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Hellwig S, Krause T, Scheitz JF, Herm J, Grittner U, Jauert N, Fiebach JB, Kasner M, Doehner W, Endres M, Wachter R, Elgeti T, Nolte CH, Haeusler KG. Enhanced diagnostic workup increases pathological findings in patients with acute ischaemic stroke: results of the prospective HEBRAS study. Stroke Vasc Neurol 2024; 9:145-152. [PMID: 37353342 PMCID: PMC11103153 DOI: 10.1136/svn-2022-002179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 06/05/2023] [Indexed: 06/25/2023] Open
Abstract
BACKGROUND Stroke aetiology remains cryptogenic in a relevant proportion of patients with acute ischaemic stroke (AIS). We assessed whether enhanced diagnostic workup after AIS yields a higher rate of prespecified pathological findings compared with routine diagnostic care in-hospital. METHODS Hospitalised patients with AIS were prospectively enrolled in the investigator-initiated observational HEart and BRain Interfaces in Acute Ischaemic Stroke (HEBRAS) study at the Charité, Berlin, Germany. Patients with AIS without known atrial fibrillation (AF) underwent cardiovascular MR imaging (CMR), MR-angiography of the aortic arch and prolonged Holter-ECG monitoring on top of routine diagnostic care. RESULTS Among 356 patients with AIS (mean age 66 years, 37.6% female), enhanced workup yielded a higher rate of prespecified pathological findings compared with routine care (17.7% vs 5.3%; p<0.001). Consequently, fewer patients were classified as cryptogenic after enhanced diagnostic workup (38.5% vs 45.5%, p<0.001). Routine care included echocardiography in 228 (64.0%) patients. CMR was successfully performed in 292 (82.0%) patients and revealed more often a prespecified pathological finding compared with routine echocardiography (16.1% vs 5.3%). Furthermore, study-related ECG monitoring (median duration 162 hours (IQR 98-210)) detected AF in 16 (4.5%) patients, while routine monitoring (median duration 51 hours (IQR 34-74)) detected AF in seven (2.0%) patients. CONCLUSIONS Enhanced diagnostic workup revealed a higher rate of prespecified pathological findings in patients with AIS compared with routine diagnostic care and significantly reduced the proportion of patients with cryptogenic stroke. TRIAL REGISTRATION NUMBER NCT02142413.
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Affiliation(s)
- Simon Hellwig
- Department of Neurology with Experimental Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Center for Stroke Research Berlin, Berlin, Germany
- Berlin Institute of Health at Charité -Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, Berlin, Germany
| | - Thomas Krause
- Department of Neurology, Jüdisches Krankenhaus Berlin, Berlin, Germany
| | - Jan F Scheitz
- Department of Neurology with Experimental Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Center for Stroke Research Berlin, Berlin, Germany
- Berlin Institute of Health at Charité -Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, Berlin, Germany
- German Center for Cardiovascular Diseases (DZHK), Partner Site Berlin, Berlin, Germany
| | - Juliane Herm
- Department of Neurology with Experimental Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Center for Stroke Research Berlin, Berlin, Germany
| | - Ulrike Grittner
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Nadja Jauert
- Center for Stroke Research Berlin, Berlin, Germany
- German Center for Cardiovascular Diseases (DZHK), Partner Site Berlin, Berlin, Germany
- BIH Center for Regenerative Therapies (BCRT), Berlin Institute of Health at Charité -Universitätsmedizin Berlin, Berlin, Germany
- Department of Cardiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | - Mario Kasner
- Department of Cardiology, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Wolfram Doehner
- Center for Stroke Research Berlin, Berlin, Germany
- German Center for Cardiovascular Diseases (DZHK), Partner Site Berlin, Berlin, Germany
- BIH Center for Regenerative Therapies (BCRT), Berlin Institute of Health at Charité -Universitätsmedizin Berlin, Berlin, Germany
- Department of Cardiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Matthias Endres
- Department of Neurology with Experimental Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Center for Stroke Research Berlin, Berlin, Germany
- Berlin Institute of Health at Charité -Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, Berlin, Germany
- German Center for Cardiovascular Diseases (DZHK), Partner Site Berlin, Berlin, Germany
- German Center for Neurodegenerative Diseases (DZNE), Partner Site Berlin, Berlin, Germany
| | - Rolf Wachter
- Department of Cardiology, University Hospital Leipzig, Leipzig, Germany
| | - Thomas Elgeti
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Christian H Nolte
- Department of Neurology with Experimental Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Center for Stroke Research Berlin, Berlin, Germany
- Berlin Institute of Health at Charité -Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, Berlin, Germany
- German Center for Cardiovascular Diseases (DZHK), Partner Site Berlin, Berlin, Germany
- German Center for Neurodegenerative Diseases (DZNE), Partner Site Berlin, Berlin, Germany
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Petersen A, Nagel SN, Hamm B, Elgeti T, Schaafs LA. The influence of left bundle branch block on myocardial T1 mapping. Sci Rep 2024; 14:5379. [PMID: 38438510 PMCID: PMC10912434 DOI: 10.1038/s41598-024-55821-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 02/28/2024] [Indexed: 03/06/2024] Open
Abstract
Tissue characterisation using T1 mapping has become an established magnetic resonance imaging (MRI) technique to detect myocardial diseases. This retrospective study aimed to determine the influence of left bundle branch block (LBBB) on T1 mapping at 1.5 T. Datasets of 36 patients with LBBB and 27 healthy controls with T1 mapping (Modified Look-Locker inversion-recovery (MOLLI), 5(3)3 sampling) were included. T1 relaxation times were determined on mid-cavity short-axis images. R2 maps were generated as a pixel-wise indicator for the goodness of the fit of T1 maps. R2 values were significantly lower in patients with LBBB than in healthy controls (whole myocardium/septum, 0.997, IQR, 0.00 vs. 0.998, IQR, 0.00; p = 0.008/0.998, IQR, 0.00 vs. 0.999, IQR, 0.00; p = 0.027). Manual correction of semi-automated evaluation tended to improve R2 values but not significantly. Strain analysis was performed and the systolic dyssynchrony index (SDIglobal) was calculated as a measure for left ventricular dyssynchrony. While MRI is generally prone to artefacts, lower goodness of the fit in LBBB may be mainly attributable to asynchronous contraction. Therefore, careful checking of the source data and, if necessary, manual post-processing is important. New techniques might improve the goodness of the fit of T1 mapping by reducing sampling in the motion prone diastole of LBBB patients.
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Affiliation(s)
- Antonia Petersen
- Department of Radiology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203, Berlin, Germany.
| | - Sebastian Niko Nagel
- Academic Department of Diagnostic and Interventional Radiology and Paediatric Radiology, Protestant Hospital of the Bethel Foundation, Bielefeld University, Medical School and University Medical Center East Westphalia-Lippe, Burgsteig 13, 33617, Bielefeld, Germany
| | - Bernd Hamm
- Department of Radiology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Thomas Elgeti
- Department of Radiology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Lars-Arne Schaafs
- Department of Radiology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
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Weidlich M, Hamm B, Schaafs LA, Elgeti T. Epicardial fat volume and its association with cardiac arrhythmias in CT coronary angiography. Pol J Radiol 2024; 89:e122-e127. [PMID: 38510546 PMCID: PMC10953510 DOI: 10.5114/pjr.2024.135797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 02/01/2024] [Indexed: 03/22/2024] Open
Abstract
Purpose This retrospective study aimed to investigate the epicardial fat volume in cardiac computed tomography (CT), its relationship with cardiac arrhythmias, and its correlation with the coronary artery disease reporting and data system (CAD-RADS) score. Material and methods Ninety-six patients who underwent CT coronary angiography (CTCA) were included in this study. Patient data, including demographic information, clinical history, and imaging data were collected retrospectively. Epicardial fat volume was quantified using a standardised algorithm, the CAD-RADS scoring system was applied to assess the extent of coronary artery disease (CAD). Descriptive statistics, correlation analyses, and receiver operating characteristics methods were used. Results The study found a significant correlation between epicardial fat volume and CAD-RADS score (r2 = 0.31; p < 0.001), indicating the known influence of epicardial fat on CAD risk. Moreover, patients with higher epicardial fat volumes were more likely to experience cardiac tachyarrhythmia (p < 0.001). Receiver operating characteristic analysis established a threshold value of 123 cm3 for epicardial fat volume to predict tachyarrhythmia with 80% sensitivity (AUC = 0.69). Conclusions In this study a volume of at least 123 cm3 epicardial fat in native coronary calcium scans is associated with cardiac tachyarrhythmia. In these patients, careful selection of suitable imaging protocols is advised.
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Affiliation(s)
- Matthias Weidlich
- Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Bernd Hamm
- Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Lars-Arne Schaafs
- Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Thomas Elgeti
- Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Jensen LJ, Kim D, Elgeti T, Steffen IG, Schaafs LA, Hamm B, Nagel SN. The role of parametric feature maps to correct different volume of interest sizes: an in vivo liver MRI study. Eur Radiol Exp 2023; 7:48. [PMID: 37670193 PMCID: PMC10480134 DOI: 10.1186/s41747-023-00362-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 06/13/2023] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND Different volume of interest (VOI) sizes influence radiomic features. This study examined if translating images into feature maps before feature sampling could compensate for these effects in liver magnetic resonance imaging (MRI). METHODS T1- and T2-weighted sequences from three different scanners (two 3-T scanners, one 1.5-T scanner) of 66 patients with normal abdominal MRI were included retrospectively. Three differently sized VOIs (10, 20, and 30 mm in diameter) were drawn in the liver parenchyma (right lobe), excluding adjacent structures. Ninety-three features were extracted conventionally using PyRadiomics. All images were also converted to 93 parametric feature maps using a pretested software. Agreement between the three VOI sizes was assessed with overall concordance correlation coefficients (OCCCs), while OCCCs > 0.85 were rated reproducible. OCCCs were calculated twice: for the VOI sizes of 10, 20, and 30 mm and for those of 20 and 30 mm. RESULTS When extracted from original images, only 4 out of the 93 features were reproducible across all VOI sizes in T1- and T2-weighted images. When the smallest VOI was excluded, 5 features (T1-weighted) and 7 features (T2-weighted) were reproducible. Extraction from parametric maps increased the number of reproducible features to 9 (T1- and T2-weighted) across all VOIs. Excluding the 10-mm VOI, reproducibility improved to 16 (T1-weighted) and 55 features (T2-weighted). The stability of all other features also increased in feature maps. CONCLUSIONS Translating images into parametric maps before feature extraction improves reproducibility across different VOI sizes in normal liver MRI. RELEVANCE STATEMENT The size of the segmented VOI influences the feature quantity of radiomics, while software-based conversion of images into parametric feature maps before feature sampling improves reproducibility across different VOI sizes in MRI of normal liver tissue. KEY POINTS • Parametric feature maps can compensate for different VOI sizes. • The effect seems dependent on the VOI sizes and the MRI sequence. • Feature maps can visualize features throughout the entire image stack.
