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Grözinger G, Hallecker J, Grosse U, Syha R, Ketelsen D, Brechtel K, Lescan M, Nikolaou K, Artzner C. Tibiopedal and distal femoral retrograde vascular access for challenging chronic total occlusions: predictors for technical success, and complication rates in a large single-center cohort. Eur Radiol 2020; 31:535-542. [PMID: 32725333 PMCID: PMC7755625 DOI: 10.1007/s00330-020-07082-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 05/06/2020] [Revised: 06/29/2020] [Accepted: 07/16/2020] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To evaluate the safety and effectiveness of tibiopedal and distal femoral access for retrograde crossing of chronic total occlusion (CTO) in Rutherford stage III to VI peripheral arterial occlusive disease, and to determine factors that correlate with technical success. MATERIAL AND METHODS One hundred seventy-one consecutive patients were included in this retrospective study. Rutherford stages were III, IV, and V/VI in 24%, 8%, and 67% of patients. Inclusion criteria were CTO at the superficial femoral (SFA), popliteal (PA), and/or below-the-knee (BTK) level, and a failed antegrade treatment followed by a distal retrograde approach. The numbers of occluded vascular levels (OVL), lesion length, degree of calcification, technical success rate, complications, and clinical outcome were noted. RESULTS OVL were 1 in 72%, 2 in 20%, and 3 in 8% of patients. CTOs were longer than 20 cm in 45.6% of cases and showed severe calcifications in 50.3%. Target vessels for distal access were the distal SFA/PA in 17% and BTK in 83%. The overall technical success rate was 82%. Severe calcification decreased technical success (p = 0.01) despite lesion length and Rutherford stage. Clinical outcome improved in 123/152 patients with a significant increase of the median ABI (N = 158) from 0.53 (interquartile range 0.39 to 0.61) to 0.85 (0.59 to 1.03; p < 0.001). Complications were reported in 7.6% cases with 2.3% related to the distal vascular access. CONCLUSION The tibiopedal and distal femoral retrograde access presents a safe and effective treatment option of CTOs at the thigh and/or BTK after a failed antegrade attempt improving clinical outcome. Technical success decreased with lesion's degree of calcification. KEY POINTS • Safety and effectiveness of the tibiopedal and distal femoral access for retrograde crossing of chronic total occlusion. • Target lesion's degree of calcification decreases technical success. • Complications related to the distal vascular access were rare.
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Affiliation(s)
- Gerd Grözinger
- Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Germany
| | - Jan Hallecker
- Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Germany.,Ihre-Radiologen.de MVZ GmbH, Interventional and Diagnostic Imaging Centers, Heinz-Galinski-Strasse, 13347, Berlin, Germany
| | - Ulrich Grosse
- Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Germany
| | - Roland Syha
- Department of Diagnostic and Interventional Radiology, Prosper Hospital Recklinghausen, Mühlenstrasse 27, 45659, Recklinghausen, Germany
| | - Dominik Ketelsen
- Ihre-Radiologen.de MVZ GmbH, Interventional and Diagnostic Imaging Centers, Heinz-Galinski-Strasse, 13347, Berlin, Germany
| | - Klaus Brechtel
- Ihre-Radiologen.de MVZ GmbH, Interventional and Diagnostic Imaging Centers, Heinz-Galinski-Strasse, 13347, Berlin, Germany
| | - Mario Lescan
- Department of Thoracic and Cardiovascular Surgery, University Medical Center Tübingen, Tübingen, Germany
| | - Konstantin Nikolaou
- Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Germany
| | - Christoph Artzner
- Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Germany.
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Grosse U, Grözinger G, Syha R, Ketelsen D, Partovi S, Nikolaou K, Hoffmann R. Intra-procedural bronchial artery embolization planning: the usefulness of cone-beam CT. Acta Radiol 2019; 60:1438-1444. [PMID: 30897931 DOI: 10.1177/0284185119837931] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Ulrich Grosse
- Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, Tuebingen, Germany
| | - Gerd Grözinger
- Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, Tuebingen, Germany
| | - Roland Syha
- Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, Tuebingen, Germany
| | - Dominik Ketelsen
- Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, Tuebingen, Germany
| | - Sasan Partovi
- Department of Radiology, Section of Vascular and Interventional Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Konstantin Nikolaou
- Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, Tuebingen, Germany
| | - Rüdiger Hoffmann
- Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, Tuebingen, Germany
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Grosse U, Syha R, Ketelsen D, Hoffmann R, Partovi S, Mehra T, Nikolaou K, Grözinger G. Cone beam computed tomography improves the detection of injured vessels and involved vascular territories in patients with bleeding of uncertain origin. Br J Radiol 2018; 91:20170562. [PMID: 29848014 DOI: 10.1259/bjr.20170562] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE The purpose of this preliminary retrospective study was to analyse if cone beam CT (CBCT) is able to identify more bleeding sites and corresponding feeding arteries in patients with haemorrhage of uncertain origin. METHODS In 18 vascular territories (16 patients), pre-interventional CT angiography (CTA) and selective angiograms resulted in discordant information regarding the suspected bleeding site and hence received CBCT. Image data of CTA and selective angiograms in comparison to CBCT were independently reviewed by two interventional radiologists. Image quality, diagnostic confidence, number of bleeding sites and involved vascular territories were investigated. Additionally, the correlation between number of bleeding sites and involved vascular territories with a clinical gold-standard (super-selective angiographic findings and definitive clinical outcomes) was analysed. RESULTS Overall, subjective image quality did not significantly differ between investigated imaging modalities. However, CBCT significantly improved diagnostic confidence in both readers in detecting bleeding vessel (s) (p = 0.0024/0.0005; Reader 1/Reader2). High correlation coefficients regarding the number of bleeding sites (r = 0.9163/0.7692) in contrast to the number of involved vascular territories (r = 0.2888/0.0105) were observed for CTA in comparison to clinical gold-standard. In this context, CBCT demonstrated a very strong correlation for both parameters, the number of bleeding vessels (r = 0.9720/0.9721) and the number involved vascular territories (r = 0.9441/0.9441). CONCLUSION In complex cases of suspected haemorrhage, CBCT images can aid the interventionalist in detecting bleeding sites as well as narrowing down the number of involved vascular territories and thereby identifying feeding arteries of the bleeding source. Advances in knowledge: (1) CBCT showed no improvement in image quality. However, in complex bleeding cases CBCT information might aid in treatment planning. (2) CBCT improves visualization of bleeding vessels and involved feeding arteries. (3) Particularly, less experienced interventionalists might benefit from the three-dimensional information gathered by CBCT.
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Affiliation(s)
- Ulrich Grosse
- 1 Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen , Tuebingen , Germany
| | - Roland Syha
- 1 Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen , Tuebingen , Germany
| | - Dominik Ketelsen
- 1 Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen , Tuebingen , Germany
| | - Rüdiger Hoffmann
- 1 Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen , Tuebingen , Germany
| | - Sasan Partovi
- 2 Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University , Cleveland, OH , USA
| | - Tarun Mehra
- 3 Medical Directorate, University Hospital Zurich , Zurich , Switzerland
| | - Konstantin Nikolaou
- 1 Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen , Tuebingen , Germany
| | - Gerd Grözinger
- 1 Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen , Tuebingen , Germany
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Burgstahler C, Cipowicz H, Thomas C, Schabel C, Mangold S, Ketelsen D, Claussen CD, Niess AM, Tsiflikas I. Coronary and carotid atherosclerosis in asymptomatic male marathon runners. Scand J Med Sci Sports 2018; 28:1397-1403. [PMID: 29239051 DOI: 10.1111/sms.13035] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2017] [Indexed: 12/17/2022]
Abstract
The aim of the study was to evaluate the diagnostic accuracy of carotid ultrasound (CU) to predict coronary atherosclerosis in asymptomatic male marathon runners. A total of 49 male marathon runners older than 45 years (mean age 53.3 ± 7.2 years, range 45-74 years) received CU and cardiac CT angiography (CTA) including calcium scoring (CS). Results of CU and CTA were classified binary: 1. Absence of atherosclerosis and 2. Presence of atherosclerosis. The extent of atherosclerosis was not primary end point of the study. Mean PROCAM score was 2.3% (SD 2.2, range 0.44%-12.34%). One person had to be excluded from analysis (one missing CT-scan). From the remaining 48 marathon runners, 17 (35.4%) had carotid atherosclerosis and 22 (45.8%) coronary atherosclerosis. Atherosclerosis in either exam was diagnosed in 27/48 (56.3%) marathon runners. Diagnostic accuracy of CU to predict coronary atherosclerosis was: sensitivity 54.55% (95% CI 32.2-75.6), specificity 80.8% (CI 60.6-93.4), positive predictive value 70.6 (CI 44.1-89.9), negative predictive value 67.7 (CI 48.6-83.3) with a positive likelihood ratio of 2.84 (CI 1.18-6.82) and a negative likelihood ratio of 0.56 (CI 0.34-0.92). Coronary and/or carotid atherosclerosis can be detected in more than 50% of male marathon runners aged older than 45 years. The diagnostic value of carotid ultrasound to predict coronary atherosclerosis is low but higher than the accuracy of rest- or stress-ECG. As outcome studies in sportsmen are still missing, the routine evaluation of the carotid arteries by ultrasound or even cardiac CT cannot be recommended at present. Furthermore, the incidence of atherosclerosis by our method in normal population is not known.
