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Verloh N, Vogt K, Bettinger D, Schultheiß M, Kandilaris K, Holzner PA, Doppler MC, Uller W. Percutaneous transcatheter aspiration of pulmonary embolism leading to diagnosis of hepatocellular carcinoma tumor embolus and change in systemic chemotherapy. Acta Radiol Open 2024; 13:20584601241253780. [PMID: 38766646 PMCID: PMC11100400 DOI: 10.1177/20584601241253780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 04/22/2024] [Indexed: 05/22/2024] Open
Abstract
The management of metastatic hepatocellular carcinoma (HCC) is complex, particularly when complicated by pulmonary embolism. In these cases, atezolizumab-bevacizumab therapy is contraindicated due to an elevated risk of thromboembolic events. Differentiating pulmonary tumor embolism from thromboembolic disease is diagnostically challenging. This report outlines the benefit of transcatheter aspiration to obtain pathological evidence of pulmonary artery tumor embolus in an HCC patient. The intervention enabled a significant shift in the management strategy, leading to an escalation of systemic HCC therapy. This case underscores the importance of precise diagnostic techniques such as transcatheter aspiration in guiding treatment decisions, particularly in cases where pulmonary embolism may signify an underlying malignancy-driven process.
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Affiliation(s)
- Niklas Verloh
- Department of Diagnostic and Interventional Radiology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Katharina Vogt
- Department of Diagnostic and Interventional Radiology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Dominik Bettinger
- Department of Medicine II, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Michael Schultheiß
- Department of Medicine II, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Berta-Ottenstein-Programme, Faculty of Medicine, University of Freiburg, Germany
| | - Kosmas Kandilaris
- Institute of Surgical Pathology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Philipp A Holzner
- Department of General and Visceral Surgery, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Michael C Doppler
- Department of Diagnostic and Interventional Radiology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Wibke Uller
- Department of Diagnostic and Interventional Radiology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Blum SFU, Dewald CLA, Becker L, Staudacher E, Franke M, Katoh M, Hoffmann RT, Rohde S, Paprottka PM, Wacker F, Westphalen K, Bruners P, Gebauer B, Das M, Uller W. The status of academic interventional radiologists in Germany with focus on gender disparity: how can we do better? CVIR Endovasc 2024; 7:47. [PMID: 38753113 PMCID: PMC11098981 DOI: 10.1186/s42155-024-00456-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 04/25/2024] [Indexed: 05/19/2024] Open
Abstract
PURPOSE The aim was to characterize the framework conditions in academic interventional radiology (IR) in Germany with focus on differences between genders. MATERIALS AND METHODS After IRB approval, all members of The German Society for Interventional Radiology and Minimally Invasive Therapy (n = 1,632) were invited to an online survey on work and research. Statistical comparisons were undertaken with the Fisher's exact test, Wilcoxon rank sum test or Pearson's Chi-squared test. RESULTS From 267 available questionnaires (general response rate 16.4%), 200 were fully completed. 40% of these (78/200) were involved in research (71% men vs. 29% women, p < 0.01) and eligible for further analysis. Of these, 6% worked part-time (2% vs. 17%, p < 0.05). 90% of the respondents spent less than 25% of their research during their paid working hours, and 41% performed more than 75% of their research during. leisure time. 28% received exemption for research. 88% were (rather) satisfied with their career. One in two participants successfully applied for funding, with higher success rates among male applicants (90% vs. 75%) and respondents with protected research time (93% vs. 80%). Compared to men, women rated their entrance in research as harder (p < 0.05), their research career as more important (p < 0.05), felt less noticed at congresses (93% vs. 53%, p < 0.01), less confident (98% vs. 71%, p < 0.01), and not well connected (77% vs. 36%, p < 0.01). CONCLUSION: Women and men did research under the same circumstances; however, women were underrepresented. Future programs should generally focus on protected research time and gather female mentors to advance academic IR in Germany.
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Affiliation(s)
- Sophia Freya Ulrike Blum
- Institute and Polyclinic for Diagnostic and Interventional Radiology, University Hospital Carl Gustav Carus, Technical University Dresden, Fetscherstraße 47, D-01307, Dresden, Germany.
| | | | - Lena Becker
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Carl- Neuberg-Straße 1, 30625, Hannover, Germany
| | - Emona Staudacher
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Mareike Franke
- Radiology and Nuclear Medicine, Canton Hospital Lucerne, Lucerne, Switzerland
| | - Marcus Katoh
- Department for Diagnostic and Interventional Radiology, HELIOS Hospital Krefeld, Lutherplatz 40, 47805, Krefeld, Germany
| | - Ralf-Thorsten Hoffmann
- Institute and Polyclinic for Diagnostic and Interventional Radiology, University Hospital Carl Gustav Carus, Technical University Dresden, Fetscherstraße 47, D-01307, Dresden, Germany
| | - Stefan Rohde
- Department of Radiology and Neuroradiology, Klinikum Dortmund gGmbH, Beurhausstraße 40, 44137, Dortmund, Germany
| | - Philip Marius Paprottka
- Department of Interventional Radiology, Klinikum rechts der Isar, Technical University Munich, Ismaninger Straße 22, 81675, München, Germany
| | - Frank Wacker
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Carl- Neuberg-Straße 1, 30625, Hannover, Germany
| | - Kerstin Westphalen
- Department of Radiology, DRK Hospital Berlin, Salvador-Allende-Straße 2-8, 12559, Berlin, Germany
| | - Philipp Bruners
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Bernhard Gebauer
- Department of Radiology, Charité University Medicine Berlin, Südstraße 3, 13353, Berlin, Germany
| | - Marco Das
- Department of Radiology, Helios Hospital Duisburg, Dieselstraße 185, 47166, Duisburg, Germany
| | - Wibke Uller
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Medical Center University of Freiburg, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg im Breisgau, Germany
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Goetz A, Poschenrieder F, Steer FG, Zeman F, Lange TJ, Thurn S, Greiner B, Stroszczynski C, Uller W, Hamer O, Hammer S. Intravenous Opioid Medication with Piritramide Reduces the Risk of Pneumothorax During CT-Guided Percutaneous Core Biopsy of the Lung. Cardiovasc Intervent Radiol 2024; 47:621-631. [PMID: 38639781 DOI: 10.1007/s00270-024-03717-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 03/22/2024] [Indexed: 04/20/2024]
Abstract
PURPOSE CT-guided percutaneous core biopsy of the lung is usually performed under local anesthesia, but can also be conducted under additional systemic opioid medication. The purpose of this retrospective study was to assess the effect of intravenous piritramide application on the pneumothorax rate and to identify risk factors for post-biopsy pneumothorax. MATERIALS AND METHODS One hundred and seventy-one core biopsies of the lung were included in this retrospective single center study. The incidence of pneumothorax and chest tube placement was evaluated. Patient-, procedure- and target-related variables were analyzed by univariate and multivariable logistic regression analysis. RESULTS The overall incidence of pneumothorax was 39.2% (67/171). The pneumothorax rate was 31.5% (29/92) in patients who received intravenous piritramide and 48.1% (38/79) in patients who did not receive piritramide. In multivariable logistic regression analysis periinterventional piritramide application proved to be the only independent factor to reduce the risk of pneumothorax (odds ratio 0.46, 95%-confidence interval 0.24, 0.88; p = 0.018). Two or more pleura passages (odds ratio 3.38, 95%-confidence interval: 1.15, 9.87; p = 0.026) and prone position of the patient (odds ratio 2.27, 95%-confidence interval: 1.04, 4.94; p = 0.039) were independent risk factors for a higher pneumothorax rate. CONCLUSION Procedural opioid medication with piritramide proved to be a previously undisclosed factor decreasing the risk of pneumothorax associated with CT-guided percutaneous core biopsy of the lung. LEVEL OF EVIDENCE 4: small study cohort.
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Affiliation(s)
- Andrea Goetz
- Department of Radiology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany.
| | - Florian Poschenrieder
- Department of Radiology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Frederike Georgine Steer
- Department of Radiology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Florian Zeman
- Center for Clinical Trials, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Tobias J Lange
- Department of Internal Medicine II, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Sylvia Thurn
- Department of Radiology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Barbara Greiner
- Department of Radiology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Christian Stroszczynski
- Department of Radiology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Wibke Uller
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Medical Center University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Okka Hamer
- Department of Radiology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Simone Hammer
- Department of Radiology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
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Schmidt VF, Kapp FG, Goldann C, Huthmann L, Cucuruz B, Brill R, Vielsmeier V, Seebauer CT, Michel AJ, Seidensticker M, Uller W, Weiß JBW, Sint A, Häberle B, Haehl J, Wagner A, Cordes J, Holm A, Schanze D, Ricke J, Kimm MA, Wohlgemuth WA, Zenker M, Wildgruber M. Extracranial Vascular Anomalies Driven by RAS/MAPK Variants: Spectrum and Genotype-Phenotype Correlations. J Am Heart Assoc 2024; 13:e033287. [PMID: 38563363 DOI: 10.1161/jaha.123.033287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 03/05/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND We aimed to correlate alterations in the rat sarcoma virus (RAS)/mitogen-activated protein kinase pathway in vascular anomalies to the clinical phenotype for improved patient and treatment stratification. METHODS AND RESULTS This retrospective multicenter cohort study included 29 patients with extracranial vascular anomalies containing mosaic pathogenic variants (PVs) in genes of the RAS/mitogen-activated protein kinase pathway. Tissue samples were collected during invasive treatment or clinically indicated biopsies. PVs were detected by the targeted sequencing of panels of genes known to be associated with vascular anomalies, performed using DNA from affected tissue. Subgroup analyses were performed according to the affected genes with regard to phenotypic characteristics in a descriptive manner. Twenty-five vascular malformations, 3 vascular tumors, and 1 patient with both a vascular malformation and vascular tumor presented the following distribution of PVs in genes: Kirsten rat sarcoma viral oncogene (n=10), neuroblastoma ras viral oncogene homolog (n=1), Harvey rat sarcoma viral oncogene homolog (n=5), V-Raf murine sarcoma viral oncogene homolog B (n=8), and mitogen-activated protein kinase kinase 1 (n=5). Patients with RAS PVs had advanced disease stages according to the Schobinger classification (stage 3-4: RAS, 9/13 versus non-RAS, 3/11) and more frequent progression after treatment (RAS, 10/13 versus non-RAS, 2/11). Lesions with Kirsten rat sarcoma viral oncogene PVs infiltrated more tissue layers compared with the other PVs including other RAS PVs (multiple tissue layers: Kirsten rat sarcoma viral oncogene, 8/10 versus other PVs, 6/19). CONCLUSIONS This comparison of patients with various PVs in genes of the RAS/MAPK pathway provides potential associations with certain morphological and clinical phenotypes. RAS variants were associated with more aggressive phenotypes, generating preliminary data and hypothesis for future larger studies.
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Affiliation(s)
- Vanessa F Schmidt
- Department of Radiology LMU University Hospital, LMU Munich München Germany
- Interdisziplinäres Zentrum für Gefäßanomalien (IZGA) LMU University Hospital, LMU Munich München Germany
| | - Friedrich G Kapp
- Division of Pediatric Hematology and Oncology, Department of Pediatric and Adolescent Medicine University Medical Center Freiburg, University of Freiburg Germany
| | - Constantin Goldann
- Clinic and Policlinic of Radiology Martin-Luther University Halle-Wittenberg Halle (Saale) Germany
| | - Linda Huthmann
- Clinic and Policlinic of Radiology Martin-Luther University Halle-Wittenberg Halle (Saale) Germany
| | - Beatrix Cucuruz
- Clinic and Policlinic of Radiology Martin-Luther University Halle-Wittenberg Halle (Saale) Germany
| | - Richard Brill
- Clinic and Policlinic of Radiology Martin-Luther University Halle-Wittenberg Halle (Saale) Germany
| | - Veronika Vielsmeier
- Department of Otorhinolaryngology Regensburg University Medical Center Regensburg Germany
| | - Caroline T Seebauer
- Department of Otorhinolaryngology Regensburg University Medical Center Regensburg Germany
| | - Armin-Johannes Michel
- Department of Pediatric and Adolescent Surgery Paracelsus Medical University Hospital Salzburg Austria
| | - Max Seidensticker
- Department of Radiology LMU University Hospital, LMU Munich München Germany
- Interdisziplinäres Zentrum für Gefäßanomalien (IZGA) LMU University Hospital, LMU Munich München Germany
| | - Wibke Uller
- Department of Diagnostic and Interventional Radiology University of Freiburg Medical Centre, Medical Faculty of the University of Freiburg Freiburg Germany
| | - Jakob B W Weiß
- Department of Plastic and Hand Surgery University of Freiburg Medical Centre, Medical Faculty of the University of Freiburg Freiburg Germany
| | - Alena Sint
- Department of Radiology LMU University Hospital, LMU Munich München Germany
- Interdisziplinäres Zentrum für Gefäßanomalien (IZGA) LMU University Hospital, LMU Munich München Germany
| | - Beate Häberle
- Interdisziplinäres Zentrum für Gefäßanomalien (IZGA) LMU University Hospital, LMU Munich München Germany
- Department of Pediatric Surgery, Dr. von Hauner Children's Hospital LMU University Hospital, LMU Munich München Germany
| | - Julia Haehl
- Interdisziplinäres Zentrum für Gefäßanomalien (IZGA) LMU University Hospital, LMU Munich München Germany
- Department of Pediatric Surgery, Dr. von Hauner Children's Hospital LMU University Hospital, LMU Munich München Germany
| | - Alexandra Wagner
- Interdisziplinäres Zentrum für Gefäßanomalien (IZGA) LMU University Hospital, LMU Munich München Germany
- Department of Pediatric Surgery, Dr. von Hauner Children's Hospital LMU University Hospital, LMU Munich München Germany
| | - Johanna Cordes
- Division of Pediatric Hematology and Oncology, Department of Pediatric and Adolescent Medicine University Medical Center Freiburg, University of Freiburg Germany
| | - Annegret Holm
- Division of Pediatric Hematology and Oncology, Department of Pediatric and Adolescent Medicine University Medical Center Freiburg, University of Freiburg Germany
| | - Denny Schanze
- Institute of Human Genetics, University Hospital Magdeburg Magdeburg Germany
| | - Jens Ricke
- Department of Radiology LMU University Hospital, LMU Munich München Germany
- Interdisziplinäres Zentrum für Gefäßanomalien (IZGA) LMU University Hospital, LMU Munich München Germany
| | - Melanie A Kimm
- Department of Radiology LMU University Hospital, LMU Munich München Germany
- Interdisziplinäres Zentrum für Gefäßanomalien (IZGA) LMU University Hospital, LMU Munich München Germany
| | - Walter A Wohlgemuth
- Clinic and Policlinic of Radiology Martin-Luther University Halle-Wittenberg Halle (Saale) Germany
| | - Martin Zenker
- Institute of Human Genetics, University Hospital Magdeburg Magdeburg Germany
| | - Moritz Wildgruber
- Department of Radiology LMU University Hospital, LMU Munich München Germany
- Interdisziplinäres Zentrum für Gefäßanomalien (IZGA) LMU University Hospital, LMU Munich München Germany
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Fingerhut JB, Kulka C, Doppler M, Vogt K, Uller W, Verloh N. [Stent-PTA of tumor-related venous obstructions]. ROFO-FORTSCHR RONTG 2024. [PMID: 38574675 DOI: 10.1055/a-2284-5587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Affiliation(s)
- Johannes Beat Fingerhut
- Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Freiburg, Germany
| | - Charlotte Kulka
- Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Freiburg, Germany
| | - Michael Doppler
- Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Freiburg, Germany
| | - Katharina Vogt
- Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Freiburg, Germany
| | - Wibke Uller
- Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Freiburg, Germany
| | - Niklas Verloh
- Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Freiburg, Germany
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Hammer S, Nunes DW, Hammer M, Zeman F, Akers M, Götz A, Balla A, Doppler MC, Fellner C, Platz Batista da Silva N, Thurn S, Verloh N, Stroszczynski C, Wohlgemuth WA, Palm C, Uller W. Deep learning-based differentiation of peripheral high-flow and low-flow vascular malformations in T2-weighted short tau inversion recovery MRI. Clin Hemorheol Microcirc 2024:CH232071. [PMID: 38306026 DOI: 10.3233/ch-232071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
BACKGROUND Differentiation of high-flow from low-flow vascular malformations (VMs) is crucial for therapeutic management of this orphan disease. OBJECTIVE A convolutional neural network (CNN) was evaluated for differentiation of peripheral vascular malformations (VMs) on T2-weighted short tau inversion recovery (STIR) MRI. METHODS 527 MRIs (386 low-flow and 141 high-flow VMs) were randomly divided into training, validation and test set for this single-center study. 1) Results of the CNN's diagnostic performance were compared with that of two expert and four junior radiologists. 2) The influence of CNN's prediction on the radiologists' performance and diagnostic certainty was evaluated. 3) Junior radiologists' performance after self-training was compared with that of the CNN. RESULTS Compared with the expert radiologists the CNN achieved similar accuracy (92% vs. 97%, p = 0.11), sensitivity (80% vs. 93%, p = 0.16) and specificity (97% vs. 100%, p = 0.50). In comparison to the junior radiologists, the CNN had a higher specificity and accuracy (97% vs. 80%, p < 0.001; 92% vs. 77%, p < 0.001). CNN assistance had no significant influence on their diagnostic performance and certainty. After self-training, the junior radiologists' specificity and accuracy improved and were comparable to that of the CNN. CONCLUSIONS Diagnostic performance of the CNN for differentiating high-flow from low-flow VM was comparable to that of expert radiologists. CNN did not significantly improve the simulated daily practice of junior radiologists, self-training was more effective.
