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Masouris I, Wischmann J, Schniepp R, Müller R, Fuhry L, Hamann GF, Trumm C, Liebig T, Kellert L, Schöberl F. Basilar artery occlusion: drip-and-ship versus direct-to-center for mechanical thrombectomy within the Neurovascular Network of Southwest Bavaria (NEVAS). J Neurol 2024; 271:1885-1892. [PMID: 38095722 DOI: 10.1007/s00415-023-12126-x] [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: 09/20/2023] [Revised: 11/14/2023] [Accepted: 11/20/2023] [Indexed: 03/28/2024]
Abstract
BACKGROUND Recent clinical trials revealed a substantial clinical benefit for mechanical thrombectomy (MT) in patients with basilar artery occlusion (BAO). While urban areas are sufficiently covered with comprehensive stroke centers and MT expertise, rural areas lack such resources. Structured telemedical stroke networks offer rural hospitals instant consultation by stroke experts, enabling swift administration of intravenous thrombolysis (IVT) on-site and transportation for MT. For BAO patients, data on performance and clinical outcomes in telemedical stroke networks are lacking. METHODS We retrospectively analyzed data from patients with acute BAO eligible for MT: those treated directly in our comprehensive stroke center (direct-to-center/DC) and those treated in rural hospitals that were telemedically consulted by the Neurovascular Network of Southwest Bavaria (NEVAS) and transferred to our center for MT (drip-and-ship, DS). Key time intervals, stroke management performance and functional outcome after 90 days were compared. RESULTS Baseline characteristics, including premorbid status and stroke severity, were comparable. Time from symptom onset to IVT was identical in both groups (118 min). There was a delay of 180 min until recanalization in DS patients, mainly due to patient transport for MT. Procedural treatment time intervals, success of recanalization and complications were comparable. Clinical outcome at 3 months follow-up of DS patients was not inferior to DC patients. CONCLUSION We show for the first time that patients with BAO in rural areas benefit from a structured telemedicine network such as NEVAS, regarding both on-site processing and drip-and-ship for MT. Clinical outcomes are comparable among DS and DC patients.
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Affiliation(s)
- Ilias Masouris
- Department of Neurology, LMU University Hospital, LMU, Marchioninistr. 15, 81377, Munich, Germany.
| | - J Wischmann
- Department of Neurology, LMU University Hospital, LMU, Marchioninistr. 15, 81377, Munich, Germany
| | - R Schniepp
- Department of Neurology, LMU University Hospital, LMU, Marchioninistr. 15, 81377, Munich, Germany
| | - R Müller
- Department of Neurology and Neurological Rehabilitation, Bezirkskrankenhaus Guenzburg, Günzburg, Germany
| | - L Fuhry
- Department of Neurology, Klinikum Ingolstadt, Ingolstadt, Germany
| | - G F Hamann
- Department of Neurology and Neurological Rehabilitation, Bezirkskrankenhaus Guenzburg, Günzburg, Germany
| | - C Trumm
- Institute of Neuroradiology, LMU University Hospital, LMU, Munich, Germany
| | - T Liebig
- Institute of Neuroradiology, LMU University Hospital, LMU, Munich, Germany
| | - L Kellert
- Department of Neurology, LMU University Hospital, LMU, Marchioninistr. 15, 81377, Munich, Germany
| | - F Schöberl
- Department of Neurology, LMU University Hospital, LMU, Marchioninistr. 15, 81377, Munich, Germany
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Behme D, Wiesmann M, Nikoubashman O, Ridwan H, Hassan D, Liebig T, Trumm C, Holtmannspötter M, Szikora I. Initial clinical experience with a novel mechanical thrombectomy device-the ThrombX retriever. Interv Neuroradiol 2024; 30:183-188. [PMID: 36468971 PMCID: PMC11095356 DOI: 10.1177/15910199221118146] [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: 05/03/2022] [Revised: 06/30/2022] [Accepted: 07/07/2022] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND AND PURPOSE The ThrombX Retriever is a novel mechanical thrombectomy device that adjusts the distance between two mesh segments to axially hold thrombus. A post-market study assessed safety and performance in acute ischemic stroke patients with large artery occlusion. METHODS A single-arm prospective multi-center study enrolled patients at 5 European Centers. Patients had a symptomatic large-artery occlusion of the intracranial Internal Carotid or the Middle Cerebral Artery, M1 segment. The primary outcome measure was the modified treatment in cerebral infarction (mTICI) score, on the immediate post-procedure angiogram after up to three device passes. Key secondary outcome measures were the mTICI score after a single pass and functional independence, defined as an mRS score ≤ 2 at 90 days. RESULTS Thirty patients (16 Females, mean age 72 years), with NIHSS 4-25 (mean 15.5) were treated. Twenty-eight (93%) achieved mTICI 2b-3 within 3 passes, and 24 (80%) were with the first pass (FP). FP mTICI 2c-3 reperfusion was achieved in 19 (63%) cases. Seventeen of 24 (71%) patients treated with a balloon guide and the ThrombX Retriever had a FP mTICI 2c-3 reperfusion. After all interventions, mTICI 2b-3 was seen in 30 (100%) patients. Twenty-one of the 29 (73%) patients with 90-day follow-up were functionally independent (mRS≤2). No device-related serious adverse events were observed. CONCLUSION This preliminary study suggests the ThrombX Retriever is safe and has a high rate of substantial reperfusion. A larger prospective trial to assess the device effectiveness is planned.
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Affiliation(s)
- Daniel Behme
- Department of Neuroradiology, Otto-von-Guericke University Clinic, Magdeburg, Germany
| | - Martin Wiesmann
- Department of Neuroradiology, University Hospital RWTH, Aachen, Germany
| | - Omid Nikoubashman
- Department of Neuroradiology, University Hospital RWTH, Aachen, Germany
| | - Hani Ridwan
- Department of Neuroradiology, University Hospital RWTH, Aachen, Germany
| | - Dimah Hassan
- Department of Neuroradiology, University Hospital RWTH, Aachen, Germany
| | - Thomas Liebig
- Department of Neuroradiology, Ludwig Maximilian University Hospital, Munich, Germany
| | - Christoph Trumm
- Department of Neuroradiology, Ludwig Maximilian University Hospital, Munich, Germany
| | - Markus Holtmannspötter
- Department of Neuroradiology, Nuremburg Clinic South, Paracelsus Medizinische Privatuniversität (PMU), Nuremberg, Germany
| | - Istvan Szikora
- Department of Neurointerventions, National Institute of Mental Health, Neurology and Neurosurgery, Budapest, Hungary
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Wania R, Lampart A, Niedermeier S, Stahl R, Trumm C, Reidler P, Kammerlander C, Böcker W, Klein M, Pedersen V. Diagnostic value of protein S100b as predictor of traumatic intracranial haemorrhage in elderly adults with low-energy falls: results from a retrospective observational study. Eur J Trauma Emerg Surg 2024; 50:205-213. [PMID: 37442831 PMCID: PMC10924004 DOI: 10.1007/s00068-023-02324-7] [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: 01/08/2023] [Accepted: 07/01/2023] [Indexed: 07/15/2023]
Abstract
PURPOSE The objectives of this study were to analyse the clinical value of protein S100b (S100b) in association with clinical findings and anticoagulation therapy in predicting traumatic intracranial haemorrhage (tICH) and unfavourable outcomes in elderly individuals with low-energy falls (LEF). METHODS We conducted a retrospective study in the emergency department (ED) of the LMU University Hospital, Munich by consecutively including all patients aged ≥ 65 years presenting to the ED following a LEF between September 2014 and December 2016 and receiving an emergency cranial computed tomography (cCT) examination. Primary endpoint was the prevalence of tICH. Multivariate logistic regression models and receiver operating characteristics were used to measure the association between clinical findings, anticoagulation therapy and S100b and tICH. RESULTS We included 2687 patients, median age was 81 years (60.4% women). Prevalence of tICH was 6.7% (180/2687) and in-hospital mortality was 6.1% (11/180). Skull fractures were highly associated with tICH (odds ratio OR 46.3; 95% confidence interval CI 19.3-123.8, p < 0.001). Neither anticoagulation therapy nor S100b values were significantly associated with tICH (OR 1.14; 95% CI 0.71-1.86; OR 1.08; 95% CI 0.90-1.25, respectively). Sensitivity of S100b (cut-off: 0.1 ng/ml) was 91.6% (CI 95% 85.1-95.9), specificity was 17.8% (CI 95% 16-19.6), and the area under the curve value was 0.59 (95% CI 0.54 - 0.64) for predicting tICH. CONCLUSION In conclusion, under real ED conditions, neither clinical findings nor protein S100b concentrations or presence of anticoagulation therapy was sufficient to decide with certainty whether a cCT scan can be bypassed in elderly patients with LEF. Further prospective validation is required.
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Affiliation(s)
- Rebecca Wania
- Department of Orthopedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistr 15., 81377, Munich, Germany
| | - Alina Lampart
- Department of Medicine, Kantonsspital Lucerne, Spitalstrasse, 6000, Lucerne, Switzerland
| | - Sandra Niedermeier
- Department of Anaesthesiology and Intensive Care Medicine, ISAR Klinikum, Sonnenstr. 24-26, 80331, Munich, Germany
| | - Robert Stahl
- Institute of Diagnostic and Interventional Neuroradiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Christoph Trumm
- Institute of Diagnostic and Interventional Neuroradiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Paul Reidler
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Christian Kammerlander
- Department of Orthopedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistr 15., 81377, Munich, Germany
- Trauma Hospital Styria, Goestinger Straße 24, 8020, Graz, Austria
| | - Wolfgang Böcker
- Department of Orthopedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistr 15., 81377, Munich, Germany
| | - Matthias Klein
- Department of Neurology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
- Emergency Department, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Vera Pedersen
- Department of Orthopedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistr 15., 81377, Munich, Germany.
- Emergency Department, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.
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Leitner MA, Hubert GJ, Paternoster L, Leitner MI, Rémi JM, Trumm C, Haberl RL, Hubert ND. Clinical outcome of rural in-hospital-stroke patients after interhospital transfer for endovascular therapy within a telemedical stroke network in Germany: a registry-based observational study. BMJ Open 2024; 14:e071975. [PMID: 38238050 PMCID: PMC10806718 DOI: 10.1136/bmjopen-2023-071975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 11/08/2023] [Indexed: 01/23/2024] Open
Abstract
OBJECTIVES Little is known about in-hospital-stroke (IHS) patients with large vessel occlusion and subsequent transfer to referral centres for endovascular therapy (EVT). However, this subgroup is highly relevant given the substantial amount of IHS, the ongoing trend towards greater use of EVT and lack of EVT possibilities in rural hospitals. The study objective is to explore the clinical outcomes of this vulnerable patient group, given that both IHS and interhospital transfer are associated with worse clinical outcomes due to a higher proportion of pre-existing conditions and substantial time delays during transfer. DESIGN AND SETTING Prospectively collected data of patients receiving EVT after interhospital transfer from 14 rural hospitals of the Telemedical Stroke Network in Southeast Bavaria (TEMPiS) between February 2018 and July 2020 was analysed. PARTICIPANTS 49 IHS and 274 out-of-hospital-stroke (OHS) patients were included. OUTCOME MEASURES Baseline characteristics, treatment times and outcomes were compared between IHS and OHS. The primary endpoint was a 3-month modified Rankin Scale (mRS). RESULTS In IHS patients, atrial fibrillation (55.3% vs 35.9%, p=0.012), diabetes (36.2% vs 21.1%, p=0.024) and use of oral anticoagulants (44.7% vs 20.8%, p<0.001) were more frequent. Stroke severity was similar in both groups. Treatment times from symptom onset to first brain imaging, therapy decision or EVT were shorter for IHS patients. IHS patients displayed worse clinical outcomes: 59.2% of IHS patients died within 3 months compared with 28.5% of OHS patients (p<0.001). They were less likely to achieve moderate outcomes (mRS 0-3) 3 months after stroke (20.4% vs 39.8%, p=0.010). After controlling for possible confounding variables, IHS was associated with worse clinical outcomes (adjusted OR 3.04 (95% CI 1.57 to 6.04), p<0.001). CONCLUSIONS The mortality of IHS patients after interhospital transfer and EVT was high and functional outcomes were worse compared with those of OHS patients. Further research is needed to ascertain whether IHS patients benefit from this therapeutic approach. A more careful selection of IHS patients for transfer and means to enable faster treatment should be considered. TRIAL REGISTRATION NUMBER NCT04270513; Post-results.