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Affiliation(s)
- C Burgstahler
- Department of Sports Medicine, University of Tuebingen, Tuebingen, Germany
| | - H Cipowicz
- Department of Sports Medicine, University of Tuebingen, Tuebingen, Germany
| | - C Thomas
- Department of Diagnostic and Interventional Radiology, University of Tuebingen, Tuebingen, Germany
| | - C Schabel
- Department of Diagnostic and Interventional Radiology, University of Tuebingen, Tuebingen, Germany
| | - S Mangold
- Department of Diagnostic and Interventional Radiology, University of Tuebingen, Tuebingen, Germany
| | - D Ketelsen
- Department of Diagnostic and Interventional Radiology, University of Tuebingen, Tuebingen, Germany
| | - C D Claussen
- Department of Diagnostic and Interventional Radiology, University of Tuebingen, Tuebingen, Germany
| | - A M Niess
- Department of Sports Medicine, University of Tuebingen, Tuebingen, Germany
| | - I Tsiflikas
- Department of Diagnostic and Interventional Radiology, University of Tuebingen, Tuebingen, Germany
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Kloth C, Thaiss WM, Kärgel R, Grimmer R, Fritz J, Ioanoviciu SD, Ketelsen D, Nikolaou K, Horger M. Evaluation of Texture Analysis Parameter for Response Prediction in Patients with Hepatocellular Carcinoma Undergoing Drug-eluting Bead Transarterial Chemoembolization (DEB-TACE) Using Biphasic Contrast-enhanced CT Image Data: Correlation with Liver Perfusion CT. Acad Radiol 2017; 24:1352-1363. [PMID: 28652049 DOI: 10.1016/j.acra.2017.05.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 05/16/2017] [Accepted: 05/19/2017] [Indexed: 02/07/2023]
Abstract
RATIONALE AND OBJECTIVES This study aimed to evaluate the potential role of computed tomography texture analysis (CTTA) of arterial and portal-venous enhancement phase image data for prediction and accurate assessment of response of hepatocellular carcinoma undergoing drug-eluting bead transarterial chemoembolization (TACE) by comparison to liver perfusion CT (PCT). MATERIALS AND METHODS Twenty-eight patients (27 male; mean age 67.2 ± 10.4) with 56 hepatocellular carcinoma-typical liver lesions were included. Arterial and portal-venous phase CT data obtained before and after TACE with a mean time of 39.93 ± 62.21 days between examinations were analyzed. TACE was performed within 48 hours after first contrast-enhanced CT. CTTA software was a prototype. CTTA analysis was performed blinded (for results) by two observers separately. Combined results of modified Response Evaluation Criteria In Solid Tumors (mRECIST) and PCT of the liver were used as the standard of reference. Time to progression was additionally assessed for all patients. CTTA parameters included heterogeneity, intensity, average, deviation, skewness, and entropy of co-occurrence. Each parameter was compared to those of PCT (blood flow [BF], blood volume, arterial liver perfusion [ALP], portal-venous perfusion, and hepatic perfusion index) measured before and after TACE. RESULTS mRECIST + PCT yielded 28.6% complete response (CR), 42.8% partial response, and 28.6% stable disease. Significant correlations were registered in the arterial phase in CR between changes in mean heterogeneity and BF (P = .004, r = -0.815), blood volume (P = .002, r = -0.851), and ALP (P = .002, r = -0.851), respectively. In the partial response group, changes in mean heterogeneity correlated with changes in ALP (P = .003) and to a lesser degree with hepatic perfusion index (P = .027) in the arterial phase. In the stable disease group, BF correlated with entropy of nonuniformity (P = .010). In the portal-venous phase, no statistically significant correlations were registered in all groups. Receiver operating characteristic analysis of CTTA parameters yielded predictive cutoff values for CR in the arterial contrast-enhanced CT phase for uniformity of skewness (sensitivity: 90.0%; specificity: 45.8%), and in the portal-venous phase for uniformity of heterogeneity (sensitivity: 92.3%; specificity: 81.8%). CONCLUSIONS Significant correlations exist between CTTA parameters and those derived from PCT both in the pre- and the post-TACE settings, and some of them have predictive value for TACE midterm outcome.
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Preibsch H, Spira D, Thaiss WM, Syha R, Nikolaou K, Ketelsen D, Lauer UM, Horger M. Impact of transjugular intrahepatic portosystemic shunt implantation on liver perfusion measured by volume perfusion CT. Acta Radiol 2017; 58:1167-1173. [PMID: 28084812 DOI: 10.1177/0284185116685922] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Implantation of a transjugular intrahepatic portosystemic shunt (TIPS) induces changes of liver perfusion. Purpose To determine the changes in arterial, portal venous, and total perfusion of the liver parenchyma induced by TIPS using the technique of volume perfusion computed tomography (VPCT) and compare results with invasively measured hepatic intravascular pressure values. Material and Methods VPCT quantification of liver perfusion was performed in 23 patients (mean age, 62.5 ± 8.8 years) with portal hypertension in the pre-TIPS and post-TIPS setting, respectively. A commercially available software package was used for post-processing, enabling separate calculation of the dual (arterial [ALP] and portal venous [PVP]) blood supply and additionally of the hepatic perfusion index (HPI) (HPI = ALP/(ALP + PVP)*100%). Invasive pressure measurements were performed during the intervention, before and after TIPS placement. Liver function tests performed before and after the procedure were compared. Results Mean decrease of pressure gradient through TIPS was 13.3 mmHg. Mean normal values for ALP, PVP, and total perfusion (ALP + PVP) before TIPS were 15.9, 37.7, and 53.5 mL/100 mL/min, respectively, mean HPI was 35.4%. After TIPS, ALP increased to a mean value of 37.7 mL/100 mL/min, PVP decreased (15.7 mL/100 mL/min, P < 0.05), whereas total perfusion remained unchanged (53.4 mL/100 mL/min, P = 0.97). HPI increased (71.9%; P < 0.05). No correlation between invasive pressure measurement and VPCT parameters was observed. After TIPS, liver function tests were found to worsen with a significant increase of bilirubin ( P < 0.05). Conclusion Following TIPS placement, ALP and HPI increased in all patients, whereas PVP markedly decreased. Interestingly, the magnitude of decrease in portosystemic pressure gradients was not found to correlate with VPCT parameters.
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Affiliation(s)
- Heike Preibsch
- University Department of Radiology, Diagnostic and Interventional Radiology, Tübingen, Germany
| | - Daniel Spira
- University Medical Center Heidelberg, Diagnostic and Interventional Radiology, Heidelberg, Germany
| | - Wolfgang M Thaiss
- University Department of Radiology, Diagnostic and Interventional Radiology, Tübingen, Germany
| | - Roland Syha
- University Department of Radiology, Diagnostic and Interventional Radiology, Tübingen, Germany
| | - Konstantin Nikolaou
- University Department of Radiology, Diagnostic and Interventional Radiology, Tübingen, Germany
| | - Dominik Ketelsen
- University Department of Radiology, Diagnostic and Interventional Radiology, Tübingen, Germany
| | - Ulrich M Lauer
- University Department of Medicine – Department of Internal Medicine, Gastroenterology, Hepatology and Infectious Diseases, Tübingen, Germany
| | - Marius Horger
- University Department of Radiology, Diagnostic and Interventional Radiology, Tübingen, Germany
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Weiss J, Maurer M, Ketelsen D, Notohamiprodjo M, Zinsser D, Wichmann JL, Nikolaou K, Bamberg F, Othman AE. Effect of reduced z-axis scan coverage on diagnostic performance and radiation dose of neck computed tomography in patients with suspected cervical abscess. PLoS One 2017; 12:e0180671. [PMID: 28678820 PMCID: PMC5498060 DOI: 10.1371/journal.pone.0180671] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 06/19/2017] [Indexed: 12/20/2022] Open
Abstract
Purpose To evaluate the effect of reduced z-axis scan coverage on diagnostic performance and radiation dose of neck CT in patients with suspected cervical abscess. Methods Fifty-one patients with suspected cervical abscess were included and underwent contrast-enhanced neck CT on a 2nd or 3rd generation dual-source CT system. Image acquisition ranged from the aortic arch to the upper roof of the frontal sinuses (CTstd). Subsequently, series with reduced z-axis coverage (CTred) were reconstructed starting at the aortic arch up to the orbital floor. CTstd and CTred were independently assessed by two radiologists for the presence/absence of cervical abscesses and for incidental and alternative findings. In addition, diagnostic accuracy for the depiction of the cervical abscesses was calculated for both readers. Furthermore, DLP (dose-length-product), effective dose (ED) and organ doses were calculated and compared for CTred and CTstd, using a commercially available dose management platform. Results A total of 41 abscesses and 3 incidental/alternative findings were identified in CTstd. All abscesses and incidental/alternative findings could also be detected on CTred resulting in a sensitivity and specificity of 1.0 for both readers. DLP, ED and organ doses of the brain, the eye lenses, the red bone marrow and the salivary glands of CTred were significantly lower than for CTstd (p<0.001). Conclusions Reducing z-axis coverage of neck CT allows for a significant reduction of effective dose and organ doses at similar diagnostic performance as compared to CTstd.
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Affiliation(s)
- Jakob Weiss
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Michael Maurer
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Dominik Ketelsen
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Mike Notohamiprodjo
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University Tuebingen, Tuebingen, Germany
- * E-mail:
| | - Dominik Zinsser
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Julian L. Wichmann
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Konstantin Nikolaou
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Fabian Bamberg
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Ahmed E. Othman
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University Tuebingen, Tuebingen, Germany
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Thaiss W, Haberland U, Kaufmann S, Kloth C, Preibsch H, Ketelsen D, Nikolaou K, Horger M, Sauter A. Therapieansprechen nach TACE im HCC: Vergleich der Iod-Konzentration mit Perfusions-CT und RECIST/mRECIST. ROFO-FORTSCHR RONTG 2017. [DOI: 10.1055/s-0037-1600425] [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)
- W Thaiss
- Radiologische Universitätsklinik Tübingen, Diagnostische und Interventionelle Radiologie, Tübingen
| | - U Haberland
- Siemens Healthcare GmbH, Diagnostic Imaging, Computed Tomografy, Research & Development, Forchheim
| | - S Kaufmann
- Radiologische Universitätsklinik Tübingen, Diagnostische und Interventionelle Radiologie, Tübingen
| | - C Kloth
- Radiologische Universitätsklinik Tübingen, Diagnostische und Interventionelle Radiologie, Tübingen
| | - H Preibsch
- Radiologische Universitätsklinik Tübingen, Diagnostische und Interventionelle Radiologie, Tübingen
| | - D Ketelsen
- Radiologische Universitätsklinik Tübingen, Diagnostische und Interventionelle Radiologie, Tübingen
| | - K Nikolaou
- Radiologische Universitätsklinik Tübingen, Diagnostische und Interventionelle Radiologie, Tübingen
| | - M Horger
- Radiologische Universitätsklinik Tübingen, Diagnostische und Interventionelle Radiologie, Tübingen
| | - A Sauter
- Universitätsspital Basel, Klinik für Radiologie und Nuklearmedizin, Abteilung Nuklearmedizin, Basel
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Kraus M, Notohamiprodjo M, Partovi S, Syha R, Sobieh A, Ketelsen D, Nikolaou K, Hausdorf J, Grosse U. MR Arthrography of the Hip: Diagnostic Performance and Image Quality of 3D Steady-State Free Precession versus 2D Turbo Spin-Echo Sequences. Semin Musculoskelet Radiol 2017. [DOI: 10.1055/s-0037-1600889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Mareen Kraus
- Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, Tuebingen, Germany
| | - Mike Notohamiprodjo
- Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, Tuebingen, Germany
| | - Sasan Partovi
- Department of Radiology, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Roland Syha
- Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, Tuebingen, Germany
| | - Ahmed Sobieh
- Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, Tuebingen, Germany
| | - Dominik Ketelsen
- Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, Tuebingen, Germany
| | - Konstantin Nikolaou
- Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, Tuebingen, Germany
| | - Joerg Hausdorf
- Department of Orthopedics, University Hospital Munich, Munich, Germany
| | - Ulrich Grosse
- Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, Tuebingen, Germany
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Schneeweiß S, Horger M, Grözinger A, Nikolaou K, Ketelsen D, Syha R, Grözinger G. CT-perfusion measurements in pancreatic carcinoma with different kinetic models: Is there a chance for tumour grading based on functional parameters? Cancer Imaging 2016; 16:43. [PMID: 27978850 PMCID: PMC5159980 DOI: 10.1186/s40644-016-0100-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 12/01/2016] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND To evaluate the interchangeability of perfusion parameters obtained with help of models used for post-processing of perfusion-CT images in pancreatic adenocarcinoma and to determine the mean values and ranges of perfusion in different tumour gradings. METHODS Perfusion-CT imaging was performed prospectively in 48 consecutive patients with pancreatic adenocarcinoma. In 42 patients biopsy-proven tumor grading was available (4 × G1/24 × G2/14 × G3/6× unknown). Images were post-processed using a model based on the maximum-slope (MS) approach (blood flow-BFMS) + Patlak analysis (P) (blood volume [BVP] and permeability [k-transP]), as well as a model with deconvolution-based (D) analysis (BFD, BVD and k-transD). 50 mL contrast agent were applied with a delay time of 7 s. Perfusion parameters were compared using intraclass correlation coefficient (ICC), the Wilcoxon matched-pairs test and Bland-Altman plots. RESULTS Forty eight VOIs of tumours were outlined and analysed. Moderate to good ICC values were found for the perfusion parameters (ICC = 0.62-0.75). Wilcoxon matched-pairs revealed significantly lower values (P < .001 and 0.008), for the BF and BV values obtained using the maximum-slope approach + Patlak analysis compared to deconvolution based analysis. For k-trans measurement, deconvolution revealed significantly lower values (P < 0.001). Different histologic subgroups (G1-G3) did not show significantly different functional parameters. CONCLUSION There were significant differences in the perfusion parameters obtained using the different calculation methods, and therefore these parameters are not directly interchangeable. However, the magnitude of pairs of parametric values is in constant relation to each other enabling the use of any of these methods. VPCT parameters did not allow for histologic classification.