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Affiliation(s)
- Simone Hammer
- Department of Radiology, Medical Center Universityof Regensburg, Faculty of Medicine, University of Regensburg, Regensburg, Germany
| | - Danilo Weber Nunes
- Regensburg Medical Image Computing (ReMIC), Ostbayerische Technische Hochschule Regensburg (OTH Regensburg), Regensburg, Germany
| | - Michael Hammer
- Regensburg Medical Image Computing (ReMIC), Ostbayerische Technische Hochschule Regensburg (OTH Regensburg), Regensburg, Germany
| | - Florian Zeman
- Center for Clinical Trials, Medical Center University of Regensburg, Faculty of Medicine, University of Regensburg, Regensburg, Germany
| | - Michael Akers
- Department of Radiology, Medical Center Universityof Regensburg, Faculty of Medicine, University of Regensburg, Regensburg, Germany
| | - Andrea Götz
- Department of Radiology, Medical Center Universityof Regensburg, Faculty of Medicine, University of Regensburg, Regensburg, Germany
| | - Annika Balla
- Department of Radiology, Medical Center Universityof Regensburg, Faculty of Medicine, University of Regensburg, Regensburg, Germany
| | - Michael Christian Doppler
- Department of Diagnostic and Interventional Radiology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Claudia Fellner
- Department of Radiology, Medical Center Universityof Regensburg, Faculty of Medicine, University of Regensburg, Regensburg, Germany
| | - Natascha Platz Batista da Silva
- Department of Radiology, Medical Center Universityof Regensburg, Faculty of Medicine, University of Regensburg, Regensburg, Germany
| | - Sylvia Thurn
- Department of Radiology, Medical Center Universityof Regensburg, Faculty of Medicine, University of Regensburg, Regensburg, Germany
| | - Niklas Verloh
- Department of Diagnostic and Interventional Radiology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Christian Stroszczynski
- Department of Radiology, Medical Center Universityof Regensburg, Faculty of Medicine, University of Regensburg, Regensburg, Germany
| | - Walter Alexander Wohlgemuth
- Department of Radiology, Medical Center University of Halle (Saale), Faculty of Medicine, University of Halle (Saale), Halle, Germany
| | - Christoph Palm
- Regensburg Medical Image Computing (ReMIC), Ostbayerische Technische Hochschule Regensburg (OTH Regensburg), Regensburg, Germany
- Regensburg Center of Biomedical Engineering (RCBE), OTH Regensburg and University of Regensburg, Regensburg, Germany
| | - Wibke Uller
- Department of Diagnostic and Interventional Radiology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Doppler M, Fürnstahl C, Hammer S, Melter M, Verloh N, Schlitt HJ, Uller W. Biliary Leak after Pediatric Liver Transplantation Treated by Percutaneous Transhepatic Biliary Drainage-A Case Series. Tomography 2023; 9:1965-1975. [PMID: 37888745 PMCID: PMC10610565 DOI: 10.3390/tomography9050153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 10/12/2023] [Accepted: 10/16/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND Biliary leaks are a severe complication after pediatric liver transplantation (pLT), and successful management is challenging. OBJECTIVES The aim of this case series was to assess the outcome of percutaneous transhepatic biliary drainage (PTBD) in children with bile leaks following pLT. The necessity of additional percutaneous bilioma drainage and laboratory changes during therapy and follow-up was documented. MATERIAL AND METHODS All children who underwent PTBD for biliary leak following pLT were included in this consecutive retrospective single-center study and analyzed regarding site of leak, management of additional bilioma, treatment response, and patient and transplant survival. The courses of inflammation, cholestasis parameters, and liver enzymes were retrospectively reviewed. RESULTS Ten children underwent PTBD treatment for biliary leak after pLT. Seven patients presented with leakage at the hepaticojejunostomy, two with leakage at the choledocho-choledochostomy and one with a bile leak because of an overlooked segmental bile duct. In terms of the mean, the PTBD treatment started 40.3 ± 31.7 days after pLT. The mean duration of PTBD treatment was 109.7 ± 103.6 days. Additional percutaneous bilioma drainage was required in eight cases. Bile leak treatment was successful in all cases, and no complications occurred. The patient and transplant survival rate was 100%. CRP serum level, leukocyte count, gamma-glutamyl transferase (GGT), and total and direct bilirubin level decreased significantly during treatment with a very strong effect size. Additionally, the gamma-glutamyl transferase level showed a statistically significant reduction during follow-up. CONCLUSIONS PTBD is a very successful strategy for bile leak therapy after pLT.
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Affiliation(s)
- Michael Doppler
- Department of Diagnostic and Interventional Radiology, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Christin Fürnstahl
- Department of Radiology, University of Regensburg, University Medical Center Regensburg, 93053 Regensburg, Germany
| | - Simone Hammer
- Department of Diagnostic and Interventional Radiology, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
- Department of Radiology, University of Regensburg, University Medical Center Regensburg, 93053 Regensburg, Germany
| | - Michael Melter
- University Children’s Hospital Regensburg, University of Regensburg, University Medical Center Regensburg, 93053 Regensburg, Germany
| | - Niklas Verloh
- Department of Diagnostic and Interventional Radiology, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Hans Jürgen Schlitt
- Department of Surgery, University of Regensburg, University Medical Center Regensburg, 93053 Regensburg, Germany
| | - Wibke Uller
- Department of Diagnostic and Interventional Radiology, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
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Kulka C, Lagrèze S, Verloh N, Doppler M, Hettmer S, Fichtner-Feigl S, Uller W. Controlled flow reduction of an iliacoportal shunt graft for portal vein arterialization in a pediatric patient. Pediatr Radiol 2023; 53:2305-2308. [PMID: 37612542 PMCID: PMC10562313 DOI: 10.1007/s00247-023-05733-3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 07/25/2023] [Accepted: 07/26/2023] [Indexed: 08/25/2023]
Abstract
Portal vein arterialization is a rarely used, temporary surgical salvage solution to prevent biliary and hepatic ischemia and necrosis in acute liver de-arterialization. However, it can induce portal hypertension, causing increased morbidity and mortality. We report the case of a 5-year-old girl with portal hypertension and right ventricle volume overload following the creation of an iliacoportal shunt graft for portal vein arterialization due to vessel-adhering neuroblastoma. Partial shunt graft closure was accomplished by placing a stent graft in an hourglass configuration via the right femoral artery using two slender-sheaths in a line with the second more distal than the first. Subsequently, the patient's symptoms of right ventricle volume overload and portal hypertension decreased. In conclusion, endovascular reduction of elevated portal blood flow after portal vein arterialization is feasible, even in pediatric patients.
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Affiliation(s)
- Charlotte Kulka
- Department of Diagnostic and Interventional Radiology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany.
| | - Susanne Lagrèze
- Department of General and Visceral Surgery, Medical Center Freiburg, University of Freiburg, Hugstetter Strasse 55, Freiburg, Germany
| | - Niklas Verloh
- Department of Diagnostic and Interventional Radiology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Michael Doppler
- Department of Diagnostic and Interventional Radiology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Simone Hettmer
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Stefan Fichtner-Feigl
- Department of General and Visceral Surgery, Medical Center Freiburg, University of Freiburg, Hugstetter Strasse 55, Freiburg, Germany
| | - Wibke Uller
- Department of Diagnostic and Interventional Radiology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
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9
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Verloh N, Rio Bartulos C, Utpatel K, Brennfleck F, Goetz A, Schicho A, Fellner C, Nickel D, Zeman F, Steinmann JF, Uller W, Stroszczynski C, Schlitt HJ, Wiggermann P, Haimerl M. Volume-Assisted Estimation of Remnant Liver Function Based on Gd-EOB-DTPA Enhanced MR Relaxometry: A Prospective Observational Trial. Diagnostics (Basel) 2023; 13:3014. [PMID: 37761381 PMCID: PMC10529888 DOI: 10.3390/diagnostics13183014] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 09/05/2023] [Accepted: 09/13/2023] [Indexed: 09/29/2023] Open
Abstract
In the context of liver surgery, predicting postoperative liver dysfunction is essential. This study explored the potential of preoperative liver function assessment by MRI for predicting postoperative liver dysfunction and compared these results with the established indocyanine green (ICG) clearance test. This prospective study included patients undergoing liver resection with preoperative MRI planning. Liver function was quantified using T1 relaxometry and correlated with established liver function scores. The analysis revealed an improved model for predicting postoperative liver dysfunction, exhibiting an accuracy (ACC) of 0.79, surpassing the 0.70 of the preoperative ICG test, alongside a higher area under the curve (0.75). Notably, the proposed model also successfully predicted all cases of liver failure and showed potential in predicting liver synthesis dysfunction (ACC 0.78). This model showed promise in patient survival rates with a Hazard ratio of 0.87, underscoring its potential as a valuable tool for preoperative evaluation. The findings imply that MRI-based assessment of liver function can provide significant benefits in the early identification and management of patients at risk for postoperative liver dysfunction.
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Affiliation(s)
- Niklas Verloh
- Department of Radiology, University Hospital Regensburg, 93053 Regensburg, Germany (M.H.)
- Department of Diagnostic and Interventional Radiology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Carolina Rio Bartulos
- Institut für Röntgendiagnostik und Nuklearmedizin, Städtisches Klinikum Braunschweig gGmbH, 38114 Braunschweig, Germany
| | - Kirsten Utpatel
- Department of Pathology, University Regensburg, 95053 Regensburg, Germany
| | - Frank Brennfleck
- Department of Surgery, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Andrea Goetz
- Department of Radiology, University Hospital Regensburg, 93053 Regensburg, Germany (M.H.)
| | - Andreas Schicho
- Department of Radiology, University Hospital Regensburg, 93053 Regensburg, Germany (M.H.)
| | - Claudia Fellner
- Department of Radiology, University Hospital Regensburg, 93053 Regensburg, Germany (M.H.)
| | - Dominik Nickel
- MR Applications Predevelopment, Siemens Healthcare GmbH, 91052 Erlangen, Germany
| | - Florian Zeman
- Center for Clinical Trials, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Johannes F. Steinmann
- Department of Anesthesiology, University Medical Center Regensburg, 93053 Regensburg, Germany
| | - Wibke Uller
- Department of Diagnostic and Interventional Radiology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | | | - Hans-Jürgen Schlitt
- Department of Surgery, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Phillip Wiggermann
- Institut für Röntgendiagnostik und Nuklearmedizin, Städtisches Klinikum Braunschweig gGmbH, 38114 Braunschweig, Germany
| | - Michael Haimerl
- Department of Radiology, University Hospital Regensburg, 93053 Regensburg, Germany (M.H.)
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10
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Luerken L, Dollinger M, Goetz A, Utpatel K, Doppler MC, Weiss JB, Uller W, Ignee A, Verloh N, Haimerl M. Diagnostic Accuracy of Indocyanine Green Clearance Test for Different Stages of Liver Fibrosis and Cirrhosis. Diagnostics (Basel) 2023; 13:2663. [PMID: 37627922 PMCID: PMC10453681 DOI: 10.3390/diagnostics13162663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 08/01/2023] [Accepted: 08/08/2023] [Indexed: 08/27/2023] Open
Abstract
(1) Background: This study aimed to correlate the indocyanine green clearance (ICG) test with histopathological grades of liver fibrosis and liver cirrhosis to assess its diagnostic accuracy in differentiating normal liver parenchyma from liver fibrosis and liver cirrhosis. (2) Methods: A total of 82 patients who received a histopathological liver examination, imaging, and ICG test within three months were included in this retrospective study. The histopathological level of fibrosis was graded using the Ishak scoring system, and the patients were divided into five categories: no liver fibrosis (NLF), mild liver fibrosis (MLF), advanced liver fibrosis (ALF), severe liver fibrosis (SLF), and liver cirrhosis (LC). The non-parametric Kruskal-Wallis test with post hoc pairwise comparison utilizing Mann-Whitney U tests and Bonferroni adjustment was used to analyze differences in the ICG test results between the patient groups. Cross correlation between the individual fibrosis/cirrhosis stages and the score of the ICG test was performed, and the sensitivity, specificity, and positive and negative predictive values were calculated for each model predicting liver fibrosis/cirrhosis. (3) Results: A significant difference (p ≤ 0.001) between stages of NLF, LF, and LC was found for the ICG parameters (ICG plasma disappearance rate (ICG-PDR) and ICG retention percentage at 15 min (ICG-R15)). The post hoc analysis revealed that NLF significantly differed from SLF (ICG-PDR: p = 0.001; ICG-R15: p = 0.001) and LC (ICG-PDR: p = 0.001; ICG-R15: p = 0.001). ALF also significantly differed from SLF (ICG-PDR: p = 0.033; ICG-R15: p = 0.034) and LC (ICG-PDR: p = 0.014; ICG-R15: p = 0.014). The sensitivity for detection of an initial stage of liver fibrosis compared to no liver fibrosis (Ishak ≥ 1) was 0.40; the corresponding specificity was 0.80. The differentiation of advanced liver fibrosis or cirrhosis (Ishak ≥ 4) compared to other stages of liver fibrosis was 0.75, with a specificity of 0.81. (4) Conclusions: This study shows that the ICG test, as a non-invasive diagnostic test, is able to differentiate patients with no liver fibrosis from patients with advanced liver fibrosis and liver cirrhosis. The ICG test seems to be helpful in monitoring patients with liver fibrosis regarding compensation levels, thus potentially enabling physicians to both detect progression from compensated liver fibrosis to advanced liver fibrosis and cirrhosis and to initiate antifibrotic treatment at an earlier stage.