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Affiliation(s)
- Laura Jacqueline Jensen
- Charité-Universitätsmedizin Berlin, Department of Radiology, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Hindenburgdamm 30, 12203, Berlin, Germany.
| | - Damon Kim
- Charité-Universitätsmedizin Berlin, Department of Radiology, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Hindenburgdamm 30, 12203, Berlin, Germany.
| | - Thomas Elgeti
- Charité-Universitätsmedizin Berlin, Department of Radiology, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Ingo Günter Steffen
- Charité-Universitätsmedizin Berlin, Department of Radiology, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Lars-Arne Schaafs
- Charité-Universitätsmedizin Berlin, Department of Radiology, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Bernd Hamm
- Charité-Universitätsmedizin Berlin, Department of Radiology, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Sebastian Niko Nagel
- Charité-Universitätsmedizin Berlin, Department of Radiology, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Hindenburgdamm 30, 12203, Berlin, Germany
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von Rennenberg R, Herm J, Krause T, Hellwig S, Stengl H, Scheitz JF, Elgeti T, Nagel SN, Endres M, Haeusler KG, Nolte CH. Elevation of cardiac biomarkers in stroke is associated with pathological findings on cardiac MRI-results of the HEart and BRain interfaces in Acute Stroke study. Int J Stroke 2023; 18:180-186. [PMID: 35403503 DOI: 10.1177/17474930221095698] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Cardiac biomarkers, such as high-sensitivity cardiac troponin T (hs-cTnT), are frequently elevated in ischemic stroke patients but the mechanisms underlying this elevation are insufficiently understood. We determined the presence of cardiac damage, assessed using cardiac magnetic resonance imaging (CMR), in stroke patients with elevated hs-cTnT and brain natriuretic peptide (BNP). METHODS This is a post hoc analysis of the prospective, investigator-initiated, cross-sectional HEart and BRain interfaces in Acute Stroke (HEBRAS) study. All patients underwent the measurement of hs-cTnT and BNP as well as gadolinium-enhanced CMR in the acute phase of ischemic stroke. We performed unadjusted and adjusted logistic regression models to assess the association between hs-cTnT and BNP elevation and the presence of pathological CMR findings. RESULTS Two hundred and thirty-three stroke patients (median age 67 years, 33% female) were included, of whom 43 (21%) had elevated hs-cTnT and 109 (47%) had elevated BNP. Hundred of the 233 (43%) patients had pathological findings on CMR had focal fibrosis as detected by late-gadolinium enhancement (LGE) in 51 (23%), left-ventricular hypertrophy (LVH) in 38 (16%), reduced LVEF in 32 (14%), and left-atrial dilatation in 34 (15%). After adjustment for potential confounders, both hs-cTnT (adjOR 5.0 (95%CI 2.1-11.7), p < 0.001) and BNP (adjOR 4.1 (95%CI 2.3-7.3), p < 0.001) were significantly associated with pathological findings on CMR. Hs-cTnT was associated with LGE, LVEF, and LVH, whereas BNP was associated with left-atrial dilatation and LVEF, LVH. CONCLUSION Elevated cardiac biomarkers in acute stroke including CMR are strongly associated with pathological findings on CMR. In acute stroke patients, the elevation of cardiac biomarkers may identify patients who require a more thorough cardiology work-up.
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Affiliation(s)
- Regina von Rennenberg
- Klinik und Hochschulambulanz für Neurologie, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Center for Stroke Research, Berlin, Germany.,German Center for Neurodegenerative Diseases (DZNE), Berlin, Germany
| | - Juliane Herm
- Klinik und Hochschulambulanz für Neurologie, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Center for Stroke Research, Berlin, Germany
| | - Thomas Krause
- Department of Neurology, Jüdisches Krankenhaus Berlin, Berlin, Germany
| | - Simon Hellwig
- Klinik und Hochschulambulanz für Neurologie, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Center for Stroke Research, Berlin, Germany
| | - Helena Stengl
- Klinik und Hochschulambulanz für Neurologie, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Center for Stroke Research, Berlin, Germany
| | - Jan F Scheitz
- Klinik und Hochschulambulanz für Neurologie, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Center for Stroke Research, Berlin, Germany.,German Centre for Cardiovascular Research (DZHK), partner site, Berlin, Germany
| | - Thomas Elgeti
- Departments of Radiology Pediatric Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Sebastian N Nagel
- Departments of Radiology Pediatric Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Matthias Endres
- Klinik und Hochschulambulanz für Neurologie, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Center for Stroke Research, Berlin, Germany.,German Center for Neurodegenerative Diseases (DZNE), Berlin, Germany.,German Centre for Cardiovascular Research (DZHK), partner site, Berlin, Germany.,ExcellenceCluster NeuroCure, Berlin, Germany
| | | | - Christian H Nolte
- Klinik und Hochschulambulanz für Neurologie, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Center for Stroke Research, Berlin, Germany.,German Center for Neurodegenerative Diseases (DZNE), Berlin, Germany.,German Centre for Cardiovascular Research (DZHK), partner site, Berlin, Germany
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Elgeti T, Fröhlich M, Wismayer KK, Tzschätzsch H, Hamm B, Sack I, Schaafs LA. The effect of smoking on quantification of aortic stiffness by ultrasound time-harmonic elastography. Sci Rep 2022; 12:17759. [PMID: 36273020 PMCID: PMC9588008 DOI: 10.1038/s41598-022-22638-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 10/18/2022] [Indexed: 01/19/2023] Open
Abstract
Smoking is a significant cardiovascular risk factor that causes stiffening of the central arteries, especially the aorta. While vessel stiffness can be determined indirectly by measuring pulse wave velocity, elastography allows image-based determination of vessel stiffness while at the same time providing information on vascular morphology. This study compares abdominal aortic wall stiffness as measured by ultrasound time-harmonic elastography (THE) in fifteen smokers and fifteen age-matched non-smoking controls without a history of cardiovascular disease. Smokers had a significantly higher abdominal aortic wall stiffness with a mean shear wave speed of 2.66 m/s (95% confidence interval (CI) 2.59-2.72 m/s) compared to 2.40 m/s (95% CI 2.34-2.47 m/s) (p < 0.01) in the group of non-smokers. All other baseline characteristics including aortic diameter showed no significant differences. Inter-rater variability was excellent with an intraclass correlation coefficient of 0.99 (95% CI 0.98-0.99). Our results show that THE is sensitive to subclinical stiffening of the aorta in young and middle-aged smokers even before morphological changes occur and may therefore has the potential to serve as a screening tool for early aortic abnormalities and longitudinal risk factors for cardiovascular health.
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Affiliation(s)
- Thomas Elgeti
- grid.6363.00000 0001 2218 4662Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Radiology, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Matthias Fröhlich
- grid.6363.00000 0001 2218 4662Charité – Universitätsmedizin Berlin, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Neonatology, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Kim Kathrin Wismayer
- grid.6363.00000 0001 2218 4662Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Radiology, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Heiko Tzschätzsch
- grid.6363.00000 0001 2218 4662Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Radiology, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Bernd Hamm
- grid.6363.00000 0001 2218 4662Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Radiology, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Ingolf Sack
- grid.6363.00000 0001 2218 4662Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Radiology, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Lars-Arne Schaafs
- grid.6363.00000 0001 2218 4662Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Radiology, Hindenburgdamm 30, 12203 Berlin, Germany
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Petersen A, Nagel SN, Hamm B, Elgeti T, Schaafs LA. Cardiac magnetic resonance imaging in patients with left bundle branch block: Patterns of dyssynchrony and implications for late gadolinium enhancement imaging. Front Cardiovasc Med 2022; 9:977414. [PMID: 36337885 PMCID: PMC9631472 DOI: 10.3389/fcvm.2022.977414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 09/30/2022] [Indexed: 11/16/2022] Open
Abstract
Background Left bundle branch block (LBBB) is a ventricular conduction delay with high prevalence. Aim of our study is to identify possible recurring patterns of artefacts in late gadolinium enhancement (LGE) imaging in patients with LBBB who undergo cardiac magnetic resonance imaging (MRI) and to define parameters of mechanical dyssynchrony associated with artefacts in LGE images. Materials and methods Fifty-five patients with LBBB and 62 controls were retrospectively included. Inversion time (TI) scout and LGE images were reviewed for artefacts. Dyssynchrony was identified using cardiac MRI by determining left ventricular systolic dyssynchrony indices (global, septal segments, and free wall segments) derived from strain analysis and features of mechanical dyssynchrony (apical rocking and septal flash). Results Thirty-seven patients (67%) with LBBB exhibited inhomogeneous myocardial nulling in TI scout images. Among them 25 (68%) patients also showed recurring artefact patterns in the septum or free wall on LGE images and artefacts also persisted in 18 (72%) of those cases when utilising phase sensitive inversion recovery. Only the systolic dyssynchrony index of septal segments allowed differentiation of patient subgroups (artefact/no artefact) and healthy controls (given as median, median ± interquartile range); LBBB with artefact: 10.44% (0.44–20.44%); LBBB without artefact: 6.82% (-2.18–15.83%); controls: 4.38% (1.38–7.38%); p < 0.05 with an area under the curve of 0.863 (81% sensitivity, 89% specificity). Septal flash and apical rocking were more frequent in the LBBB with artefact group than in the LBBB without artefact group (70 and 62% versus 33 and 17%; p < 0.05). Conclusion Patients with LBBB show recurring artefact patterns in LGE imaging. Use of strain analysis and evaluation of mechanical dyssynchrony may predict the occurrence of such artefacts already during the examination and counteract misinterpretation.
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Jensen LJ, Kim D, Elgeti T, Steffen IG, Schaafs LA, Hamm B, Nagel SN. Enhancing the stability of CT radiomics across different volume of interest sizes using parametric feature maps: a phantom study. Eur Radiol Exp 2022; 6:43. [PMID: 36104519 PMCID: PMC9474978 DOI: 10.1186/s41747-022-00297-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 07/05/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In radiomics studies, differences in the volume of interest (VOI) are often inevitable and may confound the extracted features. We aimed to correct this confounding effect of VOI variability by applying parametric maps with a fixed voxel size. METHODS Ten scans of a cup filled with sodium chloride solution were scanned using a multislice computed tomography (CT) unit. Sphere-shaped VOIs with different diameters (4, 8, or 16 mm) were drawn centrally into the phantom. A total of 93 features were extracted conventionally from the original images using PyRadiomics. Using a self-designed and pretested software tool, parametric maps for the same 93 features with a fixed voxel size of 4 mm3 were created. To retrieve the feature values from the maps, VOIs were copied from the original images to preserve the position. Differences in feature quantities between the VOI sizes were tested with the Mann-Whitney U-test and agreement with overall concordance correlation coefficients (OCCC). RESULTS Fifty-five conventionally extracted features were significantly different between the VOI sizes, and none of the features showed excellent agreement in terms of OCCCs. When read from the parametric maps, only 8 features showed significant differences, and 3 features showed an excellent OCCC (≥ 0.85). The OCCCs for 89 features substantially increased using the parametric maps. CONCLUSIONS This phantom study shows that converting CT images into parametric maps resolves the confounding effect of VOI variability and increases feature reproducibility across VOI sizes.
