORMAT · Stoevesandt D, Jahn P, Watzke S et al. Comparison of Acceptance and Knowledge Transfer in Patient Information Before an MRI Exam Administered by Humanoid Robot Versus a Tablet Computer: A Randomized Controlled Study. Fortschr Röntgenstr 2021; 193: 947 - 954.
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Affiliation(s)
- Dietrich Stoevesandt
- Dorothea Erxleben Skills and Simulation Centre, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Patrick Jahn
- Health service research group, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Stefan Watzke
- Department of Psychiatry, Psychotherapy and Psychosomatics, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Walter A Wohlgemuth
- Department of Radiology, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Dominik Behr
- Dorothea Erxleben Skills and Simulation Centre, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Christian Buhtz
- Dorothea Erxleben Skills and Simulation Centre, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Irina Faber
- Dorothea Erxleben Skills and Simulation Centre, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Stephanie Enger
- Department of Radiology, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Karsten Schwarz
- Dorothea Erxleben Skills and Simulation Centre, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Richard Brill
- Department of Radiology, Martin Luther University Halle-Wittenberg, Halle, Germany
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Huf VI, Grothues D, Knoppke B, Goessmann H, Wohlgemuth WA, Melter M, Brunner SM, Schlitt HJ, Uller W. Super selective percutaneous transhepatic coil embolization of intrahepatic pseudoaneurysm after pediatric liver transplantation: a case report. CVIR Endovasc 2021; 4:31. [PMID: 33740138 PMCID: PMC7979840 DOI: 10.1186/s42155-021-00221-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 12/15/2020] [Accepted: 03/10/2021] [Indexed: 11/23/2022] Open
Abstract
Background Intrahepatic arterial pseudoaneurysms are a rare, life-threatening complication after pediatric liver transplantation. Treatment of choice represents interventional radiological management with endovascular embolization of the segmental artery proximal and distal to the aneurysm. However, this technique results in loss of arterial perfusion distal to the aneurysm with subsegment arterial ischemia. Case presentation We report a case of a 1-year-old girl with a pseudoaneurysm in the split-liver graft. Direct percutaneous, transhepatic access to the pseudoaneurysm was performed followed by super selective coil application into the aneurysm. Conclusion Super selective percutaneous, transhepatic coil application is feasible even in pediatric patients after liver transplantation and results in preservation of the entire course of the liver artery.
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Affiliation(s)
- V I Huf
- Department of Radiology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - D Grothues
- KUNO University Children's Hospital, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - B Knoppke
- KUNO University Children's Hospital, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - H Goessmann
- Department of Radiology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - W A Wohlgemuth
- Department of Radiology, University Hospital Halle, Ernst-Grube-Str. 40, 06120, Halle, Germany
| | - M Melter
- KUNO University Children's Hospital, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - S M Brunner
- Department of Surgery, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - H J Schlitt
- Department of Surgery, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - W Uller
- Department of Radiology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany. .,Faculty of Medicine, Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany.
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Eisenmann S, Stangl F, Lambrecht N, Wollschläger B, Böhm S, Brill R, Vogt I, Baust H, Bucher M, Wohlgemuth WA. Interventional Radiology and Pulmonology in Life-Threatening Aneurysm of the Left Pulmonary Artery. Am J Respir Crit Care Med 2021; 203:366-367. [PMID: 33058729 DOI: 10.1164/rccm.202008-3263im] [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: 11/16/2022] Open
Affiliation(s)
| | - Franz Stangl
- Department of Diagnostic and Interventional Radiology, and.,Department of Anaesthesiology, University Hospital Halle, Halle, Germany; and
| | | | | | | | - Richard Brill
- Department of Diagnostic and Interventional Radiology, and
| | | | - Henning Baust
- Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Augsburg, Germany
| | - Michael Bucher
- Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Augsburg, Germany
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Brill R, Goldann C, Walldorf J, Messmann H, Brill E, Uller W, Michl P, Wildgruber M, Wohlgemuth WA, Rosendahl J. Fluoroscopy-guided endoscopic sclerotherapy: a novel hybrid approach for symptomatic rectosigmoidal venous malformation (with video). Gastrointest Endosc 2021; 93:496-502. [PMID: 32553568 DOI: 10.1016/j.gie.2020.06.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 06/05/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Recommendations for the treatment of lower GI bleeding do not include bleeding from venous malformations (VMs). The aim of this study was to delineate the usefulness of a novel hybrid intervention (fluoroscopy-guided endoscopic sclerotherapy) for the treatment of symptomatic VMs in the rectosigmoidal colon with bleeding. METHODS The magnetic resonance images of 421 patients with VM, referred to multicenter vascular anomaly centers from 2009 to 2017, were analyzed retrospectively. Treatment was performed for all patients who experienced bleeding from rectosigmoidal VMs using fluoroscopy-guided endoscopic sclerotherapy with polidocanol foam as a novel approach. RESULTS A total of 27 patients displayed VM in the rectosigmoidal area. Eleven of these presented with acute or previous bleeding and received treatment. Active bleeding was observed in 8 patients (72.7%), whereas 3 patients (27.3%) had signs of previous bleeding. Six of the 11 patients had anemia (54.5%). There were no adverse events within 24 hours of the intervention. In a 2-year follow-up period, only 1 patient (9.1%) presented with recurrent bleeding after 13 months and was successfully treated again with fluoroscopy-guided endoscopic sclerotherapy. CONCLUSIONS Fluoroscopy-guided endoscopic sclerotherapy was shown to be a safe and effective treatment of symptomatic VMs of the rectosigmoidal area. Thus, fluoroscopy-guided endoscopic sclerotherapy should be considered for patients with bleeding from VMs of the rectosigmoid after a comprehensive workup and interdisciplinary case discussion.
