1
|
Angermann M, Jablawi F, Keulers A, Angermann M, Schubert GA, Weiss M, Reich A, Wiesmann M, Nikoubashman O. Posterior reversible encephalopathy syndrome after induced hypertension therapy for delayed cerebral ischemia after subarachnoid hemorrhage: A case-control study. J Neurol Sci 2021; 421:117313. [PMID: 33461062 DOI: 10.1016/j.jns.2021.117313] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 01/01/2021] [Accepted: 01/05/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Posterior reversible encephalopathy syndrome (PRES) is associated with arterial hypertension. Our aim was to investigate whether induced hypertension (IH) as therapy for delayed cerebral ischemia (DCI) after subarachnoid hemorrhage (SAH) is associated with PRES and to identify risk factors for PRES. MATERIAL AND METHODS We retrospectively searched our database for patients with SAH and IH in our institution between 2009 and 2018 and identified additional cases of PRES after SAH with IH from the literature. We then analyzed demographic findings and clinical features of these patients. RESULTS 172 patients with acute SAH received IH. PRES was diagnosed in 3/172 (1.7%) patients. Our literature search revealed 17 additional cases. The pooled PRES group (n = 20) was non-significantly older than the non-PRES group (n = 169) (median, 62.5 years vs. 52 years, p = 0.06). No significant differences were found between both groups with regard to sex (p = 0.73), Hunt & Hess-Score (p = 0.9), aneurysm treatment (p = 0.13), and time from diagnosis of SAH to the start of IH (p = 0.14). CONCLUSIONS PRES after IH in SAH patients occurred in 1.7% of our patients. Our results imply that it is important to be aware of a possible development of a PRES in older SAH patients with IH, irrespective of sex, initial clinical status, and treatment modality.
Collapse
Affiliation(s)
- Maike Angermann
- Department of Neuroradiology, University Hospital RWTH, Aachen, Germany
| | - Fidaa Jablawi
- Department of Neurosurgery, Justus-Liebig-University Gießen, Germany
| | - Annika Keulers
- Department of Neuroradiology, University Hospital RWTH, Aachen, Germany
| | - Manuel Angermann
- Department of Neuroradiology, University Hospital RWTH, Aachen, Germany
| | - Gerrit A Schubert
- Department of Neurosurgery, University Hospital RWTH, Aachen, Germany
| | - Miriam Weiss
- Department of Neurosurgery, University Hospital RWTH, Aachen, Germany
| | - Arno Reich
- Department of Neurology, University Hospital RWTH, Aachen, Germany
| | - Martin Wiesmann
- Department of Neuroradiology, University Hospital RWTH, Aachen, Germany
| | - Omid Nikoubashman
- Department of Neuroradiology, University Hospital RWTH, Aachen, Germany.
| |
Collapse
|
2
|
Faron A, Sichtermann T, Teichert N, Luetkens JA, Keulers A, Nikoubashman O, Freiherr J, Mpotsaris A, Wiesmann M. Performance of a Deep-Learning Neural Network to Detect Intracranial Aneurysms from 3D TOF-MRA Compared to Human Readers. Clin Neuroradiol 2019; 30:591-598. [PMID: 31227844 DOI: 10.1007/s00062-019-00809-w] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 06/07/2019] [Indexed: 01/23/2023]
Abstract
PURPOSE To study the clinical potential of a deep learning neural network (convolutional neural networks [CNN]) as a supportive tool for detection of intracranial aneurysms from 3D time-of-flight magnetic resonance angiography (TOF-MRA) by comparing the diagnostic performance to that of human readers. METHODS In this retrospective study a pipeline for detection of intracranial aneurysms from clinical TOF-MRA was established based on the framework DeepMedic. Datasets of 85 consecutive patients served as ground truth and were used to train and evaluate the model. The ground truth without annotation was presented to two blinded human readers with different levels of experience in diagnostic neuroradiology (reader 1: 2 years, reader 2: 12 years). Diagnostic performance of human readers and the CNN was studied and compared using the χ2-test and Fishers' exact test. RESULTS Ground truth consisted of 115 aneurysms with a mean diameter of 7 mm (range: 2-37 mm). Aneurysms were categorized as small (S; <3 mm; N = 13), medium (M; 3-7 mm; N = 57), and large (L; >7 mm; N = 45) based on the diameter. No statistically significant differences in terms of overall sensitivity (OS) were observed between the CNN and both of the human readers (reader 1 vs. CNN, P = 0.141; reader 2 vs. CNN, P = 0.231). The OS of both human readers was improved by combination of each readers' individual detections with the detections of the CNN (reader 1: 98% vs. 95%, P = 0.280; reader 2: 97% vs. 94%, P = 0.333). CONCLUSION A CNN is able to detect intracranial aneurysms from clinical TOF-MRA data with a sensitivity comparable to that of expert radiologists and may have the potential to improve detection rates of incidental findings in a clinical setting.