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Affiliation(s)
- Lukas Luerken
- Department of Radiology, University Hospital Regensburg, 93053 Regensburg, Germany; (L.L.)
| | - Marco Dollinger
- Department of Radiology, University Hospital Regensburg, 93053 Regensburg, Germany; (L.L.)
| | - Andrea Goetz
- Department of Radiology, University Hospital Regensburg, 93053 Regensburg, Germany; (L.L.)
| | - Kirstin Utpatel
- Department of Pathology, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Michael Christian Doppler
- Department of Diagnostic and Interventional Radiology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, 79085 Freiburg, Germany
| | - Jakob Benedikt Weiss
- Department of Diagnostic and Interventional Radiology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, 79085 Freiburg, Germany
| | - Wibke Uller
- Department of Diagnostic and Interventional Radiology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, 79085 Freiburg, Germany
| | - André Ignee
- Department of Gastroenterology, Hospital Wuerzburg Mitte, 97074 Wuerzburg, Germany
| | - Niklas Verloh
- Department of Diagnostic and Interventional Radiology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, 79085 Freiburg, Germany
| | - Michael Haimerl
- Department of Diagnostic and Interventional Radiology, Hospital Wuerzburg Mitte, 97074 Wuerzburg, Germany
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11
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Doppler M, Reincke M, Bettinger D, Vogt K, Weiss J, Schultheiss M, Uller W, Verloh N, Goetz C. Predictive Value of [ 99mTc]-MAA-Based Dosimetry in Hepatocellular Carcinoma Patients Treated with [ 90Y]-TARE: A Single-Center Experience. Diagnostics (Basel) 2023; 13:2432. [PMID: 37510175 PMCID: PMC10378141 DOI: 10.3390/diagnostics13142432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 07/13/2023] [Accepted: 07/19/2023] [Indexed: 07/30/2023] Open
Abstract
Transarterial radioembolization is a well-established method for the treatment of hepatocellular carcinoma. The tolerability and incidence of hepatic decompensation are related to the doses delivered to the tumor and healthy liver. This retrospective study was performed at our center to evaluate whether tumor- and healthy-liver-absorbed dose levels in TARE are predictive of tumor response according to the mRECIST 1.1 criteria and overall survival. One hundred and six patients with hepatocellular carcinoma were treated with [90Y]-loaded resin microspheres and completed the follow-up. The dose delivered to each compartment was calculated using a compartmental model. The model was based on [99mTc]-labelled albumin aggregate images obtained before the start of therapy. Tumor response was assessed after three months of treatment. Kaplan-Meier analysis was used to assess survival. The mean age of our population was 66 ± 13 years with a majority being BCLC B tumors. Forty-two patients presented with portal vein thrombosis. The response rate was 57% in the overall population and 59% in patients with thrombosis. Target-to-background (TBR) values measured on initial [99mTc]MAA-SPECT-imaging and tumor model dosimetric values were associated with tumor response (p < 0.001 and p = 0.009, respectively). A dosimetric threshold of 136.5 Gy was predictive of tumor response with a sensitivity of 84.2% and specificity of 89.4%. Overall survival was 24.1 months [IQR 13.1-36.4] for patients who responded to treatment compared to 10.4 months [IQR 6.3-15.9] for the remaining patients (p = 0.022). In this cohort, the initial [99mTc]MAA imaging is predictive of response and survival. The dosimetry prior to the application of TARE can be used for treatment planning and our results also suggest that the therapy is well-tolerated. In particular, hepatic decompensation can be predicted even in the presence of PVT.
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Affiliation(s)
- Michael Doppler
- Department of Diagnostic and Interventional Radiology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, 79085 Freiburg, Germany
| | - Marlene Reincke
- Department of Medicine II, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, 79085 Freiburg, Germany
| | - Dominik Bettinger
- Department of Medicine II, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, 79085 Freiburg, Germany
| | - Katharina Vogt
- Department of Diagnostic and Interventional Radiology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, 79085 Freiburg, Germany
| | - Jakob Weiss
- Department of Diagnostic and Interventional Radiology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, 79085 Freiburg, Germany
| | - Michael Schultheiss
- Department of Medicine II, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, 79085 Freiburg, Germany
- Berta-Ottenstein-Programme, Faculty of Medicine, University of Freiburg, 79085 Freiburg, Germany
| | - Wibke Uller
- Department of Diagnostic and Interventional Radiology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, 79085 Freiburg, Germany
| | - Niklas Verloh
- Department of Diagnostic and Interventional Radiology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, 79085 Freiburg, Germany
| | - Christian Goetz
- Department of Nuclear Medicine, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, 79085 Freiburg, Germany
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12
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Hammer S, da Silva NPB, Müller J, Fellner C, Greiner B, Ingrid Huf V, Stroszczynski C, Wohlgemuth WA, Uller W. Structured magnetic resonance imaging-based characterization of the marginal vein reveals limits of the Weber-classification. VASA 2023. [PMID: 37082826 DOI: 10.1024/0301-1526/a001070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
Background: The marginal vein (MV) is a persisting embryonic vein located at the lateral aspect of the lower limb. The Weber-classification, which was developed on the basis of phlebography in the 1990s, is the only existing classification system for this rare disease. Aim of this study was the structured characterization of the lateral marginal vein (MV) using magnetic resonance imaging (MRI) and evaluation of the applicability of the Weber-classification. Patients and methods: Institutional Review Board approval was obtained for this retrospective, single-center study. All patients who underwent contrast-enhanced MRI (using a prospectively determined protocol) of the untreated MV were included. MV anatomy and associated findings were characterized in a structured way taking into account the criteria of the Weber-classification for MV: inflow, outflow and extension. If three criteria of the Weber-classification were fulfilled the MV was categorized as "classifiable according to Weber". The MV was categorized as "partially classifiable according to Weber", if two criteria were met and as "not classifiable according to Weber" if less than two criteria were applicable. Results: 56 imaging studies of 58 MV (7 thoracoabdominal, 51 lower extremities) were reviewed. 18/51 MV of the lower extremities were "classifiable" according to the Weber-classification. 33/51 lower extremity MV were not definitely categorized according to the Weber-classification: 19/51 MV were "partially classifiable" and 14/51 MV were "not classifiable". 30/51 MV presented with hypoplastic, 1/51 with aplastic deep venous system. 34/51 lower extremity and 6/7 thoracoabdominal MV were associated with an additional vascular malformation (VM). Conclusions: MRI is suitable for detailed anatomic characterization of the MV and reveals additional therapy relevant findings like associated VM. The Weber-classification was not applicable in most cases, reflecting its limits and the heterogeneity of this rare disease. Structured reports rather than an obsolete classification system should be preferred for MRI of the MV.
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Affiliation(s)
- Simone Hammer
- Department of Radiology, Medical Center University of Regensburg, Faculty of Medicine, University Hospital Regensburg, Germany
| | - Natascha Platz Batista da Silva
- Department of Radiology, Medical Center University of Regensburg, Faculty of Medicine, University Hospital Regensburg, Germany
| | - Johanna Müller
- Department of Internal Medicine, Hospital Barmherzige Brüder, Regensburg, Germany
| | - Claudia Fellner
- Department of Radiology, Medical Center University of Regensburg, Faculty of Medicine, University Hospital Regensburg, Germany
| | - Barbara Greiner
- Department of Radiology, Medical Center University of Regensburg, Faculty of Medicine, University Hospital Regensburg, Germany
| | - Veronika Ingrid Huf
- Department of Radiology, Medical Center University of Regensburg, Faculty of Medicine, University Hospital Regensburg, Germany
| | - Christian Stroszczynski
- Department of Radiology, Medical Center University of Regensburg, Faculty of Medicine, University Hospital Regensburg, Germany
| | - Walter Alexander Wohlgemuth
- Department of Radiology, Medical Center University of Halle (Saale), Faculty of Medicine, University of Halle (Saale), Germany
| | - Wibke Uller
- Department of Diagnostic and Interventional Radiology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
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13
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Verloh N, Doppler M, Hagar MT, Kulka C, von Krüchten R, Neubauer J, Weiß J, Röthele E, Schneider J, Jänigen B, Uller W. Interventional Management of Vascular Complications after Renal Transplantation. ROFO-FORTSCHR RONTG 2023; 195:495-504. [PMID: 36863368 DOI: 10.1055/a-2007-9649] [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: 03/04/2023]
Abstract
BACKGROUND Kidney transplantations are increasing due to demographic changes and are the treatment of choice for end-stage renal disease. Non-vascular and vascular complications may occur in the early phase after transplantation and at later stages. Overall postoperative complications after renal transplantations occur in approximately 12 % to 25 % of renal transplant patients. In these cases, minimally invasive therapeutic interventions are essential to ensure long-term graft function. This review article focuses on the most critical vascular complications after renal transplantation and highlights current recommendations for interventional treatment. METHOD A literature search was performed in PubMed using the search terms "kidney transplantation", "complications", and "interventional treatment". Furthermore, the 2022 annual report of the German Foundation for Organ Donation and the EAU guidelines for kidney transplantation (European Association of Urology) were considered. RESULTS AND CONCLUSION Image-guided interventional techniques are favorable compared with surgical revision and should be used primarily for the treatment of vascular complications. The most common vascular complications after renal transplantation are arterial stenoses (3 %-12.5 %), followed by arterial and venous thromboses (0.1 %-8.2 %) and dissection (0.1 %). Less frequently, arteriovenous fistulas or pseudoaneurysms occur. In these cases, minimally invasive interventions show a low complication rate and good technical and clinical results. Diagnosis, treatment, and follow-up should be performed in an interdisciplinary approach at highly specialized centers to ensure the preservation of graft function. Surgical revision should be considered only after exhausting minimally invasive therapeutic strategies. KEY POINTS · Vascular complications after renal transplantation occur in 3 % to 15 % of patients.. · Image-guided interventional procedures should be performed primarily to treat vascular complications of renal transplantation.. · Minimally invasive interventions have a low complication rate with good technical and clinical outcomes.. CITATION FORMAT · Verloh N, Doppler M, Hagar MT et al. Interventional Management of Vascular Complications after Renal Transplantation. Fortschr Röntgenstr 2023; DOI: 10.1055/a-2007-9649.
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Affiliation(s)
- Niklas Verloh
- Department of Diagnostic and Interventional Radiology, Medical Center-University of Freiburg, Germany
| | - Michael Doppler
- Department of Diagnostic and Interventional Radiology, Medical Center-University of Freiburg, Germany
| | - Muhammad Taha Hagar
- Department of Diagnostic and Interventional Radiology, Medical Center-University of Freiburg, Germany
| | - Charlotte Kulka
- Department of Diagnostic and Interventional Radiology, Medical Center-University of Freiburg, Germany
| | - Ricarda von Krüchten
- Department of Diagnostic and Interventional Radiology, Medical Center-University of Freiburg, Germany
| | - Jakob Neubauer
- Department of Diagnostic and Interventional Radiology, Medical Center-University of Freiburg, Germany
| | - Jakob Weiß
- Department of Diagnostic and Interventional Radiology, Medical Center-University of Freiburg, Germany
| | - Elvira Röthele
- Department of Medicine IV, Medical Center-University of Freiburg, Germany
| | - Johanna Schneider
- Department of Medicine IV, Medical Center-University of Freiburg, Germany
| | - Bernd Jänigen
- Department of General and Visceral Surgery, Medical Center-University of Freiburg, Germany
| | - Wibke Uller
- Department of Diagnostic and Interventional Radiology, Medical Center-University of Freiburg, Germany
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14
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Reincke M, Schultheiss M, Doppler M, Verloh N, Uller W, Sturm L, Thimme R, Goetz C, Bettinger D. Hepatic decompensation after transarterial radioembolization: A retrospective analysis of risk factors and outcome in patients with hepatocellular carcinoma. Hepatol Commun 2022; 6:3223-3233. [PMID: 36064940 PMCID: PMC9592795 DOI: 10.1002/hep4.2072] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 06/24/2022] [Accepted: 08/01/2022] [Indexed: 12/14/2022] Open
Abstract
Transarterial radioembolization (TARE) is a well-established therapy for intermediate and advanced tumor stages of hepatocellular carcinoma (HCC). Treatment-associated toxicities are rare. Previous studies have outlined that the prognosis after TARE is determined primarily by tumor stage and liver function. The subset of patients benefiting from TARE remains to be defined. Sixty-one patients with HCC treated with TARE between 2015 and 2020 were retrospectively included in the study. Hepatic decompensation was defined as an increase of bilirubin or newly developed ascites that was not explained by tumor progression within 3 months after TARE. Predictive factors of hepatic decompensation and prognostic factors were assessed. Hepatic decompensation was observed in 27.9% (n = 17) of TARE-treated patients during follow-up. Albumin-bilirubin (ALBI) score at baseline and radiation dose on nontumor liver proved to be independent risk factors for the development of hepatic decompensation in multivariable regression models (ALBI score: odds ratio [OR] 6.425 [1.735;23.797], p < 0.005; radiation dose: OR 1.072 [1.016;1.131], p < 0.011). The occurrence of hepatic decompensation markedly impaired the prognosis of the patients. Survival was significantly worsened. Hepatic decompensation has shown to be an independent negative prognostic factor for death, adjusted for Barcelona Clinic Liver Cancer stage, age and ALBI grade (hazard ratio 5.694 [2.713;11.952], p < 0.001). Conclusion: Hepatic decompensation after TARE for HCC treatment is a highly relevant complication with major effects on the prognosis of patients. Main risk factors are the pretreatment ALBI score and radiation dose. There is an urgent need to define safe cutoff values and exclusion criteria for TARE to limit complications and improve patient outcomes.
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Affiliation(s)
- Marlene Reincke
- Department of Medicine II, Medical Center University of Freiburg, Faculty of MedicineUniversity of FreiburgFreiburgGermany
| | - Michael Schultheiss
- Department of Medicine II, Medical Center University of Freiburg, Faculty of MedicineUniversity of FreiburgFreiburgGermany
| | - Michael Doppler
- Department of Diagnostic and Interventional Radiology, Medical Center University of Freiburg, Faculty of MedicineUniversity of FreiburgFreiburgGermany
| | - Niklas Verloh
- Department of Diagnostic and Interventional Radiology, Medical Center University of Freiburg, Faculty of MedicineUniversity of FreiburgFreiburgGermany
| | - Wibke Uller
- Department of Diagnostic and Interventional Radiology, Medical Center University of Freiburg, Faculty of MedicineUniversity of FreiburgFreiburgGermany
| | - Lukas Sturm
- Department of Medicine II, Medical Center University of Freiburg, Faculty of MedicineUniversity of FreiburgFreiburgGermany,Berta‐Ottenstein‐Programme, Faculty of MedicineUniversity of FreiburgFreiburgGermany
| | - Robert Thimme
- Department of Medicine II, Medical Center University of Freiburg, Faculty of MedicineUniversity of FreiburgFreiburgGermany
| | - Christian Goetz
- Department of Nuclear Medicine, Medical Center University of Freiburg, Faculty of MedicineUniversity of FreiburgFreiburgGermany
| | - Dominik Bettinger
- Department of Medicine II, Medical Center University of Freiburg, Faculty of MedicineUniversity of FreiburgFreiburgGermany
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15
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Hammer S, Schlitt JH, Uller W, Doppler CM. Kombinierte CT-Arterioportographie-Arteriosplenographie bei pädiatrischen Patienten mit portaler Hypertension: Vergleich mit der Standardschnittbildgebung und Ösophagogastroskopie. ROFO-FORTSCHR RONTG 2022. [DOI: 10.1055/s-0042-1749841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- S Hammer
- Universitätsklinikum Regensburg, Institut für Röntgendiagnostik, Regensburg
| | - J H Schlitt
- Viszeralchirurgie, Universitätsklinikum Regensburg, Regensburg
| | - W Uller
- Institut für diagnostische und interventionelle Radiologie, Universitätsklinikum Freiburg, Freiburg
| | - C M Doppler
- Institut für diagnostische und interventionelle Radiologie, Universitätsklinikum Freiburg, Freiburg
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16
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Hagar TM, Neubauer J, Uller W. Die interventionelle Nebennierenvenenblutentnahme. ROFO-FORTSCHR RONTG 2022. [DOI: 10.1055/s-0042-1756562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- T M Hagar
- Universitätsklinikum Freiburg, Klinik f. Diagn. u. Interv.