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Affiliation(s)
- Laura J Jensen
- Klinik für Radiologie, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Hindenburgdamm 30, 12203, Berlin, Germany.
| | - Damon Kim
- Klinik für Radiologie, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Hindenburgdamm 30, 12203, Berlin, Germany.
| | - Thomas Elgeti
- Klinik für Radiologie, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Ingo G Steffen
- Klinik für Radiologie, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Lars-Arne Schaafs
- Klinik für Radiologie, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Bernd Hamm
- Klinik für Radiologie, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Sebastian N Nagel
- Klinik für Radiologie, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
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9
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Thorwarth A, Haase K, Röefzaad C, Pajtler KW, Schramm K, Hauptmann K, Behnke A, Vokuhl C, Elgeti T, Gratopp A, Schulte JH, Scheer M, Hernáiz Driever P, Nysom K, Eggert A, Henssen AG, Deubzer HE. Genomic Evolution and Personalized Therapy of an Infantile Fibrosarcoma Harboring an NTRK Oncogenic Fusion. JCO Precis Oncol 2022; 6:e2100283. [PMID: 35613412 PMCID: PMC9200398 DOI: 10.1200/po.21.00283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Precision medicine for infantile fibrosarcoma by monitoring of spatial and temporal clonal evolution (requested from authors: Would you be so kind to let us know when the article is announced via Twitter?).![]()
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Affiliation(s)
- Anne Thorwarth
- Department of Pediatric Hematology and Oncology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Berlin, Berlin, Germany
| | - Kerstin Haase
- Department of Pediatric Hematology and Oncology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Berlin, Berlin, Germany.,Experimental and Clinical Research Center (ECRC) of the Charité and the Max-Delbrück-Center for Molecular Medicine (MDC) in the Helmholtz Association, Berlin, Germany.,Max-Delbrück-Center for Molecular Medicine (MDC) in the Helmholtz Association, Berlin, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany.,German Cancer Consortium (DKTK), Partner Sites Berlin and Heidelberg, Germany
| | - Claudia Röefzaad
- Department of Pediatric Hematology and Oncology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Berlin, Berlin, Germany.,Experimental and Clinical Research Center (ECRC) of the Charité and the Max-Delbrück-Center for Molecular Medicine (MDC) in the Helmholtz Association, Berlin, Germany.,Max-Delbrück-Center for Molecular Medicine (MDC) in the Helmholtz Association, Berlin, Germany
| | - Kristian W Pajtler
- German Cancer Research Center (DKFZ), Heidelberg, Germany.,German Cancer Consortium (DKTK), Partner Sites Berlin and Heidelberg, Germany.,Department of Pediatric Hematology and Oncology, University Hospital Heidelberg, Heidelberg, Germany.,Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany
| | - Kathrin Schramm
- German Cancer Research Center (DKFZ), Heidelberg, Germany.,German Cancer Consortium (DKTK), Partner Sites Berlin and Heidelberg, Germany.,Department of Pediatric Hematology and Oncology, University Hospital Heidelberg, Heidelberg, Germany.,Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany
| | - Kathrin Hauptmann
- Institute of Pathology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Berlin, Berlin, Germany
| | - Anke Behnke
- Institute of Pathology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Berlin, Berlin, Germany
| | - Christian Vokuhl
- Section of Pediatric Pathology, Institute of Pathology, University Hospital Bonn, Bonn, Germany
| | - Thomas Elgeti
- Department of Radiology (including Pediatric Radiology), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Berlin, Berlin, Germany
| | - Alexander Gratopp
- Department of Pediatric Pulmonology, Immunology and Intensive Care Medicine, Charité-Universitäts-Medizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Berlin, Berlin, Germany
| | - Johannes H Schulte
- Department of Pediatric Hematology and Oncology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Berlin, Berlin, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany.,German Cancer Consortium (DKTK), Partner Sites Berlin and Heidelberg, Germany
| | - Monika Scheer
- Department of Pediatric Hematology and Oncology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Berlin, Berlin, Germany
| | - Pablo Hernáiz Driever
- Department of Pediatric Hematology and Oncology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Berlin, Berlin, Germany
| | - Karsten Nysom
- Department of Pediatrics and Adolescent Medicine, Juliane Marie Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Angelika Eggert
- Department of Pediatric Hematology and Oncology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Berlin, Berlin, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany.,German Cancer Consortium (DKTK), Partner Sites Berlin and Heidelberg, Germany.,Berliner Institut für Gesundheitsforschung (BIH), Berlin, Germany
| | - Anton G Henssen
- Department of Pediatric Hematology and Oncology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Berlin, Berlin, Germany.,Experimental and Clinical Research Center (ECRC) of the Charité and the Max-Delbrück-Center for Molecular Medicine (MDC) in the Helmholtz Association, Berlin, Germany.,Max-Delbrück-Center for Molecular Medicine (MDC) in the Helmholtz Association, Berlin, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany.,German Cancer Consortium (DKTK), Partner Sites Berlin and Heidelberg, Germany
| | - Hedwig E Deubzer
- Department of Pediatric Hematology and Oncology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Berlin, Berlin, Germany.,Experimental and Clinical Research Center (ECRC) of the Charité and the Max-Delbrück-Center for Molecular Medicine (MDC) in the Helmholtz Association, Berlin, Germany.,Max-Delbrück-Center for Molecular Medicine (MDC) in the Helmholtz Association, Berlin, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany.,German Cancer Consortium (DKTK), Partner Sites Berlin and Heidelberg, Germany.,Berliner Institut für Gesundheitsforschung (BIH), Berlin, Germany
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10
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Jensen LJ, Kim D, Elgeti T, Steffen IG, Hamm B, Nagel SN. Differentiation of Pulmonary Lymphoma Manifestations and Nonlymphoma Infiltrates in Possible Invasive Fungal Disease Using Fast T1-weighted Magnetic Resonance Imaging at 3 T Comparison of Texture Analysis, Mapping, and Signal Intensity Quotients. J Thorac Imaging 2022; 37:80-89. [PMID: 34269753 DOI: 10.1097/rti.0000000000000606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE This study aimed to evaluate the diagnostic performance of texture analysis (TA), T1 mapping, and signal intensity quotients derived from fast T1-weighted gradient echo (T1w GRE) sequences for differentiating pulmonary lymphoma manifestations and nonlymphoma infiltrates in possible invasive fungal disease in immunocompromised hematological patients. MATERIALS AND METHODS Twenty patients with hematologic malignancies and concomitant immunosuppression (including 10 patients with pulmonary lymphoma manifestations and 10 patients with nonlymphoma infiltrates) prospectively underwent 3 T magnetic resonance imaging using a conventional T1w GRE sequence and a T1w GRE mapping sequence with variable flip angle. A region of interest was placed around the most representative lesion in each patient. TA was performed using PyRadiomics. T1 relaxation times were extracted from precompiled maps and calculated manually. Signal intensity quotients (lesion/muscle) were calculated from conventional T1w GRE sequences. RESULTS Of all TA features, variance, mean absolute deviation, robust mean absolute deviation, interquartile range, and minimum were significantly different between the 2 entities (P<0.05), with excellent diagnostic performance in receiver operating characteristic analysis (area under the curve [AUC] >80%). Neither T1 relaxation times from precompiled maps (AUC=63%; P=0.353) nor manual calculation (AUC=63%; P=0.353) nor signal intensity quotients (AUC=70%; P=0.143) yielded significant differences. CONCLUSIONS TA from fast T1w GRE images can differentiate pulmonary lymphoma manifestations and nonlymphoma infiltrates in possible invasive fungal disease with excellent diagnostic performance using the TA features variance, mean absolute deviation, robust mean absolute deviation, interquartile range, and minimum. Combining a fast T1w GRE sequence with TA seems to be a promising tool to differentiate these 2 entities noninvasively.
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Affiliation(s)
| | | | - Thomas Elgeti
- Pediatric Radiology, Charité University Medicine Berlin, Corporate Member of Free University of Berlin, Humboldt University of Berlin, Berlin, Germany
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11
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Jensen LJ, Kim D, Elgeti T, Steffen IG, Hamm B, Nagel SN. Stability of Radiomic Features across Different Region of Interest Sizes-A CT and MR Phantom Study. ACTA ACUST UNITED AC 2021; 7:238-252. [PMID: 34201012 PMCID: PMC8293351 DOI: 10.3390/tomography7020022] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [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: 04/10/2021] [Revised: 05/19/2021] [Accepted: 06/03/2021] [Indexed: 02/01/2023]
Abstract
We aimed to evaluate radiomic features' stability across different region of interest (ROI) sizes in CT and MR images. We chose a phantom with a homogenous internal structure so no differences for a feature extracted from ROIs of different sizes would be expected. For this, we scanned a plastic cup filled with sodium chloride solution ten times in CT and per MR sequence (T1-weighted-gradient-echo and T2-weighted-turbo-inversion-recovery-magnitude). We placed sphere-shaped ROIs of different diameters (4, 8, and 16 mm, and 4, 8, and 16 pixels) into the phantom's center. Features were extracted using PyRadiomics. We assessed feature stability across ROI sizes with overall concordance correlation coefficients (OCCCs). Differences were tested for significance with the Mann-Whitney U-test. Of 93 features, 87 T1w-derived, 87 TIRM-derived, and 70 CT-derived features were significantly different between ROI sizes. Among MR-derived features, OCCCs showed excellent (>0.90) agreement for mean, median, and root mean squared for ROI sizes between 4 and 16 mm and pixels. We further observed excellent agreement for 10th and 90th percentile in T1w and 10th percentile in T2w TIRM images. There was no excellent agreement among the OCCCs of CT-derived features. In summary, many features indicated significant differences and only few showed excellent agreement across varying ROI sizes, although we examined a homogenous phantom. Since we considered a small phantom in an experimental setting, further studies to investigate this size effect would be necessary for a generalization. Nevertheless, we believe knowledge about this effect is crucial in interpreting radiomics studies, as features that supposedly discriminate disease entities may only indicate a systematic difference in ROI size.
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12
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Hellwig S, Grittner U, Elgeti M, Wyschkon S, Nagel SN, Fiebach JB, Krause T, Herm J, Scheitz JF, Endres M, Nolte CH, Haeusler KG, Elgeti T. Evaluation of left ventricular function in patients with acute ischaemic stroke using cine cardiovascular magnetic resonance imaging. ESC Heart Fail 2020; 7:2572-2580. [PMID: 32667736 PMCID: PMC7524103 DOI: 10.1002/ehf2.12833] [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: 02/24/2020] [Revised: 05/05/2020] [Accepted: 05/27/2020] [Indexed: 01/09/2023] Open
Abstract
Aims Heart failure (HF) is frequent in patients with acute ischaemic stroke (AIS) and associated with higher morbidity and mortality. Assessment of cardiac function in AIS patients using cardiovascular MRI (CMR) may help to detect HF. We report the rate of systolic and diastolic dysfunction in a cohort of patients with AIS using CMR and compare cine real‐time (CRT) sequences with the reference of segmented cine steady‐state free precession sequences. Methods and results Patients with AIS without known atrial fibrillation were prospectively enrolled in the HEart and BRain Interfaces in Acute Ischemic Stroke (HEBRAS) study (NCT 02142413) and underwent CMR at 3 Tesla within 7 days after AIS. Validity of CRT sequences was determined in 50 patients. A total of 229 patients were included in the analysis (mean age 66 years; 35% women; HF 2%). Evaluation of cardiac function was successful in 172 (75%) patients. Median time from stroke onset to CMR was 82 h (interquartile range 56–111) and 54 h (interquartile range 31–78) from cerebral MRI to CMR. Systolic dysfunction was observed in 43 (25%) and diastolic dysfunction in 102 (59%) patients. Diagnostic yield was similar using CRT or segmented cine imaging (no significant difference in left ventricular ejection fraction, myocardial mass, time to peak filling rate, and peak filling rate ratio E/A). Intraobserver and interobserver agreement was high (κ = 0.78–1.0 for all modalities). Conclusions Cardiovascular MRI at 3 Tesla is an appropriate method for the evaluation of cardiac function in a selected cohort of patients with AIS. Systolic and diastolic dysfunction is frequent in these patients. CRT imaging allows reliable assessment of systolic and diastolic function.