Collapse
Affiliation(s)
- Anton Faron
- Department of Radiology, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany.
- Department of Diagnostic and Interventional Neuroradiology, University Hospital RWTH Aachen, Aachen, Germany.
| | - Thorsten Sichtermann
- Department of Diagnostic and Interventional Neuroradiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Nikolas Teichert
- Department of Diagnostic and Interventional Neuroradiology, University Hospital RWTH Aachen, Aachen, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Julian A Luetkens
- Department of Radiology, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - Annika Keulers
- Department of Diagnostic and Interventional Neuroradiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Omid Nikoubashman
- Department of Diagnostic and Interventional Neuroradiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Jessica Freiherr
- Department of Diagnostic and Interventional Neuroradiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Anastasios Mpotsaris
- Department of Diagnostic and Interventional Neuroradiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Martin Wiesmann
- Department of Diagnostic and Interventional Neuroradiology, University Hospital RWTH Aachen, Aachen, Germany
| |
Collapse
|
3
|
Abstract
Background and Purpose- It has been hypothesized that in stroke patients, complete reperfusion (modified Thrombolysis in Cerebral Infarction; mTICI 3) after a single thrombectomy pass is a predictor for favorable outcome (modified Rankin Scale score, 0-2), but a true first-pass effect defined as improved clinical outcome after complete reperfusion with one versus multiple passes has not yet been specifically addressed in the literature. Methods- We compared clinical outcome of 164 consecutive patients with occlusions in the anterior circulation and known symptom onset, in whom we achieved complete reperfusion (mTICI 3), depending on whether complete reperfusion was achieved after a single thrombectomy pass (n=62) or multiple thrombectomy passes (n=102). To adjust for confounding factors such as prolonged time spans between symptom onset and reperfusion, additional administration of intra-arterial thrombolysis, and clot localization, we also compared clinical outcome of our first-pass group with a matched cohort (n=54) and a superselective subgroup of first-pass patients (only M1 occlusions, no additional intra-arterial thrombolysis; n=46) with its matched cohort (n=24). Results- Multivariable analysis of our cohort of 164 nonmatched patients revealed that there was a significant association between first-pass complete reperfusion and favorable clinical outcome (P=0.013). This was confirmed in our case-control analyses (P=0.010 and P=0.042). In our matched cohorts, favorable clinical outcome was seen almost twice as often if complete reperfusion was achieved after one pass (62% and 67% versus 36% and 37%), and odds for favorable outcome were 2.4 to 3.2× higher (CIs, 1.1-4.8 and 1.0-9.9). Conclusions- First-pass complete reperfusion is an independent factor for favorable outcome and should be aimed for in mechanical thrombectomy.