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Affiliation(s)
- Sven Schneeweiß
- Department of Diagnostic Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str.3, 72076 Tübingen, Germany
| | - Marius Horger
- Department of Diagnostic Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str.3, 72076 Tübingen, Germany
| | - Anja Grözinger
- Department of Diagnostic Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str.3, 72076 Tübingen, Germany
| | - Konstantin Nikolaou
- Department of Diagnostic Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str.3, 72076 Tübingen, Germany
| | - Dominik Ketelsen
- Department of Diagnostic Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str.3, 72076 Tübingen, Germany
| | - Roland Syha
- Department of Diagnostic Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str.3, 72076 Tübingen, Germany
| | - Gerd Grözinger
- Department of Diagnostic Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str.3, 72076 Tübingen, Germany
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Syha R, Benz T, Hetzel J, Spengler W, Kohlhäufl MJ, Gatidis S, Grözinger G, Horger M, Nikolaou K, Ketelsen D. Bronchial Artery Embolization in Hemoptysis: 10-Year Survival and Recurrence-Free Survival in Benign and Malignant Etiologies - A Retrospective Study. ROFO-FORTSCHR RONTG 2016; 188:1061-1066. [PMID: 27760440 DOI: 10.1055/s-0042-112227] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Purpose: The aim of the study was to evaluate safety, effectiveness, recurrence rate and 10-year survival after bronchial artery embolization (BAE) in benign and malignant etiologies. Methods: The retrospective study includes 100 BAE procedures in 88 patients. Underlying disease was classified as benign (n = 67) and malignant (n = 21) etiologies. Immediate bleeding control and procedure safety were evaluated in all patients. In 51 (58 %) patients, follow-up data with a median follow-up time of 1015 days (range, 494 to 3727 days) were acquired to assess overall survival, time-to-recurrence of bleeding and recurrence-free survival, using Kaplan-Maier estimates to compare differences between both subgroups. Results: Immediate bleeding control was achieved after 96/100 procedures (96 %), with a minor complication rate of 5.0 %. No major complications occurred. The overall survival was 74 % after 1 year and 59 % after 5 years and 10 years. There was a significant difference in survival between the malignant and benign groups (p < 0.0001). Survival was 90 %, 80 % and 76 % at 1 year, 3 years and 10 years, respectively, in the benign group and 18 % and 0 % at 1 year and 3 years, respectively in the malignant group. The median time to recurrence of bleeding and recurrence-free survival were 239 days and 94 % after 1 year and 87 % after 10 years in the benign group, compared to 66 days and 34 % after 1 year and 0 % after 3 years in the malignant group (p = 0.0107). Conclusion: BAE is a safe and highly effective treatment option in hemoptysis. However, the recurrence rate and survival are highly dependent on the underlying disease. Key Points: • BAE is a safe and highly effective treatment option in hemoptysis.• Recurrence rate and survival are strongly dependent on the underlying disease with significantly impaired results in patients with malignant diseases. • Coil embolization is an effective BAE treatment method. Nevertheless, it should be mentioned, that reinterventions can be impeded, if embolization is performed in the proximal part of bronchial arteries. Citation Format: • Syha R, Benz T, Hetzel J et al. Bronchial Artery Embolization in Hemoptysis: 10-Year Survival and Recurrence-Free Survival in Benign and Malignant Etiologies - A Retrospective Study. Fortschr Röntgenstr 2016; 188: 1061 - 1066.
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Affiliation(s)
- R Syha
- Diagnostic and Interventional Radiology, University Hospital Tuebingen, Germany
| | - T Benz
- Diagnostic and Interventional Radiology, University Hospital Tuebingen, Germany
| | - J Hetzel
- Internal Medicine II, Department of Oncology, Haematology, Clinical Immunology, Rheumatology and Pneumology, University of Tuebingen, Germany
| | - W Spengler
- Internal Medicine II, Department of Oncology, Haematology, Clinical Immunology, Rheumatology and Pneumology, University of Tuebingen, Germany
| | - M J Kohlhäufl
- Center for Pulmonology and Thoracic Surgery, Division of Pulmonology, Klinik Schillerhoehe, Gerlingen, Germany
| | - S Gatidis
- Diagnostic and Interventional Radiology, University Hospital Tuebingen, Germany
| | - G Grözinger
- Diagnostic and Interventional Radiology, University Hospital Tuebingen, Germany
| | - M Horger
- Diagnostic and Interventional Radiology, University Hospital Tuebingen, Germany
| | - K Nikolaou
- Diagnostic and Interventional Radiology, University Hospital Tuebingen, Germany
| | - D Ketelsen
- Diagnostic and Interventional Radiology, University Hospital Tuebingen, Germany
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Syha R, Gatidis S, Grözinger G, Grosse U, Maurer M, Zender L, Horger M, Nikolaou K, Ketelsen D. C-arm computed tomography and volume perfusion computed tomography (VPCT)-based assessment of blood volume changes in hepatocellular carcinoma in prediction of midterm tumor response to transarterial chemoembolization: a single center retrospective trial. Cancer Imaging 2016; 16:30. [PMID: 27654658 PMCID: PMC5031258 DOI: 10.1186/s40644-016-0088-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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] [Received: 06/08/2016] [Accepted: 09/02/2016] [Indexed: 02/08/2023] Open
Abstract
Background This study aims to evaluate immediate changes in perfusion parameters in hepatocellular carcinoma (HCC) to transarterial chemoembolization (TACE) in C-arm computed tomography (CT) and volume perfusion CT (VPCT) and prediction of midterm tumor response. Methods Twenty-five patients (median age 66, range 61 to 75 years) with 62 HCC lesions undergoing TACE received immediate pre- and post-interventional assessment by C-arm CT and VPCT. Cross-sectional imaging was analyzed at baseline and approximately 12 weeks after TACE according to modified RECIST criteria. Outcome was defined as objective response (OR, > 30 % reduction of viable tumor) or non-OR. Perfusion parameters were evaluated in C-arm CT [parenchymal blood volume (PBV)] and VPCT [blood volume (BV) and blood flow (BF)]. Ratios of perfusion parameters before and after TACE within the tumor and the non-affected liver parenchyma were calculated. Results Correlation between tumor PBV and BV revealed a moderate correlation (rho = 0.45, p = 0.005). In non-affected liver parenchyma, a significant decrease in PBV was seen, compared to a significant increase in BF and BV. Perfusion ratios in HCC lesions were significantly (p < 0.05) increased in OR group compared to non-OR patients in C-arm CT and VPCT: PBV ratio (0.95 (0.06) to 0.67 (0.38), BV ratio 0.63 (0.34) to 0.15 (0.6), and BF ratio 0.6 (0.32) to 0.22 (0.51). Logistic regression including PBV and BF allowed prediction of OR (sensitivity 88 %/specificity of 83 %). Conclusions Perfusion parameters acquired by C-arm CT and VPCT cannot simply be substituted by each other, but show similar capability in prediction of midterm tumor response.
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Affiliation(s)
- Roland Syha
- Department of Radiology, Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany.
| | - Sergios Gatidis
- Department of Radiology, Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Gerd Grözinger
- Department of Radiology, Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Ulrich Grosse
- Department of Radiology, Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Michael Maurer
- Department of Radiology, Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Lars Zender
- Department of Internal Medicine I, Division of Translational Gastrointestinal Oncology, University of Tuebingen, Tuebingen, Germany
| | - Marius Horger
- Department of Radiology, Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Konstantin Nikolaou
- Department of Radiology, Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Dominik Ketelsen
- Department of Radiology, Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
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Qiu HJ, Rietig R, Steger V, Lehn-Stefan A, Ketelsen D, Balletshofer B, Randrianarisoa E. [A rare cause of pulmonary embolism]. Dtsch Med Wochenschr 2016; 141:1324. [PMID: 27598920 DOI: 10.1055/s-0042-101913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
HISTORY AND ADMISSION FINDINGS We report on a patient with acute dyspnea after several vertebral body interventions, among others a kyphoplasty, that was performed a few days earlier. INVESTIGATIONS In the computed tomography we prove a bilateral pulmonary embolism (cement and thrombus). There is no right heart failure. A deep vein thrombosis can be excluded by color-coded vascular ultrasound. DIAGNOSIS, TREATMENT AND COURSE The pulmonary embolism is due to bone cement. The cement material is also found paravertebral, intraspinal and intraneuroforaminal. By conservative treatment using therapeutic anticoagulation and analgesic medication, the patient showed a rapid clinical improvement. CONCLUSIONS In patients with cardiopulmonary symptoms after vertebroplasty and kyphoplasty, pulmonary embolism due to bone cement should be considered as a possible cause. The therapy depends on the extent of the cement embolism and the symptoms of the patient.
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Othman AE, Grözinger G, Ketelsen D. [Not Available]. ROFO-FORTSCHR RONTG 2016; 188:866-7. [PMID: 27579681 DOI: 10.1055/s-0042-106307] [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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Grözinger G, Bitzer M, Syha R, Ketelsen D, Nikolaou K, Lauer U, Horger M. Correlation of magnetic resonance signal characteristics and perfusion parameters assessed by volume perfusion computed tomography in hepatocellular carcinoma: Impact on lesion characterization. World J Radiol 2016; 8:683-692. [PMID: 27551338 PMCID: PMC4965352 DOI: 10.4329/wjr.v8.i7.683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 03/14/2016] [Accepted: 05/11/2016] [Indexed: 02/06/2023] Open
Abstract
AIM: To find out if magnetic resonance (MR)-signal characteristics of hepatocellular carcinomas (HCC) correlate with perfusion parameters assessed by volume perfusion computed tomography (VPCT).
METHODS: From October 2009 to January 2014, 26 (mean age, 69.3 years) patients with 36 HCC lesions who underwent both VPCT and MR liver imaging were analysed. We compared signal intensity in the T1w- and T2w-images and wash-in/wash-out kinetics on post-contrast MR images with mean values of blood flow (BF, mL/100 mL per minute), blood volume (BV, mL/100 mL), k-trans (mL/100 mL per minute), arterial liver perfusion (mL/100 mL per minute), portal venous perfusion and hepatic perfusion index (HPI, %) obtained by VPCT. Signal intensity on magnetic resonance imaging (MRI) was classified hyper/iso/hypointense compared with surrounding liver parenchyma.