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Affiliation(s)
- Miriam Antonia Leitner
- Department of Medicine, Ludwig Maximilian University, Munich, Germany
- Department of Neurology, TEMPiS Telemedical Stroke Center, München Klinik Harlaching, Academic Teaching Hospital of the Ludwig Maximilian University, Munich, Germany
| | - Gordian Jan Hubert
- Department of Neurology, TEMPiS Telemedical Stroke Center, München Klinik Harlaching, Academic Teaching Hospital of the Ludwig Maximilian University, Munich, Germany
| | - Laura Paternoster
- Department of Neurology, TEMPiS Telemedical Stroke Center, München Klinik Harlaching, Academic Teaching Hospital of the Ludwig Maximilian University, Munich, Germany
| | - Moritz Immanuel Leitner
- Department of Neurology, TEMPiS Telemedical Stroke Center, München Klinik Harlaching, Academic Teaching Hospital of the Ludwig Maximilian University, Munich, Germany
| | - Jan Martin Rémi
- Department of Neurology, LMU University Hospital, Munich, Germany
| | - Christoph Trumm
- Institute of Neuroradiology, LMU University Hospital, Munich, Germany
| | - Roman Ludwig Haberl
- Department of Neurology, TEMPiS Telemedical Stroke Center, München Klinik Harlaching, Academic Teaching Hospital of the Ludwig Maximilian University, Munich, Germany
| | - Nikolai Dominik Hubert
- Department of Neurology, TEMPiS Telemedical Stroke Center, München Klinik Harlaching, Academic Teaching Hospital of the Ludwig Maximilian University, Munich, Germany
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Weller J, Katzendobler S, Niedermeyer S, Harter PN, Herms J, Trumm C, Niyazi M, Thon N, Tonn JC, Stoecklein VM. Treatment benefit in patients aged 80 years or older with biopsy-proven and non-resected glioblastoma is dependent on MGMT promoter methylation status. J Neurooncol 2023:10.1007/s11060-023-04362-y. [PMID: 37289281 PMCID: PMC10322768 DOI: 10.1007/s11060-023-04362-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 06/01/2023] [Indexed: 06/09/2023]
Abstract
PURPOSE Glioblastoma is associated with especially poor outcome in the elderly. It is unclear if patients aged ≥80 years benefit from tumor-specific therapy as opposed to receiving best supportive care (BSC) only. METHODS Patients with IDH-wildtype glioblastoma (WHO 2021), aged ≥80 years, and diagnosed by biopsy between 2010 and 2022 were included. Patient characteristics and clinical parameters were assessed. Uni- and multivariate analyses were performed. RESULTS 76 patients with a median age of 82 (range 80-89) and a median initial KPS of 80 (range 50-90) were included. Tumor-specific therapy was initiated in 52 patients (68%). 22 patients (29%) received temozolomide monotherapy, 23 patients (30%) were treated with radiotherapy (RT) alone and 7 patients (9%) received combination therapies. In 24 patients (32%), tumor-specific therapy was omitted in lieu of BSC. Overall survival (OS) was longer in patients receiving tumor-specific therapy (5.4 vs. 3.3 months, p < 0.001). Molecular stratification showed that the survival benefit was owed to patients with MGMT promoter methylation (MGMTpos) who received tumor-specific therapy as opposed to BSC (6.2 vs. 2.6 months, p < 0.001), especially to those with better clinical status and no initial polypharmacy. Patients with unmethylated MGMT promoter (MGMTneg) did not benefit from tumor-specific therapy (3.6 vs. 3.7 months, p = 0.18). In multivariate analyses, better clinical status and MGMT promoter methylation were associated with prolonged survival (p < 0.01 and p = 0.01). CONCLUSION Benefit from tumor-specific treatment in patients with newly diagnosed glioblastoma aged ≥80 years might be restricted to MGMTpos patients, especially to those with good clinical status and no polypharmacy.
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Affiliation(s)
- Jonathan Weller
- Department of Neurosurgery, University Hospital, LMU Munich, Marchioninistrasse 15, Munich, 81377, Germany
| | - Sophie Katzendobler
- Department of Neurosurgery, University Hospital, LMU Munich, Marchioninistrasse 15, Munich, 81377, Germany
| | - Sebastian Niedermeyer
- Department of Neurosurgery, University Hospital, LMU Munich, Marchioninistrasse 15, Munich, 81377, Germany
| | - Patrick N Harter
- Center for Neuropathology and Prion Research, LMU Munich, Munich, Germany
- German Cancer Consortium (DKTK), Partner site Munich and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Jochen Herms
- Center for Neuropathology and Prion Research, LMU Munich, Munich, Germany
- German Cancer Consortium (DKTK), Partner site Munich and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Maximilian Niyazi
- Department of Radiotherapy and Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
- German Cancer Consortium (DKTK), Partner site Munich and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Niklas Thon
- Department of Neurosurgery, University Hospital, LMU Munich, Marchioninistrasse 15, Munich, 81377, Germany
- German Cancer Consortium (DKTK), Partner site Munich and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Joerg-Christian Tonn
- Department of Neurosurgery, University Hospital, LMU Munich, Marchioninistrasse 15, Munich, 81377, Germany
- German Cancer Consortium (DKTK), Partner site Munich and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Veit M Stoecklein
- Department of Neurosurgery, University Hospital, LMU Munich, Marchioninistrasse 15, Munich, 81377, Germany.
- German Cancer Consortium (DKTK), Partner site Munich and German Cancer Research Center (DKFZ), Heidelberg, Germany.
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Winter J, Haas N, Olivieri M, Trumm C, Hermann M, Hopfner C, Jakob A. Successful Cerebral CT Angiography Via Intraosseous Contrast Administration in an 18-Month-Old Child with Acute Stroke. Klin Padiatr 2023; 235:50-51. [PMID: 35785804 DOI: 10.1055/a-1820-6706] [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] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Julia Winter
- Department of Pediatric Cardiology and Pediatric Intensive Care, Klinikum der Universität München Standort Grosshadern, Munich, Germany
| | - Nikolaus Haas
- Department of Pediatric Cardiology and Pediatric Intensive Care, Klinikum der Universität München Standort Grosshadern, Munich, Germany
| | - Martin Olivieri
- Pädiatrische Hämostaseologie, Dr. von Haunersches Kinderspital der Universität München, Munich, Germany
| | - Christoph Trumm
- Department Neuroradiology, Klinikum der Universität München Standort Grosshadern, Munich, Germany
| | - Matthias Hermann
- Department of Pediatric Cardiology and Pediatric Intensive Care, Klinikum der Universität München Standort Grosshadern, Munich, Germany
| | - Carina Hopfner
- Department of Pediatric Cardiology and Pediatric Intensive Care, Klinikum der Universität München Standort Grosshadern, Munich, Germany
| | - Andre Jakob
- Department of Pediatric Cardiology and Pediatric Intensive Care, Klinikum der Universität München Standort Grosshadern, Munich, Germany
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Deb-Chatterji M, Flottmann F, Meyer L, Brekenfeld C, Fiehler J, Gerloff C, Thomalla G, Fiehler J, Thomalla G, Alegiani A, Boeckh-Behrens, Wunderlich S, Ernemann U, Poli S, Siebert E, Nolte CH, Zweynert S, Bohner G, Ludolph A, Henn KH, Schäfer JH, Keil F, Röther J, Eckert B, Berrouschot J, Bormann A, Dorn F, Petzold G, Kraemer C, Leischner H, Trumm C, Tiedt S, Kellert L, Petersen M, Stögbauer F, Braun M, Hamann GF, Gröschel K, Uphaus T, Reich A, Nikoubashman O, Schellinger P, Borggrefe J, Hattingen J, Liman J, Ernst M. Side matters: differences in functional outcome and quality of life after thrombectomy in left and right hemispheric stroke. Neurol Res Pract 2022; 4:58. [PMID: 36411484 PMCID: PMC9677692 DOI: 10.1186/s42466-022-00223-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 10/12/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Patients with a left (LHS) or right hemispheric stroke (RHS) differ in terms of clinical symptoms due to lateralization of specific cortical functions. Studies on functional outcome after stroke and endovascular thrombectomy (EVT) comparing both hemispheres showed conflicting results so far. The impact of stroke laterality on patient-reported health-related quality of life (HRQoL) after EVT has not yet been adequately addressed and still remains unclear. METHODS Consecutive stroke thrombectomy patients, derived from a multi-center, prospective registry (German Stroke Registry) between June 2015 and December 2019, were included in this study. At 90 days, outcome after EVT was assessed by the modified Rankin scale (mRS) and HRQoL using the European QoL-five dimensions questionnaire utility-index (EQ-5D-I; higher values indicate better HRQoL) in patients with LHS and RHS. Adjusted regression analysis was applied to evaluate the influence of stroke laterality on outcome after EVT. RESULTS In total, 5683 patients were analyzed. Of these, 2953 patients (52.8%) had LHS and 2637 (47.2%) RHS. LHS patients had a higher baseline NIHSS (16 vs. 13, p < 0.001) and a higher ASPECTS (9 vs. 8, p < 0.001) compared to RHS patients. Among survivors, patients with LHS less frequently had a self-reported affected mobility (p = 0.037), suffered less often from pain (p = 0.04) and anxiety/depression (p = 0.032) three months after EVT. After adjusting for confounders (age, sex, baseline NIHSS), LHS was associated with a better HRQoL (ß coefficient 0.04, CI 95% 0.017-0.063; p = 0.001), and better functional outcome assessed by lower values on the mRS (ß coefficient - 0.109, CI 95% - 0.217-0.000; p = 0.049). CONCLUSIONS Ninety days after EVT, LHS patients have a better functional outcome and HRQoL. Patients with RHS should be actively assessed and treated for pain, anxiety and depression to improve their HRQoL after EVT.
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Affiliation(s)
- Milani Deb-Chatterji
- grid.13648.380000 0001 2180 3484Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Fabian Flottmann
- grid.13648.380000 0001 2180 3484Department of Neuroradiological Diagnostics and Intervention, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Lukas Meyer
- grid.13648.380000 0001 2180 3484Department of Neuroradiological Diagnostics and Intervention, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Caspar Brekenfeld
- grid.13648.380000 0001 2180 3484Department of Neuroradiological Diagnostics and Intervention, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Jens Fiehler
- grid.13648.380000 0001 2180 3484Department of Neuroradiological Diagnostics and Intervention, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Christian Gerloff
- grid.13648.380000 0001 2180 3484Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Götz Thomalla
- grid.13648.380000 0001 2180 3484Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
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Thiele F, Weller J, Katzendobler S, Trumm C, Thon N, Tonn JC. NIMG-66. CANNY EDGE DETECTION ALGORITHM FOR QUANTITATIVE DIFFERENTIATION BETWEEN DIFFUSE AND CIRCUMSCRIPT GLIOMA GROWTH PATTERNS ON MRI. Neuro Oncol 2022. [PMCID: PMC9661117 DOI: 10.1093/neuonc/noac209.684] [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: 11/16/2022] Open
Abstract
Abstract
BACKGROUND
Lower grade gliomas show heterogenous appearance on T2-weighted MRI. Some tumors grow diffusely along axonal structures whereas others distort adjacent brain tissue through local mass effect. The diagnostic, therapeutic and prognostic implication of differential growth patterns on MRI remain unknown and are difficult to assess quantitatively.
METHODS
A web-based application allowing for image preprocessing and providing a comprehensive edge detection tool by means of quantifying tumor border delineation on T2-weighted images based on the canny edge detection algorithm was developed. A sigma value between 1 and 100 determined the threshold where tumor borders where not detected anymore, with 1 equating to the lowest threshold and thus detection of all edges contained in the image. Two experienced faculty members assigned sigma values to axial T2 images of a random sample of 20 WHO grade 2 astrocytomas, IDH-mutant and 1p/19q-non-codeleted. The sigma values were then compared with a binary, subjective rating by the same faculty staff according to the perceived predominant growth pattern (diffuse versus circumscript) of each glioma.