Collapse
Affiliation(s)
- Omid Nikoubashman
- From the Department of Neuroradiology (O.N., S.D., A. Riabikin, A.K., A.M., M.W.), University Hospital RWTH Aachen, Germany
| | - Sven Dekeyzer
- From the Department of Neuroradiology (O.N., S.D., A. Riabikin, A.K., A.M., M.W.), University Hospital RWTH Aachen, Germany
| | - Alexander Riabikin
- From the Department of Neuroradiology (O.N., S.D., A. Riabikin, A.K., A.M., M.W.), University Hospital RWTH Aachen, Germany
| | - Annika Keulers
- From the Department of Neuroradiology (O.N., S.D., A. Riabikin, A.K., A.M., M.W.), University Hospital RWTH Aachen, Germany
| | - Arno Reich
- Department of Neurology (A. Reich), University Hospital RWTH Aachen, Germany
| | - Anastasios Mpotsaris
- From the Department of Neuroradiology (O.N., S.D., A. Riabikin, A.K., A.M., M.W.), University Hospital RWTH Aachen, Germany
| | - Martin Wiesmann
- From the Department of Neuroradiology (O.N., S.D., A. Riabikin, A.K., A.M., M.W.), University Hospital RWTH Aachen, Germany
| |
Collapse
|
4
|
Keulers A, Nikoubashman O, Mpotsaris A, Wilson SD, Wiesmann M. Preventing vessel perforations in endovascular thrombectomy: feasibility and safety of passing the clot with a microcatheter without microwire: the wireless microcatheter technique. J Neurointerv Surg 2018; 11:653-658. [PMID: 30530771 DOI: 10.1136/neurintsurg-2018-014267] [Citation(s) in RCA: 15] [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: 08/15/2018] [Revised: 11/09/2018] [Accepted: 11/12/2018] [Indexed: 11/04/2022]
Abstract
BACKGROUND To place a stent retriever for thrombectomy in acute ischemic stroke, the clot has to be passed first. A microwire is usually used for this maneuver. As an alternative, a wireless microcatheter can be used to pass the clot. OBJECTIVE To analyze the feasibility and complication rates of passing the clot using either a microwire or a wireless microcatheter. METHODS A retrospective non-randomized analysis of 110 consecutive patients with acute ischemic stroke in the anterior circulation was performed, in whom video recordings of mechanical thrombectomies were available. In total, 203 attempts at mechanical recanalization were performed. RESULTS Successful recanalization (TICI 2b-3) was achieved in 97.3% of patients. In 71.8% of attempts the clot was successfully passed using a wireless microcatheter only. When a microwire was used initially, clot passage was successful in 95.3% of attempts. Complication rates for angiographically detectable subarachnoid hemorrhage were 6.1% when a microwire was used to pass the clot compared with 0% when a wireless microcatheter was used (p<0.001). Complication rates for angiographically occult circumscribed subarachnoid contrast extravasation observed on post-interventional CT scans were 18.2% when a microwire was used to pass the clot and 4.5% when a wireless microcatheter was used (p<0.001). CONCLUSIONS In most cases of mechanical recanalization the clot can be passed with a wireless microcatheter instead of a microwire. In our study this method significantly reduced the risk for vessel perforation and subarachnoid hemorrhage. We therefore recommend the use of this technique whenever possible.