Radiologie, Freiburg im Breisgau
| | - J Neubauer
- Universitätsklinikum Freiburg, Klinik für Diagnostische
und Interventionelle Radiologie, Freiburg im Breisgau
| | - W Uller
- Universitätsklinikum Freiburg, Klinik für Diagnostische
und Interventionelle Radiologie, Freiburg im Breisgau
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17
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Luerken L, Haimerl M, Doppler M, Uller W, Beyer LP, Stroszczynski C, Einspieler I. Update on Percutaneous Local Ablative Procedures for the Treatment of Hepatocellular Carcinoma. ROFO-FORTSCHR RONTG 2022; 194:1075-1086. [PMID: 35545102 DOI: 10.1055/a-1768-0954] [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: 10/18/2022]
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is the fifth most common tumor worldwide. Because many hepatocellular carcinomas are already unresectable at the time of initial diagnosis, percutaneous tumor ablation has become established in recent decades as a curative therapeutic approach for very early (BCLC 0) and early (BCLC A) HCC. The aim of this paper is to provide a concise overview of the percutaneous local ablative procedures currently in use, based on their technical characteristics as well as clinical relevance, taking into account the current body of studies. MATERIALS AND METHODS The literature search included all original papers, reviews, and meta-analyses available via MEDLINE and Pubmed on the respective percutaneous ablation procedures; the primary focus was on randomized controlled trials and publications from the last 10 years. RESULTS AND CONCLUSIONS Radiofrequency ablation (RFA) and microwave ablation (MWA) are well-established procedures that are considered equal to surgical resection in the treatment of stage BCLC 0 and A HCC with a diameter up to 3 cm due to their strong evidence in international and national guidelines. For tumors with a diameter between 3 and 5 cm, the current S3 guidelines recommend a combination of transarterial chemoembolization (TACE) and thermal ablation using RFA or MWA as combination therapy is superior to thermal ablation alone in tumors of this size and shows comparable results to surgical resection in terms of overall survival. Alternative, less frequently employed thermal procedures include cryotherapy (CT) and laser ablation (LA). Non-thermal procedures include irreversible electroporation (IRE), interstitial brachytherapy (IBT), and most recently, electrochemotherapy (ECT). Due to insufficient evidence, these have only been used in individual cases and within the framework of studies. However, the nonthermal methods are a reasonable alternative for ablation of tumors adjacent to large blood vessels and bile ducts because they cause significantly less damage to these structures than thermal ablation methods. With advances in the technology of the respective procedures, increasingly good evidence, and advancements in supportive techniques such as navigation devices and fusion imaging, percutaneous ablation procedures may expand their indications for the treatment of larger and more advanced tumors in the coming years. KEY POINTS · RFA and MWA are considered equal to surgical resection as a first-line therapy for the curative treatment of stage BCLC 0 and A HCCs with a diameter of up to 3 cm.. · For HCCs with a diameter between 3 and 5 cm, a combination of TACE and RFA or MWA is recommended. This combination therapy yields results comparable to those of surgical resection in terms of overall survival.. · Due to insufficient evidence, alternative ablation methods have only been used in individual cases and within the framework of studies. However, nonthermal methods, such as IRE, IBT, and, most recently, ECT, are a reasonable alternative for ablation of HCCs adjacent to large blood vessels and bile ducts because they cause significantly less damage to these structures than thermal ablation methods.. CITATION FORMAT · Luerken L, Haimerl M, Doppler M et al. Update on Percutaneous Local Ablative Procedures for the Treatment of Hepatocellular Carcinoma. Fortschr Röntgenstr 2022; DOI: 10.1055/a-1768-0954.
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Affiliation(s)
- Lukas Luerken
- Department of Radiology, University Hospital Regensburg, Germany
| | - Michael Haimerl
- Institut für Röntgendiagnostik, University Hospital Regensburg, Germany
| | - Michael Doppler
- Department of Radiology, University Hospital Freiburg Department of Radiology, Freiburg, Germany
| | - Wibke Uller
- Department of Radiology, University Hospital Freiburg Department of Radiology, Freiburg, Germany
| | - Lukas Philipp Beyer
- Institut für Röntgendiagnostik, University Hospital Regensburg, Germany.,Diagnostische und Interventionelle Radiologie, Klinikum Ernst von Bergmann gGmbH, Potsdam, Germany
| | | | - Ingo Einspieler
- Department of Radiology, University Hospital Regensburg, Germany
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Hammer S, Zeman F, Schlitt HJ, Stroszczynski C, Greiner B, Doppler MC, Uller W. Comparison of sequential CT arterioportography-arteriosplenography with standard cross-sectional imaging and endoscopy in children with portal hypertension. Sci Rep 2022; 12:6554. [PMID: 35449190 PMCID: PMC9023584 DOI: 10.1038/s41598-022-10454-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 03/29/2022] [Indexed: 11/15/2022] Open
Abstract
In this study the diagnostic capability and additional value of sequential CT arterioportography–arteriosplenography (CT AP–AS) in comparison to standard cross-sectional imaging and upper gastrointestinal endoscopy (UGE) in pediatric portal hypertension (PH) was analyzed. Patients with clinical signs of PH who underwent CT AP–AS in combination with additional contrast-enhanced magnetic resonance imaging (CE-MR) and/or contrast-enhanced computed tomography (CE-CT) were included. Two radiologists reviewed independently imaging regarding the capability to prove patency of (1) extrahepatic and intrahepatic main stem portal vein (PV), (2) intrahepatic PV system and (3) splenomesenteric venous axis. Imaging was reviewed for detection of abdominal varices and results were compared to UGE. Main venous supply of varices (PV and/or splenic vein system) and splenorenal shunting were evaluated. 47 imaging studies (20 CT AP-AS, 16 CE-MR, 11 CE-CT) and 12 UGE records of 20 patients were analyzed. CT AP–AS detected significantly more splenorenal shunts (p = 0.008) and allowed more confident characterization of the extra-/intrahepatic PV-system and splenomesenteric veins in comparison to CE-MR (p < 0.001). Extra- and intrahepatic PV-system were significantly more confidently assessed in CT AP–AS than in CE-CT (p = 0.008 and < 0.001 respectively). CT AP–AS was the only modality that detected supply of varices and additional gastric/duodenal varices. In this retrospective study CT AP–AS was superior to standard cross-sectional imaging concerning confident assessment of the venous portosplenomesenteric axis in pediatric patients. CT AP–AS detected additional varices, splenorenal shunting and supply of varices.
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Affiliation(s)
- Simone Hammer
- Department of Radiology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Florian Zeman
- Center for Clinical Trials, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Hans Jürgen Schlitt
- Department of Surgery, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Christian Stroszczynski
- Department of Radiology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Barbara Greiner
- Department of Radiology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Michael Christian Doppler
- Department of Diagnostic and Interventional Radiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Wibke Uller
- Department of Diagnostic and Interventional Radiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany.
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19
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Schicho A, Bäumler W, Verloh N, Beyer LP, Schierling W, Uller W, Gößmann H, Stroszczynski C, Dollinger M. Percutaneous Aspiration Thrombectomy for Arterial Thromboembolic Occlusion Following Percutaneous Transluminal Angioplasty: Technical Success Rates and Clinical Outcomes. ROFO-FORTSCHR RONTG 2021; 194:291-295. [PMID: 34674216 DOI: 10.1055/a-1652-1726] [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: 10/20/2022]
Abstract
PURPOSE We aimed to analyze the technical success rate of manual percutaneous aspiration thrombectomy (PAT) in patients with peripheral arterial thromboembolism as a complication of infrainguinal percutaneous transluminal angioplasty (PTA) and we sought to evaluate the 30-day postintervention clinical outcome. MATERIALS AND METHODS We retrospectively identified 29 patients (men/women, 18/11; mean age, 74 years) who underwent infrainguinal PAT to treat thromboembolic complications of infrainguinal PTA. Primary and secondary technical successes were defined as residual stenosis of < 50 % of the vessel diameter after PAT alone and PAT with additional PTA, respectively. Clinical outcome parameters (e. g., amputation, need for further intervention) were evaluated during the first 30 days after intervention. RESULTS The primary and secondary technical success rates were 58.6 % (17/29) and 79.3 % (23/29), respectively. Clinical outcome data were available for 93.1 % (27/29) of patients. No further intervention was required within 30 days in 81.5 % (22/27) of patients. Four patients underwent minor amputations owing to preexisting ulcerations (Rutherford Category 5), and no patients underwent major amputations (Rutherford Category 6). Revascularization of the previously treated vessel segment with PTA was necessary on the first postintervention day in one patient. CONCLUSION Manual PAT, with PTA if needed, has a good technical success rate and satisfactory early clinical outcome in patients with iatrogenic thromboembolic complications after infrainguinal PTA. KEY POINTS · Manual PAT is a possible first-choice treatment of infrainguinal PTA-induced acute thromboembolism.. · Performing additional PTA increases the success rate of manual PAT.. · Unlike catheter-directed intraarterial lysis, manual PAT carries no risk of bleeding.. CITATION FORMAT · Schicho A, Bäumler W, Verloh N et al. Percutaneous Aspiration Thrombectomy for Arterial Thromboembolic Occlusion Following Percutaneous Transluminal Angioplasty: Technical Success Rates and Clinical Outcomes. Fortschr Röntgenstr 2021; DOI: 10.1055/a-1652-1726.
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Affiliation(s)
| | - Wolf Bäumler
- Radiology, University Hospital Regensburg, Germany
| | | | - Lukas Philipp Beyer
- Diagnostische und Interventionelle Radiologie, Klinikum Ernst von Bergmann gGmbH, Potsdam, Germany
| | - Wilma Schierling
- Vascular and Endovascular Surgery, University Hospital Regensburg, Germany
| | - Wibke Uller
- Radiology, University Hospital Freiburg, Department of Radiology, Freiburg, Germany
| | - Holger Gößmann
- Diagnostic and Interventional Radiology, University of Leipzig, Faculty of Medicine, Leipzig, Germany
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20
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Helm M, Goldann C, Hammer S, Platz Batista da Silva N, Wildgruber M, Deistung A, Gussew A, Wohlgemuth WA, Uller W, Brill R. Vascular malformations of the female and male genitalia: type and distribution patterns revealed by magnetic resonance imaging. Clin Exp Dermatol 2021; 47:43-49. [PMID: 34236712 DOI: 10.1111/ced.14830] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Vascular malformations of the genitalia often go undetected in clinical examination. These vascular malformations can cause a variety of clinical symptoms such as swelling, pain and bleeding. AIM To characterize the distribution patterns of genital vascular malformations using magnetic resonance imaging (MRI) and to correlate these patterns with clinical findings in order to guide diagnostic decisions. METHODS A retrospective analysis of MRIs of the pelvis and legs in 370 patients with vascular malformation was performed to determine the involvement of the internal and external genitalia. RESULTS In 71 patients (19%), genital involvement could be identified by MRI. Of these, 11.3% (8 of 71) presented with internal involvement, 36.6% (26 of 71) with external involvement and 52.1% (37 of 71) with both internal and external involvement. Over half (57.1%) of the 49 patients with visible external genital signs detected during a clinical examination had additional internal genital involvement. CONCLUSIONS Genital involvement is a common finding in patients with vascular malformation of the legs and/or pelvis. Based on our data, we recommend MRI of the legs and pelvic region in patients with externally visible signs of a vascular malformation of the external genitalia in order to exclude additional internal involvement.
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Affiliation(s)
- M Helm
- Department of Radiology and Polyclinic of Radiology, University Hospital Halle (Saale), Halle (Saale), Germany
| | - C Goldann
- Department of Radiology and Polyclinic of Radiology, University Hospital Halle (Saale), Halle (Saale), Germany
| | - S Hammer
- Department of Radiology, University Regensburg, Regensburg, Germany
| | | | - M Wildgruber
- Department of Radiology, University Hospital Ludwig-Maximilians-Universität, Campus Großhadern, Munich, Germany
| | - A Deistung
- Department of Radiology and Polyclinic of Radiology, University Hospital Halle (Saale), Halle (Saale), Germany
| | - A Gussew
- Department of Radiology and Polyclinic of Radiology, University Hospital Halle (Saale), Halle (Saale), Germany
| | - W A Wohlgemuth
- Department of Radiology and Polyclinic of Radiology, University Hospital Halle (Saale), Halle (Saale), Germany
| | - W Uller
- Department of Radiology, University of Freiburg, Freiburg, Germany
| | - R Brill
- Department of Radiology and Polyclinic of Radiology, University Hospital Halle (Saale), Halle (Saale), Germany
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21
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Luerken L, Doppler M, Brunner SM, Schlitt HJ, Uller W. Stereotactic Percutaneous Electrochemotherapy as Primary Approach for Unresectable Large HCC at the Hepatic Hilum. Cardiovasc Intervent Radiol 2021; 44:1462-1466. [PMID: 34036404 PMCID: PMC8382613 DOI: 10.1007/s00270-021-02841-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 04/05/2021] [Indexed: 12/21/2022]
Abstract
Electrochemotherapy (ECT) is a novel non-thermal ablative technique that combines chemotherapy and the application of electric pulses for reversible cell membrane electroporation. This method was recently performed in the treatment of deep-seated liver tumors during open surgery but experience about percutaneous ECT is rare and further developments like combination of percutaneous ECT with stereotactic navigated devices may be very promising. We report on a case of a 4.7 × 4.5 × 3.5 cm unresectable HCC at the hepatic hilum adjacent to the major vessels and the bile duct that was successfully treated using percutaneous ECT in combination with stereotactic navigation. Follow-up imaging 6 weeks and 6 months after ECT showed complete response.
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Affiliation(s)
- L Luerken
- Department of Radiology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - M Doppler
- Department of Radiology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany.,Faculty of Medicine, Department of Diagnostic and Interventional Radiology, Medical Center, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - S M Brunner
- Department of Surgery, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - H J Schlitt
- Department of Surgery, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - W Uller
- Department of Radiology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany. .,Faculty of Medicine, Department of Diagnostic and Interventional Radiology, Medical Center, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany.
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22
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Wiesner S, Loch E, Uller W, Gößmann H, Neu R, Hofmann HS, Ried M. Evaluation of treatment options for postoperative and spontaneous chylothorax in adults. Interact Cardiovasc Thorac Surg 2021; 33:527-533. [PMID: 34000033 DOI: 10.1093/icvts/ivab127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 02/20/2021] [Accepted: 03/07/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Both postoperative and spontaneous chylothorax remain therapeutic challenges without recommendations for a standardized treatment approach. Regardless of its aetiology, patients with chylothorax experience prolonged hospitalization and suffer from the associated complications or the invasive therapy administered. METHODS We conducted a retrospective, observational review of adult patients with chylothorax treated between January 2010 and September 2019. The primary end point was successful management with sustained cessation and/or controlled chylous output. Therapy duration, inpatient stay and the incidence of complications were evaluated as secondary end points. RESULTS Of the 36 patients included (22 men; median age 63 years), 24 patients (67%) suffered from a postoperative accumulation of chylous fluid in the pleural space; in the remaining 12 (33%) patients, chylothoraces occurred spontaneously. Initial conservative treatment was successful in 42% (n = 15); in the other 20 cases (56%) additional invasive therapeutic strategies were followed. A complicated course requiring more than 1 treatment was seen in 54% (n = 13) of the postoperative and in 58% (n = 7) of the spontaneous cases. The median length of hospitalization was significantly longer in the postoperative group (37.5 vs 15.5 days; P = 0.016). Serious complications were observed only in the postoperative group (P = 0.28). There were no in-hospital deaths. CONCLUSIONS Basic treatment of both postoperative and spontaneous chylothorax should include dietary measures in all patients. Additional sclerosing radiotherapy and interventional or surgical therapy are often necessary. The choice of therapeutic approach should be indicated, depending on the aetiology and development of the chylothorax. Early, multimodal treatment is recommended.
