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Guensch DP, Utz CD, Jung B, Dozio S, Huettenmoser SP, Friess JO, Terbeck S, Erdoes G, Huber AT, Eberle B, Fischer K. Introducing a free-breathing MRI method to assess peri-operative myocardial oxygenation and function: A volunteer cohort study. Eur J Anaesthesiol 2024:00003643-990000000-00167. [PMID: 38323332 DOI: 10.1097/eja.0000000000001964] [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: 02/08/2024]
Abstract
BACKGROUND Induction of general anaesthesia has many potential triggers for peri-operative myocardial ischaemia including the acute disturbance of blood gases that frequently follows alterations in breathing and ventilation patterns. Free-breathing oxygenation-sensitive cardiovascular magnetic resonance (OS-CMR) imaging may provide the opportunity to continuously quantify the impact of such triggers on myocardial oxygenation. OBJECTIVE To investigate the impact of breathing patterns that simulate induction of general anaesthesia on myocardial oxygenation in awake healthy adults using continuous OS-CMR imaging. DESIGN Prospective observational study. SETTING Single-centre university hospital. Recruitment from August 2020 to January 2022. PARTICIPANTS Thirty-two healthy volunteers younger than 45 years old were recruited. Data were analysed from n = 29 (69% male individuals). INTERVENTION Participants performed a simulated induction breathing manoeuvre consisting of 2.5 min paced breathing with a respiration rate of 14 breaths per minute, followed by 5 deep breaths, then apnoea for up to 60s inside a magnetic resonance imaging scanner (MRI). Cardiac images were acquired with the traditional OS-CMR sequence (OSbh-cine), which requires apnoea for acquisition and with two free-breathing OS-CMR sequences: a high-resolution single-shot sequence (OSfb-ss) and a real-time cine sequence (OSfb-rtcine). MAIN OUTCOME MEASURES Myocardial oxygenation response at the end of the paced breathing period and at the 30 s timepoint during the subsequent apnoea, reflecting the time of successful intubation in a clinical setting. RESULTS The paced breathing followed by five deep breaths significantly reduced myocardial oxygenation, which was observed with all three techniques (OSbh-cine -6.0 ± 2.6%, OSfb-ss -12.0 ± 5.9%, OSfb-rtcine -5.4 ± 7.0%, all P < 0.05). The subsequent vasodilating stimulus of apnoea then significantly increased myocardial oxygenation (OSbh-cine 6.8 ± 3.1%, OSfb-ss 8.4 ± 5.6%, OSfb-rtcine 15.7 ± 10.0%, all P < 0.01). The free-breathing sequences were reproducible and were not inferior to the original sequence for any stage. CONCLUSION Breathing manoeuvres simulating induction of general anaesthesia cause dynamic alterations of myocardial oxygenation in young volunteers, which can be quantified continuously with free-breathing OS-CMR. Introducing these new imaging techniques into peri-operative studies may throw new light into the mechanisms of peri-operative perturbations of myocardial tissue oxygenation and ischaemia. VISUALABSTRACT http://links.lww.com/EJA/A922.
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Affiliation(s)
- Dominik P Guensch
- From the Department of Anaesthesiology and Pain Medicine (DPG, CDU, JOF, ST, GE, BE, KF) and Department of Diagnostic, Interventional and Paediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (DPG, BJ, SD, SPH, ATH)
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Pavlides M, Mózes FE, Akhtar S, Wonders K, Cobbold J, Tunnicliffe EM, Allison M, Godfrey EM, Aithal GP, Francis S, Romero-Gomez M, Castell J, Fernandez-Lizaranzu I, Aller R, González RS, Agustin S, Pericàs JM, Boursier J, Aube C, Ratziu V, Wagner M, Petta S, Antonucci M, Bugianesi E, Faletti R, Miele L, Geier A, Schattenberg JM, Tilman E, Ekstedt M, Lundberg P, Berzigotti A, Huber AT, Papatheodoridis G, Yki-Järvinen H, Porthan K, Schneider MJ, Hockings P, Shumbayawonda E, Banerjee R, Pepin K, Kalutkiewicz M, Ehman RL, Trylesinksi A, Coxson HO, Martic M, Yunis C, Tuthill T, Bossuyt PM, Anstee QM, Neubauer S, Harrison S. Liver Investigation: Testing Marker Utility in Steatohepatitis (LITMUS): Assessment & validation of imaging modality performance across the NAFLD spectrum in a prospectively recruited cohort study (the LITMUS imaging study): Study protocol. Contemp Clin Trials 2023; 134:107352. [PMID: 37802221 DOI: 10.1016/j.cct.2023.107352] [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] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 08/29/2023] [Accepted: 10/01/2023] [Indexed: 10/08/2023]
Abstract
Non-alcoholic fatty liver disease (NAFLD) is the liver manifestation of the metabolic syndrome with global prevalence reaching epidemic levels. Despite the high disease burden in the population only a small proportion of those with NAFLD will develop progressive liver disease, for which there is currently no approved pharmacotherapy. Identifying those who are at risk of progressive NAFLD currently requires a liver biopsy which is problematic. Firstly, liver biopsy is invasive and therefore not appropriate for use in a condition like NAFLD that affects a large proportion of the population. Secondly, biopsy is limited by sampling and observer dependent variability which can lead to misclassification of disease severity. Non-invasive biomarkers are therefore needed to replace liver biopsy in the assessment of NAFLD. Our study addresses this unmet need. The LITMUS Imaging Study is a prospectively recruited multi-centre cohort study evaluating magnetic resonance imaging and elastography, and ultrasound elastography against liver histology as the reference standard. Imaging biomarkers and biopsy are acquired within a 100-day window. The study employs standardised processes for imaging data collection and analysis as well as a real time central monitoring and quality control process for all the data submitted for analysis. It is anticipated that the high-quality data generated from this study will underpin changes in clinical practice for the benefit of people with NAFLD. Study Registration: clinicaltrials.gov: NCT05479721.
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Affiliation(s)
- Michael Pavlides
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK; Translational Gastroenterology Unit, University of Oxford, Oxford, UK; Oxford NIHR Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust and the University of Oxford, Oxford, UK.
| | - Ferenc E Mózes
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Salma Akhtar
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Kristy Wonders
- Translational & Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom; Newcastle NIHR Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Jeremy Cobbold
- Translational Gastroenterology Unit, University of Oxford, Oxford, UK; Oxford NIHR Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust and the University of Oxford, Oxford, UK
| | - Elizabeth M Tunnicliffe
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK; Oxford NIHR Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust and the University of Oxford, Oxford, UK
| | - Michael Allison
- Liver Unit, Department of Medicine, Cambridge NIHR Biomedical Research Centre, Cambridge University NHS Foundation Trust, UK
| | - Edmund M Godfrey
- Department of Radiology, Cambridge University NHS Foundation Trust, Cambridge, UK
| | - Guruprasad P Aithal
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
| | - Susan Francis
- Sir Peter Mansfield Imaging Centre, University of Nottingham, Nottingham, UK
| | - Manuel Romero-Gomez
- Digestive Diseases Unit, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Javier Castell
- Radiodiagnosis Clinical Management Unit, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | | | - Rocio Aller
- Department of Gastroenterology, Clinic University Hospital, Medical School, University of Valladolid, CIBERINFEC, Valladolid, Spain
| | - Rebeca Sigüenza González
- Department of Radiology, Clinic University Hospital, Medical School, University of Valladolid, Valladolid, Spain
| | - Salvador Agustin
- Liver Unit, Vall d'Hebron Institut de Recerca, Vall d'Hebron Barcelona Hospital, Centros de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
| | - Juan M Pericàs
- Liver Unit, Vall d'Hebron Institut de Recerca, Vall d'Hebron Barcelona Hospital, Centros de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
| | - Jerome Boursier
- Centre Hospitalier Universitaire d'Angers, Angers, France; & Laboratoire HIFIH UPRES EA3859, Université d'Angers, Angers, France
| | - Christophe Aube
- Department of Radiology, Centre Hospitalier Universitaire d'Angers, Angers, France; & Laboratoire HIFIH UPRES EA3859, Université d'Angers, Angers, France
| | - Vlad Ratziu
- Sorbonne Université, Institute of Cardiometabolism and Nutrition, Pitié-Salpêtrière Hospital, Paris, France
| | - Mathilde Wagner
- Radiology department, AP-HP.6, GH Pitié Salpêtrière - Charles Foix Sorbonne Université, Paris, France
| | - Salvatore Petta
- Section of Gastroenterology, PROMISE, University of Palermo, Italy
| | - Michela Antonucci
- Section of Radiology - Di.Bi.Me.F., University of Palermo, Palermo, Italy
| | - Elisabetta Bugianesi
- Division of Gastroenterology, Department of Medical Sciences, University of Torino, Torino, Italy
| | - Riccardo Faletti
- Department of Diagnostic and Interventional Radiology, University of Turin, Turin, Italy
| | - Luca Miele
- Department of Translational Medicine and Surgery, Medical School, Università Cattolica del S. Cuore and Fondazione Pol. Gemelli IRCCS Hospital, Rome, Italy
| | - Andreas Geier
- Department of Hepatology, University of Würzburg, Würzburg, Germany
| | - Jörn M Schattenberg
- Metabolic Liver Research Program, I. Department of Medicine, University Medical Centre, Mainz, Germany
| | - Emrich Tilman
- Department of Diagnostic and Interventional Radiology, University Medical Center of Johannes-Gutenberg-University, Langenbeckstr. 1, 55131 Mainz, Germany
| | - Mattias Ekstedt
- Department of Health, Medicine and Caring Sciences, and Centre for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Peter Lundberg
- Department of Radiation Physics, and Centre for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Annalisa Berzigotti
- Department of Visceral Surgery and Medicine, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Adrian T Huber
- Department of Diagnostic, Interventional and Paediatric Radiology (DIPR), Bern University Hospital, University of Bern, Bern, Switzerland
| | - George Papatheodoridis
- Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, General Hospital of Athens "Laiko", Athens, Greece
| | - Hannele Yki-Järvinen
- Department of Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Kimmo Porthan
- Department of Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | | | | | | | | | | | | | | | - Aldo Trylesinksi
- ADVANZPHARMA, Capital House, 1st Floor, 85 King William Street, London EC4N 7BL, United Kingdom
| | | | - Miljen Martic
- Novartis AG, Translational Medicine, Clinical and Precision Medicine Imaging, Basel, Switzerland
| | - Carla Yunis
- Clinical Development and Operations, Pfizer Inc., Lake Mary, FL, USA
| | - Theresa Tuthill
- Clinical Development and Operations, Pfizer Inc., Lake Mary, FL, USA
| | - Patrick M Bossuyt
- Department of Epidemiology & Data Science, Amsterdam Public Health, Amsterdam University Medical Centres, University of Amsterdam, the Netherlands
| | - Quentin M Anstee
- Translational & Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom; Newcastle NIHR Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Stefan Neubauer
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK; Oxford NIHR Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust and the University of Oxford, Oxford, UK
| | - Stephen Harrison
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
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Peters AA, Solomon JB, von Stackelberg O, Samei E, Alsaihati N, Valenzuela W, Debic M, Heidt C, Huber AT, Christe A, Heverhagen JT, Kauczor HU, Heussel CP, Ebner L, Wielpütz MO. Influence of CT dose reduction on AI-driven malignancy estimation of incidental pulmonary nodules. Eur Radiol 2023:10.1007/s00330-023-10348-1. [PMID: 37870625 DOI: 10.1007/s00330-023-10348-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 08/10/2023] [Accepted: 09/03/2023] [Indexed: 10/24/2023]
Abstract
OBJECTIVES The purpose of this study was to determine the influence of dose reduction on a commercially available lung cancer prediction convolutional neuronal network (LCP-CNN). METHODS CT scans from a cohort provided by the local lung cancer center (n = 218) with confirmed pulmonary malignancies and their corresponding reduced dose simulations (25% and 5% dose) were subjected to the LCP-CNN. The resulting LCP scores (scale 1-10, increasing malignancy risk) and the proportion of correctly classified nodules were compared. The cohort was divided into a low-, medium-, and high-risk group based on the respective LCP scores; shifts between the groups were studied to evaluate the potential impact on nodule management. Two different malignancy risk score thresholds were analyzed: a higher threshold of ≥ 9 ("rule-in" approach) and a lower threshold of > 4 ("rule-out" approach). RESULTS In total, 169 patients with 196 nodules could be included (mean age ± SD, 64.5 ± 9.2 year; 49% females). Mean LCP scores for original, 25% and 5% dose levels were 8.5 ± 1.7, 8.4 ± 1.7 (p > 0.05 vs. original dose) and 8.2 ± 1.9 (p < 0.05 vs. original dose), respectively. The proportion of correctly classified nodules with the "rule-in" approach decreased with simulated dose reduction from 58.2 to 56.1% (p = 0.34) and to 52.0% for the respective dose levels (p = 0.01). For the "rule-out" approach the respective values were 95.9%, 96.4%, and 94.4% (p = 0.12). When reducing the original dose to 25%/5%, eight/twenty-two nodules shifted to a lower, five/seven nodules to a higher malignancy risk group. CONCLUSION CT dose reduction may affect the analyzed LCP-CNN regarding the classification of pulmonary malignancies and potentially alter pulmonary nodule management. CLINICAL RELEVANCE STATEMENT Utilization of a "rule-out" approach with a lower malignancy risk threshold prevents underestimation of the nodule malignancy risk for the analyzed software, especially in high-risk cohorts. KEY POINTS • LCP-CNN may be affected by CT image parameters such as noise resulting from low-dose CT acquisitions. • CT dose reduction can alter pulmonary nodule management recommendations by affecting the outcome of the LCP-CNN. • Utilization of a lower malignancy risk threshold prevents underestimation of pulmonary malignancies in high-risk cohorts.
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Affiliation(s)
- Alan A Peters
- Diagnostic and Interventional Radiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany.
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland.
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Im Neuenheimer Feld 156, 69120, Heidelberg, Germany.