RESULTS: Signal intensity on native T1w- and T2w-images was hyper/iso/hypo in 4/16/16 and 21/14/1 lesions, respectively. Wash-in and wash-out contrast kinetics were found on MRI in 33 of 36 lesions (91.7%) and 25 of 36 lesions (69.4%), respectively. The latter was observed significantly more often in higher graded lesions (P < 0.005). HPI was 94.7% ± 6.5%. There was no significant relationship between lesion’s MR-signal intensity, MR signal combinations, size and any of the VPCT-perfusion parameters. However HPI was constantly high in all HCC lesions.
CONCLUSION: VPCT parameters add limited value to MR-lesion characterization. However in HCC lesions with atypical MR signal characteristics HPI can add a parameter to ensure HCC diagnosis.
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Othman A, Syha R, Ketelsen D. Schnell progredientes, rupturiertes Pseudoaneurysma eines renalen Angiomyolipoms bei einer Patientin mit tuberöser Sklerose. ROFO-FORTSCHR RONTG 2016; 188:1072-1074. [DOI: 10.1055/s-0042-110853] [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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Spira D, Kirchner S, Blumenstock G, Herz K, Ketelsen D, Wiskirchen J, Wiesinger B. Therapeutic angiographic procedures: differences in dose area product between analog image intensifier and digital flat panel detector. Acta Radiol 2016; 57:587-94. [PMID: 26231951 DOI: 10.1177/0284185115597262] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 06/27/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Radiation exposure remains an unceasing concern in angiographic procedures. Modern angiography machines such as analog image intensifiers (AII) or the new flat panel detectors (FPD) aim at a further dose reduction. PURPOSE To present dose area products (DAP) in a broad spectrum of therapeutic angiographic procedures, comparing an AII to an FPD angiography system. MATERIAL AND METHODS A total of 999 peripheral therapeutic angiography procedures performed with an FPD (n = 562) and an AII system (n = 437) were evaluated. DAP, fluoroscopy time, and patients' body mass index (BMI) were recorded. Interventions were classified into five main groups: percutaneous transluminal angioplasty (PTA); PTA and stent placement; intra-arterial thrombolysis; embolization procedures; and specialized interventions. RESULTS DAP values in therapeutic angiographic procedures were significantly higher when performed with the FPD compared to the AII system. The increase of the FPD versus AII system was 100.1% for PTA, 39.9% for PTA and stent placement, 187% for intra-arterial thrombolysis, 31.3% for embolization procedures, and 361% for specialized interventions. These differences persisted after standardizing DAP values to the geometric mean fluoroscopy duration of each procedure. Fluoroscopy times were shorter in all interventions performed at the FPD as compared to the AII system. DAPs increased with higher BMI, but the DAP increase of both systems with elevated BMI was variable, depending on the individual intervention. CONCLUSION In therapeutic angiographic procedures, the FPD system required higher DAPs despite shorter fluoroscopy times as compared to an AII system. Better ergonomics and speediness of the FPD system may be advantageous in the emergency setting.
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Affiliation(s)
- Daniel Spira
- Department of Diagnostic and Interventional Radiology, Universitätsklinik Heidelberg, Heidelberg, Germany
| | - Sebastian Kirchner
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Tübingen, Germany
| | - Gunnar Blumenstock
- Institute of Clinical Epidemiology and Applied Biometry, Eberhard-Karls-University, Tübingen, Germany
| | - Klaus Herz
- Institute for Radiation Protection and Radionuclide Laboratory, Eberhard-Karls-University, Tübingen, Germany
| | - Dominik Ketelsen
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Tübingen, Germany
| | - Jakub Wiskirchen
- Department of Radiology and Nuclear Medicine, Franziskus Hospital, Bielefeld, Germany
| | - Benjamin Wiesinger
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Tübingen, Germany
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Scheinert D, Schmidt A, Zeller T, Müller-Hülsbeck S, Sixt S, Schröder H, Weiss N, Ketelsen D, Ricke J, Steiner S, Rosenfield K. German Center Subanalysis of the LEVANT 2 Global Randomized Study of the Lutonix Drug-Coated Balloon in the Treatment of Femoropopliteal Occlusive Disease. J Endovasc Ther 2016; 23:409-16. [DOI: 10.1177/1526602816644592] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: To report a subanalysis of the German centers enrolling patients in the prospective, global, multicenter, randomized LEVANT 2 pivotal trial ( ClinicalTrials.gov identifier NCT01412541) of the Lutonix drug-coated balloon (DCB) for the treatment of femoropopliteal occlusive disease. Methods: Among the 476 patients in LEVANT 2, 126 patients (mean age 67.1±9.6 years; 79 men) were enrolled at the 8 participating German sites between August 2011 and July 2012 and were randomized 2:1 to treatment with the Lutonix DCB (n=83) vs an uncoated balloon during percutaneous transluminal angioplasty (PTA, n=43). All patients had intermittent claudication or rest pain (Rutherford categories 2–4). Average lesion length was 58 mm and average treated length was 100 mm. Severe calcification was present in 11% of lesions, and 23% were total occlusions. The efficacy outcome was primary patency at 12 months, and the safety outcome was 12-month freedom from a composite of perioperative death, index limb–related death, amputation (below or above the ankle), and index limb revascularization. Secondary endpoints included target lesion revascularization (TLR), major adverse events, and functional outcomes. Results: Demographic, clinical, and lesion characteristics were matched between Lutonix DCB and PTA groups, as were the final percent diameter stenosis (19%) and procedure success (91%). By Kaplan-Meier analysis, the 12-month primary patency rate was 80% vs 58% (p=0.015) and the composite safety endpoint rate was 94% vs 72% (p=0.001), respectively. Freedom from TLR was higher for DCBs (96%) vs PTA (82%, p=0.012). Major adverse events were similar for both groups. The benefit favoring DCB over PTA was observed in German men and women. Compared to the non-German LEVANT 2 cohort, there was a shorter time between insertion and inflation of treatment balloons (21.8 vs 39.5 seconds, p<0.001) in the German cohort. Balloons were inflated to higher pressures (9.0 vs 7.7 atm, p<0.001) but for a shorter period of time (130 vs 167 seconds, p<0.001), and although treated lesions in the German cohort had a higher baseline stenosis, final postprocedure diameter stenosis was lower (19% vs 22%, p=0.04) than in the non-German patients. Conclusion: Superiority of DCB over PTA in the German cohort of LEVANT 2 was demonstrated for primary patency, composite safety, and freedom from TLR. The benefit of DCB was also consistent for both genders. Geographic or regional differences in procedural variables may account for the different outcomes between the German and non-German cohorts.
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Affiliation(s)
- Dierk Scheinert
- Division of Interventional Angiology, University Hospital Leipzig, Germany
| | - Andrej Schmidt
- Division of Interventional Angiology, University Hospital Leipzig, Germany
| | - Thomas Zeller
- Department of Angiology, Universitäts-Herzzentrum Freiburg–Bad Krozingen, Bad Krozingen, Germany
| | | | - Sebastian Sixt
- Hamburg University Cardiovascular Center, Hamburg, Germany
| | - Henrik Schröder
- Center for Diagnostic Radiology and Minimally Invasive Therapy, Jewish Hospital, Berlin, Germany
| | - Norbert Weiss
- Center for Vascular Medicine, Universitaetsklinikum Carl Gustav Carus, Dresden, Germany
| | - Dominik Ketelsen
- Deptartment of Diagnostic & Interventional Radiology, University of Tuebingen, Germany
| | - Jens Ricke
- Clinic for Radiology and Nuclear Medicine, University Magdeburg, Germany
| | - Sabine Steiner
- Division of Interventional Angiology, University Hospital Leipzig, Germany
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Ketelsen D. Diagnostik und Therapie der Komplikationen bei peripherer PTA. ROFO-FORTSCHR RONTG 2016. [DOI: 10.1055/s-0036-1581406] [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: 10/22/2022]
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Ketelsen D. Chronische Ischämie – Interventionen bei infrapoplitealen Läsionen. ROFO-FORTSCHR RONTG 2016. [DOI: 10.1055/s-0036-1581469] [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: 10/22/2022]
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Spira D, Wiskirchen J, Lauer U, Ketelsen D, Nikolaou K, Wiesinger B. Implantability, Complications, and Follow-Up After Transjugular Intrahepatic Portosystemic Stent-Shunt Creation With the 6F Self-Expanding Sinus-SuperFlex-Visual Stent. Iran J Radiol 2016; 13:e28689. [PMID: 27853493 PMCID: PMC5106871 DOI: 10.5812/iranjradiol.28689] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Revised: 05/14/2015] [Accepted: 06/08/2015] [Indexed: 12/31/2022]
Abstract
Background The transjugular intrahepatic portosystemic stent-shunt (TIPSS) builds a shortcut between the portal vein and a liver vein, and represents a sophisticated alternative to open surgery in the management of portal hypertension or its complications. Objectives To describe clinical experiences with a low-profile nitinol stent system in TIPSS creation, and to assess primary and long-term success. Patients and Methods Twenty-six patients (5 females, 21 males; mean age 54.6 years) were treated using a low-profile 6F self-expanding sinus-SuperFlex-Visual stent system. The indication for TIPSS creation was refractory bleeding in 9 of the 26 patients, refractory ascites in 18 patients, and acute thrombosis of the portal vein confluence in one patient. Portosystemic pressure gradients before and after TIPSS, periprocedural and long-term complications, and the time to orthotopic liver transplantation (OLT) or death were recorded. Results The portosystemic pressure gradient was significantly reduced, from 20.9 ± 6.3 mmHg before to 8.2 ± 2.3 mmHg after TIPSS creation (P < 0.001). Procedure-related complications included acute tract occlusion (n = 2), liver hematoma (n = 1), hepatic encephalopathy (n = 1), and cardiac failure (n = 1). Three of the 26 patients had late-onset TIPSS occlusion (at 12, 12, and 39 months after TIPSS creation). Three patients died within one week after the procedure due to their poor general condition (multiorgan failure, acute respiratory distress syndrome, necrotizing pancreatitis, and aspiration pneumonia). Another four patients succumbed to their underlying advanced liver disease within one year after TIPSS insertion. Seven patients underwent OLT at a mean time of 9.4 months after TIPSS creation. Conclusion The sinus-SuperFlex-Visual stent system can be safely deployed as a TIPSS device. The pressure gradient reduction was clinically sufficient to treat the patients’ symptoms, and periprocedural complications were due to the TIPSS procedure per se rather than to the particular stent system employed in this study.