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Affiliation(s)
- Richard Brill
- Department of Radiology, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Constantin Goldann
- Department of Radiology, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Jens Walldorf
- Department of Internal Medicine I, Martin Luther University, Halle (Saale), Germany
| | - Helmut Messmann
- III Medizinische Klinik, University Clinic Augsburg, Augsburg, Germany
| | - Eva Brill
- Department of Radiology, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Wibke Uller
- Department of Radiology, University Medical Center, Regensburg, Germany
| | - Patrick Michl
- Department of Internal Medicine I, Martin Luther University, Halle (Saale), Germany
| | - Moritz Wildgruber
- Department of Radiology, University Hospital Ludwig-Maximilians-Universität, Campus Großhadern, Munich, Germany
| | - Walter A Wohlgemuth
- Department of Radiology, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Jonas Rosendahl
- Department of Internal Medicine I, Martin Luther University, Halle (Saale), Germany
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Brill R, Uller W, Huf V, Müller-Wille R, Schmid I, Pohl A, Häberle B, Perkowski S, Funke K, Till AM, Lauten M, Neumann J, Güttel C, Heid E, Ziermann F, Schmid A, Hüsemann D, Meyer L, Sporns PB, Schinner R, Schmidt VF, Ricke J, Rössler J, Kapp FG, Wohlgemuth WA, Wildgruber M. Additive value of transarterial embolization to systemic sirolimus treatment in kaposiform hemangioendothelioma. Int J Cancer 2020; 148:2345-2351. [PMID: 33231291 DOI: 10.1002/ijc.33406] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 10/16/2020] [Accepted: 11/09/2020] [Indexed: 01/19/2023]
Abstract
Kaposiform hemangioendothelioma (KHE) is a rare vascular tumor in children, which can be accompanied by life-threatening thrombocytopenia, referred to as Kasabach-Merritt phenomenon (KMP). The mTOR inhibitor sirolimus is emerging as targeted therapy in KHE. As the sirolimus effect on KHE occurs only after several weeks, we aimed to evaluate whether additional transarterial embolization is of benefit for children with KHE and KMP. Seventeen patients with KHE and KMP acquired from 11 hospitals in Germany were retrospectively divided into two cohorts. Children being treated with adjunct transarterial embolization and systemic sirolimus, and those being treated with sirolimus without additional embolization. Bleeding grade as defined by WHO was determined for all patients. Response of the primary tumor at 6 and 12 months assessed by magnetic resonance imaging (MRI), time to response of KMP defined as thrombocyte increase >150 × 103 /μL, as well as rebound rates of both after cessation of sirolimus were compared. N = 8 patients had undergone additive embolization to systemic sirolimus therapy, sirolimus in this group was started after a mean of 6.5 ± 3 days following embolization. N = 9 patients were identified who had received sirolimus without additional embolization. Adjunct embolization induced a more rapid resolution of KMP within a median of 7 days vs 3 months; however, tumor response as well as rebound rates were similar between both groups. Additive embolization may be of value for a more rapid rescue of consumptive coagulopathy in children with KHE and KMP compared to systemic sirolimus only.
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Affiliation(s)
- Richard Brill
- Klinik und Poliklinik für Radiologie, Universitätsklinikum Halle, Halle/Saale, Germany
| | - Wibke Uller
- Institut für Röntgendiagnostik, Universitätsklinik Regensburg, Regensburg, Germany
| | - Veronika Huf
- Institut für Röntgendiagnostik, Universitätsklinik Regensburg, Regensburg, Germany
| | - René Müller-Wille
- Institut für diagnostische und interventionelle Radiologie, Universitätsmedizin Göttingen, Göttingen, Germany
| | - Irene Schmid
- Kinderklinik und Kinderpoliklinik im Dr. von Haunerschen Kinderspital, Klinikum der Universität München, Munich, Germany
| | - Alexandra Pohl
- Kinderchirurgische Klinik und Poliklinik im Dr. von Haunerschen Kinderspital, Klinikum der Universität München, Munich, Germany
| | - Beate Häberle
- Kinderchirurgische Klinik und Poliklinik im Dr. von Haunerschen Kinderspital, Klinikum der Universität München, Munich, Germany
| | - Sybille Perkowski
- Abteilung für Kinderchirurgie, Universitätsklinikum Münster, Münster, Germany
| | - Katrin Funke
- Abteilung für Kinderchirurgie, Universitätsklinikum Münster, Münster, Germany
| | - Anne-Marie Till
- Klinik für Kinder- und Jugendmedizin, Pädiatrische Hämatologie und Onkologie, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany
| | - Melchior Lauten
- Klinik für Kinder- und Jugendmedizin, Pädiatrische Hämatologie und Onkologie, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany
| | - Jacob Neumann
- Klinik für Kinder- und Jugendmedizin, Helios Kliniken Schwerin, Schwerin, Germany
| | - Christian Güttel
- Klinik für Kinder- und Jugendmedizin, Helios Kliniken Schwerin, Schwerin, Germany
| | - Esther Heid
- Klinik für Kinder und Jugendmedizin, Klinikum rechts der Isar, TU München, Munich, Germany
| | - Franziska Ziermann
- Klinik für Kinder und Jugendmedizin, Klinikum rechts der Isar, TU München, Munich, Germany
| | - Axel Schmid
- Radiologisches Institut Universitätsklinikum Erlangen, Erlangen, Germany
| | - Dieter Hüsemann
- Klinik für Kinder- und Jugendmedizin, Werner Forßmann Krankenhaus, Eberswalde, Germany
| | - Lutz Meyer
- Abteilung Kinderchirurgie-Zentrum für Vasculäre Malformationen Eberswalde (ZVM), Klinik für Kinder- und Jugendmedizin, Werner Forßmann Krankenhaus, Eberswalde, Germany
| | - Peter B Sporns
- Diagnostische und Interventionelle Neuroradiologie, Universitätsspital Basel, Basel, Switzerland
| | - Regina Schinner
- Klinik und Poliklinik für Radiologie, Klinikum der Universität München, Munich, Germany
| | - Vanessa F Schmidt
- Klinik und Poliklinik für Radiologie, Klinikum der Universität München, Munich, Germany
| | - Jens Ricke
- Klinik und Poliklinik für Radiologie, Klinikum der Universität München, Munich, Germany
| | - Jochen Rössler
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Friedrich G Kapp
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Walter A Wohlgemuth
- Klinik und Poliklinik für Radiologie, Universitätsklinikum Halle, Halle/Saale, Germany
| | - Moritz Wildgruber
- Klinik und Poliklinik für Radiologie, Klinikum der Universität München, Munich, Germany
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Höhn F, Hammer S, Fellner C, Zeman F, Uller W, Brill R, Guntau M, Wildgruber M, Wohlgemuth WA. 3T MRI of Peripheral Vascular Malformations: Characteristics and Comparison of Two Fat-Saturated sequences: Short Tau Inversion Recovery Versus Three-Dimensional High-Resolution Volume Interpolated Gradient Recalled Echo. ROFO-FORTSCHR RONTG 2020; 193:446-458. [PMID: 33003248 DOI: 10.1055/a-1253-8422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE To assess morphological and hemodynamic characteristics of peripheral vascular malformations on 3 T magnetic resonance imaging (MRI) including qualitative comparison of two fat-saturated sequences: short tau inversion recovery (STIR) and three-dimensional high-resolution volume interpolated gradient recalled echo (GRE). MATERIALS AND METHODS During 9 months, 100 patients with suspected or known vascular malformations were prospectively assessed on a 3 T scanner using T2-weighted STIR and turbo spin echo (TSE), T1-weighted TSE, time-resolved contrast-enhanced magnetic resonance angiography (MRA) with interleaved stochastic trajectories (TWIST) and T1-weighted volume interpolated breath-hold examination (VIBE) after contrast enhancement. The analysis included signal behavior and morphologic and hemodynamic characteristics. Additionally, the image quality of the fat-saturated sequences was evaluated by 2 radiologists. RESULTS 86 patients (14 dropouts; 57 female, 29 male; mean age 26.8 years, age range 1-56) were analyzed. 22 had high-flow and 64 low-flow malformations, including 14 with a lymphatic component. In 21 of 22 patients with high-flow malformations, typical characteristics (flow voids, hyperdynamic arteriovenous fistula, dilated main/feeder-arteries and draining veins) were documented. Patients with low-flow malformations had phleboliths in 35 cases, fluid-fluid levels in 47 and dilated draining veins in 23. Lymphatic malformations showed peripheral contrast enhancement of cyst walls in the volume interpolated GRE. The comparison of fat-saturated sequences showed significantly better results of the volume interpolated GRE in all categories except the presence of artifacts which were significantly reduced in the STIR (p < 0.05). CONCLUSION 3 T MRI with MRA provides detailed morphological and hemodynamic information of different types of peripheral vascular malformations. Contrast-enhanced high-resolution volume interpolated GRE proved superior to STIR in differentiating morphologic features and to be diagnostic in the differentiation of lymphatic parts and joint involvement. KEY POINTS · 3 T MRI with MRA offers detailed information about vascular malformations.. · Fat-saturated MRI provides especially information about morphological characteristics, extent and tissue involvement.. · Volume interpolated GRE proved superior in almost all categories compared to STIR.. · Volume interpolated GRE showed more artifacts.. · Volume interpolated GRE additionally allows differentiation of lymphatic parts and evaluation of joint involvement.. CITATION FORMAT · Höhn F, Hammer S, Fellner C et al. 3T MRI of Peripheral Vascular Malformations: Characteristics and Comparison of Two Fat-Saturated sequences: Short Tau Inversion Recovery Versus Three-Dimensional High-Resolution Volume Interpolated Gradient Recalled Echo. Fortschr Röntgenstr 2021; 193: 446 - 458.