- Department of Diagnostic and Interventional Radiology With Nuclear Medicine, Thoraxklinik at University of Heidelberg, Röntgenstraße 1, 69126, Heidelberg, Germany.
| | - Justin B Solomon
- Carl E. Ravin Advanced Imaging Laboratories, Medical Physics Graduate Program, Clinical Imaging Physics Group, Department of Radiology, Duke University Medical Center, Durham, NC, USA
| | - Oyunbileg von Stackelberg
- Diagnostic and Interventional Radiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Im Neuenheimer Feld 156, 69120, Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology With Nuclear Medicine, Thoraxklinik at University of Heidelberg, Röntgenstraße 1, 69126, Heidelberg, Germany
| | - Ehsan Samei
- Carl E. Ravin Advanced Imaging Laboratories, Medical Physics Graduate Program, Clinical Imaging Physics Group, Department of Radiology, Duke University Medical Center, Durham, NC, USA
| | - Njood Alsaihati
- Carl E. Ravin Advanced Imaging Laboratories, Medical Physics Graduate Program, Clinical Imaging Physics Group, Department of Radiology, Duke University Medical Center, Durham, NC, USA
| | - Waldo Valenzuela
- University Institute for Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Manuel Debic
- Diagnostic and Interventional Radiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Im Neuenheimer Feld 156, 69120, Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology With Nuclear Medicine, Thoraxklinik at University of Heidelberg, Röntgenstraße 1, 69126, Heidelberg, Germany
| | - Christian Heidt
- Diagnostic and Interventional Radiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Im Neuenheimer Feld 156, 69120, Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology With Nuclear Medicine, Thoraxklinik at University of Heidelberg, Röntgenstraße 1, 69126, Heidelberg, Germany
| | - Adrian T Huber
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Andreas Christe
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Johannes T Heverhagen
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
- Department of BioMedical Research, Experimental Radiology, University of Bern, Bern, Switzerland
- Department of Radiology, The Ohio State University, Columbus, OH, USA
| | - Hans-Ulrich Kauczor
- Diagnostic and Interventional Radiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Im Neuenheimer Feld 156, 69120, Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology With Nuclear Medicine, Thoraxklinik at University of Heidelberg, Röntgenstraße 1, 69126, Heidelberg, Germany
| | - Claus P Heussel
- Diagnostic and Interventional Radiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Im Neuenheimer Feld 156, 69120, Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology With Nuclear Medicine, Thoraxklinik at University of Heidelberg, Röntgenstraße 1, 69126, Heidelberg, Germany
| | - Lukas Ebner
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Mark O Wielpütz
- Diagnostic and Interventional Radiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Im Neuenheimer Feld 156, 69120, Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology With Nuclear Medicine, Thoraxklinik at University of Heidelberg, Röntgenstraße 1, 69126, Heidelberg, Germany
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Guensch DP, Kuganathan S, Utz CD, Neuenschwander MD, Grob L, Becker P, Oeri S, Huber AT, Berto MB, Spano G, Gräni C, Friedrich MG, Eberle B, Fischer K. Analysis of bi-atrial function using CMR feature tracking and long-axis shortening approaches in patients with diastolic dysfunction and atrial fibrillation. Eur Radiol 2023; 33:7226-7237. [PMID: 37145149 PMCID: PMC10511591 DOI: 10.1007/s00330-023-09663-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 02/12/2023] [Accepted: 02/27/2023] [Indexed: 05/06/2023]
Abstract
OBJECTIVES Atrial function can be assessed using advancing cardiovascular magnetic resonance (CMR) post-processing methods: atrial feature tracking (FT) strain analysis or a long-axis shortening (LAS) technique. This study aimed to first compare the two FT and LAS techniques in healthy individuals and cardiovascular patients and then investigated how left (LA) and right atrial (RA) measurements are related to the severity of diastolic dysfunction or atrial fibrillation. METHODS Sixty healthy controls and 90 cardiovascular disease patients with coronary artery disease, heart failure, or atrial fibrillation, underwent CMR. LA and RA were analyzed for standard volumetry as well as for myocardial deformation using FT and LAS for the different functional phases (reservoir, conduit, booster). Additionally, ventricular shortening and valve excursion measurements were assessed with the LAS module. RESULTS The measurements for each of the LA and RA phases were correlated (p < 0.05) between the two approaches, with the highest correlation coefficients occurring in the reservoir phase (LA: r = 0.83, p < 0.01, RA: r = 0.66, p < 0.01). Both methods demonstrated reduced LA (FT: 26 ± 13% vs 48 ± 12%, LAS: 25 ± 11% vs 42 ± 8%, p < 0.01) and RA reservoir function (FT: 28 ± 15% vs 42 ± 15%, LAS: 27 ± 12% vs 42 ± 10%, p < 0.01) in patients compared to controls. Atrial LAS and FT decreased with diastolic dysfunction and atrial fibrillation. This mirrored ventricular dysfunction measurements. CONCLUSION Similar results were generated for bi-atrial function measurements between two CMR post-processing approaches of FT and LAS. Moreover, these methods allowed for the assessment of incremental deterioration of LA and RA function with increasing left ventricular diastolic dysfunction and atrial fibrillation. A CMR-based analysis of bi-atrial strain or shortening discriminates patients with early-stage diastolic dysfunction prior to the presence of compromised atrial and ventricular ejection fractions that occur with late-stage diastolic dysfunction and atrial fibrillation. KEY POINTS • Assessing right and left atrial function with CMR feature tracking or long-axis shortening techniques yields similar measurements and could potentially be used interchangeably based on the software capabilities of individual sites. • Atrial deformation and/or long-axis shortening allow for early detection of subtle atrial myopathy in diastolic dysfunction, even when atrial enlargement is not yet apparent. • Using a CMR-based analysis to understand the individual atrial-ventricular interaction in addition to tissue characteristics allows for a comprehensive interrogation of all four heart chambers. In patients, this could add clinically meaningful information and potentially allow for optimal therapies to be chosen to better target the dysfunction.
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Affiliation(s)
- Dominik P Guensch
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Diagnostic, Interventional and Paediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Shagana Kuganathan
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christoph D Utz
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Mario D Neuenschwander
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Leonard Grob
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Philipp Becker
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Salome Oeri
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Adrian T Huber
- Department of Diagnostic, Interventional and Paediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Martina Boscolo Berto
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Giancarlo Spano
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christoph Gräni
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Matthias G Friedrich
- Department of Medicine, McGill University, Montreal, QC, Canada
- Department of Radiology, McGill University, Montreal, QC, Canada
| | - Balthasar Eberle
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Kady Fischer
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
- Department of Diagnostic, Interventional and Paediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
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Guensch DP, Federer J, Schweizer T, Kauert-Willms A, Utz CD, Dozio S, Huettenmoser SP, Terbeck S, Erdoes G, Jung B, Huber AT, Stucki MP, Kämpfer M, Overney S, Eberle B, Fischer K. First findings from perioperative magnetic resonance imaging of inducible myocardial ischaemia during induction of general anaesthesia. Br J Anaesth 2023; 131:e75-e79. [PMID: 37380567 DOI: 10.1016/j.bja.2023.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 05/19/2023] [Accepted: 05/19/2023] [Indexed: 06/30/2023] Open
Affiliation(s)
- Dominik P Guensch
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Department of Diagnostic, Interventional and Paediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| | - Jonas Federer
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thilo Schweizer
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Annegret Kauert-Willms
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christoph D Utz
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Scilla Dozio
- Department of Diagnostic, Interventional and Paediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Stefan P Huettenmoser
- Department of Diagnostic, Interventional and Paediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sandra Terbeck
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Gabor Erdoes
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Bernd Jung
- Department of Diagnostic, Interventional and Paediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Adrian T Huber
- Department of Diagnostic, Interventional and Paediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Monika P Stucki
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Martina Kämpfer
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sarah Overney
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Balthasar Eberle
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Kady Fischer
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Bernhard B, Tanner G, Garachemani D, Schnyder A, Fischer K, Huber AT, Safarkhanlo Y, Stark AW, Guensch DP, Schütze J, Greulich S, Bastiaansen JAM, Pavlicek-Bahlo M, Benz DC, Kwong RY, Gräni C. Predictive value of cardiac magnetic resonance right ventricular longitudinal strain in patients with suspected myocarditis. J Cardiovasc Magn Reson 2023; 25:49. [PMID: 37587516 PMCID: PMC10433613 DOI: 10.1186/s12968-023-00957-6] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 08/07/2023] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND Recent evidence underlined the importance of right (RV) involvement in suspected myocarditis. We aim to analyze the possible incremental prognostic value from RV global longitudinal strain (GLS) by CMR. METHODS Patients referred for CMR, meeting clinical criteria for suspected myocarditis and no other cardiomyopathy were enrolled in a dual-center register cohort study. Ejection fraction (EF), GLS and tissue characteristics were assessed in both ventricles to assess their association to first major adverse cardiovascular events (MACE) including hospitalization for heart failure (HF), ventricular tachycardia (VT), recurrent myocarditis and death. RESULTS Among 659 patients (62.8% male; 48.1 ± 16.1 years), RV GLS was impaired (> - 15.4%) in 144 (21.9%) individuals, of whom 76 (58%), 108 (77.1%), 27 (18.8%) and 40 (32.8%) had impaired right ventricular ejection fraction (RVEF), impaired left ventricular ejection fraction (LVEF), RV late gadolinium enhancement (LGE) or RV edema, respectively. After a median observation time of 3.7 years, 45 (6.8%) patients were hospitalized for HF, 42 (6.4%) patients died, 33 (5%) developed VT and 16 (2.4%) had recurrent myocarditis. Impaired RV GLS was associated with MACE (HR = 1.07, 95% CI 1.04-1.10; p < 0.001), HF hospitalization (HR = 1.17, 95% CI 1.12-1.23; p < 0.001), and death (HR = 1.07, 95% CI 1.02-1.12; p = 0.004), but not with VT and recurrent myocarditis in univariate analysis. RV GLS lost its association with outcomes, when adjusted for RVEF, LVEF, LV GLS and LV LGE extent. CONCLUSION RV strain is associated with MACE, HF hospitalization and death but has neither independent nor incremental prognostic value after adjustment for RV and LV function and tissue characteristics. Therefore, assessing RV GLS in the setting of myocarditis has only limited value.
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Affiliation(s)
- Benedikt Bernhard
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Giulin Tanner
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Davide Garachemani
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Aaron Schnyder
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Kady Fischer
- Department of Anesthesiology and Pain Medicine, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Adrian T Huber
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Yasaman Safarkhanlo
- Department of Anesthesiology and Pain Medicine, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Anselm W Stark
- Department of Anesthesiology and Pain Medicine, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Dominik P Guensch
- Department of Anesthesiology and Pain Medicine, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Jonathan Schütze
- Department of Anesthesiology and Pain Medicine, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Simon Greulich
- Department of Cardiology and Angiology, University of Tübingen, Tübingen, Germany
| | - Jessica A M Bastiaansen
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Maryam Pavlicek-Bahlo
- Department of Anesthesiology and Pain Medicine, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Dominik C Benz
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Raymond Y Kwong
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Christoph Gräni
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland.
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Dack E, Christe A, Fontanellaz M, Brigato L, Heverhagen JT, Peters AA, Huber AT, Hoppe H, Mougiakakou S, Ebner L. Artificial Intelligence and Interstitial Lung Disease: Diagnosis and Prognosis. Invest Radiol 2023; 58:602-609. [PMID: 37058321 PMCID: PMC10332653 DOI: 10.1097/rli.0000000000000974] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 02/18/2023] [Indexed: 04/15/2023]
Abstract
ABSTRACT Interstitial lung disease (ILD) is now diagnosed by an ILD-board consisting of radiologists, pulmonologists, and pathologists. They discuss the combination of computed tomography (CT) images, pulmonary function tests, demographic information, and histology and then agree on one of the 200 ILD diagnoses. Recent approaches employ computer-aided diagnostic tools to improve detection of disease, monitoring, and accurate prognostication. Methods based on artificial intelligence (AI) may be used in computational medicine, especially in image-based specialties such as radiology. This review summarises and highlights the strengths and weaknesses of the latest and most significant published methods that could lead to a holistic system for ILD diagnosis. We explore current AI methods and the data use to predict the prognosis and progression of ILDs. It is then essential to highlight the data that holds the most information related to risk factors for progression, e.g., CT scans and pulmonary function tests. This review aims to identify potential gaps, highlight areas that require further research, and identify the methods that could be combined to yield more promising results in future studies.
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Affiliation(s)
- Ethan Dack
- From the ARTORG Center for Biomedical Engineering Research, University of Bern
| | - Andreas Christe
- Diagnostic, Interventional, and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern
| | | | - Lorenzo Brigato
- From the ARTORG Center for Biomedical Engineering Research, University of Bern
| | - Johannes T. Heverhagen
- Diagnostic, Interventional, and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern
| | - Alan A. Peters
- Diagnostic, Interventional, and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern
| | - Adrian T. Huber
- Diagnostic, Interventional, and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern
| | - Hanno Hoppe
- Campus Stiftung Lindenhof Bern
- University of Bern
- University of Lucerne, Switzerland
| | | | - Lukas Ebner
- Diagnostic, Interventional, and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern
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8
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Galea R, Aminian A, Meneveau N, De Marco F, Heg D, Anselme F, Gräni C, Huber AT, Teiger E, Iriart X, Franzone A, Vranckx P, Fischer U, Pedrazzini G, Bedogni F, Valgimigli M, Räber L. Impact of Preprocedural Computed Tomography on Left Atrial Appendage Closure Success: A Swiss-Apero Trial Subanalysis. JACC Cardiovasc Interv 2023; 16:1332-1343. [PMID: 37316145 DOI: 10.1016/j.jcin.2023.02.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 02/16/2023] [Accepted: 02/21/2023] [Indexed: 06/16/2023]
Abstract
BACKGROUND The benefit related to the use of preprocedural computed tomography angiography (CCTA) on top of periprocedural echocardiography to plan percutaneous left atrial appendage closure (LAAC) procedures is still unclear. OBJECTIVES The authors sought to evaluate the impact of preprocedural CCTA on LAAC procedural success. METHODS In the investigator-initiated SWISS-APERO (Comparison of Amplatzer Amulet and Watchman Device in Patients Undergoing Left Atrial Appendage Closure) trial, patients undergoing echocardiography-guided LAAC were randomly assigned to receive the Amulet (Abbott) or Watchman 2.5/FLX (Boston Scientific) device across 8 European centers. According to the study protocol ongoing at the time of the procedure, the first operators had (CCTA unblinded group) or did not have (CCTA blinded group) access to preprocedural CCTA images. In this post hoc analysis, we compared blinded vs unblinded procedures in terms of procedural success defined as complete left atrial appendage occlusion as evaluated at the end of LAAC (short-term) or at the 45-day follow-up (long-term) without procedural-related complications. RESULTS Among 219 LAACs preceded by CCTA, 92 (42.1%) and 127 (57.9%) were assigned to the CCTA unblinded and blinded group, respectively. After adjusting for confounders, operator unblinding to preprocedural CCTA remained associated with a higher rate of short-term procedural success (93.5% vs 81.1%; P = 0.009; adjusted OR: 2.76; 95% CI: 1.05-7.29; P = 0.040) and long-term procedural success (83.7% vs 72.4%; P = 0.050; adjusted OR: 2.12; 95% CI: 1.03-4.35; P = 0.041). CONCLUSIONS In a prospective multicenter cohort of clinically indicated echocardiography-guided LAACs, unblinding of the first operators to preprocedural CCTA images was independently associated with a higher rate of both short- and long-term procedural success. Further studies are needed to better evaluate the impact of preprocedural CCTA on clinical outcomes.