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Affiliation(s)
- Simon Hellwig
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Centre for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Ulrike Grittner
- Institute of Biometry and Clinical Epidemiology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany
| | - Matthias Elgeti
- Jules Stein Eye Institute and Department for Chemistry and Biochemistry, University of California, Los Angeles, CA, USA
| | - Sebastian Wyschkon
- Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Sebastian N Nagel
- Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Jochen B Fiebach
- Centre for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Thomas Krause
- Department of Neurology, Jüdisches Krankenhaus Berlin, Berlin, Germany
| | - Juliane Herm
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Centre for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Jan F Scheitz
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Centre for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany.,German Centre for Cardiovascular Diseases (DZHK), partner site Berlin, Berlin, Germany
| | - Matthias Endres
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Centre for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany.,German Centre for Neurodegenerative Diseases (DZNE), partner site Berlin, Berlin, Germany.,German Centre for Cardiovascular Diseases (DZHK), partner site Berlin, Berlin, Germany
| | - Christian H Nolte
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Centre for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany.,German Centre for Neurodegenerative Diseases (DZNE), partner site Berlin, Berlin, Germany.,German Centre for Cardiovascular Diseases (DZHK), partner site Berlin, Berlin, Germany
| | | | - Thomas Elgeti
- Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
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13
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Schrank F, Warmuth C, Tzschätzsch H, Kreft B, Hirsch S, Braun J, Elgeti T, Sack I. Cardiac-gated steady-state multifrequency magnetic resonance elastography of the brain: Effect of cerebral arterial pulsation on brain viscoelasticity. J Cereb Blood Flow Metab 2020; 40:991-1001. [PMID: 31142226 PMCID: PMC7181097 DOI: 10.1177/0271678x19850936] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 03/29/2019] [Accepted: 04/22/2019] [Indexed: 12/12/2022]
Abstract
In-vivo brain viscoelasticity measured by magnetic resonance elastography (MRE) is a sensitive imaging marker for long-term biophysical changes in brain tissue due to aging and disease; however, it is still unknown whether MRE can reveal short-term periodic alterations of brain viscoelasticity related to cerebral arterial pulsation (CAP). We developed cardiac-gated steady-state MRE (ssMRE) with spiral readout and stroboscopic sampling of continuously induced mechanical vibrations in the brain at 20, 31.25, and 40 Hz frequencies. Maps of magnitude |G*| and phase ϕ of the complex shear modulus were generated by multifrequency dual visco-elasto inversion with a temporal resolution of 40 ms over 4 s. The method was tested in 12 healthy volunteers. During cerebral systole, |G*| decreased by 6.6 ± 1.9% (56 ± 22 Pa, p < 0.001, mean ± SD), whereas ϕ increased by 0.5 ± 0.5% (0.006 ± 0.005 rad, p = 0.002). The effect size of CAP-induced softening slightly decreased with age by 0.10 ± 0.05% per year (p = 0.04), indicating lower cerebral vascular compliance in older individuals. Our data show for the first time that the brain softens and becomes more viscous during systole, possibly due to an effect of CAP-induced arterial expansion and increased blood volume on effective-medium tissue properties. This sensitivity to vascular-solid tissue interactions makes ssMRE potentially useful for detection of cerebral vascular disease.
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Affiliation(s)
- Felix Schrank
- Department of Radiology, Charité –
Universitätsmedizin Berlin, Berlin, Germany
| | - Carsten Warmuth
- Department of Radiology, Charité –
Universitätsmedizin Berlin, Berlin, Germany
| | - Heiko Tzschätzsch
- Department of Radiology, Charité –
Universitätsmedizin Berlin, Berlin, Germany
| | - Bernhard Kreft
- Department of Radiology, Charité –
Universitätsmedizin Berlin, Berlin, Germany
| | - Sebastian Hirsch
- Berlin Center for Advanced Neuroimaging,
Charité – Universitätsmedizin, Berlin, Germany
| | - Jürgen Braun
- Institute of Medical Informatics,
Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Thomas Elgeti
- Department of Radiology, Charité –
Universitätsmedizin Berlin, Berlin, Germany
| | - Ingolf Sack
- Department of Radiology, Charité –
Universitätsmedizin Berlin, Berlin, Germany
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14
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Schaafs LA, Wyschkon S, Elgeti M, Nagel SN, Knebel F, Steffen IG, Makowski MR, Hamm B, Elgeti T. Diagnosis of Left Ventricular Diastolic Dysfunction Using Cardiac Magnetic Resonance Imaging: Comparison of Volume-Time Curves Derived from Long- and Short-Axis Cine Steady-State Free Precession Datasets. ROFO-FORTSCHR RONTG 2020; 192:764-775. [PMID: 32106325 DOI: 10.1055/a-1108-1892] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE To evaluate the diagnostic performance of diastolic function parameters derived from long-axis (LAX) planimetry compared with short-axis (SAX) volumetry in cardiac magnetic resonance imaging. MATERIALS AND METHODS Cine steady-state free precession (SSFP) datasets of 15 healthy participants (8 young and 7 middle aged) and 25 patients with echocardiographically proven diastolic dysfunction (9 mild, 9 moderate, and 7 severe) were retrospectively included. Volume-time curves for assessing left ventricular (LV) function were obtained by manually contouring the LV endocardial borders in SAX and LAX datasets. The time needed for contouring was recorded for each dataset. The following LV parameters were determined: end-diastolic volume (EDV), end-systolic volume (ESV), ejection fraction (EF), myocardial mass (MM), time to peak filling rate (TPFR), normalized peak filling rate (nPFR), and the ratio of early to late peak filling rate (E/A ratio). A Wilcoxon signed-rank test was used to compare subgroups based on age and severity of diastolic dysfunction for statistical differences. Intraclass correlation coefficients were used to assess intermethod and interobserver reliability. RESULTS Accuracy for the diagnosis of diastolic dysfunction was highest for E/A (mild diastolic dysfunction) and nPFR (any stage of diastolic dysfunction) derived from LAX datasets (E/A: area under the curve (AUC) = 0.97, sensitivity of 68 % and specificity of 100 %; nPFR: AUC = 0.84, sensitivity of 84 % and specificity of 80 %). Diastolic parameters showed a moderate to good intraclass correlation between both methods. The mean differences in EDV, ESV, EF, and MM were 5.3 ml, 1.9 ml, 3.5 %, and 11 g, respectively (each p < 0.001). Significantly less time was needed to derive volume-time curves from LAX images (median 14:45 min, interquartile range 14:15-15:53 min versus median 29:25 min, interquartile range 28:12-32:22 min; p = 0.001). The interobserver reliability was generally good to excellent. CONCLUSION Diastolic function parameters derived from left ventricular LAX planimetry have high diagnostic performance and can be obtained in significantly less time compared with SAX volumetry. These findings may pave the way for routine use of LAX planimetry in the clinical diagnosis of diastolic dysfunction. KEY POINTS · Diastolic function parameters derived from long-axis datasets have high diagnostic performance.. · Generation of volume-time curves using long-axis datasets requires significantly less time.. · This time savings may allow use of cardiac MRI for the diagnosis of diastolic dysfunction in the clinical routine.. CITATION FORMAT · Schaafs LA, Wyschkon S, Elgeti M et al. Diagnosis of Left Ventricular Diastolic Dysfunction Using Cardiac Magnetic Resonance Imaging: Comparison of Volume-Time Curves Derived from Long- and Short-Axis Cine Steady-State Free Precession Datasets. Fortschr Röntgenstr 2020; 192: 764 - 775.
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Affiliation(s)
- Lars-Arne Schaafs
- Department of Radiology, Charité-Universitätsmedizin Berlin, Germany
| | | | - Matthias Elgeti
- Jules-Eye-Stein-Institute, University of California Los Angeles, United States
| | | | - Fabian Knebel
- Department of Cardiology, Charité-Universitätsmedizin Berlin, Germany
| | - Ingo G Steffen
- Department of Radiology, Charité-Universitätsmedizin Berlin, Germany
| | - Marcus R Makowski
- Department of Radiology, Charité-Universitätsmedizin Berlin, Germany
| | - Bernd Hamm
- Department of Radiology, Charité-Universitätsmedizin Berlin, Germany
| | - Thomas Elgeti
- Department of Radiology, Charité-Universitätsmedizin Berlin, Germany.,Department of Nuclear Medicine, Charité-Universitätsmedizin Berlin, Germany
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15
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Schrank F, Warmuth C, Görner S, Meyer T, Tzschätzsch H, Guo J, Uca YO, Elgeti T, Braun J, Sack I. Real‐time MR elastography for viscoelasticity quantification in skeletal muscle during dynamic exercises. Magn Reson Med 2019; 84:103-114. [DOI: 10.1002/mrm.28095] [Citation(s) in RCA: 8] [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: 08/12/2019] [Revised: 10/29/2019] [Accepted: 11/03/2019] [Indexed: 12/17/2022]
Affiliation(s)
- Felix Schrank
- Department of Radiology Charité–Universitätsmedizin Berlin Berlin Germany
| | - Carsten Warmuth
- Department of Radiology Charité–Universitätsmedizin Berlin Berlin Germany
| | - Steffen Görner
- Department of Radiology Charité–Universitätsmedizin Berlin Berlin Germany
| | - Tom Meyer
- Department of Radiology Charité–Universitätsmedizin Berlin Berlin Germany
| | - Heiko Tzschätzsch
- Department of Radiology Charité–Universitätsmedizin Berlin Berlin Germany
| | - Jing Guo
- Department of Radiology Charité–Universitätsmedizin Berlin Berlin Germany
| | - Yavuz Oguz Uca
- Department of Radiology Charité–Universitätsmedizin Berlin Berlin Germany
| | - Thomas Elgeti
- Department of Radiology Charité–Universitätsmedizin Berlin Berlin Germany
| | - Jürgen Braun
- Institute of Medical Informatics Charité–Universitätsmedizin Berlin Berlin Germany
| | - Ingolf Sack
- Department of Radiology Charité–Universitätsmedizin Berlin Berlin Germany
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16
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Nagel SN, Kim D, Wylutzki T, Steffen IG, Schwartz S, Penzkofer T, Hamm B, Elgeti T. Diagnostic Performance and Reliability of Non-Enhanced Imaging Characterization Quotients for the Differentiation of Infectious and Malignant Pulmonary Nodules in Hematological Patients Using 3T MRI. ROFO-FORTSCHR RONTG 2019; 192:327-334. [PMID: 31648350 DOI: 10.1055/a-1005-7424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE To evaluate the diagnostic performance and reliability of non-enhanced imaging characterization quotients (NICQs) derived from magnetic resonance imaging (MRI) in the differential diagnosis of pulmonary nodules in hematological patients. MATERIALS AND METHODS A total of 83 lesions in 45 consecutive hematological patients were analyzed (10 bacterial pneumonias, 16 fungal pneumonias, 19 pulmonary lymphoma manifestations). The MRI protocol included T2-weighted single-shot fast spin echo (FSE) and T1-weighted gradient echo (GRE) sequences. T2-based T2-NICQmean and T2-NICQ90th were calculated from signal intensities measured in the lesion, muscle, and fat ((SILesion - SIMuscle)/(SIFat - SIMuscle) * 100), and simple T1-based T1-Qmean from signal intensities of the lesion and muscle (SILesion/SIMuscle). Images were read by one radiologist with > 7 years and one with 1 year of experience. For statistical evaluation the Kruskal-Wallis or Mann-Whitney U-test, receiver operating characteristic (ROC) analysis with calculation of areas under the curve (AUC), and intraclass correlation coefficients (ICCs) were used. RESULTS Medians of T2-NICQs differed significantly when comparing infectious lesions and lymphoma manifestations in general (T2-NICQmean 20.33 vs. 10.14; T2-NICQ90th 34.96 vs. 25.52) or fungal lesions and lymphoma manifestations in particular (T2-NICQmean 19.00 vs. 10.14; T2-NICQ90th 34.49 vs. 25.25). The AUCs for T2-NICQs on the per-patient level ranged from 0.73 to 0.79. ICCs were at least > 0.85, except for intrarater testing of T2-NICQ90th (0.79). CONCLUSION The overall diagnostic performance of T2-NICQs is adequate for differentiating infectious and fungal lesions from lymphoma manifestations. The results show good to excellent intra- and interrater agreement. We therefore consider NICQs helpful in the diagnostic workup of pulmonary nodules in hematological patients. KEY POINTS · Non-enhanced Imaging Characterization Quotients provide a fast and pragmatic approach for assessing pulmonary lesions in hematological patients.. · The diagnostic performance of Non-enhanced Imaging Characterization Quotients is adequate for differentiating infectious and fungal infiltrates from lymphoma manifestations.. · Non-enhanced Imaging Characterization Quotients show good to excellent intra- and interrater agreement.. CITATION FORMAT · Nagel SN, Kim D, Wylutzki T et al. Diagnostic Performance and Reliability of Non-Enhanced Imaging Characterization Quotients for the Differentiation of Infectious and Malignant Pulmonary Nodules in Hematological Patients Using 3T MRI. Fortschr Röntgenstr 2020; 192: 327 - 334.