RESULTS
When subjectively categorizing tumors binarily (diffuse versus circumscript), there was moderate interrater variability between observers (cohen’s kappa=0.6). Raters agreed in 16 of 20 cases, terming 7 gliomas unanimously diffuse and 9 gliomas circumscript. In 4 cases, the raters opinions diverged. The sigma values differed significantly between diffuse and circumscript tumors in both raters (rater 1, p=0.002; rater 2, p=0.018). For rater 1, the mean sigma difference between diffuse and circumscript tumors was 10.7 and 9.3 for rater 2. The mean overall sigma value was 13.3 for rater 1 and 18.7 for rater 2 (p=0.005).
CONCLUSION
Edge detection algorithms can be efficiently applied on MRI scans and are highly accurate in differentiating diffuse from circumscript gliomas. Objectification demands defining imaging criteria for diffuse and circumscript appearance of lower grade gliomas on MRI.
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Affiliation(s)
- Frederic Thiele
- Department of Neurosurgery, University Hospital Munich, LMU Munich , Munich , Germany
| | - Jonathan Weller
- Department of Neurosurgery, University Hospital, LMU Munich , Munich , Germany
| | - Sophie Katzendobler
- Department of Neurosurgery, University Hospital Munich, LMU Munich, Germany, München , Bayern , Germany
| | - Christoph Trumm
- Department of Neuroradiology, University Hospital Munich, LMU Munich, Germany , Munich , USA
| | - Niklas Thon
- Department of Neurosurgery, Ludwig-Maximilians-University School of Medicine , Munich , Germany
| | - Joerg-Christian Tonn
- Department of Neurosurgery, Ludwig-Maximilians-University School of Medicine , Munich , Germany
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Weller JM, Dorn F, Meissner JN, Stösser S, Beckonert NM, Nordsiek J, Kindler C, Riegler C, Keil F, Petzold GC, Bode FJ, Reich A, Nikoubashman O, Röther J, Eckert B, Braun M, Hamann GF, Siebert E, Nolte CH, Bohner G, Eckert RM, Borggrefe J, Schellinger P, Berrouschot J, Bormann A, Kraemer C, Leischner H, Petersen M, Stögbauer F, Boeck-Behrens T, Wunderlich S, Ludolph A, Henn KH, Gerloff C, Fiehler J, Thomalla G, Alegiani A, Schäfer JH, Tiedt S, Kellert L, Trumm C, Ernemann U, Poli S, Liman J, Ernst M, Gröschel K, Uphaus T. Antithrombotic treatment and outcome after endovascular treatment and acute carotid artery stenting in stroke patients with atrial fibrillation. Neurol Res Pract 2022; 4:42. [PMID: 36089621 PMCID: PMC9465921 DOI: 10.1186/s42466-022-00207-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 07/22/2022] [Indexed: 11/18/2022] Open
Abstract
Background Oral anticoagulation (OAC) is the mainstay of secondary prevention in ischemic stroke patients with atrial fibrillation (AF). However, in AF patients with large vessel occlusion stroke treated by endovascular therapy (ET) and acute carotid artery stenting (CAS), the optimal antithrombotic medication remains unclear.
Methods This is a subgroup analysis of the German Stroke Registry—Endovascular Treatment (GSR-ET), a prospective multicenter cohort of patients with large vessel occlusion stroke undergoing ET. Patients with AF and CAS during ET were included. We analyzed baseline and periprocedural characteristics, antithrombotic strategies and functional outcome at 90 days. Results Among 6635 patients in the registry, a total of 82 patients (1.2%, age 77.9 ± 8.0 years, 39% female) with AF and extracranial CAS during ET were included. Antithrombotic medication at admission, during ET, postprocedural and at discharge was highly variable and overall mortality in hospital (21%) and at 90 days (39%) was high. Among discharged patients (n = 65), most frequent antithrombotic regimes were dual antiplatelet therapy (DAPT, 37%), single APT + OAC (25%) and DAPT + OAC (20%). Comparing DAPT to single or dual APT + OAC, clinical characteristics at discharge were similar (median NIHSS 7.5 [interquartile range, 3–10.5] vs 7 [4–11], p = 0.73, mRS 4 [IQR 3–4] vs. 4 [IQR 3–5], p = 0.79), but 90-day mortality was higher without OAC (32 vs 4%, p = 0.02). Conclusions In AF patients who underwent ET and CAS, 90-day mortality was higher in patients not receiving OAC. Registration: https://www.clinicaltrials.gov; Unique identifier: NCT03356392. Supplementary Information The online version contains supplementary material available at 10.1186/s42466-022-00207-7.
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Thiele F, Weller J, Katzendobler S, Trumm C, Thon N, Tonn J. P15.09.A Canny edge detection algorithm for quantitative differentiation between diffuse and circumscript glioma growth patterns on MRI. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac174.299] [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: 11/14/2022] Open
Abstract
Abstract
Background
Lower grade gliomas show heterogenous appearance on T2-weighted MRI. Some tumors grow diffusely along axonal structures whereas others distort adjacent brain tissue through local mass effect. The diagnostic, therapeutic and prognostic implication of differential growth patterns on MRI remain unknown and are difficult to assess quantitatively.
Material and Methods
A web-based application allowing for image preprocessing and providing a comprehensive edge detection tool by means of quantifying tumor border delineation on T2-weighted images based on the canny edge detection algorithm was developed. A sigma value between 1 and 100 determined the threshold where tumor borders where not detected by the algorithm anymore, with 1 equating to the lowest threshold and thus detection of all edges contained in the image. Two experienced faculty members assigned sigma values to axial T2 images of a random sample of 20 WHO grade 2 astrocytomas, IDH-mutant and 1p/19q-non-codeleted. The sigma values were then compared with a binary, subjective rating by the same faculty staff according to the perceived predominant growth pattern (diffuse versus circumscript) of each glioma.
Results
When subjectively categorizing tumors binarily (diffuse versus circumscript), there was moderate interrater variability between observers (cohen’s kappa=0.6). Raters agreed in 16 of 20 cases, terming 7 gliomas unanimously diffuse and 9 gliomas circumscript. In 4 cases, the raters opinions diverged. The sigma values differed significantly between diffuse and circumscript tumors in both raters (rater 1, p=0.002; rater 2, p=0.018). For rater 1, the mean sigma difference between diffuse and circumscript tumors was 10.7 and 9.3 for rater 2.
Conclusion
Edge detection algorithms can be efficiently applied on MRI scans and are highly accurate in differentiating diffuse from circumscript gliomas. Objectification demands defining imaging criteria for diffuse and circumscript appearance of lower grade gliomas on MRI.
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Affiliation(s)
- F Thiele
- University Hospital Munich , Munich , Germany
| | - J Weller
- University Hospital Munich , Munich , Germany
| | | | - C Trumm
- University Hospital Munich , Munich , Germany
| | - N Thon
- University Hospital Munich , Munich , Germany
| | - J Tonn
- University Hospital Munich , Munich , Germany
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11
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Leitner MA, Hubert G, Paternoster L, Leitner M, Rémi J, Trumm C, Haberl R, Hubert N. Abstract TP158: High Mortality In In-Hospital-Stroke Patients After Interhospital Transfer For Endovascular Therapy. Stroke 2022. [DOI: 10.1161/str.53.suppl_1.tp158] [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: 11/16/2022]
Abstract
There are only few studies examining In-Hospital-Stroke- (IHS) patients with a large vessel occlusion and subsequent transfer to a comprehensive stroke center for endovascular therapy (EVT). However, this patient group is highly relevant given the substantial amount of IHS, the ongoing trend towards a more frequent use of EVT and the lack of EVT capacities in rural hospitals. Furthermore, these patients are particularly vulnerable, as IHS is associated with higher rates of pre-existing conditions and worse clinical outcomes. We retrospectively analyzed prospectively collected data of patients receiving EVT after interhospital transfer from 15 rural hospitals of the Telemedical Stroke Network in Southeast Bavaria, Germany (
TEMPiS
) between 02-2018 and 07-2020. Baseline characteristics, treatment times and outcomes were compared between IHS- and Out-of-Hospital-Stroke- (OHS) patients. Primary endpoint was mRS after 3 months. A total of 49 IHS-patients and 274 OHS-patients received EVT after interhospital transfer. IHS-patients had a higher prevalence of atrial fibrillation (55.3% vs. 35.9%, p= 0.012), diabetes (36.2% vs. 21.1%, p= 0.024) and use of oral anticoagulants (44.7% vs. 20.8%, p< 0.001). Severity of stroke was similar in both groups. Treatment times from symptom onset to first brain imaging, therapy decision or groin puncture were significantly shorter for IHS-patients. IHS-patients displayed significantly worse outcomes: 59.2% of them died within 3 months compared to only 28.5% of OHS-patients (p< 0.001). Additionally, they were less likely to achieve moderate outcomes (mRS 0-3) 3 months after stroke (20.4% vs. 39.8%, p= 0.010). A logistic regression analysis revealed that - after controlling for possible confounding variables such as severity of stroke, premorbid state, pre-existing conditions, age and gender - IHS was significantly associated with a higher chance of death (adjusted OR: 3.99 (95%-CI: 1.84-8.92), p< 0.001). The mortality rate of IHS-patients who underwent EVT after interhospital transfer was substantially higher than that of OHS-patients. Thus, this patient group may not benefit from this therapeutic approach. In future studies alternative approaches that circumvent interhospital transfer should be explored.
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Affiliation(s)
| | | | | | | | - Jan Rémi
- Neurology, LMU München, Munich, Germany
| | | | - Roman Haberl
- Neurology, München Klinik Harlaching, Munich, Germany
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12
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Niedermeier S, Wania R, Lampart A, Stahl R, Trumm C, Kammerlander C, Böcker W, Nickel CH, Bingisser R, Armbruster M, Pedersen V. Incidental CT Findings in the Elderly with Low-Energy Falls: Prevalence and Implications. Diagnostics (Basel) 2022; 12:diagnostics12020354. [PMID: 35204445 PMCID: PMC8871195 DOI: 10.3390/diagnostics12020354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/10/2022] [Accepted: 01/24/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Computed tomography (CT) is commonly used in trauma care, with increasing implementation during the emergency work-up of elderly patients with low-energy falls (LEF). The prevalence of incidental findings (IFs) resulting from CT imaging and requiring down-stream actions in this patient cohort is unknown. We have investigated the prevalence and urgency of IFs from emergency CT examinations in these patients. Methods: A total of 2871 patients with LEF and emergency CT examinations were consecutively included in this retrospective cohort study. The primary endpoint was the prevalence of IFs; the secondary endpoint was their urgency. Results: The median age was 82 years (64.2% were women). IFs were identified in 73.9% of patients, with an average of 1.6 IFs per patient. Of all IFs, 16.4% were classified as urgent or relevant, predominantly in the abdomen, chest and neck. Increasing age was associated with the prevalence of an IF (odds ratio: 1.053, 95% confidence interval: 1.042–1.064). Significantly more IFs were found in female patients (75.2% vs. 71.5%). Conclusion: IFs resulting from CT examinations of the elderly are frequent, but in more than 8 out of 10, they are harmless or currently asymptomatic. For the benefit of an accurate diagnosis of traumatic lesions, concerns about IFs with respect to disease burden, further work-up and resource utilisation might be disregarded.
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Affiliation(s)
- Sandra Niedermeier
- Department of General, Trauma and Reconstructive Surgery, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany; (S.N.); (R.W.); (C.K.); (W.B.)
| | - Rebecca Wania
- Department of General, Trauma and Reconstructive Surgery, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany; (S.N.); (R.W.); (C.K.); (W.B.)
| | - Alina Lampart
- Department of Medicine, Kantonsspital Lucerne, Spitalstrasse, 6000 Lucerne, Switzerland;
| | - Robert Stahl
- Institute of Diagnostic and Interventional Neuroradiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany; (R.S.); (C.T.)
| | - Christoph Trumm
- Institute of Diagnostic and Interventional Neuroradiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany; (R.S.); (C.T.)
| | - Christian Kammerlander
- Department of General, Trauma and Reconstructive Surgery, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany; (S.N.); (R.W.); (C.K.); (W.B.)