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Affiliation(s)
- Roberto Galea
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland. https://twitter.com/RobertoGalea7
| | - Adel Aminian
- Department of Cardiology, Centre Hospitalier Universitaire de Charleroi, Charleroi, Belgium
| | - Nicolas Meneveau
- Besancon University Hospital, University of Burgundy Franche-Comté, Besancon, France
| | - Federico De Marco
- Department of Cardiology, Istituti di Ricovero e Cura a Carattere Scientifico Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Dik Heg
- Department of Clinical Research, Clinical Trials Unit Bern, University of Bern, Bern, Switzerland
| | - Frederic Anselme
- Department of Cardiology, University Hospital of Rouen, Rouen, France
| | - Christoph Gräni
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland. https://twitter.com/chrisgraeni
| | - Adrian T Huber
- Department of Diagnostic, Interventional and Pediatric Radiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Emmanuel Teiger
- Department of Cardiology, Henri-Mondor Hospital, Public Assistance Hospitals of Paris, Créteil, France
| | - Xavier Iriart
- Department of Pediatric and Adult Congenital Cardiology, Hôpital Cardiologique du Haut- Lévêque, Centre Hospitalier Universitaire de Bordeaux, Bordeaux-Pessac, France
| | - Anna Franzone
- Department of Advanced Biomedical Sciences, University Federico II University, Naples, Italy
| | - Pascal Vranckx
- Department of Cardiology and Critical Care Medicine, Hartcentrum Hasselt, Jessa Ziekenhuis, Hasselt, Belgium; Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Urs Fischer
- Department of Neurology, Bern University Hospital, University of Bern, Bern, Switzerland; Department of Neurology, University Hospital Basel, University of Basel, Switzerland
| | - Giovanni Pedrazzini
- Cardiocentro Ticino Institute and Università della Svizzera Italiana, Lugano, Switzerland
| | - Francesco Bedogni
- Department of Cardiology, Istituti di Ricovero e Cura a Carattere Scientifico Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Marco Valgimigli
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland; Cardiocentro Ticino Institute and Università della Svizzera Italiana, Lugano, Switzerland
| | - Lorenz Räber
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland.
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Mingels C, Loebelenz LI, Huber AT, Alberts I, Rominger A, Afshar-Oromieh A, Obmann VC. Literature review: Imaging in prostate cancer. Curr Probl Cancer 2023:100968. [PMID: 37336689 DOI: 10.1016/j.currproblcancer.2023.100968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 05/09/2023] [Accepted: 05/20/2023] [Indexed: 06/21/2023]
Abstract
Imaging plays an increasingly important role in the detection and characterization of prostate cancer (PC). This review summarizes the key conventional and advanced imaging modalities including multiparametric magnetic resonance imaging (MRI) and positron emission tomography (PET) imaging and tries to instruct clinicians in finding the best image modality depending on the patient`s PC-stage. We aim to give an overview of the different image modalities and their benefits and weaknesses in imaging PC. Emphasis is put on primary prostate cancer detection and staging as well as on recurrent and castration resistant prostate cancer. Results from studies using various imaging techniques are discussed and compared. For the different stages of PC, advantages and disadvantages of the different imaging modalities are discussed. Moreover, this review aims to give an outlook about upcoming, new imaging modalities and how they might be implemented in the future into clinical routine. Imaging patients suffering from PC should aim for exact diagnosis, accurate detection of PC lesions and should mirror the true tumor burden. Imaging should lead to the best patient treatment available in the current PC-stage and should avoid unnecessary therapeutic interventions. New image modalities such as long axial field of view PET/CT with photon-counting CT and radiopharmaceuticals like androgen receptor targeting radiopharmaceuticals open up new possibilities. In conclusion, PC imaging is growing and each image modality is aiming for improvement.
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Affiliation(s)
- Clemens Mingels
- Department of Nuclear Medicine, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland.
| | - Laura I Loebelenz
- Department of Interventional, Pediatric and Diagnostic Radiology, Inselspital, University of Bern, Switzerland
| | - Adrian T Huber
- Department of Interventional, Pediatric and Diagnostic Radiology, Inselspital, University of Bern, Switzerland
| | - Ian Alberts
- Department of Nuclear Medicine, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Axel Rominger
- Department of Nuclear Medicine, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Ali Afshar-Oromieh
- Department of Nuclear Medicine, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Verena C Obmann
- Department of Interventional, Pediatric and Diagnostic Radiology, Inselspital, University of Bern, Switzerland
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10
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Boscolo Berto M, Spano G, Rhyner D, Huber AT, Gräni C. Multimodality imaging of cardiac B-cell lymphoma. J Nucl Cardiol 2023; 30:1263-1265. [PMID: 35083715 PMCID: PMC10261208 DOI: 10.1007/s12350-022-02904-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 12/24/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Martina Boscolo Berto
- Department of Cardiology, Inselspital, Noninvasive Cardiac Imaging, Bern University Hospital, University of Bern, Freiburgstrasse 4, 3010, Bern, Switzerland
| | - Giancarlo Spano
- Department of Cardiology, Inselspital, Noninvasive Cardiac Imaging, Bern University Hospital, University of Bern, Freiburgstrasse 4, 3010, Bern, Switzerland
| | - Daniel Rhyner
- Department of Cardiology, Inselspital, Noninvasive Cardiac Imaging, Bern University Hospital, University of Bern, Freiburgstrasse 4, 3010, Bern, Switzerland
| | - Adrian T Huber
- Department of Diagnostic, Interventional and Paediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christoph Gräni
- Department of Cardiology, Inselspital, Noninvasive Cardiac Imaging, Bern University Hospital, University of Bern, Freiburgstrasse 4, 3010, Bern, Switzerland.
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11
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Peters AA, Huber AT, Obmann VC, Heverhagen JT, Christe A, Ebner L. Correction to: Diagnostic validation of a deep learning nodule detection algorithm in low-dose chest CT: determination of optimized dose thresholds in a virtual screening scenario. Eur Radiol 2023; 33:3785-3787. [PMID: 36752861 DOI: 10.1007/s00330-022-09350-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Affiliation(s)
- Alan A Peters
- Department of Diagnostic, Interventional and Pediatric Radiology (DIPR), Bern University Hospital, University of Bern, 3010, Inselspital Bern, Switzerland.
| | - Adrian T Huber
- Department of Diagnostic, Interventional and Pediatric Radiology (DIPR), Bern University Hospital, University of Bern, 3010, Inselspital Bern, Switzerland
| | - Verena C Obmann
- Department of Diagnostic, Interventional and Pediatric Radiology (DIPR), Bern University Hospital, University of Bern, 3010, Inselspital Bern, Switzerland
| | - Johannes T Heverhagen
- Department of Diagnostic, Interventional and Pediatric Radiology (DIPR), Bern University Hospital, University of Bern, 3010, Inselspital Bern, Switzerland.,Department of BioMedical Research, Experimental Radiology, University of Bern, 3008, Bern, Switzerland.,Department of Radiology, The Ohio State University, Columbus, OH, USA
| | - Andreas Christe
- Department of Diagnostic, Interventional and Pediatric Radiology (DIPR), Bern University Hospital, University of Bern, 3010, Inselspital Bern, Switzerland
| | - Lukas Ebner
- Department of Diagnostic, Interventional and Pediatric Radiology (DIPR), Bern University Hospital, University of Bern, 3010, Inselspital Bern, Switzerland
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12
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Peters AA, Wagner B, Spano G, Haupt F, Ebner L, Kunze KP, Schmidt M, Neji R, Botnar R, Prieto C, Jung B, Christe A, Gräni C, Huber AT. Myocardial scar detection in free-breathing Dixon-based fat- and water-separated 3D inversion recovery late-gadolinium enhancement whole heart MRI. Int J Cardiovasc Imaging 2023; 39:135-144. [PMID: 36598693 PMCID: PMC9813059 DOI: 10.1007/s10554-022-02701-0] [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] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 07/22/2022] [Indexed: 01/09/2023]
Abstract
The aim of this study was to investigate the diagnostic accuracy and reader confidence for late-gadolinium enhancement (LGE) detection of a novel free-breathing, image-based navigated 3D whole-heart LGE sequence with fat-water separation, compared to a free-breathing motion-corrected 2D LGE sequence in patients with ischemic and non-ischemic cardiomyopathy. Cardiac MRI patients including the respective sequences were retrospectively included. Two independent, blinded readers rated image quality, depiction of segmental LGE and documented acquisition time, SNR, CNR and amount of LGE. Results were compared using the Friedman or the Kruskal-Wallis test. For LGE rating, a jackknife free-response receiver operating characteristic analysis was performed with a figure of merit (FOM) calculation. Forty-two patients were included, thirty-two were examined with a 1.5 T-scanner and ten patients with a 3 T-scanner. The mean acquisition time of the 2D sequence was significantly shorter compared to the 3D sequence (07:12 min vs. 09:24 min; p < 0.001). The 3D scan time was significantly shorter when performed at 3 T compared to 1.5 T (07:47 min vs. 09:50 min; p < 0.001). There were no differences regarding SNR, CNR or amount of LGE. 3D imaging had a significantly higher FOM (0.89 vs. 0.78; p < 0.001). Overall image quality ratings were similar, but 3D sequence ratings were higher for fine anatomical structures. Free-breathing motion-corrected 3D LGE with high isotropic resolution results in enhanced LGE-detection with higher confidence and better delineation of fine structures. The acquisition time for 3D imaging was longer, but may be reduced by performing on a 3 T-scanner.
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Affiliation(s)
- Alan A Peters
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland.
| | - Benedikt Wagner
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Giancarlo Spano
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Fabian Haupt
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Lukas Ebner
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | | | - Michaela Schmidt
- Cardiovascular MR Predevelopment, Siemens Healthcare GmbH, Erlangen, Germany
| | - Radhouene Neji
- MR Research Collaborations, Siemens Healthcare Limited, Frimley, UK
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, UK
| | - René Botnar
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, UK
| | - Claudia Prieto
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, UK
| | - Bernd Jung
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Andreas Christe
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Christoph Gräni
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Adrian T Huber
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland.
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13
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Primetis E, Drakopoulos D, Sieron D, Meusburger H, Szyluk K, Niemiec P, Obmann VC, Peters AA, Huber AT, Ebner L, Delimpasis G, Christe A. Knee Diameter and Cross-Sectional Area as Biomarkers for Cartilage Knee Degeneration on Magnetic Resonance Images. Medicina (Kaunas) 2022; 59:medicina59010027. [PMID: 36676651 PMCID: PMC9865157 DOI: 10.3390/medicina59010027] [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] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 12/16/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022]
Abstract
Background and Objectives: Osteoarthritis (OA) of the knee is a degenerative disorder characterized by damage to the joint cartilage, pain, swelling, and walking disability. The purpose of this study was to assess whether demographic and radiologic parameters (knee diameters and knee cross-sectional area from magnetic resonance (MR) images) could be used as surrogate biomarkers for the prediction of OA. Materials and Methods: The knee diameters and cross-sectional areas of 481 patients were measured on knee MR images, and the corresponding demographic parameters were extracted from the patients' clinical records. The images were graded based on the modified Outerbridge arthroscopic classification that was used as ground truth. Receiver-operating characteristic (ROC) analysis was performed on the collected data. Results: ROC analysis established that age was the most accurate predictor of severe knee cartilage degeneration (corresponding to Outerbridge grades 3 and 4) with an area under the curve (AUC) of the specificity-sensitivity plot of 0.865 ± 0.02. An age over 41 years was associated with a sensitivity and specificity for severe degeneration of 82.8% (CI: 77.5-87.3%), and 76.4% (CI: 70.4-81.6%), respectively. The second-best degeneration predictor was the normalized knee cross-sectional area, with an AUC of 0.767 ± 0.04), followed by BMI (AUC = 0.739 ± 0.02), and normalized knee maximal diameter (AUC = 0.724 ± 0.05), meaning that knee degeneration increases with increasing knee diameter. Conclusions: Age is the best predictor of knee damage progression in OA and can be used as surrogate marker for knee degeneration. Knee diameters and cross-sectional area also correlate with the extent of cartilage lesions. Though less-accurate predictors of damage progression than age, they have predictive value and are therefore easily available surrogate markers of OA that can be used also by general practitioners and orthopedic surgeons.
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Affiliation(s)
- Elias Primetis
- Department of Radiology SLS, Inselgroup, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010 Bern, Switzerland
| | - Dionysios Drakopoulos
- Department of Radiology SLS, Inselgroup, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010 Bern, Switzerland
| | - Dominik Sieron
- Department of Radiology SLS, Inselgroup, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010 Bern, Switzerland
| | - Hugo Meusburger
- Department of Radiology SLS, Inselgroup, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010 Bern, Switzerland
| | - Karol Szyluk
- Department of Physiotherapy, Faculty of Health Sciences in Katowice, Medical University of Silesia in Katowice, 40-752 Katowice, Poland
- District Hospital of Orthopaedics and Trauma Surgery, Bytomska 62 St., 41-940 Piekary Slaskie, Poland
| | - Paweł Niemiec
- Department of Biochemistry and Medical Genetics, Faculty of Health Sciences in Katowice, Medical University of Silesia in Katowice, 40-752 Katowice, Poland
| | - Verena C. Obmann
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Alan A. Peters
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Adrian T. Huber
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Lukas Ebner
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Georgios Delimpasis
- Department of Radiology SLS, Inselgroup, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010 Bern, Switzerland
| | - Andreas Christe
- Department of Radiology SLS, Inselgroup, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010 Bern, Switzerland
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
- Correspondence:
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14
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Bigler MR, Stark AW, Giannopoulos AA, Huber AT, Siepe M, Kadner A, Räber L, Gräni C. Coronary CT FFR vs Invasive Adenosine and Dobutamine FFR in a Right Anomalous Coronary Artery. JACC Case Rep 2022; 4:929-933. [PMID: 35935159 PMCID: PMC9350890 DOI: 10.1016/j.jaccas.2022.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 05/27/2022] [Accepted: 06/06/2022] [Indexed: 11/29/2022]
Abstract
We present the management of an anomalous coronary artery originating from the opposite sinus of Valsalva with comprehensive diagnostic workup including noninvasive coronary computed tomography (CT) derived fractional flow reserve (FFR) and invasive dobutamine-volume challenge-FFR/intravascular ultrasound. After surgical operation, treatment success was quantified by anatomical and functional analysis in postoperative CT. (Level of Difficulty: Advanced.)