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Affiliation(s)
| | - Damon Kim
- Department of Radiology, Charité - Universitätsmedizin Berlin, Germany
| | - Tatjana Wylutzki
- Department of Radiology, Charité - Universitätsmedizin Berlin, Germany
| | - Ingo G Steffen
- Department of Radiology, Charité - Universitätsmedizin Berlin, Germany
| | - Stefan Schwartz
- Department of Hematology and Oncology, Charité - Universitätsmedizin Berlin, Germany
| | - Tobias Penzkofer
- Department of Radiology, Charité - Universitätsmedizin Berlin, Germany
| | - Bernd Hamm
- Department of Radiology, Charité - Universitätsmedizin Berlin, Germany
| | - Thomas Elgeti
- Department of Radiology, Charité - Universitätsmedizin Berlin, Germany.,Department of Nuclear Medicine, Charité - Universitätsmedizin Berlin, Germany
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Poller W, Skurk C, Escher F, Manes C, Elgeti T, Schultheiss HP, Taupitz M, Landmesser U. Multimodality Imaging Reveals Divergent Responses of Left and Right Heart to Treatment in Cardiac Amyloidosis. JACC Case Rep 2019; 1:360-366. [PMID: 34316826 PMCID: PMC8289130 DOI: 10.1016/j.jaccas.2019.07.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 07/29/2019] [Accepted: 07/31/2019] [Indexed: 11/30/2022]
Abstract
Cardiac amyloidosis is associated with very high morbidity and mortality. Only if treated early, cardiac amyloidosis responds well to therapy, and early recognition with a full differential diagnostic workup including multimodality imaging is therefore critical at first presentation. Closely meshed clinical monitoring and imaging are indispensable to ensure optimal individualized treatment. (Level of Difficulty: Beginner.).
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Affiliation(s)
- Wolfgang Poller
- Department of Cardiology, Campus Benjamin Franklin, Charite-Universitätsmedizin Berlin, Berlin, Germany.,German Center for Cardiovascular Research, Site Berlin, Berlin, Germany
| | - Carsten Skurk
- Department of Cardiology, Campus Benjamin Franklin, Charite-Universitätsmedizin Berlin, Berlin, Germany.,German Center for Cardiovascular Research, Site Berlin, Berlin, Germany
| | - Felicitas Escher
- German Center for Cardiovascular Research, Site Berlin, Berlin, Germany.,Department of Cardiology, Campus Virchow-Klinikum, Charite-Universitätsmedizin Berlin, Berlin, Germany.,Institute for Cardiac Diagnostics and Therapy, Berlin, Germany
| | - Costantina Manes
- Department of Cardiology, Campus Benjamin Franklin, Charite-Universitätsmedizin Berlin, Berlin, Germany
| | - Thomas Elgeti
- Institute for Radiology, Charite-Universitätsmedizin Berlin, Berlin, Germany
| | | | - Matthias Taupitz
- Institute for Radiology, Charite-Universitätsmedizin Berlin, Berlin, Germany
| | - Ulf Landmesser
- Department of Cardiology, Campus Benjamin Franklin, Charite-Universitätsmedizin Berlin, Berlin, Germany.,German Center for Cardiovascular Research, Site Berlin, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany
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Schaafs LA, Tzschätzsch H, Figiel C, van der Giet M, Reshetnik A, Hamm B, Sack I, Elgeti T. Quantitative Time-Harmonic Ultrasound Elastography of the Abdominal Aorta and Inferior Vena Cava. Ultrasound Med Biol 2019; 45:2349-2355. [PMID: 31201021 DOI: 10.1016/j.ultrasmedbio.2019.05.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 02/18/2019] [Accepted: 05/20/2019] [Indexed: 06/09/2023]
Abstract
The purpose of this study was to evaluate the sensitivity of quantitative time-harmonic ultrasound elastography (THE) of the inferior vena cava (IVC) and abdominal aorta (AA) to changes in central volume status. THE of the IVC and AA was performed in 20 healthy volunteers before and after oral intake of 1 L of water and before or during passive leg raising to augment venous filling. Compound maps of shear wave speed (SWS) as surrogate measures of vessel wall stiffness were generated within the full field of view from multifrequency harmonic wave fields. SWS was measured in regions of the IVC and AA. Blood pressure, stroke volume, cardiac output and pulse wave velocity were recorded. Statistical significance of SWS changes was tested using one-way repeated-measures analysis of variance. SWS measured in the IVC increased from 1.71 ± 0.1 m/s before water intake to 1.82 ± 0.1 m/s during passive leg raising and, further, to 1.87 ± 0.1 m/s after hydration and to 1.95 ± 0.1 m/s with hydration plus passive leg raising (p < 0.001). SWS in the AA did not change significantly after hydration (2.14 ± 0.13 m/s vs. 2.15 ± 0.16 m/s; p = 0.792). SWS was significantly higher in the AA than in the IVC across all experiments (p < 0.001). Water drinking did not significantly influence blood pressure, pulse wave velocity and cardiac output (all p values >0.1), whereas stroke volume increased significantly (p = 0.031). Time-harmonic ultrasound elastography enables quantification of the wall stiffness of the large abdominal vessels and is sensitive to different volume and pressure states in the IVC.
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Affiliation(s)
- Lars-Arne Schaafs
- Department of Radiology, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin and Campus Mitte, Berlin, Germany.
| | - Heiko Tzschätzsch
- Department of Radiology, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin and Campus Mitte, Berlin, Germany
| | - Christin Figiel
- Department of Radiology, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin and Campus Mitte, Berlin, Germany
| | - Markus van der Giet
- Department of Nephrology, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Alexander Reshetnik
- Department of Nephrology, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Bernd Hamm
- Department of Radiology, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin and Campus Mitte, Berlin, Germany
| | - Ingolf Sack
- Department of Radiology, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin and Campus Mitte, Berlin, Germany
| | - Thomas Elgeti
- Department of Radiology, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin and Campus Mitte, Berlin, Germany; Department of Nuclear Medicine, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany
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Nagel SN, Steffen IG, Schwartz S, Hamm B, Elgeti T. Age-dependent diagnostic accuracy of clinical scoring systems and D-dimer levels in the diagnosis of pulmonary embolism with computed tomography pulmonary angiography (CTPA). Eur Radiol 2019; 29:4563-4571. [PMID: 30783786 DOI: 10.1007/s00330-019-06039-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 12/14/2018] [Accepted: 01/24/2019] [Indexed: 12/28/2022]
Abstract
OBJECTIVE The aim of this study was to compare the age-dependent diagnostic performance of clinical scores and D-dimer testing to identify patients with suspected pulmonary embolism (PE). METHODS Consecutive patients with suspected PE referred from the emergency department for computed tomography pulmonary angiography (CTPA) were retrospectively evaluated. Diagnostic scores (classic Wells score (WS), modified WS, simplified WS, revised Geneva score (GS), simplified GS, and YEARS score) were calculated from medical records. Results of D-dimer testing were retrieved from the laboratory database. CTPA was the diagnostic reference standard. Four age groups were analyzed (< 50, 50-64, 65-74, and ≥ 75 years). Statistical analysis used receiver operating characteristics as well as uni- and multivariate analyses with calculation of prediction models. The study was IRB approved. RESULTS One thousand consecutive patients were included. Areas under the curve (AUC) and accuracies were superior in patients < 50 years. For the classic WS, the AUC decreased by 11% with the optimal cutoff dropping 1.5 points in patients ≥ 75 years; for D-dimer levels, the optimal cutoff was 900 μg/L higher in both ≥ 65 years groups with a max. decrease of the AUC of 9%. In terms of accuracy, the YEARS score performed best across all groups. Classic WS and D-dimer level showed a significant interaction with patient age in prediction models. CONCLUSION D-dimer measurement and clinical scores perform best in patients < 50 years. The YEARS score performs best across all age groups and is therefore recommended. KEY POINTS • The probability of pulmonary embolism predicted by fibrin fibrinogen degradation products and clinical scores shows the highest accuracy in patients < 50 years. • The probability of pulmonary embolism predicted by the YEARS score shows the highest accuracy in each age group. • Classic Wells score and fibrin fibrinogen degradation products show a significant interaction with patient age in a logistic regression model.
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Affiliation(s)
- Sebastian N Nagel
- Klinik und Hochschulambulanz für Radiologie, Charité - Universitätsmedizin Berlin Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany.
| | - Ingo G Steffen
- Klinik und Hochschulambulanz für Radiologie, Charité - Universitätsmedizin Berlin Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Stefan Schwartz
- Medizinische Klinik mit Schwerpunkt Hämatologie und Onkologie, Charité - Universitätsmedizin Berlin Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Bernd Hamm
- Klinik und Hochschulambulanz für Radiologie, Charité - Universitätsmedizin Berlin Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Thomas Elgeti
- Klinik und Hochschulambulanz für Radiologie, Charité - Universitätsmedizin Berlin Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany
- Klinik für Nuklearmedizin, Charité - Universitätsmedizin Berlin Campus Virchow Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
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Schaafs LA, Tzschätzsch H, van der Giet M, Reshetnik A, Steffen IG, Hamm B, Braun J, Sack I, Elgeti T. Time-Harmonic Ultrasound elastography of the Descending Abdominal Aorta: Initial Results. Ultrasound Med Biol 2017; 43:2550-2557. [PMID: 28818306 DOI: 10.1016/j.ultrasmedbio.2017.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Revised: 06/28/2017] [Accepted: 07/07/2017] [Indexed: 06/07/2023]
Abstract
Stiffening of central large vessels is considered a key pathophysiologic factor within the cardiovascular system. Current diagnostic parameters such as pulse wave velocity (PWV) indirectly measure aortic stiffness, a hallmark of coronary diseases. The aim of the present study was to perform elastography of the proximal abdominal aorta based on externally induced time-harmonic shear waves. Experiments were performed in 30 healthy volunteers (25 young, 5 old, >50 y) and 5 patients with longstanding hypertension (PWV >10 m/s). B-Mode-guided sonographic time-harmonic elastography was used for measurement of externally induced shear waves at 30-Hz vibration frequency. Thirty-hertz shear wave amplitudes (SWAs) within the abdominal aorta were measured and displayed in real time and processed offline for differences in SWA between systole and diastole (ΔSWA). Data were analyzed using the Kruskal-Wallis test and receiver operating characteristic curve analysis. The change in SWA over the cardiac cycle was reduced significantly in all patients as assessed with ΔSWA (volunteers: mean = 10 ± 5 μm, patients: mean = 4 ± 1 μm; p < 0.001). The best separation of healthy volunteers from patients was obtained with a ΔSWA threshold of 4.7 μm, resulting in a sensitivity of 0.9 and a specificity of 1.0, with an overall area under the curve of 0.96. Time harmonic elastography of the abdominal aorta is feasible and shows promise for the exploitation of time-varying shear wave amplitudes as a diagnostic marker for aortic wall stiffening. Patients with elevated PWVs suggesting increased aortic wall stiffness were best identified by ΔSWA-a parameter that could be related to the ability of the vessel walls to distend on passages of the pulse wave.