- Trauma Hospital Styria, Goestinger Straße 24, 8020 Graz, Austria
| | - Wolfgang Böcker
- Department of General, Trauma and Reconstructive Surgery, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany; (S.N.); (R.W.); (C.K.); (W.B.)
| | - Christian H. Nickel
- Department of Emergency Medicine, University Hospital Basel, Petersgraben 2, 4031 Basel, Switzerland; (C.H.N.); (R.B.)
| | - Roland Bingisser
- Department of Emergency Medicine, University Hospital Basel, Petersgraben 2, 4031 Basel, Switzerland; (C.H.N.); (R.B.)
| | - Marco Armbruster
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany;
| | - Vera Pedersen
- Department of General, Trauma and Reconstructive Surgery, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany; (S.N.); (R.W.); (C.K.); (W.B.)
- Correspondence: ; Tel.: +49-89-440072005; Fax: +49-89-440072102
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13
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Ozpeynirci Y, Trumm C, Stahl R, Fischer D, Liebig T, Forbrig R. Radiation Dose and Fluoroscopy Time of Diagnostic Angiography in Patients with Spinal Dural Arteriovenous Fistula. Clin Neuroradiol 2022; 32:791-797. [PMID: 34994809 PMCID: PMC9424156 DOI: 10.1007/s00062-021-01130-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 12/09/2021] [Indexed: 11/03/2022]
Abstract
PURPOSE Spinal dural arteriovenous fistulas (SDAVFs) represent the most common indication for a spinal angiography. The diagnostic reference level (DRL) for this specific endovascular procedure is still to be determined. This single-center study provides detailed dosimetrics of diagnostic spinal angiography performed in patients with SDAVFs. METHODS Retrospective analysis of all diagnostic spinal angiographies between December 2011 and January 2021. Only patients with an SDAVF who had baseline magnetic resonance angiography (MRA), diagnostic digital subtraction angiography (DSA), treatment and follow-up at this institution were included. Dose area product (DAP, Gy cm2) and fluoroscopy time were compared between preoperative and postoperative angiographies, according to SDAVF locations (common versus uncommon), MRA results at baseline (positive versus negative) and DSA protocols (low-dose, mixed-dose, normal-dose). The 75th percentile of the DAP distribution was used to define the local DRL. RESULTS A total of 62 spinal angiographies were performed in 25 patients with SDAVF. Preoperative angiographies (30/62, 48%) yielded a significantly higher DAP and longer fluoroscopy time when compared to postoperative angiographies (32/62, 53%) (p < 0.01). The local DRL was 329.41 Gy cm2 for a nonspecific (n = 62), 395.59 Gy cm2 for a preoperative and 138.6 Gy cm2 for a postoperative spinal angiography. Preoperative angiography of uncommonly located SDAVFs yielded a significantly longer fluoroscopy time (p = 0.02). The MRA-based fistula detection had no significant impact on dosimetrics (p > 0.05). A low-dose protocol yielded a 61% reduction of DAP. CONCLUSION The results of the present study suggest novel DRLs for spinal angiography in patients with SDAVF. Dedicated low-dose protocols enable radiation dose optimization in these procedures.
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Affiliation(s)
- Yigit Ozpeynirci
- Klinikum Großhadern, Institut für Neuroradiologie, Ludwig Maximilians University, Marchioninistr. 15, 81377, Munich, Germany.
| | - Christoph Trumm
- Klinikum Großhadern, Institut für Neuroradiologie, Ludwig Maximilians University, Marchioninistr. 15, 81377, Munich, Germany
| | - Robert Stahl
- Klinikum Großhadern, Institut für Neuroradiologie, Ludwig Maximilians University, Marchioninistr. 15, 81377, Munich, Germany
| | - David Fischer
- Klinikum Großhadern, Institut für Neuroradiologie, Ludwig Maximilians University, Marchioninistr. 15, 81377, Munich, Germany
| | - Thomas Liebig
- Klinikum Großhadern, Institut für Neuroradiologie, Ludwig Maximilians University, Marchioninistr. 15, 81377, Munich, Germany
| | - Robert Forbrig
- Klinikum Großhadern, Institut für Neuroradiologie, Ludwig Maximilians University, Marchioninistr. 15, 81377, Munich, Germany
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14
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Lampart A, Arnold I, Mäder N, Niedermeier S, Escher A, Stahl R, Trumm C, Kammerlander C, Böcker W, Nickel CH, Bingisser R, Pedersen V. Prevalence of Fractures and Diagnostic Accuracy of Emergency X-ray in Older Adults Sustaining a Low-Energy Fall: A Retrospective Study. J Clin Med 2019; 9:jcm9010097. [PMID: 31906002 PMCID: PMC7019509 DOI: 10.3390/jcm9010097] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 12/24/2019] [Accepted: 12/26/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Plain radiography (XR) series are standard of care for detection of fall-related fractures in older patients with low-energy falls (LEF) in the emergency department (ED). We have investigated the prevalence of fractures and diagnostic accuracy of XR imaging in the ED. METHODS 2839 patients with LEF, who were presented to two urban level I trauma centers in 2016 and received XR and computed tomography (CT), were consecutively included in this retrospective cohort study. The primary endpoint was the prevalence of fractures of the vertebral column, rib cage, pelvic ring, and proximal long bones. Secondary endpoints were diagnostic accuracy of XR for fracture detection with CT as reference standard and cumulative radiation doses applied. RESULTS Median age was 82 years (range 65-105) with 64.1% female patients. Results revealed that 585/2839 (20.6%) patients sustained fractures and 452/2839 (15.9%) patients received subsequent XR and CT examinations of single body regions. Cross-tabulation analysis revealed sensitivity of XR of 49.7%, a positive likelihood ratio of 27.6, and negative likelihood ratio of 0.5. CONCLUSIONS XR is of moderate diagnostic accuracy for ruling-out fractures of the spine, pelvic ring, and rib cage in older patients with LEF. Prospective validations are required to investigate the overall risk-benefit of direct CT imaging strategies, considering the trade-off between diagnostic safety, health care costs, and radiation exposure.
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Affiliation(s)
- Alina Lampart
- Department of Emergency Medicine, University Hospital Basel, Petersgraben 2, 4031 Basel, Switzerland; (A.L.); (I.A.); (C.H.N.); (R.B.)
| | - Isabelle Arnold
- Department of Emergency Medicine, University Hospital Basel, Petersgraben 2, 4031 Basel, Switzerland; (A.L.); (I.A.); (C.H.N.); (R.B.)
| | - Nina Mäder
- Department of Emergency Medicine, University Hospital Basel, Petersgraben 2, 4031 Basel, Switzerland; (A.L.); (I.A.); (C.H.N.); (R.B.)
| | - Sandra Niedermeier
- Department for General, Trauma and Reconstructive Surgery, Ludwig Maximilian University Munich, Marchioninstr. 15, 81377 Munich, Germany; (S.N.); (C.K.); (W.B.)
| | - Armin Escher
- Department of Radiology, University Hospital Basel, Petersgraben 2, 4031 Basel, Switzerland;
| | - Robert Stahl
- Institute of Diagnostic and Interventional Neuroradiology, Ludwig Maximilian University Munich, Marchioninstr. 15, 81377 Munich, Germany; (R.S.); (C.T.)
| | - Christoph Trumm
- Institute of Diagnostic and Interventional Neuroradiology, Ludwig Maximilian University Munich, Marchioninstr. 15, 81377 Munich, Germany; (R.S.); (C.T.)
| | - Christian Kammerlander
- Department for General, Trauma and Reconstructive Surgery, Ludwig Maximilian University Munich, Marchioninstr. 15, 81377 Munich, Germany; (S.N.); (C.K.); (W.B.)
| | - Wolfgang Böcker
- Department for General, Trauma and Reconstructive Surgery, Ludwig Maximilian University Munich, Marchioninstr. 15, 81377 Munich, Germany; (S.N.); (C.K.); (W.B.)
| | - Christian H. Nickel
- Department of Emergency Medicine, University Hospital Basel, Petersgraben 2, 4031 Basel, Switzerland; (A.L.); (I.A.); (C.H.N.); (R.B.)
| | - Roland Bingisser
- Department of Emergency Medicine, University Hospital Basel, Petersgraben 2, 4031 Basel, Switzerland; (A.L.); (I.A.); (C.H.N.); (R.B.)
| | - Vera Pedersen
- Department for General, Trauma and Reconstructive Surgery, Ludwig Maximilian University Munich, Marchioninstr. 15, 81377 Munich, Germany; (S.N.); (C.K.); (W.B.)
- Correspondence: ; Tel.: +49-89-4400711229; Fax: +49-89-440078899
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15
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Pradella M, Trumm C, Stieltjes B, Boll DT, Zech CJ, Huegli RW. Impact factors for safety, success, duration and radiation exposure in CT-guided interventions. Br J Radiol 2019; 92:20180937. [PMID: 31045438 DOI: 10.1259/bjr.20180937] [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: 01/21/2023] Open
Abstract
OBJECTIVE We aim to compare factors influencing safety, success rate and radiation dose of CT-guided biopsies and drainages in a non-teaching setting with experienced operators vs a teaching setting with residents. METHODS A total of 1021 cases were retrospectively analyzed regarding lesion size, distance from skin, procedure duration, radiation dose, complications and clinical success. Procedures were grouped into biopsies of lung, liver, (remaining) abdomen, musculoskeletal system (MSK) and drainages of any region. Procedures in non-teaching setting were performed by experienced operators (full time interventional radiology staff), teaching setting consisted of residents under supervision of interventional radiology staff. RESULTS Overall clinical success rate was 93.6 % [experienced (exp.) vs teaching setting: 93.5 and 93.6 %, p = 0.97]. Overall complication rate was 7.2% (5.7% minor, 1.6% major; exp. vs teaching: 8.0 and 6.5 %, p = 0.67]. Experienced operators performed chest and liver biopsies faster even though they were facing smaller lesions. Multiple regression analysis revealed that depth from skin significantly increased procedure duration by 36.8 s per cm (p < 0.001) and also radiation dose by 5.4 mGy per cm (p < 0.001) in all interventions. On average, teaching setting increased the duration of an intervention by 209.8 s and total radiation dose by 10.6 mGy (p < 0.001, p < 0.001 respectively). CONCLUSION CT guided interventions can be performed safe und successful disregarding anatomical parameters or teaching setting. Depth from skin and teaching setting should be taken into account both from a clinical and a time-conscious point of view since they increase radiation dose and prolong operations. ADVANCES IN KNOWLEDGE This is the first study with >1000 interventions which shows and quantifies the impact of lesion depth and teaching setting in CT-guided interventions.
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Affiliation(s)
- Maurice Pradella
- 1 Department of Radiology, Clinic of Radiology & Nuclear Medicine, University of Basel Hospital, Petersgraben , Basel , Switzerland
| | - Christoph Trumm
- 2 Institute for Diagnostic and Interventional Radiology, Neuroradiology and Nuclear Medicine, Klinikum München-Harlaching, Städtisches Klinikum München GmbH, Sanatoriumsplatz , Munich , Germany
| | - Bram Stieltjes
- 1 Department of Radiology, Clinic of Radiology & Nuclear Medicine, University of Basel Hospital, Petersgraben , Basel , Switzerland
| | - Daniel T Boll
- 1 Department of Radiology, Clinic of Radiology & Nuclear Medicine, University of Basel Hospital, Petersgraben , Basel , Switzerland
| | - Christoph J Zech
- 1 Department of Radiology, Clinic of Radiology & Nuclear Medicine, University of Basel Hospital, Petersgraben , Basel , Switzerland
| | - Rolf W Huegli
- 3 Department of Radiology and Nuclear Medicine, Kantonsspital Baselland , Bruderholz , Switzerland
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16
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Braunagel M, Ortner F, Schönermarck U, Habicht A, Schindler A, Stangl M, Strobl FF, Reiser M, Clevert DA, Trumm C, Helck A. Dynamic CTA in Native Kidneys Using a Multiphase CT Protocol-Potential of Significant Reduction of Contrast Medium. Acad Radiol 2018; 25:842-849. [PMID: 29545025 DOI: 10.1016/j.acra.2017.11.012] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 11/19/2017] [Accepted: 11/20/2017] [Indexed: 12/26/2022]
Abstract
RATIONALE AND OBJECTIVE The objective of this study was to assess an optimized renal multiphase computed tomography angiography (MP-CTA) protocol regarding reduction of contrast volume. MATERIALS AND METHODS Thirty patients underwent MP-CTA (12 phases, every 3.5 seconds, 80 kV/120 mAs) using 30 mL of contrast medium. The quality of MP-CTA was assessed quantitatively measuring vessel attenuation, image noise, and contrast-to-noise ratio. MP-CTA was evaluated qualitatively regarding depiction of vessels, cortex differentiation, and motion artifacts (grades 1-4, 1 = best). Mean effective radiation dose was registered. Results were compared to standard renal computed tomography angiography (CTA) (80 mL). Student t test was applied, if variables followed normal distribution. For other variables, nonparametric Mann-Whitney U test was used. RESULTS All acquisitions were successfully performed, and no patient had to be excluded from the study. MP-CTA enabled high attenuation (aorta: 503 ± 91 HU, renal arteries: 450 ± 73 HU/456 ± 72 HU) at adequate image noise (13.7 ± 1.5) and good contrast-to-noise ratio (34.2 ± 10.2). Good attenuation of renal veins was observed (286 ± 43 HU/282 ± 42 HU). Arterial enhancement was significantly higher compared to renal CTA (aorta: 396 ± 90 HU, renal arteries: 331 ± 74 HU/333 ± 80 HU; P < .001). MP-CTA protocol enabled good image quality of renal arteries (1.5 ± 0.6) and veins (1.7 ± 0.6). Cortex differentiation and motion artifacts were ranked 1.8 ± 0.8 and 1.6 ± 0.8. The mean effective radiation dose was 9 mSv (MP-CTA). CONCLUSIONS Compared to standard renal CTA, the renal MP-CTA enabled the significant reduction of contrast volume and simultaneously provided a significantly higher arterial attenuation.