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Affiliation(s)
- Sigrid Wiesner
- Department of Thoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Elena Loch
- Department of Thoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Wibke Uller
- Department of Radiology, University Medical Center Regensburg, Regensburg, Germany
| | - Holger Gößmann
- Department of Radiology, University Medical Center Regensburg, Regensburg, Germany
| | - Reiner Neu
- Department of Thoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Hans-Stefan Hofmann
- Department of Thoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Michael Ried
- Department of Thoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
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23
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Verloh N, Scharf G, Bäumler W, Pfister K, Oikonomou K, Stroszczynski C, Uller W, Dollinger M. Erroneous placement of central venous catheters in subclavian artery: Retrieval and successful hemostasis with a femoral closure device. J Vasc Access 2021; 23:692-697. [PMID: 33827311 DOI: 10.1177/11297298211007704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Retrospective evaluation of the safety and efficacy of the retrieval of misplaced central venous catheters (CVCs) in subclavian arteries using the femoral closure device Angio-Seal™. METHODS The clinical data of five patients (female, n = 2; mean age, 55.0 years ± 11.9) in whom a misplaced CVC within a subclavian artery was removed followed by closure of the vessel entry site with 8-French (F) Angio-Seal™ was analyzed. RESULTS In 4/5 patients (80%; CVC diameter, 7-8F) the procedure was technically successful without complications. In 1/5 patients (20%; CVC diameter, 11.5F) the procedure failed and an additional covered stent was placed for successful closure of the vessel entry site. There were no complications associated with the Angio-Seal™ or stent implantation during follow-up. CONCLUSION Retrieval of a misplaced CVC within a subclavian artery using the percutaneous closure device Angio-Seal™ is quite safe and effective; however, caution is required if there is a mismatch in the diameter of the Angio-Seal™ and CVC. In the case of procedure failure, successful closure of the vessel entry site can be achieved by covered stent placement.
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Affiliation(s)
- Niklas Verloh
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
| | - Gregor Scharf
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
| | - Wolf Bäumler
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
| | - Karin Pfister
- Department of Vascular Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Kyriakos Oikonomou
- Department of Vascular Surgery, University Hospital Regensburg, Regensburg, Germany
| | | | - Wibke Uller
- Department of Radiology, University Hospital Freiburg, Freiburg, Germany
| | - Marco Dollinger
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
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Huf VI, Grothues D, Knoppke B, Goessmann H, Wohlgemuth WA, Melter M, Brunner SM, Schlitt HJ, Uller W. Super selective percutaneous transhepatic coil embolization of intrahepatic pseudoaneurysm after pediatric liver transplantation: a case report. CVIR Endovasc 2021; 4:31. [PMID: 33740138 PMCID: PMC7979840 DOI: 10.1186/s42155-021-00221-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 03/10/2021] [Indexed: 11/23/2022] Open
Abstract
Background Intrahepatic arterial pseudoaneurysms are a rare, life-threatening complication after pediatric liver transplantation. Treatment of choice represents interventional radiological management with endovascular embolization of the segmental artery proximal and distal to the aneurysm. However, this technique results in loss of arterial perfusion distal to the aneurysm with subsegment arterial ischemia. Case presentation We report a case of a 1-year-old girl with a pseudoaneurysm in the split-liver graft. Direct percutaneous, transhepatic access to the pseudoaneurysm was performed followed by super selective coil application into the aneurysm. Conclusion Super selective percutaneous, transhepatic coil application is feasible even in pediatric patients after liver transplantation and results in preservation of the entire course of the liver artery.
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Affiliation(s)
- V I Huf
- Department of Radiology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - D Grothues
- KUNO University Children's Hospital, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - B Knoppke
- KUNO University Children's Hospital, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - H Goessmann
- Department of Radiology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - W A Wohlgemuth
- Department of Radiology, University Hospital Halle, Ernst-Grube-Str. 40, 06120, Halle, Germany
| | - M Melter
- KUNO University Children's Hospital, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - S M Brunner
- Department of Surgery, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - H J Schlitt
- Department of Surgery, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - W Uller
- Department of Radiology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany. .,Faculty of Medicine, Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany.
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25
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Brill R, Goldann C, Walldorf J, Messmann H, Brill E, Uller W, Michl P, Wildgruber M, Wohlgemuth WA, Rosendahl J. Fluoroscopy-guided endoscopic sclerotherapy: a novel hybrid approach for symptomatic rectosigmoidal venous malformation (with video). Gastrointest Endosc 2021; 93:496-502. [PMID: 32553568 DOI: 10.1016/j.gie.2020.06.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 06/05/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Recommendations for the treatment of lower GI bleeding do not include bleeding from venous malformations (VMs). The aim of this study was to delineate the usefulness of a novel hybrid intervention (fluoroscopy-guided endoscopic sclerotherapy) for the treatment of symptomatic VMs in the rectosigmoidal colon with bleeding. METHODS The magnetic resonance images of 421 patients with VM, referred to multicenter vascular anomaly centers from 2009 to 2017, were analyzed retrospectively. Treatment was performed for all patients who experienced bleeding from rectosigmoidal VMs using fluoroscopy-guided endoscopic sclerotherapy with polidocanol foam as a novel approach. RESULTS A total of 27 patients displayed VM in the rectosigmoidal area. Eleven of these presented with acute or previous bleeding and received treatment. Active bleeding was observed in 8 patients (72.7%), whereas 3 patients (27.3%) had signs of previous bleeding. Six of the 11 patients had anemia (54.5%). There were no adverse events within 24 hours of the intervention. In a 2-year follow-up period, only 1 patient (9.1%) presented with recurrent bleeding after 13 months and was successfully treated again with fluoroscopy-guided endoscopic sclerotherapy. CONCLUSIONS Fluoroscopy-guided endoscopic sclerotherapy was shown to be a safe and effective treatment of symptomatic VMs of the rectosigmoidal area. Thus, fluoroscopy-guided endoscopic sclerotherapy should be considered for patients with bleeding from VMs of the rectosigmoid after a comprehensive workup and interdisciplinary case discussion.
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Affiliation(s)
- Richard Brill
- Department of Radiology, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Constantin Goldann
- Department of Radiology, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Jens Walldorf
- Department of Internal Medicine I, Martin Luther University, Halle (Saale), Germany
| | - Helmut Messmann
- III Medizinische Klinik, University Clinic Augsburg, Augsburg, Germany
| | - Eva Brill
- Department of Radiology, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Wibke Uller
- Department of Radiology, University Medical Center, Regensburg, Germany
| | - Patrick Michl
- Department of Internal Medicine I, Martin Luther University, Halle (Saale), Germany
| | - Moritz Wildgruber
- Department of Radiology, University Hospital Ludwig-Maximilians-Universität, Campus Großhadern, Munich, Germany
| | - Walter A Wohlgemuth
- Department of Radiology, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Jonas Rosendahl
- Department of Internal Medicine I, Martin Luther University, Halle (Saale), Germany
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Brill R, Uller W, Huf V, Müller-Wille R, Schmid I, Pohl A, Häberle B, Perkowski S, Funke K, Till AM, Lauten M, Neumann J, Güttel C, Heid E, Ziermann F, Schmid A, Hüsemann D, Meyer L, Sporns PB, Schinner R, Schmidt VF, Ricke J, Rössler J, Kapp FG, Wohlgemuth WA, Wildgruber M. Additive value of transarterial embolization to systemic sirolimus treatment in kaposiform hemangioendothelioma. Int J Cancer 2020; 148:2345-2351. [PMID: 33231291 DOI: 10.1002/ijc.33406] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 09/15/2020] [Revised: 10/16/2020] [Accepted: 11/09/2020] [Indexed: 01/19/2023]
Abstract
Kaposiform hemangioendothelioma (KHE) is a rare vascular tumor in children, which can be accompanied by life-threatening thrombocytopenia, referred to as Kasabach-Merritt phenomenon (KMP). The mTOR inhibitor sirolimus is emerging as targeted therapy in KHE. As the sirolimus effect on KHE occurs only after several weeks, we aimed to evaluate whether additional transarterial embolization is of benefit for children with KHE and KMP. Seventeen patients with KHE and KMP acquired from 11 hospitals in Germany were retrospectively divided into two cohorts. Children being treated with adjunct transarterial embolization and systemic sirolimus, and those being treated with sirolimus without additional embolization. Bleeding grade as defined by WHO was determined for all patients. Response of the primary tumor at 6 and 12 months assessed by magnetic resonance imaging (MRI), time to response of KMP defined as thrombocyte increase >150 × 103 /μL, as well as rebound rates of both after cessation of sirolimus were compared. N = 8 patients had undergone additive embolization to systemic sirolimus therapy, sirolimus in this group was started after a mean of 6.5 ± 3 days following embolization. N = 9 patients were identified who had received sirolimus without additional embolization. Adjunct embolization induced a more rapid resolution of KMP within a median of 7 days vs 3 months; however, tumor response as well as rebound rates were similar between both groups. Additive embolization may be of value for a more rapid rescue of consumptive coagulopathy in children with KHE and KMP compared to systemic sirolimus only.
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Affiliation(s)
- Richard Brill
- Klinik und Poliklinik für Radiologie, Universitätsklinikum Halle, Halle/Saale, Germany
| | - Wibke Uller
- Institut für Röntgendiagnostik, Universitätsklinik Regensburg, Regensburg, Germany
| | - Veronika Huf
- Institut für Röntgendiagnostik, Universitätsklinik Regensburg, Regensburg, Germany
| | - René Müller-Wille
- Institut für diagnostische und interventionelle Radiologie, Universitätsmedizin Göttingen, Göttingen, Germany
| | - Irene Schmid
- Kinderklinik und Kinderpoliklinik im Dr. von Haunerschen Kinderspital, Klinikum der Universität München, Munich, Germany
| | - Alexandra Pohl
- Kinderchirurgische Klinik und Poliklinik im Dr. von Haunerschen Kinderspital, Klinikum der Universität München, Munich, Germany
| | - Beate Häberle
- Kinderchirurgische Klinik und Poliklinik im Dr. von Haunerschen Kinderspital, Klinikum der Universität München, Munich, Germany
| | - Sybille Perkowski
- Abteilung für Kinderchirurgie, Universitätsklinikum Münster, Münster, Germany
| | - Katrin Funke
- Abteilung für Kinderchirurgie, Universitätsklinikum Münster, Münster, Germany
| | - Anne-Marie Till
- Klinik für Kinder- und Jugendmedizin, Pädiatrische Hämatologie und Onkologie, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany
| | - Melchior Lauten
- Klinik für Kinder- und Jugendmedizin, Pädiatrische Hämatologie und Onkologie, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany
| | - Jacob Neumann
- Klinik für Kinder- und Jugendmedizin, Helios Kliniken Schwerin, Schwerin, Germany
| | - Christian Güttel
- Klinik für Kinder- und Jugendmedizin, Helios Kliniken Schwerin, Schwerin, Germany
| | - Esther Heid
- Klinik für Kinder und Jugendmedizin, Klinikum rechts der Isar, TU München, Munich, Germany
| | - Franziska Ziermann
- Klinik für Kinder und Jugendmedizin, Klinikum rechts der Isar, TU München, Munich, Germany
| | - Axel Schmid
- Radiologisches Institut Universitätsklinikum Erlangen, Erlangen, Germany
| | - Dieter Hüsemann
- Klinik für Kinder- und Jugendmedizin, Werner Forßmann Krankenhaus, Eberswalde, Germany
| | - Lutz Meyer
- Abteilung Kinderchirurgie-Zentrum für Vasculäre Malformationen Eberswalde (ZVM), Klinik für Kinder- und Jugendmedizin, Werner Forßmann Krankenhaus, Eberswalde, Germany
| | - Peter B Sporns
- Diagnostische und Interventionelle Neuroradiologie, Universitätsspital Basel, Basel, Switzerland
| | - Regina Schinner
- Klinik und Poliklinik für Radiologie, Klinikum der Universität München, Munich, Germany
| | - Vanessa F Schmidt
- Klinik und Poliklinik für Radiologie, Klinikum der Universität München, Munich, Germany
| | - Jens Ricke
- Klinik und Poliklinik für Radiologie, Klinikum der Universität München, Munich, Germany
| | - Jochen Rössler
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Friedrich G Kapp
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Walter A Wohlgemuth
- Klinik und Poliklinik für Radiologie, Universitätsklinikum Halle, Halle/Saale, Germany
| | - Moritz Wildgruber
- Klinik und Poliklinik für Radiologie, Klinikum der Universität München, Munich, Germany
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Hammer S, Schlitt HJ, Knoppke B, Huf VI, Wohlgemuth WA, Uller W. Sequential CT arterioportography-arteriosplenography depicts individual haemodynamic changes in children with portal hypertension without cirrhosis. Eur Radiol Exp 2020; 4:65. [PMID: 33263169 PMCID: PMC7708570 DOI: 10.1186/s41747-020-00193-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 11/04/2020] [Indexed: 12/12/2022] Open
Abstract
We evaluated sequential computed tomography (CT) arterioportography-arteriosplenography for the assessment of venous pathways in children with portal hypertension without cirrhosis. Institutional Review Board approval was obtained for this retrospective, single-centre study. CT was performed after contrast application via catheters placed in the superior mesenteric artery (CT arterioportography) and the splenic artery (CT arteriosplenography) consecutively. Venous pathways in 22 children were evaluated. In all patients, the detailed haemodynamic consequences of portal hypertension could be characterised. The supply of varices at different locations could be assigned to the superior mesenteric vein or splenic vein system. Retrograde blood flow through the splenic vein and inferior mesenteric vein, portosystemic shunting, and patency of splanchnic veins were determined. CT arterioportography-arteriosplenography allowed a complete evaluation of individual haemodynamic pathways in children with portal hypertension.
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Affiliation(s)
- Simone Hammer
- Department of Radiology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Hans Jürgen Schlitt
- Department of Surgery, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Birgit Knoppke
- KUNO University Children's Hospital, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Veronika Ingrid Huf
- Department of Radiology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | | | - Wibke Uller
- Department of Radiology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany.
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Alomari MH, Kozakewich HPW, Kerr CL, Uller W, Davis SL, Chaudry G, Liang MG, Orbach DB, Mulliken JB, Greene AK, Afshar S, Fishman SJ, Taghinia AH, Al-Ibraheemi A, Alomari AI. Congenital Disseminated Pyogenic Granuloma: Characterization of an Aggressive Multisystemic Disorder. J Pediatr 2020; 226:157-166. [PMID: 32622671 DOI: 10.1016/j.jpeds.2020.06.079] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 06/24/2020] [Accepted: 06/25/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To describe the clinical, radiologic, and histopathologic features of "congenital disseminated pyogenic granuloma" involving various organs with high morbidity related to cerebral hemorrhagic involvement. STUDY DESIGN We searched the database of the Vascular Anomalies Center at Boston Children's Hospital from 1999 to 2019 for patients diagnosed as having multiple vascular lesions, visceral vascular tumors, congenital hemangiomatosis, multiple pyogenic granulomas, or multiple vascular lesions without a definite diagnosis. A retrospective review of the medical records, photographs, histopathologic, and imaging studies was performed. Only patients with imaging studies and histopathologic diagnosis of pyogenic granuloma were included. RESULTS Eight children (5 male, 3 female) had congenital multifocal cutaneous vascular tumors. Lesions also were found in the brain (n = 7), liver (n = 4), spleen (n = 3), muscles (n = 4), bone (n = 3), retroperitoneum (n = 3), and intestine/mesentery (n = 2). Less commonly affected were the spinal cord, lungs, kidneys, pancreas, and adrenal gland (n = 1 each). The mean follow-up period was 21.8 months. The cerebral and visceral lesions were hemorrhagic with severe neurologic sequelae. The histopathologic diagnosis was pyogenic granuloma with prominent areas of hemorrhage and necrosis. The endothelial cells had enlarged nuclei, pale cytoplasm and were immunopositive for CD31 and negative for D2-40 and glucose transporter 1. CONCLUSIONS Congenital disseminated pyogenic granuloma is a distinct multisystemic aggressive disorder that primarily affects the skin, brain, visceral organs, and musculoskeletal system. Differentiation of this entity from other multiple cutaneous vascular lesions is critical because of possible cerebral hemorrhagic involvement.