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Affiliation(s)
- Marius R. Bigler
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Anselm W. Stark
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andreas A. Giannopoulos
- Cardiac Imaging, Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
- Cardiology Department, University Hospital Zurich, Zurich, Switzerland
| | - Adrian T. Huber
- Department of Radiology, Inselspital, University Hospital, University of Bern, Bern, Switzerland
| | - Matthias Siepe
- Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Alexander Kadner
- Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Lorenz Räber
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christoph Gräni
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Address for correspondence: Dr. Christoph Gräni, Department of Cardiology, University Hospital Bern, Freiburgstrasse 18, 3010 Bern, Switzerland.
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Wieser M, Wahl A, Huber AT, Susuri-Pfammatter N, Gräni C. Multimodality imaging of eosinophilic endocarditis with intracardiac right ventricular thrombus. Eur Heart J Cardiovasc Imaging 2022; 23:e473. [PMID: 35900252 DOI: 10.1093/ehjci/jeac155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Monika Wieser
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 4, CH-3010 Bern, Switzerland
| | - Andreas Wahl
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 4, CH-3010 Bern, Switzerland
| | - Adrian T Huber
- Department of Diagnostic, Interventional and Paediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 4, CH-3010 Bern, Switzerland
| | - Njomeza Susuri-Pfammatter
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 4, CH-3010 Bern, Switzerland
| | - Christoph Gräni
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 4, CH-3010 Bern, Switzerland
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Gräni C, Stark AW, Fischer K, Fürholz M, Wahl A, Erne SA, Huber AT, Guensch DP, Vollenbroich R, Ruberti A, Dobner S, Heg D, Windecker S, Lanz J, Pilgrim T. Diagnostic performance of cardiac magnetic resonance segmental myocardial strain for detecting microvascular obstruction and late gadolinium enhancement in patients presenting after a ST-elevation myocardial infarction. Front Cardiovasc Med 2022; 9:909204. [PMID: 35911559 PMCID: PMC9329615 DOI: 10.3389/fcvm.2022.909204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 06/30/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundMicrovascular obstruction (MVO) and Late Gadolinium Enhancement (LGE) assessed in cardiac magnetic resonance (CMR) are associated with adverse outcome in patients with ST-elevation myocardial infarction (STEMI). Our aim was to analyze the diagnostic performance of segmental strain for the detection of MVO and LGE.MethodsPatients with anterior STEMI, who underwent additional CMR were enrolled in this sub-study of the CARE-AMI trial. Using CMR feature tracking (FT) segmental circumferential peak strain (SCS) was measured and the diagnostic performance of SCS to discriminate MVO and LGE was assessed in a derivation and validation cohort.ResultsForty-eight STEMI patients (62 ± 12 years old), 39 (81%) males, who underwent CMR (i.e., mean 3.0 ± 1.5 days) after primary percutaneous coronary intervention (PCI) were included. All patients presented with LGE and in 40 (83%) patients, MVO was additionally present. Segments in all patients were visually classified and 146 (19%) segments showed MVO (i.e., LGE+/MVO+), 308 (40%) segments showed LGE and no MVO (i.e., LGE+/MVO–), and 314 (41%) segments showed no LGE (i.e., LGE–). Diagnostic performance of SCS for detecting MVO segments (i.e., LGE+/MVO+ vs. LGE+/MVO–, and LGE–) showed an AUC = 0.764 and SCS cut-off value was –11.2%, resulting in a sensitivity of 78% and a specificity of 67% with a positive predictive value (PPV) of 30% and a negative predictive value (NPV) of 94% when tested in the validation group. For LGE segments (i.e., LGE+/MVO+ and LGE+/MVO– vs. LGE–) AUC = 0.848 and SCS with a cut-off value of –13.8% yielded to a sensitivity of 76%, specificity of 74%, PPV of 81%, and NPV of 70%.ConclusionSegmental strain in STEMI patients was associated with good diagnostic performance for detection of MVO+ segments and very good diagnostic performance of LGE+ segments. Segmental strain may be useful as a potential contrast-free surrogate marker to improve early risk stratification in patients after primary PCI.
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Affiliation(s)
- Christoph Gräni
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- *Correspondence: Christoph Gräni,
| | - Anselm W. Stark
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Kady Fischer
- Department of Anesthesiology and Pain Medicine, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Monika Fürholz
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andreas Wahl
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sophie A. Erne
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Adrian T. Huber
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Dominik P. Guensch
- Department of Anesthesiology and Pain Medicine, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - René Vollenbroich
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andrea Ruberti
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Stephan Dobner
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Dik Heg
- Clinical Trials Unit, University of Bern, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jonas Lanz
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thomas Pilgrim
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Peters AA, Huber AT, Obmann VC, Heverhagen JT, Christe A, Ebner L. Diagnostic validation of a deep learning nodule detection algorithm in low-dose chest CT: determination of optimized dose thresholds in a virtual screening scenario. Eur Radiol 2022; 32:4324-4332. [PMID: 35059804 DOI: 10.1007/s00330-021-08511-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 12/06/2021] [Accepted: 12/09/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVES This study was conducted to evaluate the effect of dose reduction on the performance of a deep learning (DL)-based computer-aided diagnosis (CAD) system regarding pulmonary nodule detection in a virtual screening scenario. METHODS Sixty-eight anthropomorphic chest phantoms were equipped with 329 nodules (150 ground glass, 179 solid) with four sizes (5 mm, 8 mm, 10 mm, 12 mm) and scanned with nine tube voltage/current combinations. The examinations were analyzed by a commercially available DL-based CAD system. The results were compared by a comparison of proportions. Logistic regression was performed to evaluate the impact of tube voltage, tube current, nodule size, nodule density, and nodule location. RESULTS The combination with the lowest effective dose (E) and unimpaired detection rate was 80 kV/50 mAs (sensitivity: 97.9%, mean false-positive rate (FPR): 1.9, mean CTDIvol: 1.2 ± 0.4 mGy, mean E: 0.66 mSv). Logistic regression revealed that tube voltage and current had the greatest impact on the detection rate, while nodule size and density had no significant influence. CONCLUSIONS The optimal tube voltage/current combination proposed in this study (80 kV/50 mAs) is comparable to the proposed combinations in similar studies, which mostly dealt with conventional CAD software. Modification of tube voltage and tube current has a significant impact on the performance of DL-based CAD software in pulmonary nodule detection regardless of their size and composition. KEY POINTS • Modification of tube voltage and tube current has a significant impact on the performance of deep learning-based CAD software. • Nodule size and composition have no significant impact on the software's performance. • The optimal tube voltage/current combination for the examined software is 80 kV/50 mAs.
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Affiliation(s)
- Alan A Peters
- Department of Diagnostic, Interventional and Pediatric Radiology (DIPR), Bern University Hospital, University of Bern, Inselspital Bern, 3010, Switzerland.
| | - Adrian T Huber
- Department of Diagnostic, Interventional and Pediatric Radiology (DIPR), Bern University Hospital, University of Bern, Inselspital Bern, 3010, Switzerland
| | - Verena C Obmann
- Department of Diagnostic, Interventional and Pediatric Radiology (DIPR), Bern University Hospital, University of Bern, Inselspital Bern, 3010, Switzerland
| | - Johannes T Heverhagen
- Department of Diagnostic, Interventional and Pediatric Radiology (DIPR), Bern University Hospital, University of Bern, Inselspital Bern, 3010, Switzerland.,Department of BioMedical Research, Experimental Radiology, University of Bern, 3008, Bern, Switzerland.,Department of Radiology, The Ohio State University, Columbus, OH, USA
| | - Andreas Christe
- Department of Diagnostic, Interventional and Pediatric Radiology (DIPR), Bern University Hospital, University of Bern, Inselspital Bern, 3010, Switzerland
| | - Lukas Ebner
- Department of Diagnostic, Interventional and Pediatric Radiology (DIPR), Bern University Hospital, University of Bern, Inselspital Bern, 3010, Switzerland
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Malebranche D, Hoffner MKM, Huber AT, Cicovic A, Spano G, Bernhard B, Bartkowiak J, Okuno T, Lanz J, Räber L, Praz F, Stortecky S, Windecker S, Pilgrim T, Gräni C. Diagnostic performance of quantitative coronary artery disease assessment using computed tomography in patients with aortic stenosis undergoing transcatheter aortic-valve implantation. BMC Cardiovasc Disord 2022; 22:178. [PMID: 35436856 PMCID: PMC9014581 DOI: 10.1186/s12872-022-02623-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 04/10/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Computed tomography angiography (CTA) is a cornerstone in the pre- transcatheter aortic valve replacement (TAVI) assessment. We evaluated the diagnostic performance of CTA and coronary artery calcium score (CACS) for CAD evaluation compared to invasive coronary angiography in a cohort of TAVI patients. METHODS In consecutive TAVI patients without prior coronary revascularization and device implants, CAD was assessment by quantitative analysis in CTA. (a) Patients with non-evaluable segments were classified as obstructive CAD. (b) In patients with non-evaluable segments a CACS cut-off of 100 was applied for obstructive CAD. The reference standard was quantitative invasive coronary angiography (QCA, i.e. ≥ 50% stenosis). RESULTS 100 consecutive patients were retrospectively included, age was 82.3 ± 6.5 years and 30% of patients had CAD. In 16% of the patients, adequate visualization of the entire coronary tree (all 16 segments) was possible with CTA, while 84% had at least one segment which was not evaluable for CAD analysis due to impaired image quality. On a per-patient analysis, where patients with low image quality were classified as CAD, CTA showed a sensitivity of 100% (95% CI 88.4-100.0), specificity of 11.4% (95% CI 5.1-21.3), PPV of 32.6% (95% CI 30.8-34.5), NPV of 100% and diagnostic accuracy of 38% (95% CI 28.5-48.3) for obstructive CAD. When applying a combined approach of CTA (in patients with good image quality) and CACS (in patients with low image quality), the sensitivity and NPV remained at 100% and obstructive CAD could be ruled out in 20% of the TAVI patients, versus 8% using CTA alone. CONCLUSION In routinely acquired pre-TAVI CTA, the image quality was insufficient in a high proportion of patients for the assessment of the entire coronary artery tree. However, when adding CACS in patients with low image quality to quantitative CTA assessment in patients with good image quality, obstructive CAD could be ruled-out in 1/5 of the patients and may therefore constitute a strategy to streamline pre-procedural workup, and reduce risk, radiation and costs in selected TAVI patients without prior coronary revascularization or device implants.
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Affiliation(s)
- Daniel Malebranche
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland
| | - Maximilian K M Hoffner
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, University of Bern, Bern, Switzerland
| | - Adrian T Huber
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, University of Bern, Bern, Switzerland
| | - Aleksandar Cicovic
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland
| | - Giancarlo Spano
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland
| | - Benedikt Bernhard
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland
| | - Joanna Bartkowiak
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland
| | - Taishi Okuno
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland
| | - Jonas Lanz
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland
| | - Lorenz Räber
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland
| | - Fabien Praz
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland
| | - Stefan Stortecky
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland
| | - Thomas Pilgrim
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland
| | - Christoph Gräni
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland.
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19
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Misura T, Drakopoulos D, Mitrakovic M, Loennfors T, Primetis E, Hoppe H, Obmann VC, Huber AT, Ebner L, Christe A. Avoiding the Intercostal Arteries in Percutaneous Thoracic Interventions. J Vasc Interv Radiol 2022; 33:416-419.e2. [DOI: 10.1016/j.jvir.2021.12.026] [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: 03/23/2021] [Revised: 12/14/2021] [Accepted: 12/16/2021] [Indexed: 11/26/2022] Open
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20
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Galea R, Mahmoudi K, Gräni C, Elhadad S, Huber AT, Heg D, Siontis GCM, Brugger N, Sebag F, Windecker S, Valgimigli M, Landolff Q, Roten L, Amabile N, Räber L. Watchman FLX vs. Watchman 2.5 in a Dual-Center Left Atrial Appendage Closure Cohort: the WATCH-DUAL study. Europace 2022; 24:1441-1450. [PMID: 35253840 DOI: 10.1093/europace/euac021] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [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: 10/27/2021] [Accepted: 02/09/2022] [Indexed: 11/13/2022] Open
Abstract
AIMS No studies have compared Watchman 2.5 (W2.5) with Watchman FLX (FLX) devices to date. We aimed at comparing the FLX with W2.5 devices with respect to clinical outcomes, left atrial appendage (LAA) sealing properties and device-related thrombus (DRT). METHODS AND RESULTS All consecutive left atrial appendage closure (LAAC) procedures performed at two European centres between November 2017 and February 2021 were included. Procedure-related complications and net adverse cardiovascular events (NACE) at 6 months after LAAC were recorded. At 45-day computed tomography (CT) follow-up, intra- (IDL) and peri- (PDL) device leak, residual patent neck area (RPNA), and DRT were assessed by a Corelab. Out of 144 LAAC consecutive procedures, 71 and 73 interventions were performed using W2.5 and FLX devices, respectively. There were no differences in terms of procedure-related complications (4.2% vs. 2.7%, P = 0.626). At 45-day CT, the FLX was associated with lower frequency of IDL [21.3% vs. 40.0%; P = 0.032; odds ratio (OR): 0.375; 95% confidence interval (CI): 0.160-0.876; P = 0.024], similar rate of PDL (29.5% vs. 42.0%; P = 0.170), and smaller RPNA [6 (0-36) vs. 40 (6-115) mm2; P = 0.001; OR: 0.240; 95% CI: 0.100-0.577; P = 0.001] compared with the W2.5 group. At 45 days, rate of DRT as detected by CT and/or transoesophageal echocardiography (TOE), was higher with W2.5 (6.0% vs. 0%, P = 0.045). At 6-month follow-up, NACE did not differ between groups. CONCLUSIONS In this cohort of consecutive LAACs, FLX as compared to W2.5, was associated with similar procedure-related complications and 6-month NACE, but with improved LAA neck coverage, and lower IDL and DRT.