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Affiliation(s)
- Margarita Braunagel
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital (LMU), Marchioninistr. 15, 81377Munich, Germany
| | - Florian Ortner
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital (LMU), Marchioninistr. 15, 81377Munich, Germany
| | - Ulf Schönermarck
- Department of Internal Medicine IV, Ludwig-Maximilians-University Hospital (LMU),Munich, Germany
| | - Antje Habicht
- Transplant Center, Ludwig-Maximilians-University Hospital (LMU),Munich, Germany
| | - Andreas Schindler
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital (LMU), Marchioninistr. 15, 81377Munich, Germany
| | - Manfred Stangl
- Department of Surgery, Ludwig-Maximilians-University Hospital (LMU), Munich, Germany
| | - Frederik F Strobl
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital (LMU), Marchioninistr. 15, 81377Munich, Germany
| | - Maximilian Reiser
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital (LMU), Marchioninistr. 15, 81377Munich, Germany
| | - Dirk A Clevert
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital (LMU), Marchioninistr. 15, 81377Munich, Germany
| | - Christoph Trumm
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital (LMU), Marchioninistr. 15, 81377Munich, Germany
| | - Andreas Helck
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital (LMU), Marchioninistr. 15, 81377Munich, Germany.
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17
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Baumann A, Winter K, Garthe T, Thäns N, Bock J, Schindler R, Bischoff B, Trumm C, Reiser M, Schwarz F. Systolische Akquisition bei High-Pitch CT-Angiografien zur TAVI-Planung – Wie gut gelingt das und wann besser nicht? ROFO-FORTSCHR RONTG 2017. [DOI: 10.1055/s-0037-1600229] [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)
- A Baumann
- Institut für Klinische Radiologie, LMU München, Campus Großhadern, Radiologie, München
| | - K Winter
- Institut für Klinische Radiologie, LMU München, Campus Großhadern, Radiologie, München
| | - T Garthe
- Institut für Klinische Radiologie, LMU München, Campus Großhadern, Radiologie, München
| | - N Thäns
- Institut für Klinische Radiologie, LMU München, Campus Großhadern, Radiologie, München
| | - J Bock
- Institut für Klinische Radiologie, LMU München, Campus Großhadern, Radiologie, München
| | - R Schindler
- Institut für Klinische Radiologie, LMU München, Campus Großhadern, Radiologie, München
| | - B Bischoff
- Institut für Klinische Radiologie, LMU München, Campus Großhadern, Radiologie, München
| | - C Trumm
- Institut für Klinische Radiologie, LMU München, Campus Großhadern, Radiologie, München
| | - M Reiser
- Institut für Klinische Radiologie, LMU München, Radiologie, München
| | - F Schwarz
- Klinik für Diagnostische Radiologie und Neuroradiologie, Radiologie, Augsburg
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Abstract
BACKGROUND Pancreatic cancer is a highly aggressive malignancy and will become the second leading cause of cancer-related death in the USA and also in Germany by 2030. Furthermore, the majority of patients with pancreatic ductal adenocarcinoma (PDAC) will present with distant metastases, limiting surgical management in this population as there is little evidence available to support surgical or ablative treatment options for advanced-stage disease. However, highly selected patients suffering from synchronous and metachronous oligometastatic PDAC may potentially benefit from a surgical resection with an acceptable morbidity. METHODS This review summarizes and discusses the current literature on the management of oligometastatic disease regarding PDAC, focusing on para-aortic lymph nodes as well as isolated hepatic and pulmonary metastases. RESULTS AND CONCLUSION In order to further investigate the feasibility and efficacy of such an approach, a prospective multicenter trial, in which survival and quality of life after metastatic resection and systemic chemotherapy is evaluated, has to be initiated. Additionally, local and locoregional ablation techniques or stereotactic body radiation therapy as therapeutic options for isolated metastases in PDAC need further research in order to determine their significance and benefit.
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Affiliation(s)
- Bernhard W Renz
- Department of General, Visceral and Transplantation Surgery, Hospital of the University of Munich, Munich, Germany, Munich, Germany.,Pancreatic Cancer Center Munich, Comprehensive Cancer Center-LMU, University of Munich, Munich, Germany, Munich, Germany
| | - Stefan Boeck
- Pancreatic Cancer Center Munich, Comprehensive Cancer Center-LMU, University of Munich, Munich, Germany, Munich, Germany.,Department of Internal Medicine III, Hospital of the University of Munich, Munich, Germany, Munich, Germany
| | - Falk Roeder
- Pancreatic Cancer Center Munich, Comprehensive Cancer Center-LMU, University of Munich, Munich, Germany, Munich, Germany.,Department of Radiation Oncology, Hospital of the University of Munich, Munich, Germany, Munich, Germany.,Department of Molecular Radiation Oncology, German Cancer Research Center, Heidelberg, Germany, Munich, Germany
| | - Christoph Trumm
- Department of Clinical Radiology, Hospital of the University of Munich, Munich, Germany
| | - Volker Heinemann
- Pancreatic Cancer Center Munich, Comprehensive Cancer Center-LMU, University of Munich, Munich, Germany, Munich, Germany.,Department of Internal Medicine III, Hospital of the University of Munich, Munich, Germany, Munich, Germany
| | - Jens Werner
- Department of General, Visceral and Transplantation Surgery, Hospital of the University of Munich, Munich, Germany, Munich, Germany.,Pancreatic Cancer Center Munich, Comprehensive Cancer Center-LMU, University of Munich, Munich, Germany, Munich, Germany
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19
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Schmid-Tannwald C, Schmid-Tannwald CM, Morelli JN, Albert NL, Braunagel M, Trumm C, Reiser MF, Ertl-Wagner B, Rist C. The role of diffusion-weighted MRI in assessment of inflammatory bowel disease. Abdom Radiol (NY) 2016; 41:1484-94. [PMID: 27108127 DOI: 10.1007/s00261-016-0727-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
AIM To evaluate the role of diffusion-weighted MRI (DW-MRI) in detecting and differentiating acute from chronic bowel inflammation in patients with Crohn's disease (CD). MATERIALS AND METHODS MR-enteroclysis examinations with DW-MRI were reviewed from 24 patients with histologically proven CD. Segments of bowel were evaluated for acute and chronic inflammation in three different reviews of the MRI images: T2w alone, T2w + DWI, and T2w + CET1w. Mean ADC values of normal bowel segments, as well as bowel segments with acute and chronic inflammation were calculated and compared. Analyses of receiver-operating characteristic (ROC) curve were performed. RESULTS Hundred and forty four bowel segments in total were reviewed. Inflammation was present in 45 segments. Acute inflammation was present in 31 segments, chronic inflammation in 14. 98 bowel segments showed no inflammatory activity. Sensitivity and specificity for differentiation between normal and inflamed bowel segments was 0.6, 0.67, and 0.80 on T2w, T2w + DWI, and T2w + CET1w datasets, respectively. Specificities for differentiation between normal and inflamed bowel segments were 0.96, 0.96, and 0.98. Sensitivities for differentiation between acute and chronically inflamed bowel segments were 0.85, 0.91, and 0.96, and specificities were 0.88, 0.89, and 1.0, respectively. The mean ADC value of normal bowel (2.18 ± 0.37 × 10(-3) mm(2)/s) was statistically significantly greater than the mean value of inflamed bowel segments (p < 0.001). The mean ADC value of acutely inflamed bowel segments was statistically significantly lower than that of chronically inflamed bowel segments (1.09 ± 0.18 × 10(-3) vs. 1.55 ± 0.21 × 10(-3) mm(2)/s) (p < 0.001). Estimated area under the ROC curve for the diagnosis of acute vs. chronic inflammation was 0.950. A threshold of ADC value of 1.41 × 10(-3) mm(2)/s was optimal for calculation of sensitivity and specificity. CONCLUSION DW-MRI improves detection and differentiation of acute vs. chronic inflammatory changes of the bowel in patients with CD compared to T2w-images alone.
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Affiliation(s)
- Christine Schmid-Tannwald
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Christoph M Schmid-Tannwald
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - John N Morelli
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, 601 N Caroline, Baltimore, MD, 21287, USA
| | - Nathalie L Albert
- Department of Nuclear Medicine, Ludwig-Maximilians-University Hospital Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Margarita Braunagel
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Christoph Trumm
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Maximilian F Reiser
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Birgit Ertl-Wagner
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Carsten Rist
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Marchioninistr. 15, 81377, Munich, Germany.
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Brix G, Lechel U, Sudarski S, Trumm C, Henzler T. Spectral optimization of iodine-enhanced CT: Quantifying the effect of tube voltage on image quality and radiation exposure determined at an anthropomorphic phantom. Phys Med 2016; 32:999-1006. [PMID: 27484397 DOI: 10.1016/j.ejmp.2016.07.618] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 07/14/2016] [Accepted: 07/25/2016] [Indexed: 12/11/2022] Open
Abstract
PURPOSE To provide an experimental basis for spectral optimization of iodine-enhanced CT by a quantitative analysis of image quality and radiation dose characteristics consistently measured for a large variety of scan settings at an anthropomorphic phantom. METHODS CT imaging and thermoluminescent dosimetry were performed at an anthropomorphic whole-body phantom with iodine inserts for different tube voltages (U, 70-140kV) and current-time products (Q, 60-300mAs). For all U-Q combinations, the iodine contrast (C), the noise level (N) and, from these, the contrast-to-noise ratio (CNR) of reconstructed CT images were determined and parameterized as a function of U, Q or the measured absorbed dose (D). Finally, two characteristic curves were derived that give the relative increase of CNR at constant D and the relative decrease of D at constant CNR when lowering U. RESULTS Lowering U affects the measured CNR only slightly but markedly reduces D. For example, reducing U from 120kV to 70kV increases the CNR at constant D by a factor of nearly 1.8 or, alternatively, reduces D at constant CNR by a factor of nearly 5. CONCLUSION Spectral optimization by lowering U is an effective approach to attain the necessary CNR for a specific diagnostic task at hand while at the same time reducing radiation exposure as far as practically achievable. The characteristic curves derived in this study from extensive measurements at a reference 'person' can support CT users in an easy-to-use manner to select an appropriate voltage for various clinical scenarios.