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Affiliation(s)
- Daniel Spira
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
- Corresponding author: Daniel Spira, Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany. Tel: +49-6221566410, Fax: +49-6221565730, E-mail:
| | - Jakub Wiskirchen
- Department of Radiology and Nuclear Medicine, Franziskus Hospital, Bielefeld, Germany
| | - Ulrich Lauer
- Department of Gastroenterology and Hepatology, Eberhard-Karls-University, Tubingen, Germany
| | - Dominik Ketelsen
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Tubingen, Germany
| | - Konstantin Nikolaou
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Tubingen, Germany
| | - Benjamin Wiesinger
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Tubingen, Germany
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Souren C, Kloss-Brandstätter A, Stadler A, Kross K, Yamauchi K, Ketelsen D, Kessler P, Lethaus B. Ultrasound-guided fine-needle aspiration cytology as a diagnostic tool in comparison to ultrasound and MRI for staging in oral- and oropharyngeal squamous cell tumors. J Craniomaxillofac Surg 2016; 44:197-201. [DOI: 10.1016/j.jcms.2015.11.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 10/08/2015] [Accepted: 11/06/2015] [Indexed: 10/22/2022] Open
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Schabel C, Bongers MN, Ketelsen D, Syha R, Thomas C, Homann G, Notohamiprodjo M, Nikolaou K, Bamberg F. [Diagnostic accuracy of dual energy CT angiography in patients with diabetes mellitus]. Radiologe 2016; 55:314-22. [PMID: 25809927 DOI: 10.1007/s00117-014-2721-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVES Peripheral arterial disease (PAD) represents a major and highly prevalent complication in patients with diabetes mellitus. The diagnostic, non-invasive work-up by computed tomography angiography (CTA) is limited in the presence of extensive calcification. The aim of the study was to determine the diagnostic accuracy of dual energy CTA (DE-CTA) for the detection and characterization of PAD in patients with diabetes mellitus. MATERIAL AND METHODS In this study 30 diabetic patients with suspected or known PAD were retrospectively included in the analysis. All subjects underwent DE-CTA (Somatom Definition Flash, Siemens Healthcare, Erlangen, Germany) prior to invasive angiography, which served as the reference standard. Blinded analysis included assessment of the presence and degree of peripheral stenosis on curved multiplanar reformatting (MPR) and maximum intensity projections (MIP). Conventional measures of diagnostic accuracy were derived. RESULTS Among the 30 subjects included in the analysis (83% male, mean age 70.0 ± 10.5 years, 83% diabetes type 2), the prevalence of critical stenosis in 331 evaluated vessel segments was high (30%). Dual energy CT identified critical stenoses with a high sensitivity and good specificity using curved MPR (100% and 93.1%, respectively) and MIP images (99% and 91.8%, respectively). In stratified analysis, the diagnostic accuracy was higher for stenosis pertaining to the pelvic and thigh vessels as compared with the lower extremities (curved MPR accuracy 97.1% vs. 99.2 vs. 90.9%; respectively, p < 0.001). CONCLUSION The use of DE-CTA allows reliable detection and characterization of peripheral arterial stenosis in patients with diabetes mellitus with higher accuracy in vessels in the pelvic and thigh regions compared with the vessels in the lower legs.
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Affiliation(s)
- C Schabel
- Abteilung für Diagnostische und Interventionelle Radiologie, Klinikum der Eberhard-Karls-Universität, Hoppe-Seyler-Str. 3, 72076, Tübingen, Deutschland,
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Syha R, Grözinger G, Grosse U, Maurer M, Zender L, Horger M, Nikolaou K, Ketelsen D. C-arm computed tomography parenchymal blood volume measurement in evaluation of hepatocellular carcinoma before transarterial chemoembolization with drug eluting beads. Cancer Imaging 2015; 15:22. [PMID: 26715200 PMCID: PMC4696182 DOI: 10.1186/s40644-015-0057-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 12/01/2015] [Indexed: 02/07/2023] Open
Abstract
Background C-arm computed tomography (CT) guided intervention is an increasingly applied technique in transarterial chemoembolization (TACE) of hepatocellular carcinoma (HCC). The aim of this study was to analyse the value of parenchymal blood volume (PBV) maps acquired during C-arm CT acquisition, for pre-treatment evaluation and planning of TACE in HCC patients. Methods A total of 64 HCC lesions in 29 patients (median age, 73 years, range, 62–77 years) were included in this retrospective study. All patients received cross-sectional imaging (MRI or CT) prior to TACE and C-arm CT PBV measurement acquisition before performing TACE. Results of cross-sectional imaging regarding the number of HCC lesions and maximum diameter were compared to PBV–maps. Number of lesions and tumour feeding vessels detected in PBV-maps were compared to conventional angiography. Results of PBV were analysed concerning different tumour morphologies (pre-treated, encapsulated and diffuse). Results Pre-interventional cross-sectional imaging and PBV maps showed an excellent agreement in lesion diameter (p = 0.88, MD = −0.28 mm) and number of detected lesions (κ = 1.0). Compared to conventional angiography, PBV maps showed an increased number of detected lesions (κ = 0.77, p = 0.001) and tumour feeding vessels (κ = 0.71, p < 0.0001). Diffuse HCC lesion revealed a significantly lower PBV compared to encapsulated lesions (p = 0.0001). Conclusions C-arm CT acquired PBV measurements detect HCC tumours with a lesion detectability comparable to pre-interventional cross-sectional imaging. Furthermore, this technique facilitates TACE, allowing a more precise localization of HCC lesions and tumour feeding vessels compared to conventional angiography. Additionally, calculated PBV values enable a real time quantitative assessment of tumour perfusion.
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Affiliation(s)
- Roland Syha
- Department of Radiology, Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Gerd Grözinger
- Department of Radiology, Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany.
| | - Ulrich Grosse
- Department of Radiology, Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Michael Maurer
- Department of Radiology, Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Lars Zender
- Division of Translational Gastrointestinal Oncology, Department of Internal Medicine I, University of Tuebingen, Tuebingen, Germany
| | - Marius Horger
- Department of Radiology, Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Konstantin Nikolaou
- Department of Radiology, Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Dominik Ketelsen
- Department of Radiology, Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
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Kaufmann S, Horger T, Oelker A, Beck S, Schulze M, Nikolaou K, Ketelsen D, Horger M. Volume perfusion computed tomography (VPCT)-based evaluation of response to TACE using two different sized drug eluting beads in patients with nonresectable hepatocellular carcinoma: Impact on tumor and liver parenchymal vascularisation. Eur J Radiol 2015; 84:2548-54. [PMID: 26428842 DOI: 10.1016/j.ejrad.2015.09.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 09/02/2015] [Accepted: 09/08/2015] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Response monitoring of transarterial chemoembolization (TACE) with the help of volume perfusion computed tomography (VPCT) at day one post-TACE and analysis of TACE-impact on tumor and uninvolved liver parenchymal perfusion by using different particles sizes and epirubicin dose. MATERIALS AND METHODS Institutional review board approved this prospective study. VPCT was performed in the baseline, post-interventional (FU1; 24 h post-TACE) and at follow-up (FU2; median, 81 days) in 45 consecutive patients. 100-300 μm (n=17) and 300-500 μm (n=28) drug eluting beads (DEB) using an epirubicin dose of (<=25 vs. >25) were administered. VPCT was performed for 40-s using 80 kV, 100/120 mAs, 64×0.6 mm collimation, 26 consecutive measurements, IV injection (50 ml iodinated contrast), flow rate (5 ml/s). Blood flow (BF), blood volume (BV) and k-trans were registered as average and max values in the tumor. Arterial liver perfusion (ALP), portal-venous perfusion (PVP) and the hepatic perfusion index (HPI) were registered both in tumor and non-involved liver parenchyma. Response to TACE was classified by VPCT as complete (CR), partial (PR) or no response (NR). RESULTS A significant reduction of viable tumor tissue was found in all patients between baseline and FU1 (p<0.001) being independent on particle size and epirubicin dose (p>0.05). PPV/NPV/sensitivity/specificity of post-interventional VPCT (FU1) results for prediction of the mid-term tumor course (FU2) were 100%/70%/76%/100%. There was generally a significant increase of the ALP between baseline and FU1 in the liver parenchyma coupled by a significant subsequent decrease (normalization) of ALP and HPI between FU1 and FU2. CONCLUSION VPCT accurately measures impact of TACE on liver tumor and hepatic parenchymal perfusion. The former proved not to be significantly dependent on particle size and epirubicin dose. There was no persistent perfusion deficit in the liver after TACE.
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Affiliation(s)
- S Kaufmann
- University of Tübingen, Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str.3, 72076 Tübingen, Germany.
| | - T Horger
- Technische Universität München, M2-Lehrstuhl für Numerische Mathematik, Boltzmannstraße 3, 85748 Garching, Germany.
| | - A Oelker
- Technische Universität München, M6-Lehrstuhl für Mathematische Modellierung, Boltzmannstraße 3, 85748 Garching, Germany.
| | - S Beck
- University of Tübingen, Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str.3, 72076 Tübingen, Germany.
| | - M Schulze
- University of Tübingen, Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str.3, 72076 Tübingen, Germany.
| | - K Nikolaou
- University of Tübingen, Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str.3, 72076 Tübingen, Germany.
| | - D Ketelsen
- University of Tübingen, Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str.3, 72076 Tübingen, Germany.
| | - M Horger
- University of Tübingen, Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str.3, 72076 Tübingen, Germany.