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Affiliation(s)
- Florentine Höhn
- Clinic and Policlinic of Nuclear Medicine, University Hospital Würzburg, Germany
| | - Simone Hammer
- Department of Radiology, University Hospital Regensburg, Germany
| | - Claudia Fellner
- Department of Radiology, University Hospital Regensburg, Germany
| | - Florian Zeman
- Centre for Clinical Studies, University Hospital Regensburg, Germany
| | - Wibke Uller
- Department of Radiology, University Hospital Regensburg, Germany
| | - Richard Brill
- University Clinic and Policlinic of Radiology, Martin Luther University Hospital Halle-Wittenberg, Halle (Saale), Germany
| | - Moritz Guntau
- University Clinic and Policlinic of Radiology, Martin Luther University Hospital Halle-Wittenberg, Halle (Saale), Germany
| | - Moritz Wildgruber
- Department of Clinical Radiology, University Hospital Münster, Germany
| | - Walter A Wohlgemuth
- University Clinic and Policlinic of Radiology, Martin Luther University Hospital Halle-Wittenberg, Halle (Saale), Germany
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Huf VI, Fellner C, Wohlgemuth WA, Stroszczynski C, Schmidt M, Forman C, Wetzl J, Uller W. Fast TWIST with iterative reconstruction improves diagnostic accuracy of AVM of the hand. Sci Rep 2020; 10:16355. [PMID: 33004952 PMCID: PMC7529883 DOI: 10.1038/s41598-020-73331-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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] [Received: 04/05/2020] [Accepted: 09/14/2020] [Indexed: 11/08/2022] Open
Abstract
Very high temporal and spatial resolution is mandatory for the diagnosis of arteriovenous malformations (AVM) of the hand. Until now, magnetic resonance imaging (MRI) has not fulfilled both requirements simultaneously. This study presents how the combination of a very fast TWIST MRI (time-resolved angiography with interleaved stochastic trajectories) sequence and iterative reconstructions optimizes temporal as well as spatial resolution. 11 patients were examined at a 3-T MRI scanner with two different TWIST protocols: the standard and the study protocol, acquiring a data set every 5.57 s and 1.44 s respectively. The study data was retrospectively iteratively reconstructed with different regularization factors (0.001, 0.002, 0.004, 0.008). Results were compared using the sign-test. P-values < 0.05 were regarded statistically significant. With a low amount of contrast medium, the temporal resolution of the study protocol enabled the differentiation of arteries from veins in all patients whereas the signal-to-noise ratio (SNR) deteriorated. Depending on the regularization factors, SNR, delineation of arterial feeders and non-involved hand and interdigital arteries, as well as artefact levels varied. Overall, iterative reconstruction with regularization factor 0.004 achieved the best results, consequently showing the ability of MRI as a reliable diagnostic method in AVMs of the hand.
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Affiliation(s)
- Veronika I Huf
- Department of Radiology, University Medical Center Regensburg, 93042, Regensburg, Germany.
| | - Claudia Fellner
- Department of Radiology, University Medical Center Regensburg, 93042, Regensburg, Germany
| | - Walter A Wohlgemuth
- Interdisciplinary Center for Vascular Anomalies, University Clinic and Polyclinic of Radiology, University Hospital Halle, 06120, Halle (Saale), Germany
| | | | | | | | - Jens Wetzl
- Siemens Healthcare, 91052, Erlangen, Germany
| | - Wibke Uller
- Department of Radiology, University Medical Center Regensburg, 93042, Regensburg, Germany
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Huf VI, Wohlgemuth WA, Uller W, Piehler AP, Goessmann H, Stroszczynski C, Jung EM. Contrast-enhanced ultrasound with perfusion analysis in patients with venous malformations before and after percutaneous treatment with ethanol-gel. Clin Hemorheol Microcirc 2020; 76:161-170. [PMID: 32925019 DOI: 10.3233/ch-209215] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Percutaneous sclerotherapy is a well-established treatment option for venous malformations (VM). A recently established sclerosing agent is ethanol-gel. Aim of this study was to identify, if contrast-enhanced ultrasound (CEUS) with an integrated perfusion analysis allows for differentiation between untreated VM, healthy tissue, and with gelified ethanol treated malformation tissue. MATERIAL AND METHODS In this institutional review board approved prospective study symptomatic VM patients underwent CEUS at exactly the same position before and after sclerotherapy with ethanol-gel. Two experienced sonographers performed all examinations after the bolus injection of microbubbles using a multi-frequency probe with 6 -9 MHz of a high-end ultrasound machine. An integrated perfusion analysis was applied in the center of the VM and in healthy, surrounding tissue. For both regions peak enhancement (peak), time to peak (TTP), area under the curve (AUC), and mean transit time (MTT) were evaluated. Wilcoxon signed rank test was executed; p-values <0.05 were regarded statistically significant. RESULTS In 23 patients including children (mean age 25.3 years, 19 females) before treatment all identified parameters were significantly higher in the VM center compared to healthy tissue (peak: p < 0.01; TTP: p < 0.01; AUC: p < 0.01; MTT: p < 0.01). Comparing the VM center before and after treatment, TTP (p < 0.02) and MTT (p < 0.01) reduced significantly after sclerotherapy. In surrounding tissue only peak changed after treatment in comparison to pre-treatment results (p = 0.04). Comparing data in the VM center with surrounding tissue after sclerotherapy, results still differed significantly for peak (p < 0.01), TTP (p < 0.01), and AUC (p < 0.01), but assimilated for MTT (p = 0.07). CONCLUSION All with CEUS identified parameters seem to be excellent tools for differentiating between VM and healthy tissue. TTP and MTT could distinguish between with ethanol-gel sclerotized VM portions and untreated malformation parts and thereby might assist the monitoring of sclerotherapy with ethanol-gel.