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Affiliation(s)
- Gunnar Brix
- Department of Medical and Occupational Radiation Protection, Federal Office for Radiation Protection, Oberschleissheim, Germany.
| | - Ursula Lechel
- Department of Medical and Occupational Radiation Protection, Federal Office for Radiation Protection, Oberschleissheim, Germany
| | - Sonja Sudarski
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Christoph Trumm
- Department of Clinical Radiology, Grosshadern Clinic, Hospital of the Ludwig-Maximilians University, Munich, Germany
| | - Thomas Henzler
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
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21
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Schoenberg M, Khandoga A, Stintzing S, Trumm C, Schiergens TS, Angele M, Op den Winkel M, Werner J, Muacevic A, Rentsch M. CyberKnife Radiosurgery - Value as an Adjunct to Surgical Treatment of HCC? Cureus 2016; 8:e591. [PMID: 27284498 PMCID: PMC4889454 DOI: 10.7759/cureus.591] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION CyberKnife radiosurgery (CK) is an effective tool for the treatment of malignancies. Its greatest potential is in high-dose radiosurgery delivered to targets in organs that move with respiration, e.g., liver tumors. For hepatocellular carcinoma (HCC), however, surgical treatment (resection, transplantation) is most likely to produce long-term survival; for non-resectable tumors, therapies other than radiosurgery are typically recommended. This study evaluated the long-lasting anti-tumor effects of CK combined with surgery in patients with HCC. MATERIALS AND METHODS : Eighteen patients (three women, 15 men) were included in this prospective observational study. They received 21 single-fraction CK treatments (26 Gy). Patient characteristics, treatment effects, tumor response (according to the Response Evaluation Criteria In Solid Tumors (RECIST) grading) and survival were measured for a median period of 29 months. RESULTS Local tumor control was achieved in 15 patients, with complete and partial remission observed in 10 and five patients, respectively. One patient was treated for two separate lesions in one session, and one received three treatments each separated by two-year intervals; both patients are tumor-free. Two patients showed minimal response, and in one patient local tumor viability could not be excluded by MRI. Nine patients had HCC recurrence, all distant to the treated site. Nine patients died during follow-up, including two with clear relation to tumor progress. Tumor-free survival was 79.4% after one year and 29.8% after three years, and the corresponding overall survival was 84.8% and 66%. CONCLUSION : This study shows the high effectiveness of single-session frameless CyberKnife radiosurgery for treatment of hepatocellular carcinoma and reconfirms previous results of fractioned radiotherapy of HCC. It also demonstrates the potential of radiosurgery to be combined with surgical concepts.
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Affiliation(s)
- Markus Schoenberg
- Department of General, Visceral and Transplantation Surgery, Hospital of the University of Munich
| | | | | | | | | | | | | | - Jens Werner
- Surgery, Ludwig Maximilian University of Munich
| | | | - Markus Rentsch
- Department of General, Visceral and Transplantation Surgery, Hospital of the University of Munich
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22
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Helck A, Schumann C, Aumann J, Thierfelder K, Strobl FF, Braunagel M, Niethammer M, Clevert DA, Hoffmann RT, Reiser M, Sandner T, Trumm C. Automatic path proposal computation for CT-guided percutaneous liver biopsy. Int J Comput Assist Radiol Surg 2016; 11:2199-2205. [DOI: 10.1007/s11548-015-1349-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Accepted: 12/30/2015] [Indexed: 10/22/2022]
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23
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Kolligs FT, Bilbao JI, Jakobs T, Iñarrairaegui M, Nagel JM, Rodriguez M, Haug A, D'Avola D, op den Winkel M, Martinez-Cuesta A, Trumm C, Benito A, Tatsch K, Zech CJ, Hoffmann RT, Sangro B. Pilot randomized trial of selective internal radiation therapy vs. chemoembolization in unresectable hepatocellular carcinoma. Liver Int 2015; 35:1715-21. [PMID: 25443863 DOI: 10.1111/liv.12750] [Citation(s) in RCA: 108] [Impact Index Per Article: 12.0] [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: 09/30/2014] [Accepted: 11/19/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS To compare selective internal radiation therapy (SIRT) with transarterial chemoembolization (TACE), the standard-of-care for intermediate-stage unresectable, hepatocellular carcinoma (HCC), as first-line treatment. METHODS SIRTACE was an open-label multicenter randomized-controlled pilot study, which prospectively compared primarily safety and health-related quality of life (HRQoL) changes following TACE and SIRT. Patients with unresectable HCC, Child-Pugh ≤B7, ECOG performance status ≤2 and ≤5 liver lesions (≤20 cm total maximum diameter) without extrahepatic spread were randomized to receive either TACE (at 6-weekly intervals until tumour enhancement was not observed on MRI or disease progression) or single-session SIRT (yttrium-90 resin microspheres). RESULTS Twenty-eight patients with BCLC stage A (32.1%), B (46.4%) or C (21.4%) received either a mean of 3.4 (median 2) TACE interventions (N = 15) or single SIRT (N = 13). Both treatments were well tolerated. Despite SIRT patients having significantly worse physical functioning at baseline, at week-12, neither treatment had a significantly different impact on HRQoL as measured by Functional Assessment of Cancer Therapy-Hepatobiliary total or its subscales. Both TACE and SIRT were effective for the local control of liver tumours. Best overall response-rate (RECIST 1.0) of target lesions were 13.3% and 30.8%, disease control rates were 73.3% and 76.9% for TACE and SIRT, respectively. Two patients in each group were down-staged for liver transplantation (N = 3) or radiofrequency ablation (N = 1). CONCLUSIONS Single-session SIRT appeared to be as safe and had a similar impact on HRQoL as multiple sessions of TACE, suggesting that SIRT might be an alternative option for patients eligible for TACE.
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Affiliation(s)
- Frank T Kolligs
- Department of Internal Medicine II, University of Munich, Munich, Germany
| | - Jose I Bilbao
- Interventional Radiology, Clinica Universidad de Navarra and Instituto de Investigaciones Sanitarias de Navarra (IDISNA), Pamplona, Spain
| | - Tobias Jakobs
- Institute of Radiology, Krankenhaus der Barmherzigen Brüder, Munich, Germany
| | | | - Jutta M Nagel
- Department of Internal Medicine II, University of Munich, Munich, Germany
| | | | - Alexander Haug
- Department of Nuclear Medicine, University of Munich, Munich, Germany
| | - Delia D'Avola
- Liver Unit, Clinica Universidad de Navarra, Instituto de Investigaciones Sanitarias de Navarra (IDISNA) and Centro de Investigacion Biomedica en Red de Enfermedades Hepaticas y Digestivas (CIBEREHD), Pamplona, Spain
| | - Mark op den Winkel
- Department of Internal Medicine II, University of Munich, Munich, Germany
| | | | - Christoph Trumm
- Institute of Radiology, University of Munich, Munich, Germany
| | - Alberto Benito
- Department of Radiology, Clinica Universidad de Navarra, Pamplona, Spain
| | - Klaus Tatsch
- Department of Nuclear Medicine, Municipal Hospital Karlsruhe Inc., Karlsruhe, Germany
| | - Christoph J Zech
- Clinic of Radiology and Nuclear Medicine, University of Basel, Basel, Switzerland
| | - Ralf-Thorsten Hoffmann
- Institute and Policlinic of Radiology, University Hospital at the Technische Universitaet Dresden, Dresden, Germany
| | - Bruno Sangro
- Liver Unit, Clinica Universidad de Navarra, Instituto de Investigaciones Sanitarias de Navarra (IDISNA) and Centro de Investigacion Biomedica en Red de Enfermedades Hepaticas y Digestivas (CIBEREHD), Pamplona, Spain
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Strobl F, Schwarz J, Häußler S, Paprottka P, Reiser M, Trumm C. CT-fluoroskopisch gesteuerte Stanzbiopsie von Pankreasraumforderungen: Technische und klinische Ergebnisse eines 10-Jahres-Zeitraums. ROFO-FORTSCHR RONTG 2015. [DOI: 10.1055/s-0035-1551041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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25
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Pieske O, Landersdorfer C, Trumm C, Greiner A, Wallmichrath J, Gottschalk O, Rubenbauer B. CT-guided sacroiliac percutaneous screw placement in unstable posterior pelvic ring injuries: accuracy of screw position, injury reduction and complications in 71 patients with 136 screws. Injury 2015; 46:333-9. [PMID: 25487831 DOI: 10.1016/j.injury.2014.11.009] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Revised: 09/27/2014] [Accepted: 11/14/2014] [Indexed: 02/02/2023]
Abstract
BACKGROUND Sacroiliac-percutaneous-screw-placement (SPSP) for unstable-posterior-pelvic-ring-injuries (UPPRI) might be associated with severe neurovascular complications because of screw-mal-position. The aim of the present study was to analysis the effectivity of computer-tomography-guided (CTG)-SPSP including accuracy of screw-placement, quality of injury-reduction and documentation of perioperative-complications. Additionally, procedure-dependent radiation-dose and outcome should be analysed. METHODS A consecutive cohort of 71 patients with UPPRI was operated by CTG-SPSP at a single trauma level 1 hospital. 136 sacroiliac screws were inserted to S1 and S2. Postoperatively, by the use of a computerised-radiologic-work-station all screws were visualised three-dimensionally. Their distancesmin to the sacral-borders in anterior-posterior and cranio-caudal direction as well as to the neuroforamen S1/S2 were determined. After CTG-SPSP, injury-dislocation in anterior-posterior and cranio-caudal direction was quantified. Local and general complications were documented during the 30-day-period. In 55 patients (77.5%) a follow-up-investigation (29.1±19.1 months) was performed. RESULTS 132 screws (97.1%) were placed completely intraosseous, 3 screws (2.2%) perforated up to 1.0 mm (n(S1)=one screw; n(S2)=two screws), and one screw (0.7%) extended 2.2 mm into the S2-neuroforamen without contact to neural structures. Postoperative dislocationanterior-posterior was 1.3±0.9 mm and dislocationcranio-caudal 1.5±0.9 mm. No procedure-associated-complication was observed. Operation time showed a significant "learning curve" during the six-year study period (initially: 88.6±60.3 min; finally: 44.3±24.6 min). Perioperative effective-radiation-dose for patientsmale was 5.9±3.1 mSv and for patientsfemale 8.7±4.5 mSv. All injuries healed and 33 patients (46.5%) had metal removal after 11.0 (±4.9) months. Only two (5.0%) out of 40 patients complained persistent UPPRI-related pain so they were not able to restart work. CONCLUSIONS The CTG-SPSP is a safe procedure for UPPRI-stabilisation especially in S1 but also in S2. Injury reduction was excellent and no procedure associated complications were observed.
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Affiliation(s)
- Oliver Pieske
- Department of Traumatology, Orthopaedics and Sport Injury, Evangelisches Krankenhaus, Campus University of Oldenburg, Steinweg 13-17, 26123 Oldenburg, Germany.
| | - Christoph Landersdorfer
- Department of Trauma-, Hand- and Plastic-Surgery, University Hospital of Munich, Campus Grosshadern, Marchioninistraße 15, 81377 Munich, Germany.
| | - Christoph Trumm
- Department of Clinical Radiology, University Hospital of Munich, Campus Grosshadern, Marchioninistraße 15, 81377 Munich, Germany.
| | - Axel Greiner
- Department of Trauma-, Hand- and Plastic-Surgery, University Hospital of Munich, Campus Grosshadern, Marchioninistraße 15, 81377 Munich, Germany.
| | - Jens Wallmichrath
- Department of Trauma-, Hand- and Plastic-Surgery, University Hospital of Munich, Campus Grosshadern, Marchioninistraße 15, 81377 Munich, Germany.
| | - Oliver Gottschalk
- Department of Trauma-, Hand- and Plastic-Surgery, University Hospital of Munich, Campus Grosshadern, Marchioninistraße 15, 81377 Munich, Germany.
| | - Bianka Rubenbauer
- Department of Trauma-, Hand- and Plastic-Surgery, University Hospital of Munich, Campus Grosshadern, Marchioninistraße 15, 81377 Munich, Germany.