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Affiliation(s)
- Roberto Galea
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern CH-3010, Switzerland
| | - Khalil Mahmoudi
- Department of Cardiology, Institut Mutualiste Montsouris, Paris, France
| | - Christoph Gräni
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern CH-3010, Switzerland
| | - Simon Elhadad
- Department of Cardiology, Institut Mutualiste Montsouris, Paris, France.,Cardiology Department, Jossigny, France
| | - Adrian T Huber
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern CH-3010, Switzerland
| | - Dik Heg
- Clinical Trials Unit, University of Bern, Bern, Switzerland
| | - George C M Siontis
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern CH-3010, Switzerland
| | - Nicolas Brugger
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern CH-3010, Switzerland
| | - Frederic Sebag
- Department of Cardiology, Institut Mutualiste Montsouris, Paris, France
| | - Stephan Windecker
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern CH-3010, Switzerland
| | - Marco Valgimigli
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern CH-3010, Switzerland.,Cardiocentro Ticino, Institute and Università della Svizzera Italiana (USI), Lugano, Switzerland
| | - Quentin Landolff
- Department of Cardiology, Institut Mutualiste Montsouris, Paris, France
| | - Laurent Roten
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern CH-3010, Switzerland
| | - Nicolas Amabile
- Department of Cardiology, Institut Mutualiste Montsouris, Paris, France
| | - Lorenz Räber
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern CH-3010, Switzerland
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Bernhard B, Grogg H, Zurkirchen J, Demirel C, Hagemeyer D, Okuno T, Brugger N, De Marchi S, Huber AT, Berto MB, Spano G, Stortecky S, Windecker S, Pilgrim T, Gräni C. Reproducibility of 4D cardiac computed tomography feature tracking myocardial strain and comparison against speckle-tracking echocardiography in patients with severe aortic stenosis. J Cardiovasc Comput Tomogr 2022; 16:309-318. [DOI: 10.1016/j.jcct.2022.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 01/20/2022] [Accepted: 01/22/2022] [Indexed: 10/19/2022]
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22
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Fischer K, Linder OL, Erne SA, Stark AW, Obrist SJ, Bernhard B, Guensch DP, Huber AT, Kwong RY, Gräni C. Reproducibility and its confounders of CMR feature tracking myocardial strain analysis in patients with suspected myocarditis. Eur Radiol 2021; 32:3436-3446. [PMID: 34932165 PMCID: PMC9038796 DOI: 10.1007/s00330-021-08416-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 08/23/2021] [Accepted: 10/14/2021] [Indexed: 12/13/2022]
Abstract
Objectives Cardiovascular magnetic resonance feature tracking (CMR-FT) is an emerging technique for assessing myocardial strain with valuable diagnostic and prognostic potential. However, the reproducibility of biventricular CMR-FT analysis in a large cardiovascular population has not been assessed. Also, evidence of confounders impacting reader reproducibility for CMR-FT in patients is unknown and currently limits the clinical implementation of this technique. Methods From a dual-center database of patients referred to CMR for suspected myocarditis, 125 patients were randomly selected to undergo biventricular CMR-FT analysis for 2-dimensional systolic and diastolic measures, with additional 3-dimensional analysis for the left ventricle. All image analysis was replicated by a single reader and by a second reader for intra- and inter-reader analysis (Circle Cardiovascular Imaging). Reliability was tested with intraclass correlation (ICC) tests, and the impact of imaging confounders on agreement was assessed through multivariable analysis. Results Left and right ventricular ejection fractions were reduced in 34% and 37% of the patients, respectively. Good to excellent reliability was shown for 2D (all ICC > 0.85) and 3D (all ICC > 0.70) peak strain and early diastolic strain rate for both ventricles in longitudinal orientation as well as circumferential orientations for the left ventricle. An increased slice number improved agreement while the presence of pericardial effusion compromised diastolic strain rate agreement, and arrhythmia compromised right ventricular agreement. Conclusion In a large clinical cohort, we could show CMR-FT yields excellent inter-reader and intra-reader reproducibility. Multi-parametric CMR-FT of the right and left ventricles appears to be a robust tool in cardiovascular patients referred to CMR. Clinical trial registration. ClinicalTrials.gov Identifier: NCT03470571, NCT04774549. Key Points • Cardiovascular magnetic resonance feature tracking (CMR-FT) is an emerging technique to measure myocardial strain in cardiovascular patients referred for CMR; however, the evaluation of its reproducibility in a large cohort has not yet been performed. • In a large clinical cohort, CMR-FT yields excellent inter-reader and intra-reader reproducibility for both left and right ventricular systolic and diastolic parameters. • Arrhythmia and pericardial effusion compromise agreement of select FT parameters, but poor ejection fraction does not. Supplementary Information The online version contains supplementary material available at 10.1007/s00330-021-08416-5.
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Affiliation(s)
- Kady Fischer
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Olivier L Linder
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sophie A Erne
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Anselm W Stark
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sarah J Obrist
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Benedikt Bernhard
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Dominik P Guensch
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Adrian T Huber
- Department of Diagnostic, Interventional and Paediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Raymond Y Kwong
- Department of Medicine, Non-Invasive Cardiovascular Imaging, Brigham and Women's Hospital, Harvard Medical School, Cardiovascular Division, Boston, MA, USA
| | - Christoph Gräni
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
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Peters AA, Abbuehl H, Spano G, Graeni C, Huber AT. Chronic occluded coronary aneurysm as a complication of Kawasaki disease: a long-term follow-up. J Cardiovasc Med (Hagerstown) 2021; 22:e47-e48. [PMID: 34494604 DOI: 10.2459/jcm.0000000000001244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Alan A Peters
- Department of Diagnostic, Interventional and Pediatric Radiology
| | - Heidi Abbuehl
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Giancarlo Spano
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christoph Graeni
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Adrian T Huber
- Department of Diagnostic, Interventional and Pediatric Radiology
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24
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Galea R, De Marco F, Meneveau N, Aminian A, Anselme F, Gräni C, Huber AT, Teiger E, Iriart X, Babongo Bosombo F, Heg D, Franzone A, Vranckx P, Fischer U, Pedrazzini G, Bedogni F, Räber L, Valgimigli M. Amulet or Watchman Device for Percutaneous Left Atrial Appendage Closure: Primary Results of the SWISS-APERO Randomized Clinical Trial. Circulation 2021; 145:724-738. [PMID: 34747186 DOI: 10.1161/circulationaha.121.057859] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [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] [Indexed: 12/29/2022]
Abstract
Background: No study has so far compared Amulet with the new Watchman FLX in terms of residual left atrial appendage (LAA) patency or clinical outcomes in patients undergoing percutaneous LAA closure (LAAC). Methods: In the investigator-initiated SWISS APERO trial, patients undergoing LAAC were randomized (1:1) open-label to receive Amulet or Watchman 2.5 or FLX (Watchman) across 8 European centres. The primary endpoint was the composite of justified crossover to a non-randomized device during LAAC procedure or residual LAA patency detected by cardiac computed tomography angiography (CCTA) at 45 days. The secondary endpoints included procedural complications, device related thrombus (DRT), peridevice leak (PDL) at transesophageal echocardiography (TEE) and clinical outcomes at 45 days. Results: Between June 2018, and May 2021, 221 patients were randomly assigned to Amulet (111 [50.2%]) or Watchman (110 [49.8%]), of whom 25 (22.7%) patients included before October 2019 received Watchman 2.5, and 85 (77.3%) patients received Watchman FLX. The primary endpoint was assessable in 205 (92.8%) patients and occurred in 71 (67.6%) Amulet and 70 (70.0%) Watchman patients respectively (risk ratio [RR] 0.97 [95% CI 0.80- 1.16]; P=0.713). A single justified cross-over occurred in an Amulet patient who fulfilled LAA patency criteria at 45-day CCTA. Major procedure related complications occurred more frequently in the Amulet group (9.0% vs. 2.7%; P=0.047), owing to more frequent bleeding (7.2% vs.1.8%). At 45 days, the PDL rate at TEE was higher with Watchman than Amulet (27.5% vs. 13.7%, p=0.020), albeit none was major (i.e. > 5 mm), whereas DRT was detected in 1 (0.9%) patient with Amulet and 3 (3.0%) patients with Watchman at CCTA and in 2 (2.1%) and 5 (5.5%) patients at TEE, respectively. Clinical outcomes at 45 days did not differ between the groups. Conclusions: Amulet was not associated with lower rate of the composite of crossover or residual LAA patency compared with Watchman at 45-day CCTA. Amulet, was however associated with lower PDL rates at TEE, higher procedural complications and similar clinical outcomes at 45 days compared with Watchman. The clinical relevance of CCTA-detected LAA patency requires further investigation. Clinical Trial Registration: URL https://clinicaltrials.gov Unique Identifier NCT03399851.
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Affiliation(s)
- Roberto Galea
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Federico De Marco
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Nicolas Meneveau
- Besancon University Hospital, EA3920, University of Burgundy Franche-Comté, Besancon, France
| | - Adel Aminian
- Department of Cardiology, Centre Hospitalier Universitaire de Charleroi, Charleroi, Belgium
| | - Frédéric Anselme
- Department of Cardiology, University Hospital of Rouen, Rouen, France
| | - Christoph Gräni
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Adrian T Huber
- Department of Diagnostic, Interventional and Pediatric Radiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Emmanuel Teiger
- Department of Cardiology, Henri-Mondor Hospital, Public Assistance Hospitals of Paris, Créteil, France
| | - Xavier Iriart
- Department of Pediatric and Adult Congenital Cardiology, Hôpital Cardiologique du Haut- Lévêque, CHU de Bordeaux, Bordeaux-Pessac, France
| | - Flora Babongo Bosombo
- Department of Clinical Research, Clinical Trials Unit and Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Dik Heg
- Department of Clinical Research, Clinical Trials Unit and Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Anna Franzone
- Department of Advanced Biomedical Sciences, University Federico II University, Naples, Italy
| | - Pascal Vranckx
- Department of Cardiology and Critical Care Medicine, Hartcentrum Hasselt, Jessa Ziekenhuis, Hasselt, Belgium; Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Urs Fischer
- Department of Neurology, Bern University Hospital, University of Bern, Bern, Switzerland and Department of Neurology, University Hospital Basel, University of Basel, Switzerland
| | - Giovanni Pedrazzini
- Cardiocentro Ticino Institute and Università della Svizzera Italiana (USI), Lugano, Switzerland
| | - Francesco Bedogni
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Lorenz Räber
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Marco Valgimigli
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland; Cardiocentro Ticino Institute and Università della Svizzera Italiana (USI), Lugano, Switzerland
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Bigler MR, Spano G, Boscolo Berto M, Ueki Y, Otsuka T, Huber AT, Raeber L, Graeni C. Comprehensive non-invasive and invasive functional assessment of anomalous coronary arteries with anatomical high-risk features. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1839] [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] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Anomalous aortic origin of a coronary artery (AAOCA) is a rare congenital disease associated with an increased risk of myocardial ischemia. In AAOCA, the occurrence of ischemia is based on the extent of a fixed and a dynamic component, each attributed to different anatomical high-risk features (i.e., acute take-off angle, slit-like ostium, proximal narrowing, elliptic vessel shape and intramural course). Coronary computed tomography angiography (CCTA) is the primary non-invasive imaging method to depict the presence and quantitatively assess anatomical high-risk features while invasive physiologic evaluation under maximal dobutamine-volume challenge is the gold standard to unravel the hemodynamic relevance of AAOCA.
Methods
We included all consecutive AAOCA patients with anatomical high-risk features from our prospective, open-label registry. The objective is to quantify anatomical high-risk features in the CCTA and to measure hemodynamic relevance using invasive fractional flow reserve with maximal dobutamine-volume challenge (gradually increasing dose of dobutamine max. 40 μg/kg per body weight/min, max. 3000 mL ringer lactate and max. 1mg atropine). Pathological invasive FFR was defined as FFR Dobutamine<0.80. Additionally, CCTA-data were processed to assess computational fluid dynamics (CT FFR) and intravascular ultrasound (IVUS) was used to determine minimal lumen area (MLA) during baseline and maximal stress conditions.
Results
A total of 11 patients were included between 05/19 and 11/2020. Mean age was 59±13 years (range: 40–79), 10 patients showed a right-AAOCA and one patient showed a single right coronary artery. All patients had either one (i.e., in 1 patient) or more than one anatomical-high risk features (i.e., in 10 patients). Mean invasive FFR Dobutamine was 0.88±0.07 with n=2 (18%) being pathological. Mean non-invasive CT FFR was 0.89±0.04 (FFR<0.80; n=0), mean invasive FFR Adenosine was 0.92±0.06 (FFR<0.80; n=1; 9%). There was a significant decrease in IVUS MLA between rest (7.93±2.79mm2) and under dobutamine-volume challenge (6.57±3.20mm2, p=0.008). Mean percentage of MLA reduction was 19±18%.
Conclusion
Our preliminary results provide evidence that relevant myocardial ischemia seems to be often absent in a middle-aged population with AAOCA and anatomical high-risk features. However, in a minority of cases hemodynamic relevance could be depicted, especially when stressing with dobutamine-volume challenge. The presence of a dynamic component in AAOCA is represented by the reduced minimal lumen area under stress conditions. Comprehensive diagnostic evaluation should be performed to prevent unnecessary guideline recommended open-heart surgery in a middle-aged population with AAOCA.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- M R Bigler
- Bern University Hospital, Inselspital, Bern, Switzerland
| | - G Spano
- Bern University Hospital, Inselspital, Bern, Switzerland
| | | | - Y Ueki
- Bern University Hospital, Inselspital, Bern, Switzerland
| | - T Otsuka
- Bern University Hospital, Inselspital, Bern, Switzerland
| | - A T Huber
- Bern University Hospital, Inselspital, Bern, Switzerland
| | - L Raeber
- Bern University Hospital, Inselspital, Bern, Switzerland
| | - C Graeni
- Bern University Hospital, Inselspital, Bern, Switzerland
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Wild MG, Gloeckler M, Wustmann KB, Erne SA, Grogg H, Huber AT, Windecker S, Praz F, Gräni C. Multimodality Imaging for Evaluation of Bicaval Valved Stent Implantation in Severe Tricuspid Regurgitation. JACC Case Rep 2021; 3:1512-1518. [PMID: 34746850 PMCID: PMC8551505 DOI: 10.1016/j.jaccas.2021.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 06/22/2021] [Accepted: 07/12/2021] [Indexed: 11/10/2022]
Abstract
Preprocedural planning and postprocedural evaluation after transcatheter treatment of severe tricuspid regurgitation remain challenging and require further research and standardization. We illustrate the use of multimodality imaging techniques in 3 patients undergoing implantation of a novel custom-made bicaval valved stent for symptomatic treatment of severe tricuspid regurgitation. (Level of Difficulty: Advanced.).