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Affiliation(s)
- V I Huf
- Department of Radiology, University Medical Center Regensburg, Regensburg, Germany
| | - W A Wohlgemuth
- Interdisciplinary Center for Vascular Anomalies, University Clinic and Polyclinic of Radiology, University Hospital Halle, Halle (Saale), Germany
| | - W Uller
- Department of Radiology, University Medical Center Regensburg, Regensburg, Germany
| | - A P Piehler
- OnkoMedeor, MVZ Freising Laboratory, Freising, Germany
| | - H Goessmann
- Department of Radiology, University Medical Center Regensburg, Regensburg, Germany
| | - C Stroszczynski
- Department of Radiology, University Medical Center Regensburg, Regensburg, Germany
| | - E M Jung
- Department of Radiology, University Medical Center Regensburg, Regensburg, Germany
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Hirsch T, Wohlgemuth WA. Pelvines Stauungssyndrom: Wie wird die Diagnose gesichert, wer muss behandelt werden? Phlebologie 2020. [DOI: 10.1055/a-1195-4284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
ZusammenfassungUnterleibsbeschwerden waren lange Zeit die Domäne von Gynäkologen, Internisten und Urologen. Die Erkenntnis, dass auch eine venöse Abstrombehinderung im kleinen Becken bzw. im Abdomen ähnliche Beschwerden hervorrufen kann, hat dazu geführt, dass in den letzten Jahren auch Gefäßmediziner in die Diagnostik und Behandlung einbezogen werden.Das pelvine Stauungssyndrom kann eine Vielzahl von auch nichtspezifischen Beschwerden verursachen. Die differenzialdiagnostische Abgrenzung zu gynäkologischen, internistischen oder auch orthopädischen Störungen stellt damit eine Herausforderung dar. Die akribische Anamneseerhebung und Symptombeschreibung sind von übergeordneter Bedeutung. In der weiteren Diagnostik kommt der Sonografie die wichtigste Bedeutung zu, die durch radiologische Schichtbildverfahren ergänzt werden kann. Wird vor allem eine Varikose im Genitalbereich beklagt, ist zu klären, ob es sich um eine venöse Insuffizienz im Bereich der Vena iliaca interna bzw. der Vena ovarica handelt oder ob postthrombotische Veränderungen eine Rolle spielen. Bei pelvinen und abdominellen Schmerzzuständen müssen zusätzlich die Nierenvenen und die untere Hohlvene beurteilt werden.Nur wenn die Störung differenzialdiagnostisch sicher abgegrenzt werden kann, ist eine invasive Behandlung durch Katheterverfahren und/oder Schaumsklerotherapie angezeigt.
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Affiliation(s)
- Tobias Hirsch
- Praxis für Innere Medizin und Gefäßkrankheiten, Venen-Kompetenz-Zentrum®, Halle (Saale)
| | - Walter A. Wohlgemuth
- Universitätsklinik und Poliklinik für Radiologie, Universitätsklinikum Halle, Halle (Saale)
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Teusch VI, Uller W, Manger F, Vill K, Piehler AP, Müller-Wille R, Goessman H, Hammer S, Wohlgemuth WA. Do patients clinically diagnosed with vascular malformations of 1 lower extremity benefit from imaging of both legs from pelvis to toe? A prospective MRI study. J Am Acad Dermatol 2020; 82:981-984. [DOI: 10.1016/j.jaad.2019.06.1305] [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] [Received: 11/12/2018] [Revised: 06/07/2019] [Accepted: 06/21/2019] [Indexed: 11/28/2022]
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Brill R, Brill E, Uller W, Teusch V, Gufler H, Hammer S, Fellner C, Evert K, Goldann C, Helm M, Rosendahl J, Wohlgemuth WA. Author Correction: Rectosigmoidal manifestations of venous malformations: MR imaging findings and interdisciplinary therapeutic modalities. Sci Rep 2020; 10:2458. [PMID: 32034240 PMCID: PMC7005778 DOI: 10.1038/s41598-020-59025-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
An amendment to this paper has been published and can be accessed via a link at the top of the paper.
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Affiliation(s)
- Richard Brill
- Universitätsklinikum Halle (Saale), Martin-Luther-Universität Halle-Wittenberg, Department of Radiology and Policlinic of Radiology, Ernst-Grube-Straße 40, D-06120, Halle (Saale), Germany.
| | - Eva Brill
- Familienpraxis im Hof, Department of General Medicine, Innere Neumarkter Str. 2a, D-84453, Mühldorf, Germany
| | - Wibke Uller
- Universitätsklinikum Regensburg, Universität Regensburg, Department of Radiology, Franz-Josef-Strauß-Allee 11, D-93053, Regensburg, Germany
| | - Veronika Teusch
- Universitätsklinikum Regensburg, Universität Regensburg, Department of Radiology, Franz-Josef-Strauß-Allee 11, D-93053, Regensburg, Germany
| | - Hubert Gufler
- Universitätsklinikum Halle (Saale), Martin-Luther-Universität Halle-Wittenberg, Department of Radiology and Policlinic of Radiology, Ernst-Grube-Straße 40, D-06120, Halle (Saale), Germany
| | - Simone Hammer
- Universitätsklinikum Regensburg, Universität Regensburg, Department of Radiology, Franz-Josef-Strauß-Allee 11, D-93053, Regensburg, Germany
| | - Claudia Fellner
- Universitätsklinikum Regensburg, Universität Regensburg, Department of Radiology, Franz-Josef-Strauß-Allee 11, D-93053, Regensburg, Germany
| | - Katja Evert
- Universitätsklinikum Regensburg, Universität Regensburg, Department of Pathology, Franz-Josef-Strauß-Allee 11, D-93053, Regensburg, Germany
| | - Constantin Goldann
- Universitätsklinikum Halle (Saale), Martin-Luther-Universität Halle-Wittenberg, Department of Radiology and Policlinic of Radiology, Ernst-Grube-Straße 40, D-06120, Halle (Saale), Germany
| | - Maximilian Helm
- Universitätsklinikum Halle (Saale), Martin-Luther-Universität Halle-Wittenberg, Department of Radiology and Policlinic of Radiology, Ernst-Grube-Straße 40, D-06120, Halle (Saale), Germany
| | - Jonas Rosendahl
- Universitätsklinikum Halle (Saale), Martin-Luther-Universität Halle-Wittenberg, Department of Gastroenterology, Ernst-Grube-Straße 40, D-06120, Halle (Saale), Germany
| | - Walter A Wohlgemuth
- Universitätsklinikum Halle (Saale), Martin-Luther-Universität Halle-Wittenberg, Department of Radiology and Policlinic of Radiology, Ernst-Grube-Straße 40, D-06120, Halle (Saale), Germany
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Müller-Hülsbeck S, Marques L, Maleux G, Osuga K, Pelage JP, Wohlgemuth WA, Andersen PE. CIRSE Standards of Practice on Diagnosis and Treatment of Pulmonary Arteriovenous Malformations. Cardiovasc Intervent Radiol 2019; 43:353-361. [PMID: 31875234 DOI: 10.1007/s00270-019-02396-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 12/11/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Stefan Müller-Hülsbeck
- Department of Radiology/Neuroradiology, Ev.-Luth. Diakonissenanstalt Zu Flensburg, Knuthstrasse 1, 24939, Flensburg, Germany
| | - Leonardo Marques
- Department of Radiology/Neuroradiology, Ev.-Luth. Diakonissenanstalt Zu Flensburg, Knuthstrasse 1, 24939, Flensburg, Germany.
| | | | | | - Jean-Pierre Pelage
- UNICAEN, CEA, CNRS, ISTCT-CERVOxy, Normandie University, 14000, Caen, France
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Müller-Wille R, Wildgruber M, Wohlgemuth WA. [Interventional therapies of vascular malformations]. Dtsch Med Wochenschr 2019; 144:1675-1680. [PMID: 31791070 DOI: 10.1055/a-0867-5017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Vascular malformations can appear at any age and in every region of the body. Due to their rare appearance and differences in clinical manifestations the appropriate diagnosis and subsequent classification remains challenging. Once the diagnosis is established, various treatment options exist, requiring an interdisciplinary approach. This review provides an overview over state-of-the-art interventional therapies of vascular malformations.