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Paprottka PM, Walter A, Haug A, Trumm C, Jakobs TF, Reiser MF, Zech C. Sicherheit der Radioembolisation mit 90Yttrium-Mikrosphären in Abhängigkeit vom prä-interventionellen Verschluss aberranter Gefäße. ROFO-FORTSCHR RONTG 2014. [DOI: 10.1055/s-0034-1373017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Muacevic A, Füerweger C, Trumm C, Nuhn P, Staehler M. CyberKnife Robotic Radiosurgery of Three Pancreatic Metastases of Renal Cell Cancer in One Treatment Session. Cureus 2014. [DOI: 10.7759/cureus.163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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28
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Ashoori N, Paprottka P, Trumm C, Bamberg F, Kolligs FT, Rentsch M, Reiser MF, Jakobs TF. Multimodality treatment with conventional transcatheter arterial chemoembolization and radiofrequency ablation for unresectable hepatocellular carcinoma. Digestion 2012; 85:18-26. [PMID: 22156507 DOI: 10.1159/000334714] [Citation(s) in RCA: 6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2011] [Accepted: 10/21/2011] [Indexed: 02/04/2023]
Abstract
BACKGROUND/AIMS To evaluate the efficacy of multimodality treatment consisting of conventional transcatheter arterial chemoembolization (TACE) and radiofrequency ablation (RFA) in patients with non-resectable and non-ablatable hepatocellular carcinoma (HCC). METHODS In this retrospective study, 85 consecutive patients with HCC (59 solitary, 29 multifocal HCC) received TACE followed by RFA between 2001 and 2010. The mean number of tumors per patient was 1.6 ± 0.7 with a mean size of 3.0 ± 0.9 cm. Both local efficacy and patient survival were evaluated. RESULTS Of 120 treated HCCs, 99 (82.5%) showed a complete response (CR), while in 21 HCCs (17.5%) a partial response was depicted. Patients with solitary HCC revealed CR in 91% (51/56); in patients with multifocal HCC (n = 29) CR was achieved in 75% (48 of 64 HCCs). The median survival for all patients was 25.5 months. The 1-, 2-, 3- and 5-year survival rates were 84.6, 58.7, 37.6 and 14.6%, respectively. Statistical analysis revealed a significant difference in survival between Barcelona Clinic Liver Cancer (BCLC) A (73.4 months) and B (50.3 months) patients, while analyses failed to show a difference for Child-Pugh score, Cancer of Liver Italian Program (CLIP) score and tumor distribution pattern. CONCLUSION TACE combined with RFA provides an effective treatment approach with high local tumor control rates and promising survival data, especially for BCLC A patients. Randomized trials are needed to compare this multimodality approach with a single modality approach for early-stage HCC.
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Affiliation(s)
- N Ashoori
- Department of Radiology, Ludwig Maximilians University of Munich, Campus Grosshadern, Munich, Germany.
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Clevert DA, Helck A, Paprottka PM, Zengel P, Trumm C, Reiser MF. [Ultrasound-guided image fusion with computed tomography and magnetic resonance imaging. Clinical utility for imaging and interventional diagnostics of hepatic lesions]. Radiologe 2012; 52:63-9. [PMID: 22249703 DOI: 10.1007/s00117-011-2252-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Abdominal ultrasound is often the first-line imaging modality for assessing focal liver lesions. Due to various new ultrasound techniques, such as image fusion, global positioning system (GPS) tracking and needle tracking guided biopsy, abdominal ultrasound now has great potential regarding detection, characterization and treatment of focal liver lesions. Furthermore, these new techniques will help to improve the clinical management of patients before and during interventional procedures. This article presents the principle and clinical impact of recently developed techniques in the field of ultrasound, e.g. image fusion, GPS tracking and needle tracking guided biopsy and discusses the results based on a feasibility study on 20 patients with focal hepatic lesions.
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Affiliation(s)
- D-A Clevert
- Institut für Klinische Radiologie, Klinikum der Ludwig-Maximilians-Universität, Campus Grosshadern, Marchioninistr. 15, 81377, München, Deutschland.
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Haug AR, Tiega Donfack BP, Trumm C, Zech CJ, Michl M, Laubender RP, Uebleis C, Bartenstein P, Heinemann V, Hacker M. 18F-FDG PET/CT predicts survival after radioembolization of hepatic metastases from breast cancer. J Nucl Med 2012; 53:371-7. [PMID: 22331219 DOI: 10.2967/jnumed.111.096230] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
UNLABELLED (90)Y radioembolization (selective internal radiation therapy [SIRT]) has emerged as a valuable therapeutic option in unresectable, chemotherapy-refractory hepatic metastases from breast cancer. The objective of the present study was to evaluate (18)F-FDG PET/CT for predicting survival in these patients. METHODS Fifty-eight consecutive patients with hepatic metastases from breast cancer were treated with SIRT. Before therapy, all patients underwent MRI of the liver. (18)F-FDG PET/CT was performed at baseline and 3 mo after SIRT to calculate percentage changes in maximum (18)F-FDG standardized uptake value (SUV(max)) relative to baseline. A decrease of more than 30% in the follow-up scan, compared with the baseline examination, indicated therapy response. Treatment response at 3 mo was also assessed in 43 patients using contrast-enhanced MRI and CT on the basis of the Response Evaluation Criteria in Solid Tumors. All patients were followed to complete survival data. RESULTS Overall median survival after SIRT was 47 wk. Response as assessed with SUV(max) correlated significantly with survival after radioembolization, with responders having significantly longer survival (65 wk) than nonresponders (43 wk; P < 0.05). In multivariate analysis the change in SUV(max) was identified as the only independent predictor of survival (hazard ratio, 0.23; P < 0.005). Furthermore, a high pretherapeutic SUV(max) (>20) was associated with a significantly shorter median survival than was an SUV(max) of 20 or less (21 vs. 52 wk; P < 0.005). The presence of extrahepatic metastases (mean survival in both groups, 47 wk; P = 0.92), hormone receptor status (estrogen, P = 0.53; progesterone, P = 0.79; Her-2/neu, P = 0.49), and MRI/CT response (P = 0.91) did not predict survival. CONCLUSION The change in SUV(max) as assessed by (18)F-FDG PET/CT before and 3 mo after SIRT was identified as the only independent predictor of survival in patients with hepatic metastases of breast cancer.
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Affiliation(s)
- Alexander R Haug
- Department of Nuclear Medicine, Ludwig-Maximilians-University of Munich, Munich, Germany.
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Paprottka P, Haug A, Zech C, Sommer W, Bartenstein P, Reiser M, Trumm C. Radioembolisation von nicht-resektablen neuroendokrinen Lebermetastasen. ACTA ACUST UNITED AC 2011. [DOI: 10.1055/s-0031-1295435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- P. Paprottka
- Institut für Klinische Radiologie, Campus Großhadern, Ludwig-Maximilians-Universität München
| | - A. Haug
- Klinik für Nuklearmedizin, Campus Großhadern, Ludwig-Maximilians-Universität München
| | - C. Zech
- Institut für Klinische Radiologie, Campus Großhadern, Ludwig-Maximilians-Universität München
| | - W. Sommer
- Institut für Klinische Radiologie, Campus Großhadern, Ludwig-Maximilians-Universität München
| | - P. Bartenstein
- Klinik für Nuklearmedizin, Campus Großhadern, Ludwig-Maximilians-Universität München
| | - M. Reiser
- Institut für Klinische Radiologie, Campus Großhadern, Ludwig-Maximilians-Universität München
| | - C. Trumm
- Institut für Klinische Radiologie, Campus Großhadern, Ludwig-Maximilians-Universität München
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Clevert DA, Helck A, D’Anastasi M, Trumm C, Meimarakis G, Weidenhagen R, Kopp R, Jauch K, Reiser M. Ultraschallgesteuerte EVAR-Interventionen und Follow-up-Diagnostik mit der kontrastmittelgestützten Sonographie und der Bildfusion. Gefässchirurgie 2011. [DOI: 10.1007/s00772-011-0892-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Trumm C, Jakobs T, Pahl A, Stahl R, Helmberger T, Paprottka P, Reiser M, Hoffmann RT. CT fluoroscopy-guided percutaneous vertebroplasty in patients with multiple myeloma: analysis of technical results from 44 sessions with 67 vertebrae treated. Diagn Interv Radiol 2011; 18:111-20. [PMID: 22006576 DOI: 10.4261/1305-3825.dir.4226-11.1] [Citation(s) in RCA: 5] [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: 11/02/2022]
Abstract
PURPOSE This study aimed to assess the results of computed tomography (CT) fluoroscopy-guided vertebroplasty in patients with multiple myeloma, focusing on the frequency and clinical impact of polymethylmethacrylate (PMMA) leaks. MATERIALS AND METHODS From December 2001 to August 2008, 39 patients (17 females, 22 males; mean age, 65±7 years) with multiple myeloma suffering from painful spinal osteolyses underwent vertebroplasty. A total of 67 vertebrae were treated in 44 sessions under CT fluoroscopy (single-slice, 4-row CT, and 16-row CT). In the planning CT scan, osteolytic destruction (i.e., none, ≤25%, ≤50%, ≤75%, or ≤100%) was assessed regarding the vertebral cross-sectional area, the cortical border of the spinal canal, and the outer circumference. CT performed after vertebroplasty was used to detect local PMMA leaks. Patient charts were retrospectively reviewed with special respect to peri and postinterventional adverse events. Clinical outcomes were assessed on a visual analog scale (VAS) 24 hours before, 24 hours after, and 6 months after vertebroplasty. RESULTS Overall, 37.3%, 12.0%, and 6.0% of vertebrae showed at least 50% osteolytic involvement of the cross-sectional area, spinal canal, and outer vertebral cortex, respectively. Intradiscal, intraspinal, paravertebral, and intercostovertebral/posterolateral leaks were seen in 21.6%, 35.1%, 43.3%, and 0% of vertebrae, respectively. The ratio of basivertebral to segmental venous leaks was 16.2%/40.5%. No major complications occurred. The mean VAS score decreased significantly (P < 0.05) from 6.4 at 24 hours before vertebroplasty to 3.2 at a mean follow-up of 9.0 months. CONCLUSION Vertebroplasty in multiple myeloma can be performed safely under CT fluoroscopy, even with substantial destruction of the vertebral cross-sectional area or cortical bone. A high clinical success rate was achieved, regardless of whether PMMA leaks were present.
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Affiliation(s)
- Christoph Trumm
- Department of Clinical Radiology, Ludwig-Maximilians-Universität Munchen, Munich, Germany.
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Herold T, Seiler T, Egensperger R, Trumm C, Bergmann M, Franke D, Mumm FFH, Schinwald N, Buske C, Dreyling M. Progressive multifocal leukoencephalopathy after treatment with rituximab, fludarabine and cyclophosphamide in a patient with chronic lymphocytic leukemia. Leuk Lymphoma 2011; 53:169-72. [DOI: 10.3109/10428194.2011.608446] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Paprottka P, Jakobs TF, Bamberg TF, Trumm C, Reiser MF, Hoffmann RT. Yttrium-90 Radioembolisation bei Patienten mit unresezierbaren cholangiozellulären Karzinomen. ROFO-FORTSCHR RONTG 2011. [DOI: 10.1055/s-0031-1279221] [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: 10/18/2022]
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Paprottka PM, Hoffmann RT, Trumm C, Schmidt GP, Reiser M, Jakobs T. 90Yttrium-Microsphären-Radioembolisation von symtomatischen, unresizierbaren neuroendokrinen Lebermetastasen. ROFO-FORTSCHR RONTG 2010. [DOI: 10.1055/s-0030-1252813] [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: 10/19/2022]
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Paprottka PM, Räßler F, Hoffmann RT, Trumm C, Schmidt GP, Reiser M, Jakobs T. Hepatische Yttrium-90 Radioembolisation von chemotherapierefraktären Metastasen bei kolorektalem Karzinom. ROFO-FORTSCHR RONTG 2010. [DOI: 10.1055/s-0030-1252678] [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: 10/19/2022]
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Schmidt D, Bieberstein J, Schumann C, Trumm C, Bruners P, Weihusen A, Clasen S, Claussen C, Pereira PL. Evaluierung eines computerunterstützten Verfahren zur schnellen automatischen Ablationssondenplatzierung für die minimal-invasive CT gesteuerte RFA maligner Leberneoplasien. ROFO-FORTSCHR RONTG 2010. [DOI: 10.1055/s-0030-1252866] [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: 10/19/2022]
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Hoffmann RT, Jakobs TF, Kubisch CH, Trumm C, Weber C, Siebels M, Helmberger TK, Reiser MF. Renal cell carcinoma in patients with a solitary kidney after nephrectomy treated with radiofrequency ablation: Mid term results. Eur J Radiol 2010; 73:652-6. [PMID: 19181470 DOI: 10.1016/j.ejrad.2008.12.015] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2008] [Revised: 12/12/2008] [Accepted: 12/23/2008] [Indexed: 01/29/2023]
Affiliation(s)
- Ralf-Thorsten Hoffmann
- Institute of Clinical Radiology, Ludwig Maximilians-University, Marchioninistrasse, Munich, Germany.