Collapse
Affiliation(s)
- Annika Keulers
- Department of Neuroradiology, University Hospital Aachen, Aachen, Germany
| | - Omid Nikoubashman
- Department of Neuroradiology, University Hospital Aachen, Aachen, Germany
| | | | | | - Martin Wiesmann
- Department of Neuroradiology, University Hospital Aachen, Aachen, Germany
| |
Collapse
|
5
|
Kuhl CK, Alparslan Y, Schmoee J, Sequeira B, Keulers A, Brümmendorf TH, Keil S. Validity of RECIST Version 1.1 for Response Assessment in Metastatic Cancer: A Prospective, Multireader Study. Radiology 2018; 290:349-356. [PMID: 30398433 DOI: 10.1148/radiol.2018180648] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To determine the relationship between target lesion selection with use of Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1 and classification of therapeutic response in patients with metastatic cancer undergoing systemic cytotoxic and/or targeted therapies. Materials and Methods This prospective multireader study was conducted between July 2015 and July 2017. Three hundred sixteen consecutive participants with metastatic cancer underwent 932 CT examinations to monitor systemic treatment. CT studies were independently read by three radiologists. Readers identified a maximum of five lesions total (and a maximum of two lesions per organ). Dedicated oncology tumor response software was used. The Fleiss κ statistic was used to analyze interreader agreement in the assignment of individual response classes (complete response, partial response, progressive disease, or stable disease) and in the differentiation between progressive and nonprogressive disease. Results Readers selected the same set of target lesions in 128 of the 316 participants (41%) and selected a different set in 188 (59%). When target lesion selection was concordant, agreement was high (assignment of treatment response category: κ = 0.97; 95% confidence interval [CI]: 0.91, 1.0; differentiation between progressive and nonprogressive disease: κ = 0.98; 95% CI: 0.90, 1.0). When target lesion selection was discordant, agreement was significantly reduced (assignment of treatment response category: κ = 0.58; 95% CI: 0.54, 0.62; differentiation between progressive and nonprogressive disease: κ = 0.6; 95% CI: 0.59, 0.70). With concordant target lesion selection, readers agreed regarding diagnosis of progression in 97.7% of participants (95% CI: 95.4%, 100.0%); with discordant target lesion selection, readers agreed in only 55.3% (95% CI: 47.9%, 62.6%) (P < .01). Conclusion In patients with metastatic cancer undergoing systemic treatment, different cancer sites may appear similarly suitable and thus likely to be selected as target lesions but may yield inconsistent or even conflicting results with Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1. This indicates that the current, limited set of target lesions in RECIST 1.1 may not reflect overall tumor load or response to therapy. © RSNA, 2018 See also the editorial by Sosna in this issue.
Collapse
Affiliation(s)
- Christiane K Kuhl
- From the Department of Diagnostic and Interventional Radiology (C.K.K., Y.A., J.S., B.S., A.K., S.K.) and Department of Hematology, Oncology, and Stem Cell Transplantation (T.H.B.), RWTH Aachen University Hospital, Pauwelsstr 30, 52074 Aachen, Germany
| | - Yunus Alparslan
- From the Department of Diagnostic and Interventional Radiology (C.K.K., Y.A., J.S., B.S., A.K., S.K.) and Department of Hematology, Oncology, and Stem Cell Transplantation (T.H.B.), RWTH Aachen University Hospital, Pauwelsstr 30, 52074 Aachen, Germany
| | - Jonas Schmoee
- From the Department of Diagnostic and Interventional Radiology (C.K.K., Y.A., J.S., B.S., A.K., S.K.) and Department of Hematology, Oncology, and Stem Cell Transplantation (T.H.B.), RWTH Aachen University Hospital, Pauwelsstr 30, 52074 Aachen, Germany
| | - Bruno Sequeira
- From the Department of Diagnostic and Interventional Radiology (C.K.K., Y.A., J.S., B.S., A.K., S.K.) and Department of Hematology, Oncology, and Stem Cell Transplantation (T.H.B.), RWTH Aachen University Hospital, Pauwelsstr 30, 52074 Aachen, Germany
| | - Annika Keulers
- From the Department of Diagnostic and Interventional Radiology (C.K.K., Y.A., J.S., B.S., A.K., S.K.) and Department of Hematology, Oncology, and Stem Cell Transplantation (T.H.B.), RWTH Aachen University Hospital, Pauwelsstr 30, 52074 Aachen, Germany
