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Meram E, Hoffman C, Periyasamy S, Hetzel S, Kutlu AZ, Pieper AA, Laeseke PF. Quantification of Iliac Arterial Blood Velocity in Stenotic Phantom and Porcine Models Using Quantitative Digital Subtraction Angiography. J Vasc Interv Radiol 2023:S1051-0443(23)00907-7. [PMID: 38141780 DOI: 10.1016/j.jvir.2023.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 11/28/2023] [Accepted: 12/13/2023] [Indexed: 12/25/2023] Open
Abstract
PURPOSE To assess the feasibility of using quantitative digital subtraction angiography (qDSA) to quantify arterial velocity in phantom and porcine stenotic iliac artery models. MATERIALS AND METHODS Varying stenoses (mild, <50%; moderate, 50%-70%; and severe, >70%) were created in a silicone iliac artery phantom using vessel loops. Two-dimensional digital subtraction angiographies (DSAs) were performed, with velocities calculated using qDSA. qDSA velocities were compared with flow rates and velocities measured with an ultrasonic flow probe. Two-dimensional DSAs of the common and external iliac arteries were then performed in 4 swine (mean weight, 63 kg) before and after a severe stenosis (>70%) was created in the iliac artery using 3-0 silk suture. Peak systolic velocities on pulsed wave Doppler ultrasound (US) before and after stenosis creation were correlated with the qDSA velocities. Pearson correlation, linear regression, and analysis of variance were used for analysis. RESULTS In the phantom study, ultrasonic probe velocities positively correlated with downstream qDSA (r = 0.65; P < .001) and negatively correlated with peristenotic qDSA velocities (r = -0.80; P < .001). In the swine study, statistically significant reductions in external iliac arterial velocity were noted on US and qDSA after stenosis creation (P < .05). US and qDSA velocities strongly correlated for all flow states with both 50% and 100% contrast concentrations (r = 0.82 and r = 0.74, respectively), with an estimated US-to-qDSA ratio of 1.3-1.5 (P < .001). qDSA velocities with 50% and 100% contrast concentrations also strongly correlated (r = 0.78; P < .001). CONCLUSIONS In both phantom and swine stenosis models, changes in iliac arterial velocity could be quantified with qDSA, which strongly correlated with standard-of-care US.
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Affiliation(s)
- Ece Meram
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin.
| | - Carson Hoffman
- Department of Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin
| | - Sarvesh Periyasamy
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Scott Hetzel
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, Wisconsin
| | - Ayca Zeynep Kutlu
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Alexander A Pieper
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Paul F Laeseke
- Section of Interventional Radiology, Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin
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Badar W, Anitescu M, Ross B, Wallace S, Uy-Palmer R, Ahmed O. Quantifying Change in Perfusion after Genicular Artery Embolization with Parametric Analysis of Intraprocedural Digital Subtraction Angiograms. J Vasc Interv Radiol 2023; 34:2190-2196. [PMID: 37673399 DOI: 10.1016/j.jvir.2023.08.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 08/10/2023] [Accepted: 08/27/2023] [Indexed: 09/08/2023] Open
Abstract
PURPOSE To quantify perfusion changes during genicular artery embolization (GAE) with the qualitatively described "pruning" technique using parametric analysis. MATERIALS AND METHODS A total of 12 patients underwent unilateral GAE with a total of 36 vessels embolized. Among 34 of the 36 vessels embolized, regions of interest (ROIs) were placed on parent vessels (PVs) and hyperemic target vessels (TVs) before and after GAE. For each ROI, peak intensity (PI), time to arrival (TTA), and area under the curve (AUC) were computed and compared between PV and TV. Volume of embolic administered was correlated with adverse events. RESULTS No change was seen in PI, TTA, and AUC in the PV after GAE. Reduction in AUC (1,495.7 ± 521.5 vs 1,667.4 ± 574.0; P << .01) and PI (195.1 ± 43.8 vs 224.3 ± 49.2; P << .01) with increase in TTA (3.42 s ± 1.70 vs 1.92 s ± 1.45; P << .01) within the TV were observed after GAE. Median follow-up time was 89 days (range, 21-254 days). Reduction in clinical symptoms was also noted based on the Western-Ontario and McMaster Universities Arthritis Index total and pain scale at 1 month (total, 42.9% ± 23.0; pain, 54.4% ± 9.8; P << .01) and 3 months (total, 42.5% ± 14.9; pain, 57.8% ± 10.6; P << .01). Eight total mild adverse events (minor/self-limiting) were noted per Society of Interventional Radiology guidelines. A larger volume of embolic was observed in knees with skin changes (3.4 mL ± 0.4 vs 1.7 mL ± 0.4; P << .001). Furthermore, all skin changes were seen with embolic volumes >3.0 mL. CONCLUSIONS Quantification of intraprocedural perfusion changes with GAE demonstrated reduced flow to the TV with maintained flow in the PV and acceptable clinical outcomes. A potential relationship between embolic volume and nontarget embolization was also highlighted.