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Affiliation(s)
- Mohammed H Alomari
- Division of Vascular and Interventional Radiology, Boston Children's Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Harry P W Kozakewich
- Harvard Medical School, Boston, MA; Department of Pathology, Boston Children's Hospital, Boston, MA
| | - Cindy L Kerr
- Division of Vascular and Interventional Radiology, Boston Children's Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Wibke Uller
- Division of Vascular and Interventional Radiology, Boston Children's Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Scott L Davis
- Division of Vascular and Interventional Radiology, Boston Children's Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Gulraiz Chaudry
- Division of Vascular and Interventional Radiology, Boston Children's Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Marilyn G Liang
- Harvard Medical School, Boston, MA; Division of Dermatology, Boston Children's Hospital, Boston, MA
| | - Darren B Orbach
- Division of Vascular and Interventional Radiology, Boston Children's Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - John B Mulliken
- Harvard Medical School, Boston, MA; Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA
| | - Arin K Greene
- Harvard Medical School, Boston, MA; Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA
| | - Salim Afshar
- Harvard Medical School, Boston, MA; Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA
| | - Steven J Fishman
- Harvard Medical School, Boston, MA; Department of Surgery, Boston Children's Hospital, Boston, MA
| | - Amir H Taghinia
- Harvard Medical School, Boston, MA; Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA
| | - Alya Al-Ibraheemi
- Harvard Medical School, Boston, MA; Department of Pathology, Boston Children's Hospital, Boston, MA
| | - Ahmad I Alomari
- Division of Vascular and Interventional Radiology, Boston Children's Hospital, Boston, MA; Harvard Medical School, Boston, MA
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Höhn F, Hammer S, Fellner C, Zeman F, Uller W, Brill R, Guntau M, Wildgruber M, Wohlgemuth WA. 3T MRI of Peripheral Vascular Malformations: Characteristics and Comparison of Two Fat-Saturated sequences: Short Tau Inversion Recovery Versus Three-Dimensional High-Resolution Volume Interpolated Gradient Recalled Echo. ROFO-FORTSCHR RONTG 2020; 193:446-458. [PMID: 33003248 DOI: 10.1055/a-1253-8422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE To assess morphological and hemodynamic characteristics of peripheral vascular malformations on 3 T magnetic resonance imaging (MRI) including qualitative comparison of two fat-saturated sequences: short tau inversion recovery (STIR) and three-dimensional high-resolution volume interpolated gradient recalled echo (GRE). MATERIALS AND METHODS During 9 months, 100 patients with suspected or known vascular malformations were prospectively assessed on a 3 T scanner using T2-weighted STIR and turbo spin echo (TSE), T1-weighted TSE, time-resolved contrast-enhanced magnetic resonance angiography (MRA) with interleaved stochastic trajectories (TWIST) and T1-weighted volume interpolated breath-hold examination (VIBE) after contrast enhancement. The analysis included signal behavior and morphologic and hemodynamic characteristics. Additionally, the image quality of the fat-saturated sequences was evaluated by 2 radiologists. RESULTS 86 patients (14 dropouts; 57 female, 29 male; mean age 26.8 years, age range 1-56) were analyzed. 22 had high-flow and 64 low-flow malformations, including 14 with a lymphatic component. In 21 of 22 patients with high-flow malformations, typical characteristics (flow voids, hyperdynamic arteriovenous fistula, dilated main/feeder-arteries and draining veins) were documented. Patients with low-flow malformations had phleboliths in 35 cases, fluid-fluid levels in 47 and dilated draining veins in 23. Lymphatic malformations showed peripheral contrast enhancement of cyst walls in the volume interpolated GRE. The comparison of fat-saturated sequences showed significantly better results of the volume interpolated GRE in all categories except the presence of artifacts which were significantly reduced in the STIR (p < 0.05). CONCLUSION 3 T MRI with MRA provides detailed morphological and hemodynamic information of different types of peripheral vascular malformations. Contrast-enhanced high-resolution volume interpolated GRE proved superior to STIR in differentiating morphologic features and to be diagnostic in the differentiation of lymphatic parts and joint involvement. KEY POINTS · 3 T MRI with MRA offers detailed information about vascular malformations.. · Fat-saturated MRI provides especially information about morphological characteristics, extent and tissue involvement.. · Volume interpolated GRE proved superior in almost all categories compared to STIR.. · Volume interpolated GRE showed more artifacts.. · Volume interpolated GRE additionally allows differentiation of lymphatic parts and evaluation of joint involvement.. CITATION FORMAT · Höhn F, Hammer S, Fellner C et al. 3T MRI of Peripheral Vascular Malformations: Characteristics and Comparison of Two Fat-Saturated sequences: Short Tau Inversion Recovery Versus Three-Dimensional High-Resolution Volume Interpolated Gradient Recalled Echo. Fortschr Röntgenstr 2021; 193: 446 - 458.
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Affiliation(s)
- Florentine Höhn
- Clinic and Policlinic of Nuclear Medicine, University Hospital Würzburg, Germany
| | - Simone Hammer
- Department of Radiology, University Hospital Regensburg, Germany
| | - Claudia Fellner
- Department of Radiology, University Hospital Regensburg, Germany
| | - Florian Zeman
- Centre for Clinical Studies, University Hospital Regensburg, Germany
| | - Wibke Uller
- Department of Radiology, University Hospital Regensburg, Germany
| | - Richard Brill
- University Clinic and Policlinic of Radiology, Martin Luther University Hospital Halle-Wittenberg, Halle (Saale), Germany
| | - Moritz Guntau
- University Clinic and Policlinic of Radiology, Martin Luther University Hospital Halle-Wittenberg, Halle (Saale), Germany
| | - Moritz Wildgruber
- Department of Clinical Radiology, University Hospital Münster, Germany
| | - Walter A Wohlgemuth
- University Clinic and Policlinic of Radiology, Martin Luther University Hospital Halle-Wittenberg, Halle (Saale), Germany
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Huf VI, Fellner C, Wohlgemuth WA, Stroszczynski C, Schmidt M, Forman C, Wetzl J, Uller W. Fast TWIST with iterative reconstruction improves diagnostic accuracy of AVM of the hand. Sci Rep 2020; 10:16355. [PMID: 33004952 PMCID: PMC7529883 DOI: 10.1038/s41598-020-73331-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 09/14/2020] [Indexed: 11/08/2022] Open
Abstract
Very high temporal and spatial resolution is mandatory for the diagnosis of arteriovenous malformations (AVM) of the hand. Until now, magnetic resonance imaging (MRI) has not fulfilled both requirements simultaneously. This study presents how the combination of a very fast TWIST MRI (time-resolved angiography with interleaved stochastic trajectories) sequence and iterative reconstructions optimizes temporal as well as spatial resolution. 11 patients were examined at a 3-T MRI scanner with two different TWIST protocols: the standard and the study protocol, acquiring a data set every 5.57 s and 1.44 s respectively. The study data was retrospectively iteratively reconstructed with different regularization factors (0.001, 0.002, 0.004, 0.008). Results were compared using the sign-test. P-values < 0.05 were regarded statistically significant. With a low amount of contrast medium, the temporal resolution of the study protocol enabled the differentiation of arteries from veins in all patients whereas the signal-to-noise ratio (SNR) deteriorated. Depending on the regularization factors, SNR, delineation of arterial feeders and non-involved hand and interdigital arteries, as well as artefact levels varied. Overall, iterative reconstruction with regularization factor 0.004 achieved the best results, consequently showing the ability of MRI as a reliable diagnostic method in AVMs of the hand.
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Affiliation(s)
- Veronika I Huf
- Department of Radiology, University Medical Center Regensburg, 93042, Regensburg, Germany.
| | - Claudia Fellner
- Department of Radiology, University Medical Center Regensburg, 93042, Regensburg, Germany
| | - Walter A Wohlgemuth
- Interdisciplinary Center for Vascular Anomalies, University Clinic and Polyclinic of Radiology, University Hospital Halle, 06120, Halle (Saale), Germany
| | | | | | | | - Jens Wetzl
- Siemens Healthcare, 91052, Erlangen, Germany
| | - Wibke Uller
- Department of Radiology, University Medical Center Regensburg, 93042, Regensburg, Germany
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Seebauer CT, Kuehnel T, Uller W, Bohr C, Andorfer KE. [Diagnostic Criteria and Treatment of Hereditary Hemorrhagic Telangiectasia]. Laryngorhinootologie 2020; 99:682-693. [PMID: 32987413 DOI: 10.1055/a-1220-7045] [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: 10/23/2022]
Abstract
Hereditary hemorrhagic telangiectasia (HHT; Osler-Weber-Rendu syndrome; Morbus Osler) represents a syndrome affecting capillary vessels, leading to arteriovenous shunting. With an average worldwide prevalence of 1:5.000-8.000 HHT is considered an orphan disease. Arteriovenous shunts involve predominantly the nasal mucosa, the intestine, lung, liver and central nervous system. Epistaxis is the primary and most bothersome complaint of patients with HHT. A multistage therapeutic concept includes nasal ointment, laser therapy under local anesthesia and surgery under general anesthesia, as well as drug therapies. In addition, screening to determine affection of internal organs is carried out. Lesions that require therapy should be treated in an interdisciplinary setting. Treatment of lesions of the skin, oral and gastrointestinal mucosa and liver is carried out in regard to patients' symptoms, whereas vascular malformations of the lung and brain might need treatment without being symptomatic, due to possible life-threatening complications.
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Affiliation(s)
| | | | - Wibke Uller
- Institut für Röntgendiagnostik, Universitätsklinik Regensburg, Germany
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Huf VI, Wohlgemuth WA, Uller W, Piehler AP, Goessmann H, Stroszczynski C, Jung EM. Contrast-enhanced ultrasound with perfusion analysis in patients with venous malformations before and after percutaneous treatment with ethanol-gel. Clin Hemorheol Microcirc 2020; 76:161-170. [PMID: 32925019 DOI: 10.3233/ch-209215] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Percutaneous sclerotherapy is a well-established treatment option for venous malformations (VM). A recently established sclerosing agent is ethanol-gel. Aim of this study was to identify, if contrast-enhanced ultrasound (CEUS) with an integrated perfusion analysis allows for differentiation between untreated VM, healthy tissue, and with gelified ethanol treated malformation tissue. MATERIAL AND METHODS In this institutional review board approved prospective study symptomatic VM patients underwent CEUS at exactly the same position before and after sclerotherapy with ethanol-gel. Two experienced sonographers performed all examinations after the bolus injection of microbubbles using a multi-frequency probe with 6 -9 MHz of a high-end ultrasound machine. An integrated perfusion analysis was applied in the center of the VM and in healthy, surrounding tissue. For both regions peak enhancement (peak), time to peak (TTP), area under the curve (AUC), and mean transit time (MTT) were evaluated. Wilcoxon signed rank test was executed; p-values <0.05 were regarded statistically significant. RESULTS In 23 patients including children (mean age 25.3 years, 19 females) before treatment all identified parameters were significantly higher in the VM center compared to healthy tissue (peak: p < 0.01; TTP: p < 0.01; AUC: p < 0.01; MTT: p < 0.01). Comparing the VM center before and after treatment, TTP (p < 0.02) and MTT (p < 0.01) reduced significantly after sclerotherapy. In surrounding tissue only peak changed after treatment in comparison to pre-treatment results (p = 0.04). Comparing data in the VM center with surrounding tissue after sclerotherapy, results still differed significantly for peak (p < 0.01), TTP (p < 0.01), and AUC (p < 0.01), but assimilated for MTT (p = 0.07). CONCLUSION All with CEUS identified parameters seem to be excellent tools for differentiating between VM and healthy tissue. TTP and MTT could distinguish between with ethanol-gel sclerotized VM portions and untreated malformation parts and thereby might assist the monitoring of sclerotherapy with ethanol-gel.
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Affiliation(s)
- V I Huf
- Department of Radiology, University Medical Center Regensburg, Regensburg, Germany
| | - W A Wohlgemuth
- Interdisciplinary Center for Vascular Anomalies, University Clinic and Polyclinic of Radiology, University Hospital Halle, Halle (Saale), Germany
| | - W Uller
- Department of Radiology, University Medical Center Regensburg, Regensburg, Germany
| | - A P Piehler
- OnkoMedeor, MVZ Freising Laboratory, Freising, Germany
| | - H Goessmann
- Department of Radiology, University Medical Center Regensburg, Regensburg, Germany
| | - C Stroszczynski
- Department of Radiology, University Medical Center Regensburg, Regensburg, Germany
| | - E M Jung
- Department of Radiology, University Medical Center Regensburg, Regensburg, Germany
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Platz Batista da Silva N, Jung EM, Uller W. Kontrastmittelultraschall (CEUS) zur Erfolgskontrolle nach translumbaler Embolisation von komplizierten Typ-II-Endolecks nach endovaskulärer Aortenaneurysmarekonstruktion (EVAR). ROFO-FORTSCHR RONTG 2020; 193:77-80. [PMID: 32516827 DOI: 10.1055/a-1172-6516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
| | | | - Wibke Uller
- Department of Radiology, University Hospital Regensburg, Germany
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Wiesner S, Uller W, Hofmann HS, Ried M. Complicated chylous pericardial and thoracic effusion as the first clinical manifestation of thoracic lymphatic malformation. Interact Cardiovasc Thorac Surg 2020; 30:654-655. [PMID: 31886872 DOI: 10.1093/icvts/ivz301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 11/11/2019] [Accepted: 11/17/2019] [Indexed: 11/14/2022] Open
Abstract
Lymphatic malformations are benign focal proliferations of lymphatic vessels with a congenital origin. We present a case of an 18-year-old patient with post-traumatic chylopericardium and recurrent left-sided chylothorax, who was unresponsive to a variety of therapeutic measures until he was diagnosed with a complicated thoracic lymphatic malformation.
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Affiliation(s)
- Sigrid Wiesner
- Department of Thoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Wibke Uller
- Department of Radiology, University Medical Center Regensburg, Regensburg, Germany
| | - Hans-Stefan Hofmann
- Department of Thoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Michael Ried
- Department of Thoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
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35
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Teusch VI, Uller W, Manger F, Vill K, Piehler AP, Müller-Wille R, Goessman H, Hammer S, Wohlgemuth WA. Do patients clinically diagnosed with vascular malformations of 1 lower extremity benefit from imaging of both legs from pelvis to toe? A prospective MRI study. J Am Acad Dermatol 2020; 82:981-984. [DOI: 10.1016/j.jaad.2019.06.1305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 06/07/2019] [Accepted: 06/21/2019] [Indexed: 11/28/2022]
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Brill R, Brill E, Uller W, Teusch V, Gufler H, Hammer S, Fellner C, Evert K, Goldann C, Helm M, Rosendahl J, Wohlgemuth WA. Author Correction: Rectosigmoidal manifestations of venous malformations: MR imaging findings and interdisciplinary therapeutic modalities. Sci Rep 2020; 10:2458. [PMID: 32034240 PMCID: PMC7005778 DOI: 10.1038/s41598-020-59025-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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
An amendment to this paper has been published and can be accessed via a link at the top of the paper.