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Affiliation(s)
- René Müller-Wille
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsmedizin Göttingen
| | | | - Walter A Wohlgemuth
- Universitätsklinik und Poliklinik für Radiologie, Universitätsklinikum Halle
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Sadick M, Overhoff D, Baessler B, von Spangenberg N, Krebs L, Wohlgemuth WA. Peripheral Vascular Anomalies – Essentials in Periinterventional Imaging. ROFO-FORTSCHR RONTG 2019; 192:150-162. [DOI: 10.1055/a-0998-4300] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background Peripheral vascular anomalies represent a rare disease with an underlying congenital mesenchymal and angiogenetic disorder. Vascular anomalies are subdivided into vascular tumors and vascular malformations. Both entities include characteristic features and flow dynamics. Symptoms can occur in infancy and adulthood. Vascular anomalies may be accompanied by characteristic clinical findings which facilitate disease classification. The role of periinterventional imaging is to confirm the clinically suspected diagnosis, taking into account the extent and location of the vascular anomaly for the purpose of treatment planning.
Method In accordance with the International Society for the Study of Vascular Anomalies (ISSVA), vascular anomalies are mainly categorized as slow-flow and fast-flow lesions. Based on the diagnosis and flow dynamics of the vascular anomaly, the recommended periinterventional imaging is described, ranging from ultrasonography and plain radiography to dedicated ultrafast CT and MRI protocols, percutaneous phlebography and transcatheter angiography. Each vascular anomaly requires dedicated imaging. Differentiation between slow-flow and fast-flow vascular anomalies facilitates selection of the appropriate imaging modality or a combination of diagnostic tools.
Results Slow-flow congenital vascular anomalies mainly include venous and lymphatic or combined malformations. Ultrasound and MRI and especially MR-venography are essential for periinterventional imaging. Arteriovenous malformations are fast-flow vascular anomalies. They should be imaged with dedicated MR protocols, especially when extensive. CT with 4D perfusion imaging as well as time-resolved 3D MR-A allow multiplanar perfusion-based assessment of the multiple arterial inflow and venous drainage vessels of arterio-venous malformations. These imaging tools should be subject to intervention planning, as they can reduce procedure time significantly. Fast-flow vascular tumors like hemangiomas should be worked up with ultrasound, including color-coded duplex sonography, MRI and transcatheter angiography in case of a therapeutic approach. In combined malformation syndromes, radiological imaging has to be adapted according to the dominant underlying vessels and their flow dynamics.
Conclusion Guide to evaluation of flow dynamics in peripheral vascular anomalies, involving vascular malformations and vascular tumors with the intention to facilitate selection of periinterventional imaging modalities and diagnostic and therapeutic approach to vascular anomalies.
Key Points:
Citation Format
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Affiliation(s)
- Maliha Sadick
- University Medical Center Mannheim, Institute for Clinical Radiology and Nuclear Medicine, Mannheim, Germany
| | - Daniel Overhoff
- University Medical Center Mannheim, Institute for Clinical Radiology and Nuclear Medicine, Mannheim, Germany
| | - Bettina Baessler
- University Medical Center Mannheim, Institute for Clinical Radiology and Nuclear Medicine, Mannheim, Germany
| | - Naema von Spangenberg
- University Medical Center Mannheim, Institute for Clinical Radiology and Nuclear Medicine, Mannheim, Germany
| | - Lena Krebs
- University Medical Center Mannheim, Institute for Clinical Radiology and Nuclear Medicine, Mannheim, Germany
| | - Walter A. Wohlgemuth
- Department for Radiology, Martin-Luther-Universität Halle-Wittenberg, Halle, Germany
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Sternby H, Mahle M, Linder N, Erichson-Kirst L, Verdonk RC, Dimova A, Ignatavicius P, Ilzarbe L, Koiva P, Penttilä A, Regnér S, Bollen TL, Brill R, Stangl F, Wohlgemuth WA, Singh V, Busse H, Michl P, Beer S, Rosendahl J. Mean muscle attenuation correlates with severe acute pancreatitis unlike visceral adipose tissue and subcutaneous adipose tissue. United European Gastroenterol J 2019; 7:1312-1320. [PMID: 31839956 DOI: 10.1177/2050640619882520] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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: 05/01/2019] [Accepted: 09/18/2019] [Indexed: 12/26/2022] Open
Abstract
Background Acute pancreatitis (AP) is a frequent disorder with considerable morbidity and mortality. Obesity has previously been reported to influence disease severity. Objective The aim of this study was to investigate the association of adipose and muscle parameters with the severity grade of AP. Methods In total 454 patients were recruited. The first contrast-enhanced computed tomography of each patient was reviewed for adipose and muscle tissue parameters at L3 level. Associations with disease severity were analysed through logistic regression analysis. The predictive capacity of the parameters was investigated using receiver operating characteristic (ROC) curves. Results No distinct variation was found between the AP severity groups in either adipose tissue parameters (visceral adipose tissue and subcutaneous adipose tissue) or visceral muscle ratio. However, muscle mass and mean muscle attenuation differed significantly with p-values of 0.037 and 0.003 respectively. In multivariate analysis, low muscle attenuation was associated with severe AP with an odds ratio of 4.09 (95% confidence intervals: 1.61-10.36, p-value 0.003). No body parameter presented sufficient predictive capability in ROC-curve analysis. Conclusions Our results demonstrate that a low muscle attenuation level is associated with an increased risk of severe AP. Future prospective studies will help identify the underlying mechanisms and characterise the influence of body composition parameters on AP.