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Affiliation(s)
- Lars-Arne Schaafs
- Klinik und Hochschulambulanz für Radiologie, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Heiko Tzschätzsch
- Klinik und Hochschulambulanz für Radiologie, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Markus van der Giet
- Medizinische Klinik mit Schwerpunkt Nephrologie, Transplantationszentrum-Hypertoniezentrum, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Alexander Reshetnik
- Medizinische Klinik mit Schwerpunkt Nephrologie, Transplantationszentrum-Hypertoniezentrum, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Ingo G Steffen
- Klinik und Hochschulambulanz für Radiologie, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Bernd Hamm
- Klinik und Hochschulambulanz für Radiologie, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Jürgen Braun
- Institut für Medizinische Informatik, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Ingolf Sack
- Klinik und Hochschulambulanz für Radiologie, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Thomas Elgeti
- Klinik und Hochschulambulanz für Radiologie, Charité-Universitätsmedizin Berlin, Berlin, Germany.
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Nagel SN, Kim D, Penzkofer T, Steffen IG, Wyschkon S, Hamm B, Schwartz S, Elgeti T. Pulmonary MRI at 3T: Non-enhanced pulmonary magnetic resonance Imaging Characterization Quotients for differentiation of infectious and malignant lesions. Eur J Radiol 2017; 89:33-39. [PMID: 28267546 DOI: 10.1016/j.ejrad.2017.01.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 12/15/2016] [Accepted: 01/15/2017] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To investigate 3T pulmonary magnetic resonance imaging (MRI) for characterization of solid pulmonary lesions in immunocompromised patients and to differentiate infectious from malignant lesions. MATERIALS AND METHODS Thirty-eight pulmonary lesions in 29 patients were evaluated. Seventeen patients were immunocompromised (11 infections and 6 lymphomas) and 12 served as controls (4 bacterial pneumonias, 8 solid tumors). Ten of the 15 infections were acute. Signal intensities (SI) were measured in the lesion, chest wall muscle, and subcutaneous fat. Scaled SIs as Non-enhanced Imaging Characterization Quotients ((SILesion-SIMuscle)/(SIFat-SIMuscle)*100) were calculated from the T2-weighted images using the mean SI (T2-NICQmean) or the 90th percentile of SI (T2-NICQ90th) of the lesion. Simple quotients were calculated by dividing the SI of the lesion by the SI of chest wall muscle (e.g. T1-Qmean: SILesion/SIMuscle). RESULTS Infectious pulmonary lesions showed a higher T2-NICQmean (40.1 [14.6-56.0] vs. 20.9 [2.4-30.1], p<0.05) and T2-NICQ90th (74.3 [43.8-91.6] vs. 38.5 [15.8-48.1], p<0.01) than malignant lesions. T1-Qmean was higher in malignant lesions (0.85 [0.68-0.94] vs. 0.93 [0.87-1.09], p<0.05). Considering infections only, T2-NICQ90th was lower when anti-infectious treatment was administered >24h prior to MRI (81.8 [71.8-97.6] vs. 41.4 [26.6-51.1], p<0.01). Using Youden's index (YI), the optimal cutoff to differentiate infectious from malignant lesions was 43.1 for T2-NICQmean (YI=0.42, 0.47 sensitivity, 0.95 specificity) and 55.5 for T2-NICQ90th (YI=0.61, 0.71 sensitivity, 0.91 specificity). Combining T2-NICQ90th and T1-Qmean increased diagnostic performance (YI=0.72, 0.77 sensitivity, 0.95 specificity). CONCLUSION Considering each quotient alone, T2-NICQ90th showed the best diagnostic performance and could allow differentiation of acute infectious from malignant pulmonary lesions with high specificity. Combining T2-NICQ90th with T1-Qmean increased overall performance, especially regarding sensitivity.
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Affiliation(s)
- Sebastian Niko Nagel
- Klinik und Hochschulambulanz für Radiologie, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany.
| | - Damon Kim
- Klinik und Hochschulambulanz für Radiologie, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany; Institut für Röntgendiagnostik, HELIOS Klinikum Berlin-Buch, Schwanebecker Chaussee 50, 13125 Berlin, Germany.
| | - Tobias Penzkofer
- Klinik und Hochschulambulanz für Radiologie, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany.
| | - Ingo G Steffen
- Klinik und Hochschulambulanz für Radiologie, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany.
| | - Sebastian Wyschkon
- Klinik und Hochschulambulanz für Radiologie, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany.
| | - Bernd Hamm
- Klinik und Hochschulambulanz für Radiologie, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany.
| | - Stefan Schwartz
- Medizinische Klinik mit Schwerpunkt Hämatologie und Onkologie, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany.
| | - Thomas Elgeti
- Klinik und Hochschulambulanz für Radiologie, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany.
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Preuß A, Schaafs LA, Werncke T, Steffen IG, Hamm B, Elgeti T. Run-Off Computed Tomography Angiography (CTA) for Discriminating the Underlying Causes of Intermittent Claudication. PLoS One 2016; 11:e0152780. [PMID: 27054846 PMCID: PMC4824428 DOI: 10.1371/journal.pone.0152780] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Accepted: 03/19/2016] [Indexed: 12/21/2022] Open
Abstract
Aim To evaluate run-off computed tomography angiography (CTA) of abdominal aorta and lower extremities for detecting musculoskeletal pathologies and clinically relevant extravascular incidental findings in patients with intermittent claudication (IC) and suspected peripheral arterial disease (PAD). Does run-off CTA allow image-based therapeutic decision making by discriminating the causes of intermittent claudication in patients with suspected peripheral arterial disease PAD? Material and Methods Retrospective re-evaluation of CTAs performed in patients with acute or chronic intermittent claudication (i.e., Fontaine stages I to IIB) between January 2005 and October 2013. Allocation to one of three categories of underlying causes of IC symptoms: vascular, musculoskeletal (MSK) or both. Clinically relevant extravascular incidental findings were evaluated. Medical records were reviewed to verify specific therapies as well as main and incidental findings. Results While focused on vascular imaging, CTA image quality was sufficient for evaluation of the MSK system in all cases. The underlying cause of IC was diagnosed in run-off CTA as vascular, MSK and a combination in n = 138 (65%), n = 10 (4%), and n = 66 (31%) cases, respectively. Specific vascular or MSK therapy was recorded in n = 123 and n = 9 cases. In n = 82, no follow-up was possible. Clinically relevant extravascular incidental findings were detected in n = 65 patients (30%) with neoplasia, ascites and pleural effusion being the most common findings. Discussion Run-off CTA allows identification of vascular, MSK, and combined causes of IC in patients with suspected PAD and can guide specific therapy. CTA also allowed confident detection of crEVIF although detection did not necessarily trigger workup or treatment.
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Affiliation(s)
- Alexandra Preuß
- Department of Radiology, Charité-Universitätsmedizin, Berlin, Germany
| | - Lars-Arne Schaafs
- Department of Radiology, Charité-Universitätsmedizin, Berlin, Germany
- * E-mail:
| | - Thomas Werncke
- Institute for Radiology, Medizinische Hochschule Hannover, Hannover, Germany
| | - Ingo G. Steffen
- Department of Radiology, Charité-Universitätsmedizin, Berlin, Germany
| | - Bernd Hamm
- Department of Radiology, Charité-Universitätsmedizin, Berlin, Germany
| | - Thomas Elgeti
- Department of Radiology, Charité-Universitätsmedizin, Berlin, Germany
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Nagel SN, Wyschkon S, Schwartz S, Hamm B, Elgeti T. Can magnetic resonance imaging be an alternative to computed tomography in immunocompromised patients with suspected fungal infections? Feasibility of a speed optimized examination protocol at 3 Tesla. Eur J Radiol 2016; 85:857-63. [DOI: 10.1016/j.ejrad.2016.02.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 01/29/2016] [Accepted: 02/04/2016] [Indexed: 11/28/2022]
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Elgeti T. Kardiale MR Elastografie – Evaluation zeitaufgelöster Parameter für die Diagnostik diastolischer Fehlfunktion. ROFO-FORTSCHR RONTG 2015. [DOI: 10.1055/s-0035-1550946] [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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Preuß A, Elgeti T, Hamm B, Werncke T. Extravascular incidental findings in run-off CT angiography in patients with acute limb ischaemia: incidence and clinical relevance. Clin Radiol 2015; 70:622-9. [PMID: 25819627 DOI: 10.1016/j.crad.2015.02.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Revised: 02/07/2015] [Accepted: 02/20/2015] [Indexed: 12/21/2022]
Abstract
AIM To evaluate the incidence and clinical relevance of extravascular incidental findings (EVIFs) in CT angiography of the abdominal aorta and lower extremities (run-off CTA) in patients presenting with acute limb ischaemia (ALI). MATERIALS AND METHODS In this institutional review board-approved, retrospective study, 141 run-off CTA examinations conducted between 2005 and 2013 of patients (67 women, mean age 80 years; 74 men, mean age 69 years) presenting with clinical symptoms of ALI were re-evaluated by two radiologists (2 and 7 years of experience in interpreting run-off CTA). Imaging was conducted using 16- and 64-section CT systems. Image acquisition ranged from the costodiaphragmatic recess to the forefoot. The medical history form of each patient served as the standard of reference for assessment of incidence of EVIFs. CT morphology was assessed to assign EVIFs to one of three categories of clinical relevance: (I) immediate, (II) potential, and (III) no clinical relevance. RESULTS Thirty-eight patients had category I findings, including four patients (2.8%) with previously unknown malignancy and 67 patients with category II EVIFs. In total 473 extravascular EVIFs were found in 141 patients: 52 category I, 163 category II and 258 category III. CONCLUSION EVIFs with immediate clinical relevance are very common in run-off CTA in patients presenting with acute peripheral artery disease. Therefore, it is important to evaluate all body regions included in a CT examination carefully, even if the clinical focus is on vascular evaluation. The adequate classification of these EVIFs is required to avoid possible unnecessary diagnostic work-up with associated risks and costs.
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Affiliation(s)
- A Preuß
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - T Elgeti
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - B Hamm
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - T Werncke
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany.