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Affiliation(s)
- Richard Brill
- Universitätsklinikum Halle (Saale), Martin-Luther-Universität Halle-Wittenberg, Department of Radiology and Policlinic of Radiology, Ernst-Grube-Straße 40, D-06120, Halle (Saale), Germany.
| | - Eva Brill
- Familienpraxis im Hof, Department of General Medicine, Innere Neumarkter Str. 2a, D-84453, Mühldorf, Germany
| | - Wibke Uller
- Universitätsklinikum Regensburg, Universität Regensburg, Department of Radiology, Franz-Josef-Strauß-Allee 11, D-93053, Regensburg, Germany
| | - Veronika Teusch
- Universitätsklinikum Regensburg, Universität Regensburg, Department of Radiology, Franz-Josef-Strauß-Allee 11, D-93053, Regensburg, Germany
| | - Hubert Gufler
- Universitätsklinikum Halle (Saale), Martin-Luther-Universität Halle-Wittenberg, Department of Radiology and Policlinic of Radiology, Ernst-Grube-Straße 40, D-06120, Halle (Saale), Germany
| | - Simone Hammer
- Universitätsklinikum Regensburg, Universität Regensburg, Department of Radiology, Franz-Josef-Strauß-Allee 11, D-93053, Regensburg, Germany
| | - Claudia Fellner
- Universitätsklinikum Regensburg, Universität Regensburg, Department of Radiology, Franz-Josef-Strauß-Allee 11, D-93053, Regensburg, Germany
| | - Katja Evert
- Universitätsklinikum Regensburg, Universität Regensburg, Department of Pathology, Franz-Josef-Strauß-Allee 11, D-93053, Regensburg, Germany
| | - Constantin Goldann
- Universitätsklinikum Halle (Saale), Martin-Luther-Universität Halle-Wittenberg, Department of Radiology and Policlinic of Radiology, Ernst-Grube-Straße 40, D-06120, Halle (Saale), Germany
| | - Maximilian Helm
- Universitätsklinikum Halle (Saale), Martin-Luther-Universität Halle-Wittenberg, Department of Radiology and Policlinic of Radiology, Ernst-Grube-Straße 40, D-06120, Halle (Saale), Germany
| | - Jonas Rosendahl
- Universitätsklinikum Halle (Saale), Martin-Luther-Universität Halle-Wittenberg, Department of Gastroenterology, Ernst-Grube-Straße 40, D-06120, Halle (Saale), Germany
| | - Walter A Wohlgemuth
- Universitätsklinikum Halle (Saale), Martin-Luther-Universität Halle-Wittenberg, Department of Radiology and Policlinic of Radiology, Ernst-Grube-Straße 40, D-06120, Halle (Saale), Germany
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Pfister K, Kasprzak P, Oikonomou K, Apfelbeck H, Derwich W, Uller W, Stehr A, Schierling W. [Management of Visceral Artery Aneurysms with Preservation of Organ Perfusion: More Than Twenty Years Experience]. Zentralbl Chir 2018; 143:516-525. [PMID: 30357795 DOI: 10.1055/a-0750-6016] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Visceral artery aneurysms (VAA) are rare and often incidental findings. Indications for treatment are symptomatic patients, pseudoaneurysms and a true aneurysm of diameter of ≥ 2.5 cm for mesenteric arteries and ≥ 3 cm for renal artery aneurysms. Pregnancy and liver transplantation play an important role in aneurysm rupture. Technical success after open or endovascular procedure and maintenance of organ perfusion are crucial. The aim of this review is to evaluate our data and experience of more than 20 years and to develop a strategy to deal with visceral artery aneurysm in elective and emergency cases. PATIENTS Between 1995 and 2018, 179 patients (84 males, 95 females, median age 62 [18 - 87] years) were diagnosed with VAA at the Regensburg University Hospital. The site of aneurysm was the splenic artery in 113 (63%) patients (pts), hepatic and renal arteries in 22 and 21 pts (12% each), and gastropancreaticoduodenal artery in 14 (8%) and superior/inferior mesenteric artery in 9 (5%) cases. Surveillance without intervention occurred in 110 (62%) pts, and 34 (19%) pts underwent open and 35 (19%) endovascular repair. In all patients, preoperative imaging was performed, preferably by computed tomography angiography (CTA). RESULTS A total of 69 patients underwent open or endovascular repair. 51 (74%) pts were treated electively, 18 (26%) pts presented urgently with acute bleeding. 16 emergency pts received endovascular treatment, and in 2 pts open surgery was performed. After emergency treatment, two pts exhibited segmental liver malperfusion without consequences. In one case, segmental bowel resection was necessary. 32/51 (63%) patients were treated electively by open surgery, 19/51 (37%) by endovascular procedures. There were no liver or bowel infarctions. Four splenectomies and one unilateral nephrectomy were necessary in patients with splenic or renal artery aneurysms. Moreover, three partial renal infarctions were noticed postoperatively (overall 8/21 [38%]). After endovascular repair of splenic or renal artery aneurysms, two cases of splenic and three cases of renal segmental infarction were observed. Splenectomy had to be performed twice (overall 7/14 [50%]). Organ perfusion was monitored by CTA, and preferentially by contrast enhanced ultrasound. CONCLUSION The endovascular approach is the preferred option in an emergency to control bleeding in pseudoaneurysms. Patients for elective splenic or renal artery aneurysm repair have to be evaluated very carefully to achieve technical success with occlusion of the aneurysm and excellent organ perfusion. Imaging techniques such as ultrasound, especially CEUS, are strongly recommended in postoperative follow-up. Partial or complete splenic infarction leads to vaccination.
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Affiliation(s)
- Karin Pfister
- Abteilung für Gefäßchirurgie, Universitätsklinikum Regensburg, Deutschland
| | - Piotr Kasprzak
- Abteilung für Gefäßchirurgie, Universitätsklinikum Regensburg, Deutschland
| | - Kyriakos Oikonomou
- Abteilung für Gefäßchirurgie, Universitätsklinikum Regensburg, Deutschland
| | - Hanna Apfelbeck
- Abteilung für Gefäßchirurgie, Universitätsklinikum Regensburg, Deutschland
| | | | - Wibke Uller
- Institut für Röntgendiagnostik, Universitätsklinikum Regensburg, Deutschland
| | - Alexander Stehr
- Klinik für Gefäßchirurgie, Evangelisches Krankenhaus Mülheim an der Ruhr, Deutschland
| | - Wilma Schierling
- Abteilung für Gefäßchirurgie, Universitätsklinikum Regensburg, Deutschland
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Ranieri M, Wohlgemuth W, Müller-Wille R, Prantl L, Kehrer A, Geis S, Klein S, Lamby P, Schiltz D, Uller W, Aung T, Dolderer JH. Vascular malformations of upper and lower extremity - from radiological interventional therapy to surgical soft tissue reconstruction - an interdisciplinary treatment. Clin Hemorheol Microcirc 2018; 67:355-372. [PMID: 28885203 DOI: 10.3233/ch-179216] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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: 01/21/2023]
Abstract
This article presents our experience in managing peripheral vascular malformations of upper and lower extremities over a 4-year period in a series of 46 patients of the Department of Plastic Surgery treated in the Interdisciplinary Center of Vascular Anomalies (ICVA) at the University of Regensburg. The patients presented vascular malformations of upper and lower extremity and were selected from our prospective vascular anomalies file archive from 2012 to 2016. During this period in the ICVA at University of Regensburg were performed more than 1400 radiological interventional treatments in patients with vascular malformations.The purpose of this retrospective study was to review combined embolotherapy, sclerotherapy (embolo/sclerotherapy), and surgical procedures (surgical excision and soft tissue reconstruction) to manage vascular malformations. Treatments were principally induced to reduce pain, daily physical limitations, social discomfort and recover tegument continuity after ulceration.The 46 patients were first examined with noninvasive radiological procedures. After diagnosis was posed, embolo/sclerotherapy, surgical procedures and clinically as well as radiological follow-ups were coordinated and established by the multidisciplinary team. All vascular malformations were categorized according to the classification approved at the April 2014 General Assembly of International Society for the Study of Vascular Anomalies (ISSVA) in Melbourne, Australia. Arteriovenous malformations (AVMs) were further classified following the Cho-Do and Schobinger classification.Embolo/sclerotherapy shows to be the most appropriate procedure in vascular malformations treatment. Nevertheless was found that in case of complications or lack of improvement as well as to improve functional or aesthetical results, a following partial or complete surgical excision and immediate soft tissue reconstruction seems to be the gold-standard treatment. In addition, the precise clinical and radiological diagnosis as well as an intensive postoperative patient care have a significant positive influence on the clinical outcome and patient satisfaction while decreasing morbidity and recurrence during early and late follow-up.Vascular malformations require a multidisciplinary approach and individual treatment after complex excision and indispensable reconstruction.
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Affiliation(s)
- M Ranieri
- Center of Plastic, Hand and reconstructive Surgery, University Hospital Regensburg, Germany
| | - W Wohlgemuth
- Department of Radiology, University Hospital Regensburg, Germany.,Institute of Radiology, University Hospital Halle, Germany
| | - R Müller-Wille
- Institute for Diagnostic and Interventional Radiology, University Medical Center Göttingen, Germany
| | - L Prantl
- Center of Plastic, Hand and reconstructive Surgery, University Hospital Regensburg, Germany
| | - A Kehrer
- Center of Plastic, Hand and reconstructive Surgery, University Hospital Regensburg, Germany
| | - S Geis
- Center of Plastic, Hand and reconstructive Surgery, University Hospital Regensburg, Germany
| | - S Klein
- Center of Plastic, Hand and reconstructive Surgery, University Hospital Regensburg, Germany
| | - P Lamby
- Center of Plastic, Hand and reconstructive Surgery, University Hospital Regensburg, Germany
| | - D Schiltz
- Center of Plastic, Hand and reconstructive Surgery, University Hospital Regensburg, Germany
| | - W Uller
- Department of Radiology, University Hospital Regensburg, Germany
| | - T Aung
- Center of Plastic, Hand and reconstructive Surgery, University Hospital Regensburg, Germany
| | - J H Dolderer
- Center of Plastic, Hand and reconstructive Surgery, University Hospital Regensburg, Germany
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Uller W, El-sobky S, Alomari AI, Fishman SJ, Spencer SA, Taghinia AH, Chaudry G. Preoperative Embolization of Venous Malformations Using n-Butyl Cyanoacrylate. Vasc Endovascular Surg 2018; 52:269-274. [DOI: 10.1177/1538574418762192] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: The purpose of this study was to evaluate the safety and efficacy of preoperative percutaneous n-butyl cyanoacrylate (nBCA) embolization of venous malformations in children. Material and Methods: Clinical data were retrospectively reviewed in children who underwent embolization using nBCA followed by resection of venous malformations. Results: A total of 17 embolizations were performed in 14 patients (9 females, mean age: 5.5 years; median age: 3 years; range 0.1-16 years). The venous malformations involved the lower extremity and the knee joint (n = 7), the trunk (n = 4), head and neck (n = 2), and hand (n = 1). n-Butyl cyanoacrylate was diluted with iodized oil at a ratio of 1:3 to 1:5. The mean and median volume of nBCA per procedure were 2.1 and 2 mL, respectively (range: 0.5-8 mL). There were no complications associated with the procedures. The mean and median time between final embolization and resection were 3.6 and 2 days, respectively. All children underwent successful resection of the symptomatic lesions. The estimated mean and median blood loss were 75 and 50 mL, respectively (range: 5-350 mL). The postprocedure course was uneventful, the days to discharge ranged between 1 and 6 days (mean 3 days). Conclusion: Initial results suggest that preoperative percutaneous n-butyl cyanoacrylate embolization of venous malformations is safe and effective in children, with the potential for minimizing blood loss and inpatient stay.
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Affiliation(s)
- Wibke Uller
- Vascular Anomalies Center, Boston Children’s Hospital and Harvard Medical School, Boston, MA, USA
- Division of Vascular and Interventional Radiology, Boston Children’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Sherif El-sobky
- Vascular Anomalies Center, Boston Children’s Hospital and Harvard Medical School, Boston, MA, USA
- Division of Vascular and Interventional Radiology, Boston Children’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Ahmad I. Alomari
- Vascular Anomalies Center, Boston Children’s Hospital and Harvard Medical School, Boston, MA, USA
- Division of Vascular and Interventional Radiology, Boston Children’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Steven J. Fishman
- Vascular Anomalies Center, Boston Children’s Hospital and Harvard Medical School, Boston, MA, USA
- Department of Surgery, Boston Children’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Samantha A. Spencer
- Vascular Anomalies Center, Boston Children’s Hospital and Harvard Medical School, Boston, MA, USA
- Department of Orthopaedics, Boston Children’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Amir H. Taghinia
- Vascular Anomalies Center, Boston Children’s Hospital and Harvard Medical School, Boston, MA, USA
- Department of Plastic Surgery, Boston Children’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Gulraiz Chaudry
- Vascular Anomalies Center, Boston Children’s Hospital and Harvard Medical School, Boston, MA, USA
- Division of Vascular and Interventional Radiology, Boston Children’s Hospital and Harvard Medical School, Boston, MA, USA
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Wildgruber M, Köhler M, Brill R, Goessmann H, Uller W, Müller-Wille R, Wohlgemuth WA. Impact of low dose settings on radiation exposure during pediatric fluoroscopic guided interventions. Eur J Radiol 2018; 100:1-6. [PMID: 29496066 DOI: 10.1016/j.ejrad.2018.01.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 12/08/2017] [Accepted: 01/08/2018] [Indexed: 10/18/2022]
Abstract
PURPOSE To evaluate the effects of lowering the detector entrance exposure in children undergoing interventional radiology procedures. MATERIALS AND METHODS The study retrospectively investigated radiation dose levels in pediatric patients aged 0-18 years before (n = 39) and after (n = 26) lowering detector entrance dose, undergoing embolization of peripheral Arteriovenous malformations, Portal Vein Interventions or Percutaneous Transhepatic Cholangio Drainage (PTCD) between 2014 and 2017. Patient characteristics, fluoroscopy time, protocols used as well as resulting Skin Dose and Dose Area Product (DAP) were compared in each cohort. Image quality was assessed by two independent readers. RESULTS The two patient cohorts did not differ in terms of patient demographics. Similarly, fluoroscopy time did not differ before and after implementation of the low dose settings. An overall reduction of skin dose of 75.1% for AVM embolizations, 80.5% for Portal Vein Interventions and 85.3% for PTCD placement was observed. The DAP decrease was 82.5% for AVM embolizations, 72.2% for Portal Vein Interventions and 79.8% for PTCD placement. Image quality was generally considered to be good with an insignificant difference between pre and post implementation of the low dose approach and good agreement between the two readers. Manual inroom-switching to higher dose levels was possible, however this was not performed more frequently after implementation of the low dose settings. CONCLUSION Lowering the detector entrance dose in pediatric interventional radiology procedures results in a significant decrease of the radiation dose burden.
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Affiliation(s)
- Moritz Wildgruber
- Institut für Röntgendiagnostik, Universitätsklinikum Regensburg, Franz-Josef-Strauss-Allee 11, Regensburg, D-93053, Germany; Institut für Klinische Radiologie, Westfälische Wilhelms-Universität Münster, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, Münster, D-48149, Germany.