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Affiliation(s)
- Hanna Sternby
- Department of Surgery, Institution of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Mariella Mahle
- Department of Internal Medicine I, Martin Luther University, Halle (Saale), Germany
| | - Nicolas Linder
- Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Leipzig, Germany.,IFB Adiposity Diseases, University of Leipzig, Leipzig, Germany
| | - Laureen Erichson-Kirst
- Department of Internal Medicine, Neurology and Dermatology, Division of Gastroenterology, Leipzig, Germany
| | - Robert C Verdonk
- Department of Gastroenterology, St. Antonius Ziekenhuis, Nieuwegein, the Netherlands
| | - Alexandra Dimova
- Department of Surgery, University Hospital for Emergency Medicine "Pirogov", Sofia, Bulgaria
| | - Povilas Ignatavicius
- Department of Surgery, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Lucas Ilzarbe
- Department of Gastroenterology, Hospital del Mar, Barcelona, Spain
| | - Peeter Koiva
- Department of Gastroenterology, East Tallinn Central Hospital, Tallinn, Estonia
| | - Anne Penttilä
- Department of Surgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Sara Regnér
- Department of Surgery, Institution of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Thomas L Bollen
- Department of Radiology, St. Antonius Ziekenhuis, Nieuwegein, the Netherlands
| | - Richard Brill
- Department of Radiology, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Franz Stangl
- Department of Radiology, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Walter A Wohlgemuth
- Department of Radiology, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Vijay Singh
- Department of Medicine, Mayo Clinic, Scottsdale, Arizona, USA
| | - Harald Busse
- Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Leipzig, Germany.,IFB Adiposity Diseases, University of Leipzig, Leipzig, Germany
| | - Patrick Michl
- Department of Internal Medicine I, Martin Luther University, Halle (Saale), Germany
| | - Sebastian Beer
- Department of Internal Medicine, Neurology and Dermatology, Division of Gastroenterology, Leipzig, Germany
| | - Jonas Rosendahl
- Department of Internal Medicine I, Martin Luther University, Halle (Saale), Germany
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Evert K, Kühnel T, Weiß KT, Wohlgemuth WA, Vielsmeier V. [Diagnosis and management of vascular malformations : Interdisciplinary teamwork in demand]. Pathologe 2019; 40:422-430. [PMID: 31243549 DOI: 10.1007/s00292-019-0625-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Vascular anomalies are very rare, but can occur in children and adults in almost every region of the body. Due to the complexity of this disease, the path to a definitive diagnosis is often difficult. It requires interdisciplinary teamwork with close exchange of information between the individual treatment partners to reach the correct diagnosis and then to start the best therapy. This article provides an overview of the main types of vascular malformations from a clinical, imaging, and histological point of view, following the current classification of the International Society for the Study of Vascular Anomalies (ISSVA).
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Affiliation(s)
- K Evert
- Institut für Pathologie, Universität Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland.
- Interdisziplinäres Zentrum für Gefäßanomalien, Universitätsklinikum Regensburg, Regensburg, Deutschland.
- Deutsche interdisziplinäre Gesellschaft für Gefäßanomalien e. V., Halle, Deutschland.
| | - T Kühnel
- Interdisziplinäres Zentrum für Gefäßanomalien, Universitätsklinikum Regensburg, Regensburg, Deutschland
- Deutsche interdisziplinäre Gesellschaft für Gefäßanomalien e. V., Halle, Deutschland
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum Regensburg, Regensburg, Deutschland
| | - K T Weiß
- Interdisziplinäres Zentrum für Gefäßanomalien, Universitätsklinikum Regensburg, Regensburg, Deutschland
- Klinik und Poliklinik für Dermatologie, Universitätsklinikum Regensburg, Regensburg, Deutschland
| | - W A Wohlgemuth
- Deutsche interdisziplinäre Gesellschaft für Gefäßanomalien e. V., Halle, Deutschland
- Department für Strahlenmedizin, Universitätsklinik und Poliklinik für Radiologie, Universitätsklinikum Halle (Saale), Halle (Saale), Deutschland
- Interdisziplinäres Zentrum für Gefäßanomalien, Universitätsklinikum Halle (Saale), Halle (Saale), Deutschland
| | - V Vielsmeier
- Interdisziplinäres Zentrum für Gefäßanomalien, Universitätsklinikum Regensburg, Regensburg, Deutschland
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum Regensburg, Regensburg, Deutschland
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Wildgruber M, Wohlgemuth WA. Brief an den Herausgeber in Bezug auf die Arbeit „Radiologische Diagnostik von Weichteiltumoren im Erwachsenenalter: MRT-Bildgebung ausgewählter Entitäten mit Abgrenzung zwischen benignen und malignen Tumoren“ von Lisson et al. ROFO-FORTSCHR RONTG 2019; 191:566-567. [DOI: 10.1055/a-0914-3479] [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: 10/26/2022]
Affiliation(s)
- Moritz Wildgruber
- Department for Clinical Radiology, Westfälische Wilhelms-Universität Münster, Munster, Germany
| | - Walter A. Wohlgemuth
- Department for Radiology, Martin-Luther-Universität Halle-Wittenberg, Halle, Germany
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Abstract
Malignant vascular tumors as part of the vascular anomalies spectrum are extremely rare in children and young adults. Instead, benign vascular neoplasias are frequently encountered in the pediatric patient population. While vascular malformations are congenital vascular lesions, originating from a mesenchymal stem cell defect, vascular tumors are neoplastic transformations of endothelial and other vascular cells. The appropriate differential diagnosis and nomenclature according to the classification of the International Society for the Study of Vascular Anomalies (ISSVA) is decisive to initiate correct therapy. While infantile hemangioma can be routinely diagnosed by clinical means and rarely require therapy, more rare vascular tumors are frequently difficult to diagnose, require dedicated cross-sectional imaging, and benefit from an interdisciplinary treatment approach. The focus of this review is to provide an overview over the spectrum of vascular tumors, typical imaging characteristics, and summarize treatment options including interventional radiology approaches.
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Affiliation(s)
- Moritz Wildgruber
- Institut für Klinische Radiologie, Universitätsklinikum Münster, Albert-Schweitzer Campus 1, 48149, Münster, Germany.
| | - Maliha Sadick
- Institut für Klinische Radiologie und Nuklearmedizin, Universitätsmedizin Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - René Müller-Wille
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsmedizin Göttingen, Robert-Koch Strasse 40, 37075, Göttingen, Germany
| | - Walter A Wohlgemuth
- Universitätsklinik und Poliklinik für Radiologie, Ernst-Grube-Strasse 40, 06120, Halle (Saale), Germany
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Turowski LS, Dollinger M, Wohlgemuth WA, Wildgruber M, Beyer LP, Pfister K, Stroszczynski C, Müller-Wille R. Preoperative computed tomography angiography (CTA) of the body in vascular patients: prevalence and significance of unsuspected extravascular findings. ROFO-FORTSCHR RONTG 2019; 191:716-724. [PMID: 30703822 DOI: 10.1055/a-0775-2544] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE Evaluation of the prevalence and significance of unsuspected extravascular findings on computed tomography angiography (CTA) of the body before endovascular or surgical treatment in vascular patients. MATERIALS AND METHODS This study was approved by the local institutional review board. Radiology reports of 806 patients who underwent CTA of the body during January 2004 until December 2014 before endovascular or surgical treatment of vascular diseases were retrospectively reviewed. All unexpected extravascular abnormalities were classified as clinically non-significant (requiring no follow-up) or clinically significant (requiring further follow-up/immediate treatment). The course of patients with significant extravascular findings was retrospectively evaluated. RESULTS Overall 806 patients were included in this study (592 men; mean age: 67 years). In 778 (96.5 %) of 806 patients 3293 incidental extravascular findings were diagnosed. There were 259 suspicious findings in 205 patients (25.4 %) that required further follow-up or immediate treatment. A previously unknown malignant tumor was diagnosed in 23 (2.9 %) patients. 10 patients (1.2 %) were diagnosed with lung cancer. Malignant tumors were detected more often in men than in women (3.5 % versus 0.9 %). Patients with an incidental tumor were significantly older than patients without a tumor (mean age: 72.3 vs. 67.5 years). CONCLUSION Clinically significant unexpected extravascular findings are common in vascular patients. Especially noteworthy are malignant tumors of the lung. KEY POINTS · Clinically relevant extravascular findings were detected in 25.4 % of the patients.. · The incidence of malignant tumors was 2.9 %.. · Lung cancer had the highest incidence among all malignancies (1.2 %).. CITATION FORMAT · Turowski LS, Dollinger M, Wohlgemuth WA et al. Preoperative computed tomography angiography (CTA) of the body in vascular patients: prevalence and significance of unsuspected extravascular findings. Fortschr Röntgenstr 2019; 191: 716 - 724.