| | - Tim H Brümmendorf
- From the Department of Diagnostic and Interventional Radiology (C.K.K., Y.A., J.S., B.S., A.K., S.K.) and Department of Hematology, Oncology, and Stem Cell Transplantation (T.H.B.), RWTH Aachen University Hospital, Pauwelsstr 30, 52074 Aachen, Germany
| | - Sebastian Keil
- From the Department of Diagnostic and Interventional Radiology (C.K.K., Y.A., J.S., B.S., A.K., S.K.) and Department of Hematology, Oncology, and Stem Cell Transplantation (T.H.B.), RWTH Aachen University Hospital, Pauwelsstr 30, 52074 Aachen, Germany
| |
Collapse
|
6
|
Kuhl CK, Keulers A, Strobel K, Schneider H, Gaisa N, Schrading S. Not all false positive diagnoses are equal: On the prognostic implications of false-positive diagnoses made in breast MRI versus in mammography / digital tomosynthesis screening. Breast Cancer Res 2018; 20:13. [PMID: 29426360 PMCID: PMC5807753 DOI: 10.1186/s13058-018-0937-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [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: 09/19/2017] [Accepted: 01/17/2018] [Indexed: 12/23/2022] Open
Abstract
Background Breast magnetic resonance imaging (MRI) has been reported to frequently result in false-positive diagnoses, limiting its positive predictive value (PPV). However, for PPV calculation, all nonmalignant tissue changes are equally considered false-positive, although the respective prognostic importance, and thus patient management implications, of different pathologies may well differ. We investigated the pathology of false-positive diagnoses made by MRI compared with radiographic (digital mammography/tomosynthesis [DM/DBT]) screening. Methods We conducted an institutional review board-approved prospective analysis of 710 consecutive asymptomatic women at average risk for breast cancer who underwent vacuum biopsy with or without surgical biopsy for screen-detected DM/DBT (n = 344) or MRI (n = 366) findings. We compared the frequency of false-positive biopsies (given by PPV3), as well as the types of nonmalignant tissue changes that caused the respective false-positive biopsies. In an order of increasing relative risk of subsequent breast cancer, pathologies of false-positive biopsies were categorized as nonproliferative, simple proliferative, complex proliferative, or atypical proliferative (including lobular carcinoma in situ/lobular intraepithelial neoplasia). The Mann-Whitney U test was used to compare distributions. Results Histology yielded nonmalignant tissue in 202 of 366 biopsies done for positive MRI studies and 195 of 344 biopsies for positive DM/DBT studies, respectively, yielding a similar PPV3 percentages of 44.8% (164 of 202) and 43.3% (149 of 202) for both methods. However, the distribution of tissue types that caused false-positive diagnoses differed significantly (p < 0.0001). On the basis of MRI, high-risk atypical proliferative changes (40.1%; 81 of 202) were most common, followed by complex proliferative changes (23.8%; 48 of 202). In DM/DBT, low-risk, nonproliferative changes were the dominant reason for false-positive diagnoses (49.7%; 97 of 195), followed by simple proliferative changes (25.2%; 51 of 195). Low-risk nonproliferative changes resulted in false-positive diagnoses based on MRI as infrequently as did high-risk atypical proliferative changes based on DM/DBT (18.8% [38 of 202] vs. 18.0% [35 of 195]). The likelihood of a false-positive diagnosis including atypias was twice as high in women undergoing biopsy for MRI findings (81 of 202; 40%) as for those with DM/DBT findings (35 of 195; 18%). Conclusions The prognostic importance, and thus the clinical implications, of false-positive diagnoses made on the basis of breast MRI vs. radiographic screening differed significantly, with a reversed prevalence of high- and low-risk lesions. This should be taken into account when discussing the rate of false-positive diagnoses (i.e., PPV levels of MRI vs. radiographic screening). Current benchmarks that rate the utility of breast cancer screening programs (i.e., cancer detection rates and PPVs) do not reflect these substantial biological differences and the different prognostic implications.