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Preuß A, Werncke T, Meyer B, Hamm B, Elgeti T. Inzidenz und Relevanz von extravaskulären Zufallsbefunden in der CT-Angiografie der Becken- und Beingefäße bei Patienten mit pAVK. ROFO-FORTSCHR RONTG 2014. [DOI: 10.1055/s-0034-1372923] [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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Dulce M, Steffen I, Preuss A, Hamm B, Elgeti T. Positionierung zentralvenöser Katheter – Vergleich von konventioneller Röntgenthoraxaufnahme und Computertomografie bei der topografischen Analyse von Landmarken zur ZVK-Positionierung. ROFO-FORTSCHR RONTG 2014. [DOI: 10.1055/s-0034-1373420] [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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Elgeti T. MR Elastografie des Herzens zur Scherwellenamplituden basierten Diagnose diastolischer Dysfunktion. ROFO-FORTSCHR RONTG 2014. [DOI: 10.1055/s-0034-1372887] [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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Dulce M, Steffen I, Preuss A, Renz D, Hamm B, Elgeti T. Topographic analysis and evaluation of anatomical landmarks for placement of central venous catheters based on conventional chest X-ray and computed tomography. Br J Anaesth 2014; 112:265-71. [DOI: 10.1093/bja/aet341] [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] [Indexed: 12/22/2022] Open
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Elgeti T, Knebel F, Hättasch R, Hamm B, Braun J, Sack I. Shear-wave amplitudes measured with cardiac MR elastography for diagnosis of diastolic dysfunction. Radiology 2014; 271:681-7. [PMID: 24475861 DOI: 10.1148/radiol.13131605] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
PURPOSE To test whether shear-wave amplitudes (SWAs) in the myocardium measured with cardiac magnetic resonance (MR) elastography enable diagnosis of myocardial relaxation abnormalities in patients with diastolic dysfunction. MATERIALS AND METHODS Each subject gave written informed consent to participate in this institutional review board-approved prospective study. Electrocardiographically triggered SWA-based cardiac MR elastography with 24.13-Hz external vibration frequency was performed in 50 subjects grouped into asymptomatic young (n = 10, 18-39 years) and asymptomatic old (n = 10, 40-68 years) subjects and patients with echocardiographically proved mild, moderate, or severe diastolic dysfunction (n = 30, 44-73 years). SWA images were analyzed in the left ventricular (LV) region and were normalized against reference SWA of the thoracic wall. Analysis of variance with Bonferroni-corrected pairwise comparison and Pearson correlation were used for statistical evaluation. RESULTS Young and old control subjects had normalized mean LV SWA of 0.67 ± 0.04 (standard error of the mean) and 0.56 ± 0.04 (P = .18, F test), respectively. Compared with the control groups, patients with mild, moderate, and severe diastolic dysfunction displayed significantly reduced normalized mean LV SWA of 0.37 ± 0.04, 0.34 ± 0.04, and 0.29 ± 0.04 (P < .001, F test), respectively, which was inversely correlated to the severity of diastolic dysfunction (R = -0.61, P < .001). The best cutoff value to differentiate between asymptomatic volunteers and patients was 0.43, yielding an area under the receiver operating characteristic curve of 0.92, with 90% sensitivity and 89.7% specificity. CONCLUSION LV SWA measured with cardiac MR elastography provides image contrast sensitive to myocardial relaxation abnormalities and shows significantly lower values in patients with diastolic dysfunction.
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Affiliation(s)
- Thomas Elgeti
- From the Department of Radiology (T.E., B.H., I.S.), Department of Cardiology, Angiology and Pulmonology (F.K., R.H.), and Institute of Medical Informatics (J.B.), Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
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Renz DM, Ghadamgahi E, Elgeti T, Böttcher J, Maurer MH, Streitparth F, Pfeil A, Berger F, Hamm B, Röttgen R. Wertigkeit der kardiovaskulären MRT-Untersuchung und Vergleich mit echokardiographischen Daten bei Patienten mit Marfan-Syndrom. ROFO-FORTSCHR RONTG 2013. [DOI: 10.1055/s-0033-1352573] [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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Werncke T, von Falck C, Wittmann M, Elgeti T, Wacker FK, Meyer BC. Optimal table feed in run-off CT angiography in patients with abdominal aortic aneurysms. Eur Radiol 2013; 23:2482-91. [DOI: 10.1007/s00330-013-2865-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Revised: 03/20/2013] [Accepted: 03/25/2013] [Indexed: 10/26/2022]
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Renz DM, Ghadamgahi E, Elgeti T, Böttcher J, Freyhardt P, Maurer MH, Streitparth F, Pfeil A, Berger F, Hamm B, Röttgen R. Hereditäres Marfansyndrom: Wertigkeit der kardiovaskulären MRT-Untersuchung und Vergleich mit echokardiografischen Daten. ROFO-FORTSCHR RONTG 2013. [DOI: 10.1055/s-0033-1346213] [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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Hirsch S, Posnansky O, Papazoglou S, Elgeti T, Braun J, Sack I. Measurement of vibration-induced volumetric strain in the human lung. Magn Reson Med 2012; 69:667-74. [PMID: 22529038 DOI: 10.1002/mrm.24294] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2011] [Revised: 03/08/2012] [Accepted: 03/21/2012] [Indexed: 01/22/2023]
Abstract
Noninvasive image-based measurement of intrinsic tissue pressure is of great interest in the diagnosis and characterization of diseases. Therefore, we propose to exploit the capability of phase-contrast MRI to measure three-dimensional vector fields of tissue motion for deriving volumetric strain induced by external vibration. Volumetric strain as given by the divergence of mechanical displacement fields is related to tissue compressibility and is thus sensitive to the state of tissue pressure. This principle is demonstrated by the measurement of three-dimensional vector fields of 50-Hz oscillations in a compressible agarose phantom and in the lungs of nine healthy volunteers. In the phantom, the magnitude of the oscillating divergence increased by about 400% with 4.8 bar excess air pressure, corresponding to an effective-medium compression modulus of 230 MPa. In lungs, the averaged divergence magnitude increased in all volunteers (N = 9) between 7 and 78% from expiration to inspiration. Measuring volumetric strain by MRI provides a compression-sensitive parameter of tissue mechanics, which varies with the respiratory state in the lungs. In future clinical applications for diagnosis and characterization of lung emphysema, fibrosis, or cancer, divergence-sensitive MRI may serve as a noninvasive marker sensitive to disease-related alterations of regional elastic recoil pressure in the lungs.
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Affiliation(s)
- Sebastian Hirsch
- Department of Radiology, Charité-Universitätsmedizin Berlin, Campus Charité Mitte, Berlin, Germany
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Affiliation(s)
- Jan A Graw
- Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow Klinikum, Charité-Universitätsmedizin Berlin, Berlin, Germany.
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Tzschätzsch H, Elgeti T, Rettig K, Kargel C, Klaua R, Schultz M, Braun J, Sack I. In Vivo time harmonic elastography of the human heart. Ultrasound Med Biol 2012; 38:214-222. [PMID: 22178163 DOI: 10.1016/j.ultrasmedbio.2011.11.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2011] [Revised: 11/04/2011] [Accepted: 11/05/2011] [Indexed: 05/31/2023]
Abstract
Time harmonic elastography is introduced as a modality for assessing myocardial elasticity changes during the cardiac cycle. It is based on external stimulation and real-time analysis of 30-Hz harmonic shear waves in axial direction of a parasternal line of sight through the lateral heart wall. In 20 healthy volunteers, the externally induced waves showed smaller amplitudes during systole (76.0 ± 30.8 μm) and higher amplitudes during diastole (126.7 ± 52.1 μm). This periodic wave amplitude alteration preceded ventricular contraction and dilation by about 100 ms. The amplitude ratio of 1.75 ± 0.49 indicates a relative change in myocardial shear elasticity on the order of 14 ± 11. These results well agree with observations made by cardiac magnetic resonance elastography for a similar displacement component and region of the heart. The proposed method provides reproducible elastodynamic information on the heart in real-time and may help in diagnosing myocardial relaxation abnormalities in the future.
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Affiliation(s)
- Heiko Tzschätzsch
- Department of Radiology, Charité-Universitätsmedizin Berlin, Campus Charité Mitte, Berlin, Germany
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Elgeti T, Tzschätzsch H, Hirsch S, Krefting D, Klatt D, Niendorf T, Braun J, Sack I. Vibration-synchronized magnetic resonance imaging for the detection of myocardial elasticity changes. Magn Reson Med 2012; 67:919-24. [DOI: 10.1002/mrm.24185] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2011] [Revised: 11/18/2011] [Accepted: 01/05/2012] [Indexed: 12/27/2022]
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Renz DM, Röttgen R, Habedank D, Wagner M, Böttcher J, Pfeil A, Dietz R, Kivelitz D, Elgeti T. New insights into peripartum cardiomyopathy using cardiac magnetic resonance imaging. ROFO-FORTSCHR RONTG 2011; 183:834-41. [PMID: 21830182 DOI: 10.1055/s-0031-1281600] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
PURPOSE The aim of this study was to evaluate a comprehensive cardiac magnetic resonance (MR) imaging approach in patients with peripartum cardiomyopathy (PPCM). The focus was on inflammatory myocardial changes. MATERIALS AND METHODS Retrospective analysis of 12 cardiac MR examinations was performed in 6 patients with PPCM. The protocol comprised cine sequences for the determination of chamber sizes and function. T 2-weighted sequences for determination of edema (T 2 ratio), T 1-weighted images for measurement of early gadolinium enhancement ratio (EGER), and late gadolinium enhancement (LGE) sequences were used for tissue characterization. 5 examinations were performed during the acute stage, and 7 examinations were performed during the course of the disease. RESULTS Initially, 3 of 5 patients presented with an elevated left ventricular end-diastolic volume (LVEDV); in one patient, the LVEDV was in the upper range. In 4 of 5 subjects, the left ventricular ejection fraction (LVEF) was decreased. The T 2 ratio and EGER values were initially elevated in all women. No LGE was detected in initial scans. In follow-up examinations, the LVEDV decreased and the LVEF increased in all patients. Tissue-characterizing parameters decreased to normal in all but 1 patient. 2 patients showing LGE did not present a favorable clinical course. CONCLUSION Myocardial inflammation was detected in the acute stage of PPCM, which was mostly transient. In our small group, patients showing LGE had a non-favorable clinical course. Future studies should include tissue-characterizing parameters, such as T 2 ratio and EGER. Thus, further insights into pathophysiology can be gained and therapeutic effects can be measured in a more extensive manner.
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Affiliation(s)
- D M Renz
- Institut für Radiologie, Charité Universitätsmedizin Berlin, Germany
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Elgeti T, Beling M, Hirsch S, Hamm B, Braun J, Sack I. MR-Elastographie am Herzen - Änderungen der Elastizität in Alter und Krankheit. ROFO-FORTSCHR RONTG 2011. [DOI: 10.1055/s-0031-1279078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Renz DM, Röttgen R, Habedank D, Wagner M, Böttcher J, Pfeil A, Dietz R, Hamm B, Kivelitz DE, Elgeti T. Kardiale Bildgebung bei peripartaler Kardiomyopathie: Evaluation eines umfassenden MR-Untersuchungsprotokolls. ROFO-FORTSCHR RONTG 2011. [DOI: 10.1055/s-0031-1279373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Holinski S, Schmeck B, Claus B, Radtke H, Elgeti T, Holzhausen M, Konertz W. Encouraging Experience with Intracardiac Transplantation of Unselected Autologous Bone Marrow Cells Concomitant with Coronary Artery Bypass Surgery after Myocardial Infarction. Ann Thorac Cardiovasc Surg 2011; 17:383-9. [DOI: 10.5761/atcs.oa.10.01552] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Elgeti T, Beling M, Hamm B, Braun J, Sack I. Elasticity-based determination of isovolumetric phases in the human heart. J Cardiovasc Magn Reson 2010; 12:60. [PMID: 20979648 PMCID: PMC2987769 DOI: 10.1186/1532-429x-12-60] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2010] [Accepted: 10/27/2010] [Indexed: 01/09/2023] Open
Abstract
UNLABELLED BACKGROUND/MOTIVATION: To directly determine isovolumetric cardiac time intervals by magnetic resonance elastography (MRE) using the magnitude of the complex signal for deducing morphological information combined with the phase of the complex signal for tension-relaxation measurements. METHODS Thirty-five healthy volunteers and 11 patients with relaxation abnormalities were subjected to transthoracic wave stimulation using vibrations of approximately 25 Hz. A k-space-segmented, ECG-gated gradient-recalled echo steady-state sequence with a 500-Hz bipolar motion-encoding gradient was used for acquiring a series of 360 complex images of a short-axis view of the heart at a frame rate of less than 5.2 ms. Magnitude images were employed for measuring the cross-sectional area of the left ventricle, while phase images were used for analyzing the amplitudes of the externally induced waves. The delay between the decrease in amplitude and onset of ventricular contraction was determined in all subjects and assigned to the time of isovolumetric tension. Conversely, the delay between the increase in wave amplitude and ventricular dilatation was used for measuring the time of isovolumetric elasticity relaxation. RESULTS Wave amplitudes decreased during systole and increased during diastole. The variation in wave amplitude occurred ahead of morphological changes. In healthy volunteers the time of isovolumetric elasticity relaxation was 75 ± 31 ms, which is significantly shorter than the time of isovolumetric tension of 136 ± 36 ms (P < 0.01). In patients with relaxation abnormalities (mild diastolic dysfunction, n = 11) isovolumetric elasticity relaxation was significantly prolonged, with 133 ± 57 ms (P < 0.01), whereas isovolumetric tension time was in the range of healthy controls (161 ± 45 ms; P = 0.053). CONCLUSION The complex MRE signal conveys complementary information on cardiac morphology and elasticity, which can be combined for directly measuring isovolumetric tension and elasticity relaxation in the human heart.