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Bongers M, Schabel C, Homann G, Mangold S, Tsiflikas I, Ketelsen D, Nikolaou K, Thomas C. Das Potential von Gadolinium als Kontrastmittel in der Dual-Energy Computertomografie – eine ex vivo Phantom-Studie. ROFO-FORTSCHR RONTG 2015. [DOI: 10.1055/s-0035-1550858] [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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Syha R, Gebhardt H, Grosse U, Martirosian P, Thomas C, Ketelsen D, Notohamiprodjo M, Nikolaou K, Schick F, Springer F. MRT des Annulus fibrosus und der kartilaginären Endplatte lumbaler Bandscheiben mittels ultrakurzen Echozeiten: Quantifizierung degenerativer Veränderungen mittels offresonanten Sättigungsratios. ROFO-FORTSCHR RONTG 2015. [DOI: 10.1055/s-0035-1550848] [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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Syha R, Grözinger G, Thomas C, Schmehl J, Horger M, Nikolaou K, Ketelsen D. Parenchymblutvolumen (PBV) in der C-Arm Computertomografie: periinterventionelle Evaluation und Therapieplannung des hepatozelluären Karzinoms während der transarteriellen Chemoembolization. ROFO-FORTSCHR RONTG 2015. [DOI: 10.1055/s-0035-1551122] [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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Tsiflikas I, Thomas C, Fallmann C, Schabel C, Mangold S, Ketelsen D, Claussen C, Axmann D, Schroeder S, Burgstahler C. Prevalence of Subclinical Coronary Artery Disease in Middle-Aged, Male Marathon Runners Detected by Cardiac CT. ROFO-FORTSCHR RONTG 2015; 187:561-8. [DOI: 10.1055/s-0034-1399221] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- I. Tsiflikas
- Diagnostic and Interventional Radiology, University Hospital of Tuebingen, Germany
| | - C. Thomas
- Diagnostic and Interventional Radiology, University Hospital of Tuebingen, Germany
| | - C. Fallmann
- Sports Medicine, University Hospital of Tuebingen, Germany
| | - C. Schabel
- Diagnostic and Interventional Radiology, University Hospital of Tuebingen, Germany
| | - S. Mangold
- Diagnostic and Interventional Radiology, University Hospital of Tuebingen, Germany
| | - D. Ketelsen
- Diagnostic and Interventional Radiology, University Hospital of Tuebingen, Germany
| | - C. Claussen
- Diagnostic and Interventional Radiology, University Hospital of Tuebingen, Germany
| | - D. Axmann
- Center of Dentistry Oral Medicine and Maxillofacial Surgery, University Hospital of Tuebingen, Germany
| | - S. Schroeder
- Internal Medicine, Klinikum am Eichert, Goeppingen, Germany
| | - C. Burgstahler
- Center of Dentistry Oral Medicine and Maxillofacial Surgery, University Hospital of Tuebingen, Germany
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Schneeweiß S, Horger M, Ketelsen D, Ioanoviciu SD. [Complications after TACE in HCC - complications after transarterial chemoembolization (TACE) in hepatocellular carcinoma]. ROFO-FORTSCHR RONTG 2015; 36:79-82. [PMID: 25629286 DOI: 10.1055/s-0034-1369532] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Bongers MN, Schabel C, Krauss B, Tsiflikas I, Ketelsen D, Mangold S, Claussen CD, Nikolaou K, Thomas C. Noise-optimized virtual monoenergetic images and iodine maps for the detection of venous thrombosis in second-generation dual-energy CT (DECT): an ex vivo phantom study. Eur Radiol 2014; 25:1655-64. [PMID: 25528670 DOI: 10.1007/s00330-014-3544-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [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: 08/21/2014] [Revised: 10/15/2014] [Accepted: 11/25/2014] [Indexed: 12/25/2022]
Abstract
AIMS AND OBJECTIVES Deep venous thrombosis (DVT) can be difficult to detect using CT due to poor and heterogeneous contrast. Dual-energy CT (DECT) allows iodine contrast optimization using noise-optimized monoenergetic extrapolations (MEIs) and iodine maps (IMs). Our aim was to assess whether MEI and IM could improve the delineation of thrombotic material within iodine-enhanced blood compared to single-energy CT (SECT). MATERIALS AND METHODS Six vessel phantoms, including human thrombus and contrast media-enhanced blood and one phantom without contrast, were placed in an attenuation phantom and scanned with DECT 100/140 kV and SECT 120 kV. IM, virtual non-contrast images (VNC), mixed images, and MEI were calculated. Attenuation of thrombi and blood were measured. Contrast and contrast-to-noise-ratios (CNRs) were calculated and compared among IM, VNC, mixed images, MEI, and SECT using paired t tests. RESULTS MEI40keV and IM showed significantly higher contrast and CNR than SE120kV from high to intermediate iodine concentrations (contrast:pMEI40keV < 0.002,pIM < 0.005;CNR:pMEI40keV < 0.002,pIM < 0.004). At low iodine concentrations, MEI190keV and VNC images showed significantly higher contrast and CNR than SE120kV with inverted contrasts (contrast:pMEI190keV < 0.008,pVNC < 0.002;CNR:pMEI190keV < 0.003,pVNC < 0.002). CONCLUSIONS Noise-optimized MEI and IM provide significantly higher contrast and CNR in the delineation of thrombosis compared to SECT, which may facilitate the detection of DVT in difficult cases. KEY POINTS • Poor contrast makes it difficult to detect thrombosis in CT. • Dual-energy-CT allows contrast optimization using monoenergetic extrapolations (MEI) and iodine maps (IM). • Noise-optimized-MEI and IM are significantly superior to single-energy-CT in delineation of thrombosis. • Noise-optimized-MEI and IM may facilitate the detection of deep vein thrombosis.
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Affiliation(s)
- Malte N Bongers
- Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Germany
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Syha R, Grau S, Nieß AM, Hein T, Werner MK, Ketelsen D, Schick F, Best R. Computer-based quantification of the Achilles tendon thickness in sequential B-mode ultrasound images: a study of feasibility and reliability. Arch Orthop Trauma Surg 2014; 134:1443-9. [PMID: 25052771 DOI: 10.1007/s00402-014-2043-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Assessment of the Achilles tendon thickness (ATT) using B-mode ultrasound is a common technique for clinical evaluation of chronic mid-part tendinosis. Currently used image-based assessment is limited by relatively high inter- and intra-observer variability. In this study, it was tested whether a new sequence-based automated assessment of ATT provides more reliable and reproducible results than the standard image-based procedure. MATERIALS AND METHODS A total of 118 non-operated tendons of 59 healthy subjects (44, range 28-50 years) were analysed using an automated image based as well as a newly developed automated sequence-based method. Correlation and agreement of both methods were evaluated. The root mean square deviation (RMSD) and a Bland-Altman analysis were performed to highlight observer (n = 18 tendons) as well as reader (n = 40 tendons) dependent variabilities of both methods. RESULTS A strong correlation was found between image and sequence-based ATT assessment (p = 0.92). The Bland-Altman analysis showed a good agreement between both methods (mean difference 0.0018, 95 % CI: -0.046; 0.05). In repetitive examinations, sequence-based analysis showed a significant reduction concerning reader- and observer-dependent variability compared to image-based assessment. The RMSD for repetitive sequence-based measurements was approximately 0.3 mm (compared to 0.6 mm for image-based measurement), respectively. CONCLUSIONS The study shows sequence-based automated assessment of ATT being clearly superior to the standard image-based procedure. The new method provides a clear reduction of reader as well as observer-dependent variability. Due to the decreased scattering of measurement data sequence-based measurement seems especially valuable for quantification of small tendon thickness changes such as exercise-induced hypertrophy.
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Affiliation(s)
- R Syha
- Section on Experimental Radiology, Eberhard-Karls-University, Tubingen, Germany
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Hoffmann R, Rempp H, Syha R, Ketelsen D, Pereira PL, Claussen CD, Clasen S. Transarterial chemoembolization using drug eluting beads and subsequent percutaneous MR-guided radiofrequency ablation in the therapy of intermediate sized hepatocellular carcinoma. Eur J Radiol 2014; 83:1793-8. [PMID: 25052871 DOI: 10.1016/j.ejrad.2014.06.031] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2014] [Revised: 06/10/2014] [Accepted: 06/26/2014] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To evaluate safety, efficacy, survival and recurrence-free survival of transarterial chemoembolization (TACE) with drug eluting (DC) beads combined with MR-guided radiofrequency (RF) ablation for the treatment of hepatocellular carcinomas (HCC) larger than 3 cm. MATERIALS AND METHODS This retrospective study was approved by the institutional review board. 20 patients (69.6 years ± SD 8.8) with HCC underwent DC Bead TACE and subsequent MR-guided RF ablation. Treatment interval varied between 5 and 15 days. Mean HCC diameter was 39 mm ± SD 7 mm (range 31-50mm). Rates of recurrence-free survival and overall survival were estimated using the Kaplan-Meier method. RESULTS Technical success rate, primary and secondary technical effectiveness rate were 100%, 90% and 95%, respectively. Local tumour progression developed in one patient. Cumulative survival rates at 1, 3 and 5 years were 90% (Confidence Interval [CI]: 67%-97%), 50% (CI: 29%-70%), 27% (CI: 11%-51%) respectively. Median survival time was 37.4 months. During follow up (mean: 39.1 months ± SD 22.4; range 5-84 months), tumour progression in untreated liver developed in 14 cases. Cumulative recurrence-free survival rates at 1, 3 and 5 years were 48% (CI: 27-69%), 16% (5-39%), 16% (5-39%) respectively. Median recurrence-free survival time was 10.7 months. One major complication occurred due to misdiagnosed local recurrence. CONCLUSION In conclusion, we demonstrated that MR-guided RF ablation with subsequent DC Bead TACE is safe and effective in local tumour control in patients with intermediate sized HCC.
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Affiliation(s)
- Rüdiger Hoffmann
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Strasse 3, 72076 Tübingen, Germany.
| | - Hansjörg Rempp
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Strasse 3, 72076 Tübingen, Germany.
| | - Roland Syha
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Strasse 3, 72076 Tübingen, Germany.
| | - Dominik Ketelsen
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Strasse 3, 72076 Tübingen, Germany.
| | - Philippe L Pereira
- Department of Radiology, Minimally Invasive Therapies and Nuclearmedicine, SLK-Kliniken Heilbronn GmbH, Am Gesundbrunnen 20-26, 74078 Heilbronn, Germany.
| | - Claus D Claussen
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Strasse 3, 72076 Tübingen, Germany.
| | - Stephan Clasen
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Strasse 3, 72076 Tübingen, Germany.
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Tsiflikas I, Thomas C, Ketelsen D, Seitz G, Warmann S, Claussen CD, Schäfer JF. High-pitch computed tomography of the lung in pediatric patients: an intraindividual comparison of image quality and radiation dose to conventional 64-MDCT. ROFO-FORTSCHR RONTG 2014; 186:585-90. [PMID: 24756428 DOI: 10.1055/s-0034-1366426] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE The aim of this study was to investigate frequencies of typical artifacts in low-dose pediatric lung examinations using high-pitch computed tomography (HPCT) compared to MDCT, and to estimate the effective radiation dose (Eeff). MATERIALS AND METHODS Institutional review board approval for this retrospective study was obtained. 35 patients (17 boys, 18 girls; mean age 112 ± 69 months) were included and underwent MDCT and follow-up scan by HPCT or vice versa (mean follow-up time 87 days), using the same tube voltage and current. The total artifact score (0 - 8) was defined as the sum of artifacts arising from movement, breathing or pulsation of the heart or pulmonary vessels (0 - no; 1 - moderate; 2 - severe artifacts). Eeff was estimated according to the European Guidelines on Quality Criteria for Multislice Computed Tomography. The Mann-Whitney U test was used to analyze differences between the patient groups. The Spearman's rank correlation coefficient was used for correlation of ordinal variables. RESULTS The scan time was significantly lower for HPCT compared to MDCT (0.72 ± 0.13 s vs. 3.65 ± 0.81s; p < 0.0001). In 28 of 35 (80 %) HPCT examinations no artifacts were visible, whereas in MDCT artifacts occurred in all examinations. The frequency of pulsation artifacts and breathing artifacts was higher in MDCT compared to HPCT (100 % vs. 17 % and 31 % vs. 6 %). The total artifact score significantly correlated with the patient's age in MDCT (r = - 0.42; p = 0.01), but not in HPCT (r = - 0.32; p = 0.07). The estimated Eeff was significantly lower in HPCT than in MDCT (1.29 ± 0.31 vs. 1.47 ± 0.37 mSv; p < 0.0001). CONCLUSION Our study indicates that the use of HPCT has advantages for pediatric lung imaging with a reduction of breathing and pulsation artifacts. Moreover, the estimated Eeff was lower. In addition, examinations can be performed without sedation or breath-hold without losing image quality. KEY POINTS • Fewer artifacts in pediatric lung imaging with HPCT• Reduced Eeff in HPCT• HPCT without sedation or breath-hold without loss of image quality.