| | - Michael Köhler
- Institut für Klinische Radiologie, Westfälische Wilhelms-Universität Münster, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, Münster, D-48149, Germany
| | - Richard Brill
- Universitätsklinik und Poliklinik für Radiologie, Universitätsklinikum Halle, Ernst-Grube-Str 40, Halle, D-06120, Germany
| | - Holger Goessmann
- Institut für Röntgendiagnostik, Universitätsklinikum Regensburg, Franz-Josef-Strauss-Allee 11, Regensburg, D-93053, Germany
| | - Wibke Uller
- Institut für Röntgendiagnostik, Universitätsklinikum Regensburg, Franz-Josef-Strauss-Allee 11, Regensburg, D-93053, Germany
| | - René Müller-Wille
- Institut für Röntgendiagnostik, Universitätsklinikum Regensburg, Franz-Josef-Strauss-Allee 11, Regensburg, D-93053, Germany; Institut für diagnostische und interventionelle Radiologie, Universitätsmedizin Göttingen, Robert-Koch-Str 40, Göttingen, D-37075, Germany
| | - Walter A Wohlgemuth
- Institut für Röntgendiagnostik, Universitätsklinikum Regensburg, Franz-Josef-Strauss-Allee 11, Regensburg, D-93053, Germany; Universitätsklinik und Poliklinik für Radiologie, Universitätsklinikum Halle, Ernst-Grube-Str 40, Halle, D-06120, Germany
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Teusch V, Piehler A, Uller W, Müller-Wille R, Prantl L, Stroszczynski C, Wohlgemuth W, Jung E. Value of different ultrasound elastography techniques in patients with venous malformations prior to and after sclerotherapy. Clin Hemorheol Microcirc 2017; 66:347-355. [DOI: 10.3233/ch-179106] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- V.I. Teusch
- Department of Radiology, University Medical Center Regensburg, Regensburg, Germany
- Department of Radiology, Klinikum Schwabing, Städtisches Klinikum München, Munich, Germany
| | - A.P. Piehler
- Bioscientia Institute for Medical Diagnostics GmbH, Karlsfeld, Germany
| | - W. Uller
- Department of Radiology, University Medical Center Regensburg, Regensburg, Germany
| | - R. Müller-Wille
- Department of Radiology, University Medical Center Regensburg, Regensburg, Germany
| | - L. Prantl
- Department of Plastic, Hand and Reconstructive Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - C. Stroszczynski
- Department of Radiology, University Medical Center Regensburg, Regensburg, Germany
| | - W.A. Wohlgemuth
- Department of Radiology, University Medical Center Regensburg, Regensburg, Germany
| | - E.M. Jung
- Department of Radiology, University Medical Center Regensburg, Regensburg, Germany
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Goessmann H, Uller W, Bayer L, Teusch V, Poschenrieder F, Dendl L, Stroszczynski C, Schreyer A. Klinischer Stellenwert einer postinterventionellen Kontrastdarstellung von CT-gesteuerten Drainageanlagen. ROFO-FORTSCHR RONTG 2017. [DOI: 10.1055/s-0037-1600270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- H Goessmann
- Universitaetsklinikum Regensburg, Institut fuer Roentgendiagnostik, Regensburg
| | - W Uller
- Universitaetsklinikum Regensburg, Institut fuer Roentgendiagnostik, Regensburg
| | - L Bayer
- Universitaetsklinikum Regensburg, Institut fuer Roentgendiagnostik, Regensburg
| | - V Teusch
- Universitaetsklinikum Regensburg, Institut fuer Roentgendiagnostik, Regensburg
| | - F Poschenrieder
- Universitaetsklinikum Regensburg, Institut fuer Roentgendiagnostik, Regensburg
| | - L Dendl
- Universitaetsklinikum Regensburg, Institut fuer Roentgendiagnostik, Regensburg
| | - C Stroszczynski
- Universitaetsklinikum Regensburg, Institut fuer Roentgendiagnostik, Regensburg
| | - A Schreyer
- Universitaetsklinikum Regensburg, Institut fuer Roentgendiagnostik, Regensburg
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Wildgruber M, Müller-Wille R, Goessmann H, Uller W, Wohlgemuth W. Bestimmung von effektiver Dosis in Fluoroskopie-gesteuerten pädiatrischen abdominalen Interventionen mittels Rando-Alderson Phantomen. ROFO-FORTSCHR RONTG 2017. [DOI: 10.1055/s-0037-1600318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- M Wildgruber
- Universitätsklinikum Münster, Institut für Klinische Radiologie, Münster
| | - R Müller-Wille
- Institut für Rötngendiagnostik, Universitäsklinikum Regensburg, Regensburg
| | - H Goessmann
- Institut für Rötngendiagnostik, Universitätsklinikum Regensburg, Regensburg
| | - W Uller
- Institut für Röntgendiagnostik, Universitätsklinikum Regensburg, Regensburg
| | - W Wohlgemuth
- Institut für Röntgendiagnostik, Universitätsklinikum Regensburg, Regensburg
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Wildgruber M, Müller-Wille R, Goessmann H, Uller W, Wohlgemuth WA. Direct Effective Dose Calculations in Pediatric Fluoroscopy-Guided Abdominal Interventions with Rando-Alderson Phantoms - Optimization of Preset Parameter Settings. PLoS One 2016; 11:e0161806. [PMID: 27556584 PMCID: PMC4996450 DOI: 10.1371/journal.pone.0161806] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 08/14/2016] [Indexed: 11/24/2022] Open
Abstract
Objective The aim of the study was to calculate the effective dose during fluoroscopy-guided pediatric interventional procedures of the liver in a phantom model before and after adjustment of preset parameters. Methods Organ doses were measured in three anthropomorphic Rando-Alderson phantoms representing children at various age and body weight (newborn 3.5kg, toddler 10kg, child 19kg). Collimation was performed focusing on the upper abdomen representing mock interventional radiology procedures such as percutaneous transhepatic cholangiography and drainage placement (PTCD). Fluoroscopy and digital subtraction angiography (DSA) acquisitions were performed in a posterior-anterior geometry using a state of the art flat-panel detector. Effective dose was directly measured from multiple incorporated thermoluminescent dosimeters (TLDs) using two different parameter settings. Results Effective dose values for each pediatric phantom were below 0.1mSv per minute fluoroscopy, and below 1mSv for a 1 minute DSA acquisition with a frame rate of 2 f/s. Lowering the values for the detector entrance dose enabled a reduction of the applied effective dose from 12 to 27% for fluoroscopy and 22 to 63% for DSA acquisitions. Similarly, organ doses of radiosensitive organs could be reduced by over 50%, especially when close to the primary x-ray beam. Conclusion Modification of preset parameter settings enabled to decrease the effective dose for pediatric interventional procedures, as determined by effective dose calculations using dedicated pediatric Rando-Alderson phantoms.
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Affiliation(s)
- Moritz Wildgruber
- Institut für Röntgendiagnostik, Universitätsklinikum Regensburg, Regensburg, Germany
- Institut für klinische Radiologie, Westfälische Wilhelms-Universität Münster, Universitätsklinikum Münster, Münster, Germany
- * E-mail:
| | - René Müller-Wille
- Institut für Röntgendiagnostik, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Holger Goessmann
- Institut für Röntgendiagnostik, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Wibke Uller
- Institut für Röntgendiagnostik, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Walter A. Wohlgemuth
- Institut für Röntgendiagnostik, Universitätsklinikum Regensburg, Regensburg, Germany
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Ayx I, Goessmann H, Hubauer H, Uller W, Wiesinger I, Uhl C, Töpel I, Zorger N. Interventional Removal of Intravascular Medical Devices: Methods and Technical Success. ROFO-FORTSCHR RONTG 2016; 188:566-73. [PMID: 27093394 DOI: 10.1055/s-0042-104204] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE Evaluation of the technical success rate and complications when retrieving dislocated intravascular foreign bodies. MATERIAL AND METHODS Between 1999 and 2015 38 patients (21 female; 17 male; Age: 17 - 92; Average 54.3 years) underwent an extraction of intravascular dislocated foreign bodies, which were not lost during a radiological intervention. The extracted material included 29 port catheters, 3 tips of tunneled dialysis catheters, 2 stents, 2 guide wires, 1 CVC tip and 1 AS occluder device. Various catheters for repositioning and extraction were used. The access was transarterial as well as transvenous. Technical success was defined as complete removal of the foreign body. RESULTS The technical success rate was 92.1 % (35 of 38). In 17 patients an additional catheter was necessary to reposition the foreign body in order to make it accessible for the extraction catheter. In one case a stent was relocated and remodeled within the patient and was not extracted. In another case we experienced a dislocation of a small fragment of the port catheter into the distal parts of the pulmonary artery, which couldn't be extracted. A guide wire could not be extracted as it was already adhered with the vessel wall. Peri-interventional complications were not documented. CONCLUSION The percutaneous extraction of dislocated intravascular foreign bodies is technically successful and poor of complications. Interventional therapy can avoid surgical removal. KEY POINTS • The percutaneous extraction of dislocated intravascular foreign bodies is technically successful and safe.• In most cases surgical removal can be avoided.• The gooseneck-snare catheter was mainly used for the extraction of intravascular foreign bodies. Citation Format: • Ayx I, Goessmann H, Hubauer H et al. Interventional Removal of Intravascular Medical Devices: Methods and Technical Success. Fortschr Röntgenstr 2016; 188: 566 - 573.
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Affiliation(s)
- I Ayx
- Radiology, KH Barmherzige Brüder, Regensburg, Germany
| | - H Goessmann
- Radiology, University Hospital Regensburg, Germany
| | - H Hubauer
- Radiology, KH Barmherzige Brüder, Regensburg, Germany
| | - W Uller
- Radiology, University Hospital Regensburg, Germany
| | - I Wiesinger
- Radiology, University Hospital Regensburg, Germany
| | - C Uhl
- Vascular Surgery, KH Barmherzige Brüder, Regensburg, Germany
| | - I Töpel
- Vascular Surgery, KH Barmherzige Brüder, Regensburg, Germany
| | - N Zorger
- Vascular Surgery, KH Barmherzige Brüder, Regensburg, Germany
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Affiliation(s)
- Wibke Uller
- Division of Vascular and Interventional Radiology, Boston Children's Hospital and Harvard Medical School, 300 Longwood Ave, Boston, MA 02115
| | - Ahmad I Alomari
- Division of Vascular and Interventional Radiology, Boston Children's Hospital and Harvard Medical School, 300 Longwood Ave, Boston, MA 02115
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Luks VL, Kamitaki N, Vivero MP, Uller W, Rab R, Bovée JV, Rialon KL, Guevara CJ, Alomari AI, Greene AK, Fishman SJ, Kozakewich HP, Maclellan RA, Mulliken JB, Rahbar R, Spencer SA, Trenor CC, Upton J, Zurakowski D, Perkins JA, Kirsh A, Bennett JT, Dobyns WB, Kurek KC, Warman ML, McCarroll SA, Murillo R. Lymphatic and other vascular malformative/overgrowth disorders are caused by somatic mutations in PIK3CA. J Pediatr 2015; 166:1048-54.e1-5. [PMID: 25681199 PMCID: PMC4498659 DOI: 10.1016/j.jpeds.2014.12.069] [Citation(s) in RCA: 336] [Impact Index Per Article: 37.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 12/08/2014] [Accepted: 12/23/2014] [Indexed: 01/19/2023]
Abstract
OBJECTIVES To test the hypothesis that somatic phosphatidylinositol-4,5-bisphospate 3-kinase, catalytic subunit alpha (PIK3CA) mutations would be found in patients with more common disorders including isolated lymphatic malformation (LM) and Klippel-Trenaunay syndrome (KTS). STUDY DESIGN We used next generation sequencing, droplet digital polymerase chain reaction, and single molecule molecular inversion probes to search for somatic PIK3CA mutations in affected tissue from patients seen at Boston Children's Hospital who had an isolated LM (n = 17), KTS (n = 21), fibro-adipose vascular anomaly (n = 8), or congenital lipomatous overgrowth with vascular, epidermal, and skeletal anomalies syndrome (n = 33), the disorder for which we first identified somatic PIK3CA mutations. We also screened 5 of the more common PIK3CA mutations in a second cohort of patients with LM (n = 31) from Seattle Children's Hospital. RESULTS Most individuals from Boston Children's Hospital who had isolated LM (16/17) or LM as part of a syndrome, such as KTS (19/21), fibro-adipose vascular anomaly (5/8), and congenital lipomatous overgrowth with vascular, epidermal, and skeletal anomalies syndrome (31/33) were somatic mosaic for PIK3CA mutations, with 5 specific PIK3CA mutations accounting for ∼ 80% of cases. Seventy-four percent of patients with LM from Seattle Children's Hospital also were somatic mosaic for 1 of 5 specific PIK3CA mutations. Many affected tissue specimens from both cohorts contained fewer than 10% mutant cells. CONCLUSIONS Somatic PIK3CA mutations are the most common cause of isolated LMs and disorders in which LM is a component feature. Five PIK3CA mutations account for most cases. The search for causal mutations requires sampling of affected tissues and techniques that are capable of detecting low-level somatic mosaicism because the abundance of mutant cells in a malformed tissue can be low.
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Affiliation(s)
- Valerie L. Luks
- Vascular Anomalies Center, Boston Children’s Hospital, Boston, MA
| | - Nolan Kamitaki
- Department of Genetics, Harvard Medical School, Boston, MA
| | | | - Wibke Uller
- Vascular Anomalies Center, Boston Children’s Hospital, Boston, MA
| | - Rashed Rab
- Howard Hughes Medical Institute, Boston Children’s Hospital, Boston, MA
| | - Judith V.M.G. Bovée
- Department of Pathology, Leiden University Medical Center, Leiden, Netherlands
| | - Kristy L. Rialon
- Vascular Anomalies Center, Boston Children’s Hospital, Boston, MA
| | | | - Ahmad I. Alomari
- Vascular Anomalies Center, Boston Children’s Hospital, Boston, MA
| | - Arin K. Greene
- Vascular Anomalies Center, Boston Children’s Hospital, Boston, MA
| | | | | | | | - John B. Mulliken
- Vascular Anomalies Center, Boston Children’s Hospital, Boston, MA
| | - Reza Rahbar
- Vascular Anomalies Center, Boston Children’s Hospital, Boston, MA
| | | | | | - Joseph Upton
- Vascular Anomalies Center, Boston Children’s Hospital, Boston, MA
| | - David Zurakowski
- Vascular Anomalies Center, Boston Children’s Hospital, Boston, MA
| | | | - Andrew Kirsh
- Departments of Pediatrics and Surgery, University of Washington, Seattle WA
| | - James T Bennett
- Departments of Pediatrics and Surgery, University of Washington, Seattle WA
| | - William B Dobyns
- Departments of Pediatrics and Surgery, University of Washington, Seattle WA
| | - Kyle C. Kurek
- Vascular Anomalies Center, Boston Children’s Hospital, Boston, MA
| | - Matthew L. Warman
- Vascular Anomalies Center, Boston Children’s Hospital, Boston, MA,Department of Genetics, Harvard Medical School, Boston, MA,Howard Hughes Medical Institute, Boston Children’s Hospital, Boston, MA
| | | | - Rudy Murillo
- Vascular Anomalies Center, Boston Children's Hospital, Boston, MA.
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Wohlgemuth WA, Müller-Wille R, Teusch VI, Dudeck O, Cahill AM, Alomari AI, Uller W. The Retrograde Transvenous Push-Through Method: A Novel Treatment of Peripheral Arteriovenous Malformations with Dominant Venous Outflow. Cardiovasc Intervent Radiol 2015; 38:623-31. [DOI: 10.1007/s00270-015-1063-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 01/19/2015] [Indexed: 10/23/2022]
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Müller-Wille R, Schötz S, Zeman F, Uller W, Güntner O, Pfister K, Kasprzak P, Stroszczynski C, Wohlgemuth WA. CT features of early type II endoleaks after endovascular repair of abdominal aortic aneurysms help predict aneurysm sac enlargement. Radiology 2014; 274:906-16. [PMID: 25380455 DOI: 10.1148/radiol.14140284] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To determine computed tomographic (CT) features of early type II endoleaks associated with aneurysm sac enlargement after endovascular aortic aneurysm repair (EVAR) of abdominal aortic aneurysm. MATERIALS AND METHODS Institutional review board approval was not required for this retrospective study. The authors reviewed imaging and clinical data from 56 patients (seven women, 49 men; mean age ± standard deviation, 71 years ± 7.9; age range, 52-85 years) with early type II endoleak who had undergone EVAR between December 2002 and December 2011 and who had been followed up with imaging and clinical evaluation for at least 6 months. The number and diameter of all feeding and/or draining arteries were measured, and endoleaks were classified according to their sources into simple inferior mesenteric artery (IMA), simple lumbar artery (LA), complex LA, and complex IMA-LA type II endoleaks. Volume and attenuation of the nidus were measured. Aneurysm enlargement was defined as an increase in the aneurysm volume of more than 5% during follow-up. Simple and multivariate logistic regression analyses were performed to identify independent clinical and imaging variables associated with aneurysm enlargement. RESULTS Twenty-three of the 56 patients (41%) showed aneurysm sac enlargement during follow-up (mean follow-up, 3.0 years ± 2.0). With the multivariate model, the variables that showed the strongest indicators for aneurysm sac enlargement were complex IMA-LA type II endoleak (odds ratio [OR] = 10.29, P = .004) and the diameter of the largest feeding and/or draining artery (OR = 4.55, P = .013). Patients without complex IMA-LA type II endoleak in whom the largest feeding and/or draining artery was larger than 3.8 mm and patients with a complex IMA-LA type II endoleak in whom the largest feeding and/or draining artery was larger than 2.2 mm were at high risk for aneurysm sac enlargement. CONCLUSION The strongest indicators for aneurysm sac enlargement are complex IMA-LA type II endoleak and the diameter of the largest feeding and/or draining artery.
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Affiliation(s)
- René Müller-Wille
- From the Department of Radiology (R.M.W., S.S., W.U., O.G., C.S., W.A.W.), Center for Clinical Studies (F.Z.), and Department of Surgery (K.P., P.K.), University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
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