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Affiliation(s)
- Mirjam G. Wild
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Martin Gloeckler
- Department of Cardiology, Center for Congenital Heart Disease, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Kerstin B. Wustmann
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sophie A. Erne
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Hanna Grogg
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Adrian T. Huber
- Department of Diagnostic, Interventional, and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Fabien Praz
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christoph Gräni
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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27
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Obmann VC, Bickel F, Hosek N, Ebner L, Huber AT, Damonti L, Zimmerli S, Christe A. Radiological CT Patterns and Distribution of Invasive Pulmonary Aspergillus, Non-Aspergillus, Cryptococcus and Pneumocystis Jirovecii Mold Infections - A Multicenter Study. ROFO-FORTSCHR RONTG 2021; 193:1304-1314. [PMID: 34034346 DOI: 10.1055/a-1482-8336] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE Clinical signs and symptoms related to invasive fungal disease are nonspecific and need to be followed up by appropriate diagnostic procedures. The goal of this study was to analyze CT imaging patterns in invasive fungal infections and their correlation with the immune status and clinical outcome. MATERIALS AND METHODS We performed a retrospective multicenter study including 85 consecutive patients with invasive pulmonary fungal infection (2011-2014). Lung patterns on computed tomography (CT) scans were classified according to the Fleischner Society glossary. The patients were grouped according to immune status (neutropenia, steroid therapy, organ transplant recipient, and other cause) and outcome (positive outcome, progressive disease, and death). The Chi square test or Fisher exact test was used. Bonferroni correction was applied. RESULTS The total number of patients with invasive Aspergillus and non-Aspergillus infection (IANA), Pneumocystis jirovecii pneumonia (PCP), and Cryptococcus (CRY) was 60, 22, and 3, respectively. Patients with IANA demonstrated significantly more nodules (93 % vs. 59 %, p = 0.001), significantly fewer ground glass opacities (58 % vs. 96 %, p = 0.005), and significantly fewer positive lymph nodes (5 % vs. 41 %, p < 0.001) than patients with PCP. All patients with PCP and CRY had a favorable outcome. Patients with IANA and an adverse outcome demonstrated significantly more nodules with halo sign than patients with IANA and a favorable outcome (42.5 % vs. 15.9 %, p < 0.0001). Interestingly, patients with IANA and a favorable outcome had a higher prevalence of pulmonary infarction than patients with an adverse outcome (8 % vs. 1 %, p = 0.047). Patients with neutropenia showed significantly more consolidations (66 %) than organ transplant recipients (27 %, p = 0.045). CONCLUSION Patients with IANA showed a higher prevalence of nodules and a lower prevalence of ground glass opacities than patients with PCP. In patients with IANA, nodules with halo sign were associated with an adverse outcome. Patients with neutropenia showed generally more consolidations, but the consolidations were not associated with an adverse outcome. KEY POINTS · Nodules, ground glass opacities, and consolidations are common CT findings in all invasive pulmonary fungal infections.. · There is no pattern that is unique for one specific pathogen, although nodules are more predominant in IANA and Cryptococcus, and ground glass opacities are more predominant in PCP patients.. · Immune status had an impact on CT findings in fungal pneumonia with less consolidation in patients after organ transplantation compared to patients with neutropenia.. · Nodules with a halo sign are associated with a worse outcome.. CITATION FORMAT · Obmann VC, Bickel F, Hosek N et al. Radiological CT Patterns and Distribution of Invasive Pulmonary Aspergillus, Non-Aspergillus, Cryptococcus and Pneumocystis Jirovecii Mold Infections - A Multicenter Study. Fortschr Röntgenstr 2021; DOI: 10.1055/a-1482-8336.
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Affiliation(s)
- Verena C Obmann
- Department of Interventional, Pediatric and Diagnostic Radiology, Inselspital, University of Bern, Switzerland
| | - Flurina Bickel
- Department of Interventional, Pediatric and Diagnostic Radiology, Inselspital, University of Bern, Switzerland
| | - Nicola Hosek
- Department of Interventional, Pediatric and Diagnostic Radiology, Inselspital, University of Bern, Switzerland
| | - Lukas Ebner
- Department of Interventional, Pediatric and Diagnostic Radiology, Inselspital, University of Bern, Switzerland
| | - Adrian T Huber
- Department of Interventional, Pediatric and Diagnostic Radiology, Inselspital, University of Bern, Switzerland
| | - Lauro Damonti
- Department of Infectious Diseases, Inselspital, University of Bern, Switzerland
| | - Stefan Zimmerli
- Department of Infectious Diseases, Inselspital, University of Bern, Switzerland
| | - Andreas Christe
- Department of Interventional, Pediatric and Diagnostic Radiology, Inselspital, University of Bern, Switzerland
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Fürholz M, Gisler F, Hunziker L, Huber AT, Gräni C. Posture dependent dynamic external outflow graft compression in HeartMate 3TM left ventricular assist device. Eur Heart J 2021; 42:205. [PMID: 32372100 DOI: 10.1093/eurheartj/ehaa362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 03/29/2020] [Accepted: 04/17/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Monika Fürholz
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 4, CH-3010 Bern, Switzerland
| | - Fabian Gisler
- Department of Cardiac Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Lukas Hunziker
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 4, CH-3010 Bern, Switzerland
| | - Adrian T Huber
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, University of Bern, Bern, Switzerland
| | - Christoph Gräni
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 4, CH-3010 Bern, Switzerland
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29
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Galea R, De Marco F, Aminian A, Meneveau N, Anselme F, Gräni C, Huber AT, Teiger E, Iriart X, Angelillis M, Brugger N, Spirito A, Corpataux N, Franzone A, Vranckx P, Fischer U, Pedrazzini G, Bedogni F, Windecker S, Räber L, Valgimigli M. Design and Rationale of the Swiss-Apero Randomized Clinical Trial: Comparison of Amplatzer Amulet vs Watchman Device in Patients Undergoing Left Atrial Appendage Closure. J Cardiovasc Transl Res 2021; 14:930-940. [PMID: 33884564 DOI: 10.1007/s12265-020-10095-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 12/16/2020] [Indexed: 12/29/2022]
Abstract
Residual or newly acquired leaks are routinely appraised after left atrial appendage closure (LAAC). The Watchman and the Amulet are the two most frequently used devices for LAAC but no randomized study has so far assessed their comparative leak rates after intervention. The "Comparison of Amplatzer Amulet vs Watchman devices in patients undergoing left atrial appendage closure" (Swiss-Apero, clinicaltrial.gov NCT03399851) is an academic-sponsored multicenter, randomized clinical trial comparing Amulet versus Watchman/FLX devices among patients undergoing a clinically indicated LAAC. The study is designed to assess the superiority of Amulet vs. Watchman/FLX in terms of leaks detected by cardiac computed tomography angiography (CCTA) at 45 days (primary endpoint) and 13 months (secondary endpoint) after intervention by an imaging Core Laboratory. The Swiss-Apero study is the first randomized clinical trial comparing Amulet and Watchman/FLX with respect to the prevalence of post-procedural leak as assessed with CCTA.
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Affiliation(s)
- Roberto Galea
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Federico De Marco
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Adel Aminian
- Department of Cardiology, Centre Hospitalier Universitaire de Charleroi, Charleroi, Belgium
| | - Nicolas Meneveau
- Besancon University Hospital, EA3920, University of Burgundy Franche-Comté, Besancon, France
| | - Frederic Anselme
- Department of Cardiology, University Hospital of Rouen, Rouen, France
| | - Christoph Gräni
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Adrian T Huber
- Department of Diagnostic, Interventional and Pediatric Radiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Emmanuel Teiger
- Department of Cardiology, Henri-Mondor Hospital, Public Assistance Hospitals of Paris, Créteil, France
| | - Xavier Iriart
- Department of Pediatric and Adult Congenital Cardiology, Hôpital Cardiologique du Haut- Lévêque, CHU de Bordeaux, Bordeaux-Pessac, France
| | - Marco Angelillis
- Cardiac Thoracic and Vascular Department, University of Pisa, Pisa, Italy
| | - Nicolas Brugger
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Alessandro Spirito
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Noé Corpataux
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Anna Franzone
- Department of Advanced Biomedical Sciences, University Federico II University, Naples, Italy
| | - Pascal Vranckx
- Department of Cardiology and Critical Care Medicine, Hartcentrum Hasselt, Jessa Ziekenhuis, Hasselt, Belgium.,Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Urs Fischer
- Department of Neurology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Giovanni Pedrazzini
- Cardiocentro Ticino, Via Tesserete 48, 6900, Lugano, Switzerland.,Department of Biomedical Sciences, University of Italian Switzerland, 6900, Lugano, Switzerland
| | - Francesco Bedogni
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Lorenz Räber
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Marco Valgimigli
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland. .,Cardiocentro Ticino, Via Tesserete 48, 6900, Lugano, Switzerland.
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30
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Bollache E, Huber AT, Lamy J, Afari E, Bacoyannis TM, De Cesare A, Bravetti M, Giron A, Rigolet A, Allenbach Y, Cluzel P, Benveniste O, Kerneis M, Redheuil A, Kachenoura N. T1 mapping-derived signature of myocardial involvement in idiopathic inflammatory myopathy compared to acute viral myocarditis: a texture-based analysis. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.314] [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] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background. Recent studies revealed the ability of MRI T1 mapping to characterize myocardial involvement in both idiopathic inflammatory myopathy (IIM) and acute viral myocarditis (AVM), as compared to healthy controls. However, neither myocardial T1 nor T2 maps were able to discriminate between IIM and AVM patients, when considering conventional myocardial mean values and derived indices such as lambda and extracellular volume.
Purpose. To investigate the ability of T1 mapping-derived texture analysis to differentiate IIM from AVM.
Methods. Forty patients, 20 with IIM (51 ± 17 years, 9 men) and 20 with AVM (34 ± 13 years, 16 men) underwent 1.5T MRI T1 mapping using a modified Look-Locker inversion-recovery sequence before and 15 minutes after injection of a gadolinium contrast agent. After manual delineation of endocardial and epicardial borders and co-registration of all inversion time images, native and post-contrast T1 maps were estimated. Myocardial texture analysis was performed on native T1 maps. Textural features such as: autocorrelation, contrast, dissimilarity, energy and sum entropy were used to build a least squares-based linear regression model. Finally, receiver operating characteristic (ROC) analysis was used to investigate the ability of such texture features score to classify IIM vs. AVM patients, compared to the performance of mean myocardial T1. A Wilcoxon rank-sum test was also used to test difference significance between groups.
Results. Both native and post-contrast mean myocardial T1 values were comparable between IIM (native: 1022 ± 43 ms; post-contrast: 319 ± 44 ms) and AVM (1056 ± 59 ms, p = 0.07; 318 ± 35 ms, p = 0.90, respectively) groups. Results of ROC analyses are provided in the Table, indicating that a better discrimination between IIM and AVM patients was obtained when using texture features, with higher AUC and accuracy than mean T1 values (Figure).
Conclusion. Texture analysis derived from MRI T1 maps without contrast agent injection was able to discriminate between IIM and AVM with higher accuracy, sensitivity and specificity than conventional T1 indices. Such analysis could provide a useful myocardial signature to help diagnose and manage cardiac alterations associated with IIM in patients presenting with myocarditis and primarily suspected of AVM.
Table Area under curve (AUC) Accuracy Sensitivity Specificity Native T1 0.67 0.70 0.65 0.75 Post-contrast T1 0.49 0.60 0.25 0.95 Texture features score 0.85 0.82 0.90 0.75 ROC analyses for classification between IIM and AVM patients Abstract Figure
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Affiliation(s)
- E Bollache
- Sorbonne Universite, CNRS, INSERM, Paris, France
| | - AT Huber
- Sorbonne Universite, CNRS, INSERM, Paris, France
| | - J Lamy
- Yale University, Department of Radiology and Biomedical Imaging, New Haven, United States of America
| | - E Afari
- Sorbonne Universite, CNRS, INSERM, Paris, France
| | | | - A De Cesare
- Sorbonne Universite, CNRS, INSERM, Paris, France
| | - M Bravetti
- Sorbonne Universite, CNRS, INSERM, Paris, France
| | - A Giron
- Sorbonne Universite, CNRS, INSERM, Paris, France
| | - A Rigolet
- Hospital Pitie-Salpetriere, Department of Cardiovascular and Thoracic Imaging, Paris, France
| | - Y Allenbach
- Hospital Pitie-Salpetriere, Department of Internal Medicine, Paris, France
| | - P Cluzel
- Hospital Pitie-Salpetriere, Department of Interventional Radiology, Paris, France
| | - O Benveniste
- Hospital Pitie-Salpetriere, Department of Internal Medicine, Paris, France
| | - M Kerneis
- Hospital Pitie-Salpetriere, Department of Cardiology, Institute of Cardiology, Paris, France
| | - A Redheuil
- Hospital Pitie-Salpetriere, Department of Cardiovascular and Thoracic Imaging, Paris, France
| | - N Kachenoura
- Sorbonne Universite, CNRS, INSERM, Paris, France
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31
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Spano G, Fischer K, Maillat C, Vicario G, Huber AT, Gräni C. Delayed isolated peri-myocarditis in a Covid-19 patient with respiratory symptoms but without lung involvement. Int J Cardiovasc Imaging 2020; 36:2279-2280. [PMID: 32725422 PMCID: PMC7385195 DOI: 10.1007/s10554-020-01943-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 07/18/2020] [Indexed: 12/02/2022]
Affiliation(s)
| | | | - Cédric Maillat
- Hopital du Jura Bernois St. Imier, Saint-Imier, Switzerland
| | - Grégory Vicario
- Bern University Hospital, Bern, Switzerland.,Hopital du Jura Bernois St. Imier, Saint-Imier, Switzerland
| | | | - Christoph Gräni
- Bern University Hospital, Bern, Switzerland. .,University Hospital Bern, University of Bern, Bern, Switzerland.
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32
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Bigler MR, Ueki Y, Otsuka T, Huber AT, Kadner A, Räber L, Gräni C. Discrepancy Between SPECT and Dobutamine FFR in Right Anomalous Coronary Artery Undergoing Unroofing. Ann Thorac Surg 2020; 110:e569. [PMID: 32707198 DOI: 10.1016/j.athoracsur.2020.05.128] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 05/17/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Marius R Bigler
- Department of Cardiology, University Hospital Bern, Bern, Switzerland
| | - Yasushi Ueki
- Department of Cardiology, University Hospital Bern, Bern, Switzerland
| | - Tatsuhiko Otsuka
- Department of Cardiology, University Hospital Bern, Bern, Switzerland
| | - Adrian T Huber
- Department of Radiology, University Hospital Bern, Bern, Switzerland
| | - Alexander Kadner
- Department of Cardiac Surgery, University Hospital Bern, Bern, Switzerland
| | - Lorenz Räber
- Department of Cardiology, University Hospital Bern, Bern, Switzerland
| | - Christoph Gräni
- Department of Cardiology, University Hospital Bern, Bern, Switzerland.