Collapse
Affiliation(s)
- Christiane K Kuhl
- Department of Diagnostic and Interventional Radiology, Hospital of the University of Aachen, RWTH, Pauwelsstrasse 30, 52074, Aachen, Germany.
| | - Annika Keulers
- Department of Diagnostic and Interventional Radiology, Hospital of the University of Aachen, RWTH, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Kevin Strobel
- Department of Diagnostic and Interventional Radiology, Hospital of the University of Aachen, RWTH, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Hannah Schneider
- Department of Diagnostic and Interventional Radiology, Hospital of the University of Aachen, RWTH, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Nadine Gaisa
- Department of Pathology, Hospital of the University of Aachen, RWTH, Aachen, Germany
| | - Simone Schrading
- Department of Diagnostic and Interventional Radiology, Hospital of the University of Aachen, RWTH, Pauwelsstrasse 30, 52074, Aachen, Germany
| |
Collapse
|
7
|
Kuhl CK, Alparslan Y, Sequeira B, Schmoe J, Engelke H, Keulers A, Bruemmendorf T, Keil S. Effect of target lesions selection on between-reader variability of response assessment according to RECIST 1.1. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.2528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
2528 Background: Response-classification-systems, e.g. RECIST1.1, and dedicated oncology software-tools (DOST) are used to standardize response assessment. Expectation is that different readers should yield the same response-classification for any given patient. We investigated real-life variability between readers who, as in clinical practice, were free to select target-lesions (TL). Methods: Prospective study on 316 patients with metastatic disease who underwent 932 CT-studies, yielding a total 616 follow-up occasions (baseline vs. follow-up) for analysis. All CT-studies were independently evaluated by 3 radiologists who used state-of-the-art DOST (MintLesion). Readers were free to select TL in the respective baseline study, and did so independently. Kappa-statistics were used to analyse agreement for RECIST1.1 response-class-assignment depending on whether readers had selected the same or different TL.To investigate possible impact on treatment decisions, agreement was also determined after aggregating response classes into progressive (PD) vs. non-progressive (CR/PR/SD). Results: Readers used the same TL in 38.6 (238/616), different in 61.4% (378/616). Where readers happened to select the same TL, agreement was “almost perfect” (κ = 0.966 [96%-CI: 0.912–1.00] for assignment of individual response-classes, and 0.977 [0.898–1.0] for the distinction progressive-vs-non-progressive). Where readers had selected different TL, agreement was only “moderate” (0.583 [0.541–0.624] for individual response-class-assignment, and 0.644 [0.587 to 0.701] for distinction progressive-vs.-non-progressive). Choice of the same TL was associated with agreement for distinction between progressive-vs.-non-progressive-disease in 97.7 % [95.4%–100.0%] of patients; choice of different TL was associated with disagreement in 44.7% [37.6%–51.8%]. Conclusions: If different radiologists use RECIST1.1 and DOST for response assessment, they will select different TL more often than not. Just depending on whether TL selection was concordant or not, radiologists will exhibit perfect agreement, or substantial disagreement, even for distinguishing progressive vs non-progressive disease.
Collapse
Affiliation(s)
| | - Yunus Alparslan
- Department of Diagnostic and Interventional Radiology, RWTH Aachen, Aachen, Germany
| | - Bruno Sequeira
- Department of Diagnostic and Interventional Radiology, RWTH Aachen, Aachen, Germany
| | - Jonas Schmoe
- Department of Diagnostic and Interventional Radiology, RWTH Aachen, Aachen, Germany
| | - Hannah Engelke
- Department of Diagnostic and Interventional Radiology, RWTH Aachen, Aachen, Germany
| | - Annika Keulers
- Department of Diagnostic and Interventional Radiology, RWTH Aachen, Aachen, Germany
| | | | | |
Collapse
|
8
|
Schrading S, Keulers A, Dirrichs T, Strobel K, Kuhl C. Früherkennung des Mammakarzinoms: Welchen Einfluss hat die mammografische Drüsengewebs-Dichte tatsächlich bei mammografisch okkulten Karzinomen? ROFO-FORTSCHR RONTG 2017. [DOI: 10.1055/s-0037-1600338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- S Schrading