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Affiliation(s)
| | - Marco Dollinger
- Radiology, University Medical Center Regensburg, Regensburg, Germany
| | | | - Moritz Wildgruber
- Department of Clinical Radiology, University-Medical-Center Münster, Münster, Germany
| | | | - Karin Pfister
- Department of Vascular and Endovascular Surgery, University-Medical-Center Regensburg, Regensburg, Germany
| | | | - René Müller-Wille
- Department of Radiology, University Medical Center Göttingen, Göttingen, Germany
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Wiesinger I, Jung W, Zausig N, Wohlgemuth WA, Pregler B, Wiggermann P, Stroszczynski C, Jung EM. Evaluation of dynamic effects of therapy-induced changes in microcirculation after percutaneous treatment of vascular malformations using contrast-enhanced ultrasound (CEUS) and time intensity curve (TIC) analyses. Clin Hemorheol Microcirc 2018; 69:45-57. [PMID: 29630543 DOI: 10.3233/ch-189118] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [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
The aim of this follow-up study was to demonstrate the effect of percutaneous interventional treatment on local microcirculation of peripheral vascular malformations using CEUS and TIC analysis. MATERIAL AND METHODS Retrospective analysis of 197 patients (136 female; 61 male; 3-86 years) with 135 venous (VM), 39 arterio-venous (AVM), 8 lymphatic and 15 veno-lymphatic peripheral vascular malformations before and after the first percutaneous treatment.CEUS was performed after i.v. injection of 1-2.4 ml of sulfur hexafluoride microbubbles (SonoVue®) using a 6-9 MHz linear probe. Digitally stored cine loops (starting in the early arterial phase for 60 sec) were read by independent readers in consensus. Regions of interest (ROI) were defined in the center and at the margins of the malformation, as well as in the healthy surrounding tissue. TIC analyses with Time to Peak (TTP) and Area under the Curve (AUC) were calculated using integrated perfusion software. RESULTS After the treatment there was a significant decrease for median AUC in VM in the center from 297.8 (14.5-2167.6) rU down to 243.3 (0.1-1678.8) rU (p = 0.043) and in the surrounding tissue down to 107.7 (20.2-660.2) rU (p = 0.018). For the other malformations AUC decreased in the center and the margins as well. TTP rose, however these changes did not reach the level of significance. CONCLUSION Analyzing the capillary microcirculation TICs offer a possibility of monitoring therapy-induced capillary changes of vascular malformations.
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Affiliation(s)
- I Wiesinger
- Institute of Radiology, University Medical Center Regensburg, Germany
| | - W Jung
- Institute of Radiology, University Medical Center Regensburg, Germany
| | - N Zausig
- Institute of Radiology, University Medical Center Regensburg, Germany
| | - W A Wohlgemuth
- Institute of Radiology, University Medical Center Regensburg, Germany
| | - B Pregler
- Institute of Radiology, University Medical Center Regensburg, Germany
| | - P Wiggermann
- Institute of Radiology, University Medical Center Regensburg, Germany
| | - C Stroszczynski
- Institute of Radiology, University Medical Center Regensburg, Germany
| | - E M Jung
- Institute of Radiology, University Medical Center Regensburg, Germany
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Sadick M, Müller-Wille R, Wildgruber M, Wohlgemuth WA. Vascular Anomalies (Part I): Classification and Diagnostics of Vascular Anomalies. ROFO-FORTSCHR RONTG 2018; 190:825-835. [PMID: 29874693 DOI: 10.1055/a-0620-8925] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Vascular anomalies are a diagnostic and therapeutic challenge. They require dedicated interdisciplinary management. Optimal patient care relies on integral medical evaluation and a classification system established by experts in the field, to provide a better understanding of these complex vascular entities. METHOD A dedicated classification system according to the International Society for the Study of Vascular Anomalies (ISSVA) and the German Interdisciplinary Society of Vascular Anomalies (DiGGefA) is presented. The vast spectrum of diagnostic modalities, ranging from ultrasound with color Doppler, conventional X-ray, CT with 4 D imaging and MRI as well as catheter angiography for appropriate assessment is discussed. RESULTS Congenital vascular anomalies are comprised of vascular tumors, based on endothelial cell proliferation and vascular malformations with underlying mesenchymal and angiogenetic disorder. Vascular tumors tend to regress with patient's age, vascular malformations increase in size and are subdivided into capillary, venous, lymphatic, arterio-venous and combined malformations, depending on their dominant vasculature. According to their appearance, venous malformations are the most common representative of vascular anomalies (70 %), followed by lymphatic malformations (12 %), arterio-venous malformations (8 %), combined malformation syndromes (6 %) and capillary malformations (4 %). CONCLUSION The aim is to provide an overview of the current classification system and diagnostic characterization of vascular anomalies in order to facilitate interdisciplinary management of vascular anomalies. KEY POINTS · Vascular anomalies are comprised of vascular tumors and vascular malformations, both considered to be rare diseases.. · Appropriate treatment depends on correct classification and diagnosis of vascular anomalies, which is based on established national and international classification systems, recommendations and guidelines.. · In the classification, diagnosis and treatment of congenital vascular anomalies, radiology plays an integral part in patient management.. CITATION FORMAT · Sadick M, Müller-Wille R, Wildgruber M et al. Vascular Anomalies (Part I): Classification and Diagnostics of Vascular Anomalies. Fortschr Röntgenstr 2018; 190: 825 - 835.