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Fischer K, Obrist SJ, Erne SA, Stark AW, Marggraf M, Kaneko K, Guensch DP, Huber AT, Greulich S, Aghayev A, Steigner M, Blankstein R, Kwong RY, Gräni C. Feature Tracking Myocardial Strain Incrementally Improves Prognostication in Myocarditis Beyond Traditional CMR Imaging Features. JACC Cardiovasc Imaging 2020; 13:1891-1901. [PMID: 32682718 DOI: 10.1016/j.jcmg.2020.04.025] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 04/20/2020] [Accepted: 04/21/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVES This study investigated the association of cardiovascular cardiac magnetic resonance (CMR) feature tracking (FT) with outcome in a patient cohort with myocarditis and evaluated the possible incremental prognostic benefit beyond clinical features and traditional CMR features. BACKGROUND CMR is used to diagnose and risk stratify patients with myocarditis. CMR-FT allows quantitative strain analysis of myocardial function; however, its prognostic benefit in myocarditis is unknown. METHODS Consecutive patients with clinically suspected myocarditis and presence of midmyocardial or epicardial late gadolinium enhancement (LGE) and/or myocardial edema in CMR were included. Clinical and CMR features were analyzed with regard to major adverse cardiovascular events (MACE) (i.e., hospitalization for heart failure, sustained ventricular tachycardia, and all-cause mortality). RESULTS Of 740 patients with clinically suspected myocarditis, 455 (61%) met our final diagnostic criteria based on CMR tissue characterization. At a median follow-up of 3.9 years, MACE occurred in 74 (16%) patients. In the univariable analysis, CMR-FT global longitudinal peak strain (GLS) was significantly associated with MACE. In a multivariable model adjusting for clinical variables (age, sex, body mass index, and acuteness of symptoms) and traditional CMR features (left ventricular ejection fraction [LVEF] and LGE extent), GLS remained independently associated with outcome (GLS hazard ratio: 1.21; 95% confidence interval: 1.08 to 1.36; p = 0.001) and incrementally improved prognostication (chi-square increases from 42.6 to 79.8 to 88.5; p < 0.001). CONCLUSIONS Myocardial strain using CMR-FT provides independent and incremental prognostic value over clinical features, LVEF, and LGE in patients with myocarditis. CMR-FT may serve as a novel marker to improve risk stratification in myocarditis. (CMR Features in Patients With Suspected Myocarditis [CMRMyo]; NCT03470571).
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Affiliation(s)
- Kady Fischer
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sarah J Obrist
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sophie A Erne
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Anselm W Stark
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Maximilian Marggraf
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Kyoichi Kaneko
- Non-invasive Cardiovascular Imaging, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Dominik P Guensch
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Department of Diagnostic, Interventional and Paediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Adrian T Huber
- Department of Diagnostic, Interventional and Paediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Simon Greulich
- Department of Cardiology and Angiology, University of Tübingen, Tübingen, Germany
| | - Ayaz Aghayev
- Non-invasive Cardiovascular Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Michael Steigner
- Non-invasive Cardiovascular Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ron Blankstein
- Non-invasive Cardiovascular Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Raymond Y Kwong
- Non-invasive Cardiovascular Imaging, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Christoph Gräni
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Non-invasive Cardiovascular Imaging, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
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Gräni C, Fischer K, Obrist SJ, Erne SA, Stark AW, Kaneko K, Guensch DP, Huber AT, Greulich S, Aghayev A, Steigner ML, Blankstein R, Kwong RY. FEATURE TRACKING MYOCARDIAL STRAIN INCREMENTALLY IMPROVES PROGNOSTICATION IN MYOCARDITIS BEYOND TRADITIONAL CMR FEATURES. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)32199-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Fischer K, Marggraf M, Stark AW, Kaneko K, Aghayev A, Guensch DP, Huber AT, Steigner M, Blankstein R, Reichlin T, Windecker S, Kwong RY, Gräni C. Association of ECG parameters with late gadolinium enhancement and outcome in patients with clinical suspicion of acute or subacute myocarditis referred for CMR imaging. PLoS One 2020; 15:e0227134. [PMID: 31923225 PMCID: PMC6953836 DOI: 10.1371/journal.pone.0227134] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 09/13/2019] [Accepted: 12/11/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Risk stratification of myocarditis is challenging due to variable clinical presentations. Cardiovascular magnetic resonance (CMR) is the primary non-invasive imaging modality to investigate myocarditis while electrocardiograms (ECG) are routinely included in the clinical work-up. The association of ECG parameters with CMR tissue characterisation and their prognostic value were investigated in patients with clinically suspected myocarditis. METHODS AND RESULTS Consecutive patients with suspected myocarditis who underwent CMR and ECG were analysed. Major adverse cardiovascular event (MACE) included all-cause death, hospitalisation for heart failure, heart transplantation, documented sustained ventricular arrhythmia, or recurrent myocarditis. A total of 587 patients were followed for a median of 3.9 years. A wide QRS-T angle, low voltage and fragmented QRS were significantly associated with late gadolinium enhancement. Further, a wide QRS-T angle, low voltage and prolonged QTc duration were associated with MACE in the univariable analysis. In a multivariable model, late gadolinium enhancement (HR: 1.90, 95%CI: 1.17-3.10; p = 0.010) and the ECG parameters of a low QRS voltage (HR: 1.86, 95%CI: 1.01-3.42; p = 0.046) and QRS-T-angle (HR: 1.01, 95%CI: 1.00-1.01; p = 0.029) remained independently associated with outcome. The cumulative incidence of MACE was incrementally higher when findings of both CMR and ECG were abnormal (p<0.001). CONCLUSION In patients with clinically suspected myocarditis, abnormal ECG parameters are associated with abnormal tissue characteristics detected by CMR. Further, ECG and CMR findings have independent prognostic implications for morbidity and mortality. Integrating both exams into clinical decision-making may play a role in risk stratification in this heterogeneous patient population.
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Affiliation(s)
- Kady Fischer
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Maximilian Marggraf
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Anselm W. Stark
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Kyoichi Kaneko
- Non-invasive Cardiovascular Imaging, Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Ayaz Aghayev
- Non-invasive Cardiovascular Imaging, Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Dominik P. Guensch
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Diagnostic, Interventional and Paediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Adrian T. Huber
- Department of Diagnostic, Interventional and Paediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Michael Steigner
- Non-invasive Cardiovascular Imaging, Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Ron Blankstein
- Non-invasive Cardiovascular Imaging, Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Tobias Reichlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Raymond Y. Kwong
- Non-invasive Cardiovascular Imaging, Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Christoph Gräni
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Non-invasive Cardiovascular Imaging, Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States of America
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Sieron D, Drakopoulos D, Loebelenz LI, Schroeder C, Ebner L, Obmann VC, Huber AT, Christe A. Correlation between fat signal ratio on T1-weighted MRI in the lower vertebral bodies and age, comparing 1.5-T and 3-T scanners. Acta Radiol Open 2020; 9:2058460120901517. [PMID: 32166041 PMCID: PMC7055425 DOI: 10.1177/2058460120901517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 12/30/2019] [Indexed: 11/28/2022] Open
Abstract
Background The hypothesis was that the fat-dependent T1 signal intensity in vertebral
bodies increases with age due to red-yellow marrow conversion. Purpose To analyze the increasing fatty conversion of red bone marrow with age. Material and Methods A continuous sample of 524 patients (age range 2–96 years) with normal lumbar
spine MRIs (T11–L5) was retrospectively selected in order to get a
representative sample from our 1.5-T and 3-T MRI units (Siemens, Erlangen,
Germany). Four radiologists read the images independently. Absolute T1
signal intensities were measured in the lower vertebral bodies and
standardized by dividing their value by the signal of the subcutaneous fat
on lumbar and sacral level. Results The standardized T1 signal correlated significantly with patients’ age at the
1.5-T unit, with the best correlation demonstrated by thoracic vertebra T11,
followed by lumbar vertebra L1, with correlation coefficients (R) of 0.64
(95% CI 0.53–0.72, P < 0.0001) and 0.49 (95% CI
0.38–0.59, P < 0.0001), respectively. For women and men,
the R values were similar in thoracic vertebra T11 at 0.62 (95% CI
0.49–0.72) and 0.64 (95% CI 0.44–0.77), respectively. The vertebral signal
correlated significantly better with age in the 1.5-T compared to the 3-T
unit on all vertebral levels: the best R value of the 3-T unit was only 0.20
(95% CI 0.09–0.30, P < 0.0001). Our study showed an
average increase of the relative T1 signal in T11 of 10% per decade. Conclusion T1 fat signal ratio increases with age in the vertebral bodies, which could
help estimating the age of a person. Best age correlation was found when
measuring T1 signal in T11, standardized by the sacral subcutaneous fat
signal and using a 1.5-T MRI.
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Affiliation(s)
- Dominik Sieron
- Department of Radiology, Division City and County Hospitals, INSELGROUP, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Dionysios Drakopoulos
- Department of Radiology, Division City and County Hospitals, INSELGROUP, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Laura I Loebelenz
- Department of Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christophe Schroeder
- Department of Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Lukas Ebner
- Department of Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Verena C Obmann
- Department of Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Adrian T Huber
- Department of Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andreas Christe
- Department of Radiology, Division City and County Hospitals, INSELGROUP, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Loebelenz LI, Ebner L, Obmann VC, Huber AT, Christe A. Kerley B lines in the lung apex - a distinct CT sign for pulmonary congestion. Swiss Med Wkly 2019; 149:w20119. [PMID: 31476240 DOI: 10.4414/smw.2019.20119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
AIMS OF THE STUDY The purpose of this study was to establish a new computed tomography (CT) sign for pulmonary congestion (Kerley B lines in the lung apex in patients with cardiac or renal insufficiency) and to find the best signs to differentiate between pulmonary congestion and interstitial lung disease (ILD). METHODS 180 consecutive patients undergoing CT were retrospectively included: 43 patients with cardiac, 17 with renal and 30 with mixed cardiac/renal insufficiency. In addition, we selected 90 patients with known ILD (usual interstitial pneumonia and nonspecific interstitial pneumonia). The cases were retrieved by means of a full text search of radiological reports and electronic patient files. The cardiothoracic ratio and diameters of the superior and inferior vena cava were measured. Pleural effusion, peribronchial cuffing, Kerley B lines (interlobular septa), ground glass opacity (GGO) and consolidation were analysed for prevalence, distribution and quantity (1 to 3). Fisher’s exact and Mann-Whitney-test were applied using Bonferroni correction. RESULTS Kerley B lines in the lung apex were present in 81% and 76% of the cardiac and renal groups, respectively, which was significantly more than in the ILD group (26%, p <0.0001). In the insufficiency group, Kerley B lines were distributed more homogenously throughout the lungs compared with the ILD group in which they increased in amount from 32% in the upper lobe to 90% in the lower lobe. The septal lines were thinner in the ILD than in the insufficiency group (p <0.0001). Peribronchial cuffing was significantly more frequent in the cardiac group (67%) compared with the renal group (29%, p = 0.040) and the ILD group (0%, p <0.0001). Other pulmonary congestion signs such as cardiothoracic ratio, enlargement of the superior and inferior vena cava and pleural effusion did not vary between the cardiac and the renal groups but were significantly lower in the ILD group. However, ILD patients showed more GGO in the lower lobes (87%) then patients with insufficiency (42%, p <0.0001). CONCLUSION Interlobular septal thickening (Kerley B lines) in the lung apex is a specific sign for pulmonary congestion, although not exclusive (since in ILD there may be apical reticulation). In combination with peribronchial cuffing and increased cardiothoracic ratio, it allows differentiation between cardiac/renal insufficiency and pulmonary ILD.
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Affiliation(s)
- Laura I Loebelenz
- Department of Diagnostic, Interventional and Paediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Lukas Ebner
- Department of Diagnostic, Interventional and Paediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Verena C Obmann
- Department of Diagnostic, Interventional and Paediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Adrian T Huber
- Department of Diagnostic, Interventional and Paediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Andreas Christe
- Department of Diagnostic, Interventional and Paediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Switzerland / Department of Diagnostic, Interventional and Paediatric Radiology, Inselgroup, Radiology Division SLS, University of Bern, Switzerland
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Obmann VC, Mertineit N, Marx C, Berzigotti A, Ebner L, Heverhagen JT, Christe A, Huber AT. Liver MR relaxometry at 3T - segmental normal T 1 and T 2* values in patients without focal or diffuse liver disease and in patients with increased liver fat and elevated liver stiffness. Sci Rep 2019; 9:8106. [PMID: 31147588 PMCID: PMC6542826 DOI: 10.1038/s41598-019-44377-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 05/10/2019] [Indexed: 02/07/2023] Open
Abstract
Magnetic resonance (MR) T1 and T2* mapping allows quantification of liver relaxation times for non-invasive characterization of diffuse liver disease. We hypothesized that liver relaxation times are not only influenced by liver fibrosis, inflammation and fat, but also by air in liver segments adjacent to the lung – especially in MR imaging at 3T. A total of 161 study participants were recruited, while 6 patients had to be excluded due to claustrophobia or technically uninterpretable MR elastography. Resulting study population consisted of 12 healthy volunteers and 143 patients who prospectively underwent multiparametric MR imaging at 3T. Of those 143 patients, 79 had normal liver stiffness in MR elastography (shear modulus <2.8 kPa, indicating absence of fibrosis) and normal proton density fat fraction (PDFF < 10%, indicating absence of steatosis), defined as reference population. T1 relaxation times in these patients were significantly shorter in liver segments adjacent to the lung than in those not adjacent to the lung (p < 0.001, mean of differences 33 ms). In liver segments not adjacent to the lung, T1 allowed to differentiate significantly between the reference population and patients with steatosis and/or fibrosis (p ≤ 0.011), while there was no significant difference of T1 between the reference population and healthy volunteers. In conclusion, we propose to measure T1 relaxation times in liver segments not adjacent to the lung. Otherwise, we recommend taking into account slightly shorter T1 values in liver segments adjacent to the lung.