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Affiliation(s)
- I Tsiflikas
- Diagnostic and Interventional Radiology, University Hospital of Tuebingen
| | - C Thomas
- Diagnostic and Interventional Radiology, University Hospital of Tuebingen
| | - D Ketelsen
- Diagnostic and Interventional Radiology, University Hospital of Tuebingen
| | - G Seitz
- Pediatric Surgery, University Hospital of Tuebingen
| | - S Warmann
- Pediatric Surgery, University Hospital of Tuebingen
| | - C D Claussen
- Diagnostic and Interventional Radiology, University Hospital of Tuebingen
| | - J F Schäfer
- Diagnostic and Interventional Radiology, University Hospital of Tuebingen
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Syha R, Grünwald L, Horger T, Spira D, Ketelsen D, Vogel W, Claussen CD, Horger M. Volumen Perfusions-CT (VPCT) in der Beurteilung residueller Befunde bei Lymphompatienten am Therapieende. ROFO-FORTSCHR RONTG 2014. [DOI: 10.1055/s-0034-1373609] [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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Tsiflikas I, Thomas C, Schabel C, Fallmann C, Ketelsen D, Mangold S, Claussen CD, Burgstahler C. Prävalenz subklinischer Koronarer Herzkrankheit bei asymptomatischen Marathonläufern: Detektion mittels koronarer CT-Angiografie. ROFO-FORTSCHR RONTG 2014. [DOI: 10.1055/s-0034-1372895] [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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Ketelsen D, Thomas C, Schmehl J, König C, Syha R, Rittig K, Balletshofer B, Claussen C, Brechtel K. Endovascular Aneurysm Repair of Abdominal Aortic Aneurysms: Standards, Technical Options and Advanced Indications. ROFO-FORTSCHR RONTG 2014; 186:337-47. [DOI: 10.1055/s-0034-1366185] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- D. Ketelsen
- Diagnostic and Interventional Radiology, University Hospital Tuebingen
| | - C. Thomas
- Diagnostic and Interventional Radiology, University Hospital Tuebingen
| | - J. Schmehl
- Diagnostic and Interventional Radiology, University Hospital Tuebingen
| | - C. König
- Diagnostic and Interventional Radiology, University Hospital Tuebingen
| | - R. Syha
- Diagnostic and Interventional Radiology, University Hospital Tuebingen
| | - K. Rittig
- Internal Medicine IV – Angiology, University Hospital Tuebingen
| | - B. Balletshofer
- Internal Medicine IV – Angiology, University Hospital Tuebingen
| | - C. Claussen
- Diagnostic and Interventional Radiology, University Hospital Tuebingen
| | - K. Brechtel
- Diagnostic and Interventional Radiology, University Hospital Tuebingen
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Roethke M, Kaufmann S, Kniess M, Ketelsen D, Claussen C, Schlemmer H, Stenzl A, Schilling D. Seminal Vesicle Invasion: Accuracy and Analysis of Infiltration Patterns with High-Spatial Resolution T2-Weighted Sequences on Endorectal Magnetic Resonance Imaging. Urol Int 2014; 92:294-9. [DOI: 10.1159/000353968] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Accepted: 06/20/2013] [Indexed: 11/19/2022]
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Syha R, Grünwald L, Horger T, Spira D, Ketelsen D, Vogel W, Claussen CD, Horger M. Assessment of the nature of residual masses at end of treatment in lymphoma patients using volume perfusion computed tomography. Eur Radiol 2013; 24:770-9. [PMID: 24306426 DOI: 10.1007/s00330-013-3077-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Revised: 10/21/2013] [Accepted: 11/02/2013] [Indexed: 01/27/2023]
Abstract
OBJECTIVES To determine the diagnostic benefit of volume perfusion computed tomography (VPCT) at end of treatment for response assessment in lymphoma patients. METHODS Seventy-five patients with different lymphoma subtypes were included: 50/75 patients had residual masses at end of treatment, 26/50 patients underwent VPCT at baseline and at end of treatment, and 24/50 patients only had end-of-treatment VPCTs. We evaluated the size of the main lymphoma mass, its blood flow (BF), blood volume (BV) and k-trans, calculated ratios (baseline and end of treatment) as well as sensitivity/specificity/negative (NPV)/positive predictive values (PPV). For VPCT at end of treatment, a cutoff threshold between responders and non-responders was calculated. RESULTS For patients undergoing VPCT at baseline and end of treatment, reduction in size, BF, BV and k-trans was significant (P < 0.001). Identification of non-response was reached at: <53% reduction in size (sensitivity/specificity/accuracy/PPV/NPV of 88.89%/62.5%/80.77%/84.21%/71.43%), <15% reduction of BF (sensitivity/specificity/accuracy/PPV/NPV of 100%/37.5%/80.77%/0.26%/100%), or <45% reduction of k-trans (sensitivity/specificity/accuracy/PPV/NPV of 88.89%/75%/84.62%/88.89%/75%). In the subgroup undergoing VPCT at end of treatment, BF >18.51 ml/100 ml indicated non-responsiveness (sensitivity 92.86%, specificity 72.73%, accuracy 84%, PPV 81.25%, NPV 88.89%). CONCLUSIONS VPCT seems adequate for assessment of lymphoma response at end of treatment. The degree of residual lymphoma perfusion at end of treatment helps to identify patients likely to remain in remission 1 year after completion of therapy. KEY POINTS • Volume perfusion computed tomography (VPCT) offers measurements for assessing tumour response. • Perfusion parameter changes measured by VPCT correlate with antitumour therapy response. • In lymphoma, baseline and end-of-treatment perfusion parameter ratios can predict response. • Perfusion measurements after treatment identify patients likely to remain in remission.
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Affiliation(s)
- R Syha
- Department of Diagnostic Radiology, Eberhard Karls University, Hoppe-Seyler-Str.3, 72076, Tübingen, Germany,
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Syha R, Springer F, Grözinger G, Würslin C, Ipach I, Ketelsen D, Schabel C, Gebhard H, Hein T, Martirosian P, Schick F, Claussen CD, Grosse U. Short-term exercise-induced changes in hydration state of healthy achilles tendons can be visualized by effects of off-resonant radiofrequency saturation in a three-dimensional ultrashort echo time MRI sequence applied at 3 tesla. J Magn Reson Imaging 2013; 40:1400-7. [DOI: 10.1002/jmri.24488] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Accepted: 09/25/2013] [Indexed: 11/06/2022] Open
Affiliation(s)
- Roland Syha
- Diagnostic and Interventional Radiology; Eberhard-Karls-University; Tübingen Germany
- Section on Experimental Radiology; Eberhard-Karls-University; Tübingen Germany
| | - Fabian Springer
- Diagnostic and Interventional Radiology; Eberhard-Karls-University; Tübingen Germany
- Section on Experimental Radiology; Eberhard-Karls-University; Tübingen Germany
| | - Gerd Grözinger
- Diagnostic and Interventional Radiology; Eberhard-Karls-University; Tübingen Germany
- Section on Experimental Radiology; Eberhard-Karls-University; Tübingen Germany
| | - Christian Würslin
- Section on Experimental Radiology; Eberhard-Karls-University; Tübingen Germany
| | - Ingmar Ipach
- Department of Orthopaedic surgery; University hospital of Tübingen; Tübingen Germany
| | - Dominik Ketelsen
- Diagnostic and Interventional Radiology; Eberhard-Karls-University; Tübingen Germany
| | - Christoph Schabel
- Diagnostic and Interventional Radiology; Eberhard-Karls-University; Tübingen Germany
| | - Harry Gebhard
- Berufsgenossenschaftliche Unfallklinik Tübingen; Tübingen Germany
| | - Tobias Hein
- Department of Sports medicine; University of Tübingen; Tübingen Germany
| | - Petros Martirosian
- Section on Experimental Radiology; Eberhard-Karls-University; Tübingen Germany
| | - Fritz Schick
- Section on Experimental Radiology; Eberhard-Karls-University; Tübingen Germany
| | - Claus D. Claussen
- Diagnostic and Interventional Radiology; Eberhard-Karls-University; Tübingen Germany
| | - Ulrich Grosse
- Diagnostic and Interventional Radiology; Eberhard-Karls-University; Tübingen Germany
- Section on Experimental Radiology; Eberhard-Karls-University; Tübingen Germany
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Syha R, Springer F, Ketelsen D, Ipach I, Kramer U, Horger M, Schick F, Grosse U. Achillodynia - Radiological Imaging of Acute and Chronic Overuse Injuries of the Achilles Tendon. ROFO-FORTSCHR RONTG 2013; 185:1041-55. [DOI: 10.1055/s-0033-1335170] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- R. Syha
- Diagnostic and Interventional Radiology, Eberhard-Karls-University, Tübingen
| | - F. Springer
- Diagnostic and Interventional Radiology, Eberhard-Karls-University, Tübingen
| | - D. Ketelsen
- Diagnostic and Interventional Radiology, Eberhard-Karls-University, Tübingen
| | - I. Ipach
- Orthopaedic Surgery, University Hospital Tübingen
| | - U. Kramer
- Diagnostic and Interventional Radiology, Eberhard-Karls-University, Tübingen
| | - M. Horger
- Diagnostic and Interventional Radiology, Eberhard-Karls-University, Tübingen
| | - F. Schick
- Section on Experimental Radiology, Eberhard-Karls-University, Tübingen
| | - U. Grosse
- Diagnostic and Interventional Radiology, Eberhard-Karls-University, Tübingen
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Kaufmann S, Sauter A, Spira D, Gatidis S, Ketelsen D, Heuschmid M, Claussen CD, Thomas C. Tin-filter enhanced dual-energy-CT: image quality and accuracy of CT numbers in virtual noncontrast imaging. Acad Radiol 2013; 20:596-603. [PMID: 23490736 DOI: 10.1016/j.acra.2013.01.010] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [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: 09/28/2012] [Revised: 01/08/2013] [Accepted: 01/09/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To measure and compare the objective image quality of true noncontrast (TNC) images with virtual noncontrast (VNC) images acquired by tin-filter-enhanced, dual-source, dual-energy computed tomography (DECT) of upper abdomen. MATERIALS AND METHODS Sixty-three patients received unenhanced abdominal CT and enhanced abdominal DECT (100/140 kV with tin filter) in portal-venous phase. VNC images were calculated from the DECT datasets using commercially available software. The mean attenuation of relevant tissues and image quality were compared between the TNC and VNC images. Image quality was rated objectively by measuring image noise and the sharpness of object edges using custom-designed software. Measurements were compared using Student two-tailed t-test. Correlation coefficients for tissue attenuation measurements between TNC and VNC were calculated and the relative deviations were illustrated using Bland-Altman plots. RESULTS Mean attenuation differences between TNC and VNC (HUTNC - HUVNC) image sets were as follows: right liver lobe -4.94 Hounsfield units (HU), left liver lobe -3.29 HU, vena cava -2.19 HU, spleen -7.46 HU, pancreas 1.29 HU, fat -11.14 HU, aorta 1.29 HU, bone marrow 36.83 HU (all P < .05); right kidney 0.46 HU, left kidney 0.56 HU, vena portae -0.48 HU and muscle -0.62 HU (nonsignificant). Good correlations between VNC and TNC series were observed for liver, vena portae, kidneys, pancreas, muscle and bone marrow (Pearson's correlation coefficient ≥0.75). Mean image noise was significantly higher in TNC images (P < .0001). Measurements of edge sharpness revealed no significant differences between VNC and TNC images (P = .19). CONCLUSION The Hounsfield units in VNC images closely resemble TNC images in the majority of the organs of the upper abdomen (kidneys, liver, pancreas). In spleen and fat, Hounsfield numbers in VNC images are tend to be higher than in TNC images. VNC images show a low image noise and satisfactory edge sharpness. Other criteria of image quality and the depiction of certain lesions need to be evaluated additionally.
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Affiliation(s)
- Sascha Kaufmann
- Department of Radiology, Diagnostic and Interventional Radiology, Hoppe-Seyler-Str. 3, 72076 Tuebingen, Germany.