- Klinik für Diagnostische und Interventionelle Radiologie der RWTH Aaachen, Aachen
| | - A Keulers
- Klinik für Diagnostische und Interventionelle Radiologie der RWTH Aaachen, Aachen
| | - T Dirrichs
- Klinik für Diagnostische und Interventionelle Radiologie der RWTH Aaachen, Aachen
| | - K Strobel
- Klinik für Diagnostische und Interventionelle Radiologie der RWTH Aaachen, Aachen
| | - C Kuhl
- Klinik für Diagnostische und Interventionelle Radiologie der RWTH Aaachen, Aachen
| |
Collapse
|
9
|
Schrading S, Keulers A, Dirrichs T, Arnemann J, Kuhl C. Suche nach einem bildgebenden Biomarker für eine Tamoxifen-Resistenz: Korrelation des Hintergrund-Anreicherns (BPE) in der Mamma-MRT mit dem CYP2D6 Genotyp bei Patientinnen unter Tamoxifen-Therapie. ROFO-FORTSCHR RONTG 2017. [DOI: 10.1055/s-0037-1600339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- S Schrading
- Klinik für Diagnostische und Interventionelle Radiologie der RWTH Aaachen, Aachen
| | - A Keulers
- Klinik für Diagnostische und Interventionelle Radiologie der RWTH Aaachen, Aachen
| | - T Dirrichs
- Klinik für Diagnostische und Interventionelle Radiologie der RWTH Aaachen, Aachen
| | | | - C Kuhl
- Klinik für Diagnostische und Interventionelle Radiologie der RWTH Aaachen, Aachen
| |
Collapse
|
10
|
Apitzsch J, Jost G, Bonifer E, Keulers A, Pietsch H, Mahnken AH. Revival of monophasic contrast injection protocols: superiority of a monophasic injection protocol compared to a biphasic injection protocol in high-pitch CT angiography. Acta Radiol 2016; 57:1210-6. [PMID: 26663210 DOI: 10.1177/0284185115618546] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 10/23/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Biphasic injection protocols are frequently used because they yield homogenous contrast enhancement. We hypothesize that with faster scanners and shorter scan times, biphasic injection protocols are no longer necessary. PURPOSE To evaluate whether a monophasic injection protocol is equivalent to a biphasic protocol in terms of contrast enhancement and homogeneity. MATERIAL AND METHODS Repeated high-pitch CTA (pitch 3) and conventional standard-pitch computed tomography angiography (CTA) (pitch 1.2) from the cervical region to the symphysis was performed in seven beagles (11.2 ± 2.5 kg) in a cross-over study design. Arterial contrast enhancement was measured along the z-axis in the ascending, descending, and abdominal aorta and the iliac arteries. The z-axis is the longitudinal axis of the human body and at the same time the direction in which the CT table is moving. The data were analyzed using repeated measures ANOVA with a post-hoc t-test and visual assessment of the scans. RESULTS In high-pitch CTA, monophasic injection protocols were superior to biphasic injection protocols in enhancement levels (P < 0.05) and enhancement homogeneity along the z-axis (P < 0.05). In conventional CTA, enhancement levels did not differ. Contrast homogeneity was better for biphasic protocols. CONCLUSION High-pitch CTA monophasic injection protocols are superior to biphasic injection protocols, due to a higher and more homogeneous contrast enhancement with the same amount of contrast medium used.
Collapse
Affiliation(s)
- Jonas Apitzsch
- UKGM Marburg University Hospital, Diagnostic and Interventional Radiology, Marburg, Germany
| | - Gregor Jost
- Bayer Healthcare, MR and CT Contrast Media Research, Berlin, Berlin, Germany
| | - Elisabeth Bonifer
- Department of Radiology, Giessen University Hospital, Giessen, Hessen, Germany
| | - Annika Keulers
- UKGM Marburg University Hospital, Diagnostic and Interventional Radiology, Marburg, Germany
| | - Hubertus Pietsch
- Bayer Healthcare, MR and CT Contrast Media Research, Berlin, Berlin, Germany
| | - Andreas Horst Mahnken
- UKGM Marburg University Hospital, Diagnostic and Interventional Radiology, Marburg, Germany
| |
Collapse
|
11
|
Affiliation(s)
- Li Zhang
- Department of Diagnostic and Interventional Radiology, University Hospital Giessen and Marburg, Philipps University of Marburg, Marburg, Germany.