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Affiliation(s)
- V C Obmann
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, INO B, Freiburgstrasse 10, 3010, Bern, Switzerland
| | - N Mertineit
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, INO B, Freiburgstrasse 10, 3010, Bern, Switzerland
| | - C Marx
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, INO B, Freiburgstrasse 10, 3010, Bern, Switzerland
| | - A Berzigotti
- Hepatology, Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, INO A, Freiburgstrasse 10, 3010, Bern, Switzerland
| | - L Ebner
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, INO B, Freiburgstrasse 10, 3010, Bern, Switzerland
| | - J T Heverhagen
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, INO B, Freiburgstrasse 10, 3010, Bern, Switzerland
| | - A Christe
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, INO B, Freiburgstrasse 10, 3010, Bern, Switzerland
| | - A T Huber
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, INO B, Freiburgstrasse 10, 3010, Bern, Switzerland.
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Huber AT, Lamy J, Bravetti M, Bouazizi K, Bacoyannis T, Roux C, De Cesare A, Rigolet A, Benveniste O, Allenbach Y, Kerneis M, Cluzel P, Redheuil A, Kachenoura N. Comparison of MR T1 and T2 mapping parameters to characterize myocardial and skeletal muscle involvement in systemic idiopathic inflammatory myopathy (IIM). Eur Radiol 2019; 29:5139-5147. [DOI: 10.1007/s00330-019-06054-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 12/19/2018] [Accepted: 01/30/2019] [Indexed: 12/30/2022]
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Obmann VC, Mertineit N, Berzigotti A, Marx C, Ebner L, Kreis R, Vermathen P, Heverhagen JT, Christe A, Huber AT. CT predicts liver fibrosis: Prospective evaluation of morphology- and attenuation-based quantitative scores in routine portal venous abdominal scans. PLoS One 2018; 13:e0199611. [PMID: 29990333 PMCID: PMC6038998 DOI: 10.1371/journal.pone.0199611] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 02/02/2018] [Accepted: 06/11/2018] [Indexed: 12/15/2022] Open
Abstract
Objectives Our aim was to prospectively determine whether quantitative computed tomography (CT) scores, consisting of simplified indices for liver remodeling and attenuation, may predict liver fibrosis in abdominal CT scans. Materials and methods This cross-sectional, prospective study was approved by the local IRB (Kantonale Ethikkommission Bern). Written informed consent was given from all patients undergoing study-MR exams. Between 02/16 and 05/17, four different liver fibrosis scores (CRL-R = caudate-right-lobe ratio, LIMV-, LIMA- and LIMVA-fibrosis score, with “LIM” for liver imaging morphology, “V” for liver vein diameter and “A” for attenuation) were calculated in 1534 consecutive abdominal CT scans, excluding patients with prior liver surgery and liver metastasis. Patients were invited to undergo magnetic resonance (MR) elastography as the non-invasive gold standard to evaluate liver fibrosis. MR elastography shear modulus ≥2.8 kPa was defined as beginning liver fibrosis, while ≥3.5 kPa was defined as significant liver fibrosis (which would correspond to fibrosis stage F2 or higher in histology). Cutoff values, sensitivities and specificities obtained from the receiver operating characteristics (ROC) analysis were then calculated in 141 patients who followed the invitation for MR elastography. To mitigate selection bias, prevalence was estimated in the screened total population (n = 1534) by applying the cutoff values with sensitivities and specificities calculated in the MR elastography sub-group. Positive predictive values (PPV) and negative predictive values (NPV) were then calculated. Results Fibrosis scores including liver vein attenuation LIMA-FS and LIMVA-FS showed higher areas under the ROC curves (0.96–0.97) than CRL-R (0.82) to detect significant liver fibrosis, while LIMV-FS showed good performance as well (0.92). The prevalence-corrected PPV were 29% for CRL-R, 70% for LIMV-FS, 76% for LIMA-FS and 82% for LIMVA-FS. Conclusion CT fibrosis scores, notably LIMA-FS and LIMVA-FS, may predict significant liver fibrosis on routine abdominal CT scans.
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Affiliation(s)
- Verena C. Obmann
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Nando Mertineit
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Annalisa Berzigotti
- Department of Visceral Surgery and Medicine, Hepatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christina Marx
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Lukas Ebner
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Roland Kreis
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department for BioMedical Research, Unit for Magnetic Resonance Spectroscopy and Methodology, University of Bern, Bern, Switzerland
| | - Peter Vermathen
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department for BioMedical Research, Unit for Magnetic Resonance Spectroscopy and Methodology, University of Bern, Bern, Switzerland
| | - Johannes T. Heverhagen
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andreas Christe
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Adrian T. Huber
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- * E-mail:
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Huber AT, Bravetti M, Lamy J, Bacoyannis T, Roux C, de Cesare A, Rigolet A, Benveniste O, Allenbach Y, Kerneis M, Cluzel P, Kachenoura N, Redheuil A. Non-invasive differentiation of idiopathic inflammatory myopathy with cardiac involvement from acute viral myocarditis using cardiovascular magnetic resonance imaging T1 and T2 mapping. J Cardiovasc Magn Reson 2018; 20:11. [PMID: 29429407 PMCID: PMC5808400 DOI: 10.1186/s12968-018-0430-6] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [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: 07/21/2017] [Accepted: 01/23/2018] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Idiopathic inflammatory myopathy (IIM) is a group of autoimmune diseases with systemic myositis which may involve the myocardium. Cardiac involvement in IIM, although often subclinical, may mimic clinical manifestations of acute viral myocarditis (AVM). Our aim was to investigate the usefulness of the combined analysis of cardiovascular magnetic resonance (CMR) T1 and T2 mapping parameters measured both in the myocardium and in the thoracic skeletal muscles to differentiate AVM from IIM cardiac involvement. METHODS Sixty subjects were included in this retrospective study (36 male, age 45 ± 16 years): twenty patients with AVM, twenty patients with IIM and cardiac involvement and twenty healthy controls. Study participants underwent CMR imaging with modified Look-Locker inversion-recovery (MOLLI) T1 mapping and 3-point balanced steady-state-free precession T2 mapping. Relaxation times were quantified after endocardial and epicardial delineation on basal and medial short-axis slices, as well as in different thoracic skeletal muscle groups present in the CMR field-of-view. ROC-Analysis was performed to assess the ability of mapping indices to discriminate the study groups. RESULTS Mapping parameters in the thoracic skeletal muscles were able to discriminate between AVM and IIM patients. Best skeletal muscle parameters to identify IIM from AVM patients were reduced post-contrast T1 and increased extracellular volume (ECV), resulting in an area under the ROC curve (AUC) of 0.95 for post-contrast T1 and 0.96 for ECV. Conversely, myocardial mapping parameters did not discriminate IIM from AVM patients but increased native T1 (AUC 0.89 for AVM; 0.84 for IIM) and increased T2 (AUC 0.82 for AVM; 0.88 for IIM) could differentiate both patient groups from healthy controls. CONCLUSION CMR myocardial mapping detects cardiac inflammation in AVM and IIM compared to normal myocardium in healthy controls but does not differentiate IIM from AVM. However, thoracic skeletal muscle mapping was able to accurately discern IIM from AVM.
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Affiliation(s)
- Adrian T. Huber
- Sorbonne Universités, UPMC Univ Paris 06, INSERM 1146, CNRS 7371, Laboratoire d’Imagerie Biomédicale (LIB), Faculté de Médecine, 91, Boulevard de l’hôpital, 75013 Paris, France
- Department of Cardiovascular Imaging, Interventional and Thoracic Radiology, Institute of Cardiology, Hôpital Pitié-Salpêtrière, Paris, France
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Marine Bravetti
- Sorbonne Universités, UPMC Univ Paris 06, INSERM 1146, CNRS 7371, Laboratoire d’Imagerie Biomédicale (LIB), Faculté de Médecine, 91, Boulevard de l’hôpital, 75013 Paris, France
- Department of Cardiovascular Imaging, Interventional and Thoracic Radiology, Institute of Cardiology, Hôpital Pitié-Salpêtrière, Paris, France
| | - Jérôme Lamy
- Sorbonne Universités, UPMC Univ Paris 06, INSERM 1146, CNRS 7371, Laboratoire d’Imagerie Biomédicale (LIB), Faculté de Médecine, 91, Boulevard de l’hôpital, 75013 Paris, France
- Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
| | - Tania Bacoyannis
- Sorbonne Universités, UPMC Univ Paris 06, INSERM 1146, CNRS 7371, Laboratoire d’Imagerie Biomédicale (LIB), Faculté de Médecine, 91, Boulevard de l’hôpital, 75013 Paris, France
| | - Charles Roux
- Sorbonne Universités, UPMC Univ Paris 06, INSERM 1146, CNRS 7371, Laboratoire d’Imagerie Biomédicale (LIB), Faculté de Médecine, 91, Boulevard de l’hôpital, 75013 Paris, France
- Department of Cardiovascular Imaging, Interventional and Thoracic Radiology, Institute of Cardiology, Hôpital Pitié-Salpêtrière, Paris, France
| | - Alain de Cesare
- Sorbonne Universités, UPMC Univ Paris 06, INSERM 1146, CNRS 7371, Laboratoire d’Imagerie Biomédicale (LIB), Faculté de Médecine, 91, Boulevard de l’hôpital, 75013 Paris, France
- Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
| | - Aude Rigolet
- Department of Internal Medicine, Hôpital Pitié-Salpêtrière, Paris, France
| | - Olivier Benveniste
- Department of Internal Medicine, Hôpital Pitié-Salpêtrière, Paris, France
- Sorbonne Universités, UPMC Univ Paris 06, INSERM UMR974, Centre de Recherche en Myologie, Paris, France
| | - Yves Allenbach
- Department of Internal Medicine, Hôpital Pitié-Salpêtrière, Paris, France
- Sorbonne Universités, UPMC Univ Paris 06, INSERM UMR974, Centre de Recherche en Myologie, Paris, France
| | - Mathieu Kerneis
- Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
- Department of Cardiology, Institute of Cardiology, Hôpital Pitié-Salpêtrière, Paris, France
| | - Philippe Cluzel
- Sorbonne Universités, UPMC Univ Paris 06, INSERM 1146, CNRS 7371, Laboratoire d’Imagerie Biomédicale (LIB), Faculté de Médecine, 91, Boulevard de l’hôpital, 75013 Paris, France
- Department of Cardiovascular Imaging, Interventional and Thoracic Radiology, Institute of Cardiology, Hôpital Pitié-Salpêtrière, Paris, France
- Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
| | - Nadjia Kachenoura
- Sorbonne Universités, UPMC Univ Paris 06, INSERM 1146, CNRS 7371, Laboratoire d’Imagerie Biomédicale (LIB), Faculté de Médecine, 91, Boulevard de l’hôpital, 75013 Paris, France
- Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
| | - Alban Redheuil
- Sorbonne Universités, UPMC Univ Paris 06, INSERM 1146, CNRS 7371, Laboratoire d’Imagerie Biomédicale (LIB), Faculté de Médecine, 91, Boulevard de l’hôpital, 75013 Paris, France
- Department of Cardiovascular Imaging, Interventional and Thoracic Radiology, Institute of Cardiology, Hôpital Pitié-Salpêtrière, Paris, France
- Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
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Sieron DA, Steib M, Suter D, Obmann VC, Huber AT, Ebner L, Inderbitzin D, Christe A. Computed tomography imaging for the characterisation of drugs with radiation density measurements and HU spectroscopy. Swiss Med Wkly 2018; 148:w14585. [PMID: 29376556 DOI: 10.4414/smw.2018.14585] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
AIMS OF THE STUDY To investigate the computed tomography (CT) density of frequently administered medications (1) for the better characterisation of substances on abdominal CT, (2) to allow radiologists to narrow down possibilities in the identification of hyperdense material in the bowel and (3) to provide forensic doctors with a tool to identify gastric contents before an autopsy. MATERIAL AND METHODS From the list of the local hospital pharmacy, the 50 most frequently used medications were identified and scanned twice with a 128 row CT scanner (Acquillion, Toshiba, Tokyo, Japan). The protocol comprised two tube voltages of 100 kVp and 120 kVp, with a tube current of 100 mAs, a collimation of 0.5 mm and a slice thickness of 0.5 mm. Two readers were asked to measure the density (in Hounsfield units) and the noise (standard deviation of the Hounsfield units) of each pill in the two scans (100/120 kVp). After 4 weeks, both readers repeated the measurements to test repeatability (intra-rater agreement). The behaviour of each pill in hydrochloric acid (pH 2) was examined and the dissolution time was determined. RESULTS The most dense pill was Cordarone (7265 HU), and the least was Perenterol (529 HU), with an attenuation that was lower than fat density (<120 HU). The standard deviation of pixel density (noise) reflects inhomogeneity of the pharmacological product, varying from 9 to 1592 HU among the different pills (at 120 kVp). The absolute average HU increase per pill when changing to lower voltage was 78 ± 253 HU, with a linear fitting line with a slope of 0.21 as a constant variable in the density spectroscopy. After 4 hours in hydrochloric acid, only six tablets were still intact, including Flagyl and Dafalgan. The intra- and inter-rater agreements for all measurements were nearly perfect, with a correlation coefficient r of ≥0.99 (p <0.0001). CONCLUSION Our data suggest that measuring the attenuation of drugs on CT images, including the homogeneity, and applying CT spectroscopy can narrow down possible identities of the most frequently medications. Other clinicians and forensic pathologists can perform this easy measurement, as the intra- and inter-reader variability is very small.
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Affiliation(s)
| | - Moritz Steib
- Department of Pneumology, Tiefenauspital, Bern, Switzerland
| | - Dominik Suter
- Department of Surgery, Tiefenauspital, Bern, Switzerland
| | | | - Adrian T Huber
- Department of Diagnostic, Interventional and Paediatric Radiology, Bern University Hospital, Inselspital, University of Bern, Switzerland
| | - Lukas Ebner
- Department of Diagnostic, Interventional and Paediatric Radiology, Bern University Hospital, Inselspital, University of Bern, Switzerland
| | | | - Andreas Christe
- Department of Radiology, Tiefenauspital, Bern, Switzerland / Department of Diagnostic, Interventional and Paediatric Radiology, Bern University Hospital, Inselspital, University of Bern, Switzerland
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Huber AT, Lamy J, Rahhal A, Evin M, Atassi F, Defrance C, Lebreton G, Clément K, Berthet M, Isnard R, Leprince P, Cluzel P, Hatem SN, Kachenoura N, Redheuil A. Cardiac MR Strain: A Noninvasive Biomarker of Fibrofatty Remodeling of the Left Atrial Myocardium. Radiology 2018; 286:83-92. [DOI: 10.1148/radiol.2017162787] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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