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Affiliation(s)
- Maliha Sadick
- University Medical Center Mannhein, Institute for Clinical Radiology and Nuclear Medicine, Mannheim, Germany
| | - René Müller-Wille
- Department for Radiology, Universitätsmedizin Göttingen, Georg-August-Universität, Göttingen, Germany
| | - Moritz Wildgruber
- Department for Clinical Radiology, Universitätsklinikum Münster, Westfälische Wilhelms Universität, Münster, Germany
| | - Walter A Wohlgemuth
- Department for Radiology, Martin-Luther-Universität Halle-Wittenberg, Halle, Germany
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Wildgruber M, Köhler M, Brill R, Goessmann H, Uller W, Müller-Wille R, Wohlgemuth WA. Impact of low dose settings on radiation exposure during pediatric fluoroscopic guided interventions. Eur J Radiol 2018; 100:1-6. [PMID: 29496066 DOI: 10.1016/j.ejrad.2018.01.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 12/08/2017] [Accepted: 01/08/2018] [Indexed: 10/18/2022]
Abstract
PURPOSE To evaluate the effects of lowering the detector entrance exposure in children undergoing interventional radiology procedures. MATERIALS AND METHODS The study retrospectively investigated radiation dose levels in pediatric patients aged 0-18 years before (n = 39) and after (n = 26) lowering detector entrance dose, undergoing embolization of peripheral Arteriovenous malformations, Portal Vein Interventions or Percutaneous Transhepatic Cholangio Drainage (PTCD) between 2014 and 2017. Patient characteristics, fluoroscopy time, protocols used as well as resulting Skin Dose and Dose Area Product (DAP) were compared in each cohort. Image quality was assessed by two independent readers. RESULTS The two patient cohorts did not differ in terms of patient demographics. Similarly, fluoroscopy time did not differ before and after implementation of the low dose settings. An overall reduction of skin dose of 75.1% for AVM embolizations, 80.5% for Portal Vein Interventions and 85.3% for PTCD placement was observed. The DAP decrease was 82.5% for AVM embolizations, 72.2% for Portal Vein Interventions and 79.8% for PTCD placement. Image quality was generally considered to be good with an insignificant difference between pre and post implementation of the low dose approach and good agreement between the two readers. Manual inroom-switching to higher dose levels was possible, however this was not performed more frequently after implementation of the low dose settings. CONCLUSION Lowering the detector entrance dose in pediatric interventional radiology procedures results in a significant decrease of the radiation dose burden.
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Affiliation(s)
- Moritz Wildgruber
- Institut für Röntgendiagnostik, Universitätsklinikum Regensburg, Franz-Josef-Strauss-Allee 11, Regensburg, D-93053, Germany; Institut für Klinische Radiologie, Westfälische Wilhelms-Universität Münster, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, Münster, D-48149, Germany.
| | - Michael Köhler
- Institut für Klinische Radiologie, Westfälische Wilhelms-Universität Münster, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, Münster, D-48149, Germany
| | - Richard Brill
- Universitätsklinik und Poliklinik für Radiologie, Universitätsklinikum Halle, Ernst-Grube-Str 40, Halle, D-06120, Germany
| | - Holger Goessmann
- Institut für Röntgendiagnostik, Universitätsklinikum Regensburg, Franz-Josef-Strauss-Allee 11, Regensburg, D-93053, Germany
| | - Wibke Uller
- Institut für Röntgendiagnostik, Universitätsklinikum Regensburg, Franz-Josef-Strauss-Allee 11, Regensburg, D-93053, Germany
| | - René Müller-Wille
- Institut für Röntgendiagnostik, Universitätsklinikum Regensburg, Franz-Josef-Strauss-Allee 11, Regensburg, D-93053, Germany; Institut für diagnostische und interventionelle Radiologie, Universitätsmedizin Göttingen, Robert-Koch-Str 40, Göttingen, D-37075, Germany
| | - Walter A Wohlgemuth
- Institut für Röntgendiagnostik, Universitätsklinikum Regensburg, Franz-Josef-Strauss-Allee 11, Regensburg, D-93053, Germany; Universitätsklinik und Poliklinik für Radiologie, Universitätsklinikum Halle, Ernst-Grube-Str 40, Halle, D-06120, Germany
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Müller-Wille R, Wildgruber M, Sadick M, Wohlgemuth WA. Vascular Anomalies (Part II): Interventional Therapy of Peripheral Vascular Malformations. ROFO-FORTSCHR RONTG 2018; 190:927-937. [PMID: 29415296 DOI: 10.1055/s-0044-101266] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND The International Society for the Study of Vascular Anomalies (ISSVA) categorizes vascular anomalies into vascular tumors and vascular malformations. Vascular malformations are further divided into slow-flow (venous, lymphatic, and capillary malformation) and fast-flow malformations (arteriovenous malformation and arteriovenous fistula). This interdisciplinary classification has therapeutic implications. METHODS The objective of this article is to provide concise information about the current terminology and treatment strategies of peripheral vascular malformations, based on the currently available literature, with a focus on interventional therapy of venous malformations (VM), lymphatic malformations (LM), arteriovenous malformations (AVM) and arteriovenous fistulae (AVF). RESULTS AND CONCLUSION Accurate classification is crucial for appropriate therapy of peripheral vascular malformations. Modern imaging technologies and refined interventional treatment strategies are now central parts in the multidisciplinary management of these patients. Slow-flow and fast-flow vascular malformations can be treated successfully by percutaneous sclerotherapy and endovascular embolotherapy as first-line interventions. KEY POINTS · The ISSVA classification is essential for the correct diagnosis of vascular malformations. · The Schobinger classification as well as the Cho classification should be used for description of arteriovenous malformations (AVM). · Sclerotherapy and embolotherapy are the primary treatments of choice for vascular malformations. CITATION FORMAT · Müller-Wille R, Wildgruber M, Sadick M et al. Vascular Anomalies (Part II): Interventional Therapy of Peripheral Vascular Malformations. Fortschr Röntgenstr 2018; DOI: 10.1055/s-0044-101266.
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Affiliation(s)
- René Müller-Wille
- Institute for Diagnostic and Interventional Radiology, Georg-August-Universität Göttingen, Universitätsmedizin, Göttingen, Germany
| | - Moritz Wildgruber
- Department for Clinical Radiology, Westfälische Wilhelms Universität Münster, Medizinische Fakultät, Münster, Germany
| | - Maliha Sadick
- University Medical Center Mannhein, Institute for Clinical Radiology and Nuclear Medicine, Mannheim, Germany
| | - Walter A Wohlgemuth
- Department for Radiology, Martin-Luther-Universität Halle-Wittenberg, Halle, Germany
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Schnitzbauer M, Güntner O, Wohlgemuth WA, Zeman F, Haimerl M, Stroszczynski C, Müller-Wille R. CT after Endovascular Repair of Abdominal Aortic Aneurysms: Diagnostic Accuracy of Diameter Measurements for the Detection of Aneurysm Sac Enlargement. J Vasc Interv Radiol 2018; 29:178-187.e3. [DOI: 10.1016/j.jvir.2017.09.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 08/07/2017] [Accepted: 09/18/2017] [Indexed: 11/26/2022] Open
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Rosendahl J, Michl P, Kleeff J, Wohlgemuth WA, Garbe J. Severe Colitis After an Alcohol Enema. Am J Gastroenterol 2018; 113:172. [PMID: 29467528 DOI: 10.1038/ajg.2017.460] [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: 12/11/2022]
Affiliation(s)
- Jonas Rosendahl
- Department of Internal Medicine I, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Patrick Michl
- Department of Internal Medicine I, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Jörg Kleeff
- Department of Visceral, Vascular, and Endocrine Surgery, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Walter A Wohlgemuth
- Department of Radiology, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Jakob Garbe
- Department of Internal Medicine I, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
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