| | - Karin Runzheimer
- Department of Diagnostic and Interventional Radiology, University Hospital Giessen and Marburg, Philipps University of Marburg, Marburg, Germany
| | - Elisabeth Bonifer
- Department of Diagnostic and Interventional Radiology, University Hospital Giessen and Marburg, Philipps University of Marburg, Marburg, Germany
| | - Annika Keulers
- Department of Diagnostic and Interventional Radiology, University Hospital Giessen and Marburg, Philipps University of Marburg, Marburg, Germany
| | - Eike Piechowiak
- Department of Diagnostic and Interventional Radiology, University Hospital Giessen and Marburg, Philipps University of Marburg, Marburg, Germany
| | - Andreas Mahnken
- Department of Diagnostic and Interventional Radiology, University Hospital Giessen and Marburg, Philipps University of Marburg, Marburg, Germany
| |
Collapse
|
12
|
Keulers A, Mahnken A, Kiesow L. Radiologische Portimplantation bei Patienten mit schwerer Thrombozytopenie. ROFO-FORTSCHR RONTG 2015. [DOI: 10.1055/s-0035-1551076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
13
|
Bonifer E, Jost G, Pietsch H, Keulers A, Mahnken A. Rückkehr monophasischer Kontrastmittel-Injektionsprotokolle in der high-pitch CT-Angiografie. ROFO-FORTSCHR RONTG 2014. [DOI: 10.1055/s-0034-1373142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
14
|
Keulers A, Mahnken AH. Orale Brause-Applikation als einfache und effektive Methode für eine verbesserte Beurteilbarkeit des Ösophagus in der thorakalen Computertomografie. ROFO-FORTSCHR RONTG 2014. [DOI: 10.1055/s-0034-1373419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
15
|
Keulers A, Cunha-Cruz V, Bruners P, Penzkofer T, Braunschweig T, Schmitz-Rode T, Mahnken A. Knochen-Biopsiesysteme: mechanische Eigenschaften, Nadeldesign und Probenqualität. ROFO-FORTSCHR RONTG 2011; 183:274-81. [DOI: 10.1055/s-0029-1245906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
16
|
Nicolas V, Beese M, Keulers A, Bressel M, Kastendieck H, Huland H. [MR tomography in prostatic carcinoma: comparison of conventional and endorectal MRT]. ROFO-FORTSCHR RONTG 1994; 161:319-26. [PMID: 7948978 DOI: 10.1055/s-2008-1032539] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
In a prospective study an attempt was made to determine the value of conventional MRI (354 patients) and MRI using the endorectal surface coil (ESC) (36 patients) in the preoperative staging of prostatic carcinoma. Local preoperative staging with conventional MRI was correct in 83.9% and 88.9% with ESC-MRI. Compared to conventional MRI, ESC-MRI was better in the delineation of the prostatic capsule and early detection of infiltration into the neurovascular bundle. Lymph node staging with MRI showed a sensitivity of 54.4% in detecting pelvic lymph node metastasis. MRI is as limited as CT in assessing pelvic lymph node metastasis.
Collapse
Affiliation(s)
- V Nicolas
- Abteilung Röntgendiagnostik, Universitäts-Krankenhaus Hamburg-Eppendorf
| | | | | | | | | | | |
Collapse
|
17
|
Abstract
Cell lines infected by different species of mycoplasma (Mycoplasma orale, Mycoplasma hominis) were decontaminated by co-culture with human blood monocyte (BM)-derived macrophages and pooled human immunoglobulin preparations. Co-cultures with BM-derived macrophages or murine peritoneal macrophages (PM) alone were not successful. The phenotype of infected cell lines did not differ from that of uninfected cell lines as revealed by morphological, enzymecytochemical, and immunocytochemical analysis.
Collapse
Affiliation(s)
- H Kreipe
- Institute of Pathology, University of Kiel, F.R.G
| | | | | | | |
Collapse
|