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Ketelsen D. Wie spart man Dosis? ROFO-FORTSCHR RONTG 2013. [DOI: 10.1055/s-0033-1346122] [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: 10/26/2022]
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Heuschmid M, Ketelsen D. Lymphknotendiagnostik Hals: Gegenwärtiger Stand. ROFO-FORTSCHR RONTG 2013. [DOI: 10.1055/s-0033-1346111] [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: 10/26/2022]
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Brechtel K, Ketelsen D. AFS/POP - wann Stents, wann Grafts, wann DEB-PTA? ROFO-FORTSCHR RONTG 2013. [DOI: 10.1055/s-0033-1346163] [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: 10/26/2022]
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Schabel C, Fenchel M, Schmidt B, Flohr TG, Wuerslin C, Thomas C, Korn A, Tsiflikas I, Claussen CD, Heuschmid M, Ketelsen D. Clinical evaluation and potential radiation dose reduction of the novel sinogram-affirmed iterative reconstruction technique (SAFIRE) in abdominal computed tomography angiography. Acad Radiol 2013; 20:165-72. [PMID: 23099242 DOI: 10.1016/j.acra.2012.08.015] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2012] [Revised: 08/13/2012] [Accepted: 08/21/2012] [Indexed: 01/11/2023]
Abstract
RATIONALE AND OBJECTIVES Computed tomographic angiography is the standard in routine follow-up after endovascular aneurysm repair, causing radiation exposure; thus, dose-saving strategies should be applied. The aim of this study was to evaluate the novel sinogram-affirmed iterative reconstruction (SAFIRE) algorithm in terms of clinical usability and potential reduction of radiation exposure. MATERIALS AND METHODS Forty-six patients underwent computed tomographic angiographic follow-up after endovascular aneurysm repair. Data were acquired using a dual-source computed tomographic scanner running both x-ray tubes at the same voltage (120 kV). Raw data were reconstructed using projections of both tubes with filtered back projection (FBP) and of only one tube with FBP and SAFIRE, corresponding to synthetic acquisition with half the radiation dose of the clinical routine radiation dose. Image sets were objectively compared regarding signal-to-noise ratio and edge sharpness. Two radiologists independently assessed a set of subjective criteria, including diagnostic usability, depiction of contrasted vessels, and image noise. RESULTS Half-dose (HD) SAFIRE images showed significantly higher signal-to-noise ratios compared to full-dose FBP images (P < .001), while having equal edge sharpness (P = .56). Most of the subjectively assessed parameters, such as diagnostic usability and depiction of contrasted vessels, were rated similar for HD SAFIRE and full-dose FBP images. Full-dose FBP images depicted fine anatomic structures more clearly (P < .05), while HD SAFIRE data sets showed less noise (P < .01). HD FBP images performed worse on all criteria (P < .001). Interrater agreement was good (κ = 0.74-0.80). CONCLUSIONS Using the SAFIRE algorithm, the radiation dose of high-contrast abdominal computed tomographic angiography is reducible from routine clinical levels by up to 50% while maintaining good image quality and diagnostic accuracy.
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Korn A, Fenchel M, Bender B, Danz S, Thomas C, Ketelsen D, Claussen CD, Moonis G, Krauss B, Heuschmid M, Ernemann U, Brodoefel H. High-pitch dual-source CT angiography of supra-aortic arteries: assessment of image quality and radiation dose. Neuroradiology 2012; 55:423-30. [PMID: 23223824 DOI: 10.1007/s00234-012-1120-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2012] [Accepted: 11/13/2012] [Indexed: 01/31/2023]
Abstract
INTRODUCTION High-pitch CT angiography (CTA) is a recent innovation that allows significant shortening of scan time with volume coverage of 43 mm per second. The aim of our study was to assess this technique in CTA of the head and neck. METHODS CTA of supra-aortic arteries was performed in 50 patients using two acquisition protocols: conventional single-source 64-slice (pitch 1.2) and high-pitch dual-source 128-slice CT (pitch 3.2). Subjective and objective image quality of supra-aortic vessel ostia as well as intra- and extra-cranial segments was retrospectively assessed by blinded readers and radiation dose compared between the two protocols. RESULTS Conventional and high-pitch CTA achieved comparable signal-to-noise ratios in arterial (54.3 ± 16.5 versus 57.3 ± 14.8; p = 0.50) and venous segments (15.8 ± 6.7 versus 18.9 ± 8.9; p = 0.21). High-pitch scanning was, however, associated with sharper delineation of vessel contours and image quality significantly improved at the level of supra-aortic vessel ostia (p < 0.0001) as well as along the brachiocephalic trunk (p < 0.0001), the subclavian arteries (p < 0.0001), proximal common carotid arteries (p = 0.01), and vertebral V1 segments (p < 0.0001). Using the high-pitch mode, the dose-length product was reduced by about 35% (218.2 ± 30 versus 141.8 ± 20 mGy × cm). CONCLUSIONS Due to elimination of transmitted cardiac motion, high-pitch CTA of the neck improves image quality in the proximity of the aortic arch while significantly lowering radiation dose. The technique thus qualifies as a promising alternative to conventional spiral CTA and may be particularly useful for identification of ostial stenosis.
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Affiliation(s)
- A Korn
- Department of Diagnostic und Interventional Neuroradiology, Hoppe-Seyler-Strasse 3, 72076 Tuebingen, Germany
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Teufel M, Ketelsen D, Fleischer S, Martirosian P, Graebler-Mainka U, Stern M, Claussen CD, Schick F, Schaefer JF. Comparison between high-resolution CT and MRI using a very short echo time in patients with cystic fibrosis with extra focus on mosaic attenuation. ACTA ACUST UNITED AC 2012. [PMID: 23207712 DOI: 10.1159/000343085] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND It would be beneficial to establish pulmonary MRI as a complementary approach to CT for direct visualization of mosaic perfusion, bullae, and emphysema in patients with cystic fibrosis. OBJECTIVES The purpose of this study was to compare both modalities, CT and MRI, using the Helbich-Bhalla score with a special focus on reliable detection of a mosaic pattern. METHODS Out of 51 patients examined by MRI on a 1.5-Tesla system during a period of 2 years, 19 patients were scheduled for additional low-dose CT in a clinical context. The MRI protocol comprised a gradient echo (GRE) sequence with a very short echo time (TE = 0.8 ms) in inspiration and expiration, a 3-D GRE sequence in breath hold, and a fast spin echo sequence with respiration and ECG triggering. MDCT was carried out in inspiration and adapted to body weight using 100 or 120 kV, 30-60 mA, 1- and 3-mm slice thicknesses, as well as low and high kernels. Additionally incremental slices in 3 positions were recorded in expiration for distinct detection of air trapping. CT and MRI analyses were performed by two radiologic readers in consensus unaware of the clinical parameters. The Helbich-Bhalla score of both examinations was correlated. Mean difference and accordance were assessed in each category. RESULTS There was a strong correlation between CT and MRI (R = 0.87, p < 0.01). The mean Helbich-Bhalla score for CT was 12.2 (range 1-18) and for MRI it was 11.7 (range 2-19). The mean difference was 0.5 points. Besides this strong correlation for findings (bronchiectasis, mucus plugging, peribronchial thickening, and consolidation) with a prolonged T2 TE in MRI, we could also state a qualitative agreement of 95-100% in the categories with short T2 and low signal intensity in MRI as emphysema, bullae, and mosaic perfusion. CONCLUSIONS These results suggest that in our patient group none of the relevant findings were missed by MR imaging and reading.
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Affiliation(s)
- Matthias Teufel
- Section of Experimental Radiology, University of Tübingen, Tübingen, Germany
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Ketelsen D, Warmann SW, Schaefer JF, Haber P, Fuchs J, Claussen CD, Brechtel K. Percutaneous revascularization of reoccluded meso-Rex shunts in extrahepatic portal vein obstruction. J Pediatr Surg 2012; 47:E23-8. [PMID: 22974631 DOI: 10.1016/j.jpedsurg.2012.04.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Revised: 03/11/2012] [Accepted: 04/07/2012] [Indexed: 12/13/2022]
Abstract
Extrahepatic portal vein (PV) obstruction (EHPVO) is a rare disorder in early childhood with unknown incidence and mostly unknown etiology. In children with EHPVO, the hepatopedal flow of the mesenteric venous blood is hindered by an obstruction of the PV resulting in prehepatic portal hypertension. The curative treatment with a meso-Rex shunt connects the superior mesenteric vein to the left PV by a venous autograft. Despite good primary patency, reocclusion of a meso-Rex bypass and its treatment can be challenging. We present 2 patients with EHPVO with subtotal functional occlusion of a meso-Rex shunt treated by percutaneous interventions with short- and mid-term follow-up.
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Affiliation(s)
- Dominik Ketelsen
- Department of Diagnostic and Interventional Radiology, University of Tuebingen, Hoppe-Seyler-Str. 3, 72076 Tuebingen, Germany
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Syha R, Beck R, Hetzel J, Ketelsen D, Grosse U, Springer F, Horger M. Human metapneumovirus (HMPV) associated pulmonary infections in immunocompromised adults--initial CT findings, disease course and comparison to respiratory-syncytial-virus (RSV) induced pulmonary infections. Eur J Radiol 2012; 81:4173-8. [PMID: 22795844 DOI: 10.1016/j.ejrad.2012.06.024] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [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: 05/15/2012] [Revised: 06/22/2012] [Accepted: 06/26/2012] [Indexed: 11/17/2022]
Abstract
AIM To describe computed tomography (CT)-imaging findings in human metapneumovirus (HMPV)-related pulmonary infection as well as their temporal course and to analyze resemblances/differences to pulmonary infection induced by the closely related respiratory-syncytial-virus (RSV) in immunocompromised patients. MATERIALS AND METHODS Chest-CT-scans of 10 HMPV PCR-positive patients experiencing pulmonary symptoms were evaluated retrospectively with respect to imaging findings and their distribution and results were then compared with data acquired in 13 patients with RSV pulmonary infection. Subsequently, we analyzed the course of chest-findings in HMPV patients. RESULTS In HMPV, 8/10 patients showed asymmetric pulmonary findings, whereas 13/13 patients with RSV-pneumonia presented more symmetrical bilateral pulmonary infiltrates. Image analysis yielded in HMPV patients following results: ground-glass-opacity (GGO) (n=6), parenchymal airspace consolidations (n=5), ill-defined nodular-like centrilobular opacities (n=9), bronchial wall thickening (n=8). In comparison, results in RSV patients were: GGO (n=10), parenchymal airspace consolidations (n=9), ill-defined nodular-like centrilobular opacities (n=10), bronchial wall thickening (n=4). In the course of the disease, signs of acute HMPV interstitial pneumonia regressed transforming temporarily in part into findings compatible with bronchitis/bronchiolitis. CONCLUSIONS Early chest-CT findings in patients with HMPV-related pulmonary symptoms are compatible with asymmetric acute interstitial pneumonia accompanied by signs of bronchitis; the former transforming with time into bronchitis and bronchiolitis before they resolve. On the contrary, RSV-induced pulmonary infection exhibits mainly symmetric acute interstitial pneumonia.
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Affiliation(s)
- R Syha
- Department of Diagnostic Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str.3, 72076 Tübingen, Germany.
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