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Affiliation(s)
- Thomas Elgeti
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany
| | - Mark Beling
- Department of Cardiology, Angiology and Pulmonology, Charité - Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany
| | - Bernd Hamm
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany
| | - Jürgen Braun
- Institute of Medical Informatics, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200 Berlin, Germany
| | - Ingolf Sack
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany
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Voigt A, Elgeti T, Durmus T, Idiz ME, Butler C, Beling M, Schilling R, Klingel K, Kandolf R, Stangl K, Taupitz M, Kivelitz D, Wagner M. Cardiac magnetic resonance imaging in dilated cardiomyopathy in adults—towards identification of myocardial inflammation. Eur Radiol 2010; 21:925-35. [DOI: 10.1007/s00330-010-1985-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2010] [Revised: 08/30/2010] [Accepted: 09/10/2010] [Indexed: 01/07/2023]
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Elgeti T, Laule M, Kaufels N, Schnorr J, Hamm B, Samani A, Braun J, Sack I. Cardiac MR elastography: comparison with left ventricular pressure measurement. J Cardiovasc Magn Reson 2009; 11:44. [PMID: 19900266 PMCID: PMC2777142 DOI: 10.1186/1532-429x-11-44] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2009] [Accepted: 11/09/2009] [Indexed: 01/11/2023] Open
Abstract
PURPOSE OF STUDY To compare magnetic resonance elastography (MRE) with ventricular pressure changes in an animal model. METHODS Three pigs of different cardiac physiology (weight, 25 to 53 kg; heart rate, 61 to 93 bpm; left ventricular [LV] end-diastolic volume, 35 to 70 ml) were subjected to invasive LV pressure measurement by catheter and noninvasive cardiac MRE. Cardiac MRE was performed in a short-axis view of the heart and applying a 48.3-Hz shear-wave stimulus. Relative changes in LV-shear wave amplitudes during the cardiac cycle were analyzed. Correlation coefficients between wave amplitudes and LV pressure as well as between wave amplitudes and LV diameter were determined. RESULTS A relationship between MRE and LV pressure was observed in all three animals (R2 >or= 0.76). No correlation was observed between MRE and LV diameter (R2 CONCLUSION Externally induced shear waves provide information reflecting intraventricular pressure changes which, if substantiated in further experiments, has potential to make cardiac MRE a unique noninvasive imaging modality for measuring pressure-volume function of the heart.
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Affiliation(s)
- Thomas Elgeti
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany
| | - Michael Laule
- Department of Medicine (Cardiology, Angiology, Pulmonology) Charité - Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
| | - Nikola Kaufels
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany
| | - Jörg Schnorr
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany
| | - Bernd Hamm
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany
| | - Abbas Samani
- Department of Medical Biophysics, University of Western Ontario, Ontario, Canada
- Department of Electrical and Computer Engineering, University of Western Ontario, Ontario, Canada
| | - Jürgen Braun
- Institute of Medical Informatics, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200 Berlin, Germany
| | - Ingolf Sack
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany
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Proquitté H, Elgeti T, Roehr CC, Rogalla P, Wauer RR, Schmalisch G. Comparison of lung volume measurements by multiple-breath heptafluoropropane washout and computed tomography in small ventilated piglets. Med Sci Monit 2009; 15:BR275-BR280. [PMID: 19789503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Knowledge of lung volume is essential for monitoring and optimizing mechanical ventilation. The aim of this study was to compare lung volume measurements by multiple-breath heptafluoropropane (HFP) washout (MBW) and by respiratory gated computed tomography (CT) in ventilated newborn piglets. MATERIAL/METHODS In 6 ventilated piglets (age: <12 h, median weight: 945 g) blood gases, respiratory mechanics, and lung volumes were measured in both the supine and prone positions. The measurements were performed in random order. Functional residual capacity (FRC) was measured simultaneously by HFP MBW (FRC(HFP)) using a new infrared mainstream sensor and by CT (FRC(CT)) at the end of inspiration and expiration (multi-slice Toshiba Aquilon 16, Otawara, Japan). Tidal volume (V(T)) was measured both by the Dräger Babylog 8000 ventilator (V(T BL)) and the volume difference of the CT scans (V(T CT)). RESULTS FRC(HFP) (25.2+/-8.5 ml) and FRC(CT) (24.9+/-7.6 ml) correlated strongly (r=0.97) without significant bias. Bland-Altman limits of agreement showed differences between the two methods that ranged from -19.7 to +19.5%. A similar strong correlation without statistically significant bias was found between V(T BL) (8.5+/-2.0 ml) and V(T CT) (9.0+/-2.4 ml) with r=0.91. The limits of agreement were -24.4 and +14.0%. Body position (prone vs. supine) had no significant effect on blood gases, respiratory mechanics, or lung volumes. CONCLUSIONS Lung volumes measured in small ventilated lungs by HFP washout and CT are highly correlated and independent of body position. However, the relatively large limits of agreement indicate differences in the two techniques.
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Affiliation(s)
- Hans Proquitté
- Clinic of Neonatology (Charité Campus Mitte), Charité Universitätsmedizin, Berlin, Germany.
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Sack I, Rump J, Elgeti T, Samani A, Braun J. MR elastography of the human heart: noninvasive assessment of myocardial elasticity changes by shear wave amplitude variations. Magn Reson Med 2009; 61:668-77. [PMID: 19097236 DOI: 10.1002/mrm.21878] [Citation(s) in RCA: 95] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Many cardiovascular diseases and disorders are associated with hemodynamic dysfunction. The heart's ability to contract and pump blood through the vascular system primarily depends on the elasticity of the myocardium. This article introduces a magnetic resonance elastography (MRE) technique that allows noninvasive and time-resolved measurement of changes in myocardial elasticity over the cardiac cycle. To this end, low-frequency shear vibrations of 24.3 Hz were induced in the human heart via the anterior chest wall. An electrocardiograph (ECG)-triggered, steady-state MRE sequence was used to capture shear oscillations with a frame rate of eight images per vibration cycle. The time evolution of 2D-shear wave fields was observed in two imaging planes through the short axis of the heart in six healthy volunteers. Correlation analysis revealed that wave amplitudes were modulated in synchrony to the heartbeat with up to 2.45 +/- 0.18 higher amplitudes during diastole than during systole (interindividual mean +/- SD). The reduction of wave amplitudes started at 75 +/- 9 ms prior to changes in left ventricular diameter occurring at the beginning of systole. Analysis of this wave amplitude alteration using a linear elastic constitutive model revealed a maximum change in the myocardial wall stiffness of a factor of 37.7 +/- 10.6 during the cardiac cycle.
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Affiliation(s)
- Ingolf Sack
- Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany.
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Franiel T, Diederichs G, Engelken F, Elgeti T, Rost J, Rogalla P. Multi-detector CT in peritoneal carcinomatosis: diagnostic role of thin slices and multiplanar reconstructions. ACTA ACUST UNITED AC 2009; 34:49-54. [PMID: 18264738 DOI: 10.1007/s00261-008-9372-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND In order to investigate whether 1-mm thin slices and multiplanar reconstructions (MPRs) of multi-detector computed tomography (CT) datasets interpreted in addition to isotropic 5-mm thick slices in one session improve the detection of peritoneal carcinomatosis. METHODS The abdominal CT datasets of 44 patients with histologically proven tumors of the abdomen or pelvis were retrospectively evaluated for peritoneal carcinomatosis by four radiologists with variable experience (radiologist 1: >or=10 years, radiologists 2 and 3: 1.5 years, radiologist 4: 0.5 years). In three successive steps, the radiologists evaluated first the axial 5-mm slices, second the 1-mm slices, and third the MPRs and rated their diagnostic confidence. RESULTS Specificity was nearly unchanged for all the four radiologists. Sensitivity improved for the most experienced and the least experienced radiologists and was unchanged for the two readers with intermediate skills. Except for the third step of radiologist 4, no statistically significant differences in diagnostic performance were detected. The diagnostic confidence of all the four readers benefited to variable degrees from interpretation of the 1-mm slices and MPRs. CONCLUSIONS While 5-mm slices are sufficient for the detection of peritoneal carcinomatosis, 1-mm slices and MPRs can improve sensitivity and diagnostic confidence.
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Affiliation(s)
- Tobias Franiel
- Department of Radiology, Charité Universitätsmedizin, Campus Charité Mitte, Berlin, Germany.
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Abstract
OBJECTIVES To develop cardiac magnetic resonance elastography (MRE) for noninvasively measuring left ventricular (LV) pressure-volume (P-V) work. MATERIAL AND METHODS The anterior chest wall of 8 healthy volunteers was vibrated by 24.3-Hz acoustic waves for stimulating oscillating shear deformation in myocardium and adjacent blood. The induced motion was recorded by an electrocardiogram-gated, vibration-synchronized and segmented gradient-recalled echo MRE sequence acquiring 360 phase-contrast wave images with a temporal resolution of 5.16 milliseconds in the short-axis view during controlled breathing. Relative changes in wave amplitudes served as a measure of LV pressure variation during the cardiac cycle. MRE pressure data were combined with LV volumes obtained from segmentation of 3D cine-steady-state free precession data sets. RESULTS Shear wave amplitudes decreased from diastole to systole, which reflects the dynamics of myocardial shear modulus variations during the cardiac cycle. Assuming spherical shear stress, a linear relationship between myocardial stiffness and LV pressure was derived. The MRE-measured pressure was plotted as a function of LV volumes. Characteristic P-V cycles displayed an isovolumetric increase in pressure during early systole, whereas less pronounced volume conservation was observed in early diastole. Mean cardiac P-V work in all volunteers was 0.85 +/- 0.11 J. CONCLUSION In vivo cardiac MRE is a noninvasive method for measuring pressure-related heart function determined by shear modulus variations in the LV wall. This is the first noninvasive mechanical test of cardiac work in the human heart and is potentially useful for assessing pathologies associated with increased myocardial stiffness such as diastolic dysfunction.
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Affiliation(s)
- Thomas Elgeti
- Department of Radiology, Charité-Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
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Habedank D, Kühnle Y, Elgeti T, Dudenhausen JW, Haverkamp W, Dietz R. Recovery from peripartum cardiomyopathy after treatment with bromocriptine. Eur J Heart Fail 2008; 10:1149-51. [DOI: 10.1016/j.ejheart.2008.09.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2008] [Revised: 06/18/2008] [Accepted: 09/08/2008] [Indexed: 11/27/2022] Open
Affiliation(s)
- Dirk Habedank
- Department of Cardiology; Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum; Berlin Germany
| | - York Kühnle
- Department of Cardiology; Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum; Berlin Germany
| | - Thomas Elgeti
- Department of Radiology; Charité - Universitätsmedizin Berlin, Campus Charité-Mitte; Berlin Germany
| | - Joachim W. Dudenhausen
- Department of Obstetrics; Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum; Berlin Germany
| | - Wilhelm Haverkamp
- Department of Cardiology; Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum; Berlin Germany
| | - Rainer Dietz
- Department of Cardiology; Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum; Berlin Germany
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