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Trumm C, Hoffmann RT, Reiser MF. [Radiological interventional procedures for the acute abdomen]. Radiologe 2010; 50:262-71. [PMID: 20182685 DOI: 10.1007/s00117-009-1905-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
In patients with acute thrombo-embolic occlusion of the superior mesenteric artery, catheter-assisted thrombolytic therapy represents a procedure of increasing importance in addition to surgery and intensive care treatment. The thrombolytic drugs utilized for this purpose are urokinase, streptokinase and recombinant tissue plasminogen activator (rtPA).Therapeutic embolization is predominantly used in the treatment of arterial bleeding from the gastro-intestinal tract, the liver, the intestines (due to an aneurysm or vascular malformation) and in bleeding from intestinal anastomoses. Polyvinyl alcohol particles, embospheres, gelfoam and microcoils can be utilized as embolic agents. Percutaneous transhepatic cholangiodrainage and stent implantation are applied in patients with biliary obstructions caused by inoperable tumors of the gall bladder or bile ducts, of the pancreatic head or duodenum and by metastases located in the liver parenchyma or hepatic hilum.Image-guided percutaneous drainage is a valuable option in the management of abscesses in the peritoneal cavity; less common indications are lymphoceles, biliomas, urinomas, hematomas, necrosis and pseudocysts.
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Affiliation(s)
- C Trumm
- Institut für Klinische Radiologie, Klinikum der Ludwig-Maximilians-Universität München, Campus Grosshadern, München, Deutschland.
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Kolligs FT, Hoffmann RT, op den Winkel M, Bruns CJ, Herrmann K, Jakobs TF, Lamerz R, Trumm C, Zech CJ, Wilkowski R, Graeb C. [Diagnosis and multimodal therapy for hepatocellular carcinoma]. Z Gastroenterol 2010; 48:274-88. [PMID: 20119895 DOI: 10.1055/s-0028-1109901] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Hepatocellular carcinoma (HCC) is one of the leading causes of cancer-related death in the world. The majority of HCCs develops on the basis of a chronic liver disease. This often complicates diagnosis and therapy. Non-invasive diagnostic criteria are based on dynamic imaging techniques and the serum level of AFP (alpha-fetoprotein). When evaluating HCC patients for therapy, besides tumor burden and localisation, the therapeutic evaluation must also consider the general condition of the patient and his/her liver function. For this purpose, the BCLC algorithm of the Barcelona Clinic for Liver Disease has proven helpful. Only one-third of the patients can be cured by resection, transplantation or local tumour ablation. In locally advanced cases transarterial procedures including transarterial chemoembolisation and radioembolisation are applied. HCC is a chemo-resistant tumour and chemotherapy is not accepted as standard of care in HCC. Sorafenib is the first systemic treatment with proven efficacy approved for the treatment of advanced and metastatic HCC. Interdisciplinary management of HCC patients is essential in order to provide every patient with the optimal therapy at his specific stage of disease.
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Affiliation(s)
- F T Kolligs
- Medizinische Klinik und Poliklinik II, Klinikum der Universität München, Campus Grosshadern, München, Germany.
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Trumm C, Jakobs T, Zech CJ, Reiser MF, Hoffmann RT. CT-gesteuerte Vertebroplastie von spinalen Osteolysen bei Patienten mit multiplem Myelom: Technische Ergebnisse bei 67 behandelten Wirbelkörpern. ROFO-FORTSCHR RONTG 2009. [DOI: 10.1055/s-0029-1221291] [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: 10/20/2022]
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Hoffmann RT, Jakobs TF, Kubisch CH, Stemmler HJ, Trumm C, Tatsch K, Helmberger TK, Reiser MF. Radiofrequency ablation after selective internal radiation therapy with Yttrium90 microspheres in metastatic liver disease-Is it feasible? Eur J Radiol 2009; 74:199-205. [PMID: 19269763 DOI: 10.1016/j.ejrad.2009.02.001] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2008] [Revised: 02/05/2009] [Accepted: 02/05/2009] [Indexed: 01/04/2023]
Abstract
This retrospective study analyzes, whether patients suffering from extensive hepatic metastatic disease treated with SIRT can become suitable candidates for RFA.Within 38 months 46 patients (26 female, 20 male; age 32-75 years) bearing an extensive hepatic metastatic disease were treated with SIRT. Patients suffered from metastases of breast cancer (16/46), colorectal cancer (CRC) (21/46), neuroendocrine (3/46), and other primary carcinomas (6/46). The indication for SIRT was otherwise untreatable metastases confined to the liver. Forty-three patients received single-session whole-liver radioembolization treatment using Yttrium90 resin microspheres with a mean activity of 2.13GBq. In 1 patient SIRT was confined to the left and in 2 patients to the right liver lobe. In 3 patients major complications (2/3 gastric ulceration and 1/3 oedematous pancreatitis) and in 24 patients minor complications occurred (acute abdominal/epigastric pain and/or nausea). Follow-up CT and/or MRI were obtained in 44 of 46 patients. In 5 of 44 patients tumor load decreased substantially (3/5 breast cancer, 1/5 CRC and 1/5 pancreatic cancer) making RFA feasible. The patients were referred for RFA after the first 3-month follow-up. RFA of the liver was successful in all cases in terms of complete ablation. In selected patients radioembolization is able to downstage liver metastases to an extent making a subsequent RFA suitable and therefore allows increasing the number of patients with a "complete response" after a minimally invasive therapy.
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Affiliation(s)
- R T Hoffmann
- Institute of Clinical Radiology, Ludwig Maximilians-University - Campus Grosshadern, Marchioninstr. 15, 81377 Munich, Germany.
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Abstract
Selective internal radiation therapy (SIRT) is used for the treatment of patients with liver tumors, especially for those with hepatocellular carcinoma (HCC) or liver metastases from various primary tumors. Currently this innovative treatment concept is recommended when established state-of-the-art treatment regimes have failed and tumor progression is noted or if the treatment has to be abandoned because of intolerable toxic effects. For SIRT small biocompatible microspheres (SIR-Spheres(R)) are labelled with the radioactive isotope 90Yttrium, a pure beta emitter, and are superselectively infused into the hepatic arteries. The microspheres are collected in the precapillary vessels in and surrounding the tumor. The beta radiation of 90Yttrium has an average penetration in tissue of approximately 2.5 mm and results in very high doses of radiation being selectively targeted to metastases providing protection to the surrounding healthy liver tissue. In this paper we review the results of SIRT in patients with hepatic metastases from colorectal cancer, breast cancer, neuroendocrine tumors and primary liver cancer (HCC).
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Affiliation(s)
- T F Jakobs
- Institut für Klinische Radiologie, Klinikum Grosshadern der Ludwig-Maximilians-Universität München , Marchioninistr. 15, 81377 München, Deutschland.
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Jakobs TF, Hoffmann RT, Dehm K, Trumm C, Stemmler HJ, Tatsch K, La Fougere C, Murthy R, Helmberger TK, Reiser MF. Hepatic yttrium-90 radioembolization of chemotherapy-refractory colorectal cancer liver metastases. J Vasc Interv Radiol 2008; 19:1187-95. [PMID: 18656012 DOI: 10.1016/j.jvir.2008.05.013] [Citation(s) in RCA: 117] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2007] [Revised: 04/28/2008] [Accepted: 05/16/2008] [Indexed: 12/17/2022] Open
Abstract
PURPOSE To present data for radioembolization with yttrium-90 ((90)Y) resin microspheres in patients with colorectal cancer liver metastases in whom currently available therapies had failed. MATERIALS AND METHODS Retrospective review was conducted of case files of patients with colorectal cancer liver metastases in whom chemotherapy had failed, prompting hepatic (90)Y radioembolization administered as a single-session, whole-liver treatment. Imaging and laboratory follow-up results were available for 36 patients. Response and toxicity were assessed by computed tomography/magnetic resonance imaging with the Response Evaluation Criteria in Solid Tumors and the National Cancer Institute's Common Terminology Criteria for Adverse Events, version 3.0. RESULTS Forty-one patients (mean age, 61 years; 30 men) received hepatic (90)Y radioembolization with resin microspheres (mean activity, 1.9 GBq). At a median interval of 2.9 months after radioembolization, partial response, stable disease, and progressive disease were demonstrated in seven, 25, and four patients, respectively. Median overall survival was 10.5 months, with improved survival for patients with a decrease in carcinoembryonic antigen level (19.1 months vs 5.4 months) and imaging response (29.3 months vs 4.3 months; P = .0001). Except for one instance of treatment-associated cholecystitis (grade 4 toxicity) and two gastric ulcers (grade 2 toxicity), no severe toxicities were observed. CONCLUSIONS Hepatic (90)Y radioembolization can be performed with manageable toxicity in patients with colorectal cancer liver metastases whose disease is refractory to chemotherapy. The antitumoral effect is supported by imaging and tumor marker responses. Further investigation is warranted to determine the optimal use of this emerging therapeutic modality.
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Affiliation(s)
- Tobias F Jakobs
- Department of Radiology, Ludwig-Maximilians-University of Munich, Munich, Germany.
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Jakobs TF, Hoffmann RT, Schrader A, Stemmler HJ, Trumm C, Lubienski A, Murthy R, Helmberger TK, Reiser MF. CT-guided radiofrequency ablation in patients with hepatic metastases from breast cancer. Cardiovasc Intervent Radiol 2008; 32:38-46. [PMID: 18575933 DOI: 10.1007/s00270-008-9384-7] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2008] [Revised: 05/27/2008] [Accepted: 06/03/2008] [Indexed: 01/14/2023]
Abstract
The purpose of this study was to evaluate technical success, technique effectiveness, and survival following radiofrequency ablation for breast cancer liver metastases and to determine prognostic factors. Forty-three patients with 111 breast cancer liver metastases underwent CT-guided percutaneous radiofrequency (RF) ablation. Technical success and technique effectiveness was evaluated by performing serial CT scans. We assessed the prognostic value of hormone receptor status, overexpression of human epidermal growth factor receptor 2 (HER2), and presence of extrahepatic tumor spread. Survival rates were calculated using the Kaplan-Meier method. Technical success was achieved in 107 metastases (96%). Primary technique effectiveness was 96%. During follow-up local tumor progression was observed in 15 metastases, representing a secondary technique effectiveness of 86.5%. The overall time to progression to the liver was 10.5 months. The estimated overall median survival was 58.6 months. There was no significant difference in terms of survival probability with respect to hormone receptor status, HER2 overexpression, and presence of isolated bone metastases. Survival was significantly lower among patients with extrahepatic disease, with the exception of skeletal metastases. We conclude that CT-guided RF ablation of liver metastases from breast cancer can be performed with a high degree of technical success and technique effectiveness, providing promising survival rates in patients with no visceral extrahepatic disease. Solitary bone metastases did not negatively affect survival probability after RF ablation.
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Affiliation(s)
- Tobias F Jakobs
- Department of Radiology, Ludwig-Maximilians-University of Munich, Campus Grosshadern, Munich, Germany.
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Jakobs T, Hoffmann RT, Dehm K, Trumm C, Stemmler HJ, Tatsch K, Murthy R, Helmberger T, Reiser M. Abstract No. 30: Regional 90Yttrium Microsphere Treatment of Chemotherapy-Refractory Colorectal Cancer Liver Metastases. J Vasc Interv Radiol 2008. [DOI: 10.1016/j.jvir.2007.12.034] [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: 11/28/2022] Open
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Notohamiprodjo M, Horng A, Horger W, Park J, Trumm C, Raya JG, Reiser M, Glaser C. Hochaufgelöste Knie-MRT bei 3 Tesla mit einer 3D- moderat T2-gewichteten TSE-Sequenz (SPACE). ROFO-FORTSCHR RONTG 2008. [DOI: 10.1055/s-2008-1073697] [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: 10/21/2022]
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Trumm C, Matzko M, Grosse C, Helck A, Ertl-Wagner B, Reiser M. Einfluss eines modifizierten Outlook Web Access (OWA)-Systems auf die Verfügbarkeit teleradiologischer Notfallbefunde. ROFO-FORTSCHR RONTG 2008. [DOI: 10.1055/s-2008-1073773] [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: 10/21/2022]
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Jakobs TF, Hoffmann RT, Dehm K, Trumm C, Stemmler HJ, Tatsch K, Helmberger T, Reiser M. Regionale 90Yttrium Radioembolisation beim hepatisch metastasierten kolorektalen Karzinom. ROFO-FORTSCHR RONTG 2008. [DOI: 10.1055/s-2008-1073561] [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: 10/21/2022]
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