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Affiliation(s)
- Wali Badar
- Division of Interventional Radiology, Department of Radiology, University of Illinois Hospital and Health Sciences System, Chicago, Illinois. https://twitter.com/walsterIR
| | - Magdalena Anitescu
- Division of Pain Management, Department of Anesthesia and Critical Care, University of Chicago, Chicago, Illinois. https://twitter.com/MagdaAnitescuMD
| | - Brendon Ross
- Orthopedic Surgery and Rehabilitation Medicine, University of Chicago, Chicago, Illinois
| | - Sara Wallace
- Orthopedic Surgery and Rehabilitation Medicine, University of Chicago, Chicago, Illinois
| | - Rosemary Uy-Palmer
- Division of Interventional Radiology, Department of Radiology, University of Chicago, Chicago, Illinois
| | - Osman Ahmed
- Division of Interventional Radiology, Department of Radiology, University of Chicago, Chicago, Illinois.
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3
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Troisi N, Michelagnoli S, Panci S, Bacchi S, Incerti D, Lo Vecchio L, Dedola GL, Chisci E. Association of 2D Perfusion Angiography and Wound Healing Rate in Combined Femoro-popliteal and Below-the-Knee Lesions in Ischemic Patients Undergoing Isolated Femoro-popliteal Endovascular Revascularization. INT J LOW EXTR WOUND 2023; 22:459-465. [PMID: 34028304 DOI: 10.1177/15347346211020269] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim of this study was to demonstrate the association between 2-dimensional (2D) perfusion angiography and wound healing rate in patients with combined femoro-popliteal and below-the-knee lesions in critical limb-threatening ischemia (CLTI) and foot wounds undergoing isolated femoro-popliteal endovascular revascularization. Between January and June 2019, 24 patients with multilevel CLTI and foot wounds underwent isolated femoro-popliteal endovascular revascularization. In all of them, an assessment of foot perfusion by 2D perfusion angiography was performed. To evaluate the foot perfusion, a region of interest was identified, and time-density curves were calculated. Changes of the overall time-density curves were evaluated together with transcutaneous oximetry (TcPO2) using bivariate correlation (Pearson correlation coefficient) and associated with 6-month wound healing. The mean increase of time-density curves was 212.2% (range from +9.8% to +1984.9%) and the mean increase of TcPO2 was 116.4% (range from -4.7% to 485.7%). No significant association between time-density curves and TcPO2 values (Pearson correlation coefficient: -0.24) was observed (P = .3). At 6 months, wound healing occurred in 15 of 24 (62.5%) patients. In conclusion, this preliminary experience confirmed that 2D perfusion angiography associates with wound healing rate in CLTI patients with ischemic foot wounds and combined femoro-popliteal and below-the-knee lesions who are undergoing isolated femoro-popliteal endovascular revascularization. No association between time-density curves and TcPO2 values was observed.
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Affiliation(s)
- Nicola Troisi
- Vascular and Endovascular Surgery Unit, San Giovanni di Dio Hospital, Florence, Italy
| | - Stefano Michelagnoli
- Vascular and Endovascular Surgery Unit, San Giovanni di Dio Hospital, Florence, Italy
| | - Simone Panci
- Vascular and Endovascular Surgery Unit, San Giovanni di Dio Hospital, Florence, Italy
| | - Sara Bacchi
- Vascular and Endovascular Surgery Unit, San Giovanni di Dio Hospital, Florence, Italy
| | - Daniela Incerti
- Vascular and Endovascular Surgery Unit, San Giovanni di Dio Hospital, Florence, Italy
| | - Luigi Lo Vecchio
- Vascular and Endovascular Surgery Unit, San Giovanni di Dio Hospital, Florence, Italy
| | - Giovanni L Dedola
- Vascular and Endovascular Surgery Unit, San Giovanni di Dio Hospital, Florence, Italy
| | - Emiliano Chisci
- Vascular and Endovascular Surgery Unit, San Giovanni di Dio Hospital, Florence, Italy
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Ichihashi S, Fujimura N, Utsunomiya M, Bolstad F, Nakai T, Iwakoshi S, Tanaka T. Hemodynamic evaluation of lower limbs in patients with chronic limb-threatening ischemia. Cardiovasc Interv Ther 2022; 37:635-640. [PMID: 35941316 DOI: 10.1007/s12928-022-00883-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 08/01/2022] [Indexed: 11/29/2022]
Abstract
Revascularization plays an important role in the treatment of chronic limb-threatening ischemia. Evaluation of hemodynamic compromise in the lower extremity is required to optimize the treatment strategy for each patient. A variety of methods have been reported to detect arterial obstruction or impaired foot perfusion. This article reviews each method, clarifying features and limitations.
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Affiliation(s)
- Shigeo Ichihashi
- Department of Diagnostic and Interventional Radiology, Nara Medical University, 840 Shijyocho, Kashihara, Nara, 634-8521, Japan.
| | - Naoki Fujimura
- Division of Vascular Surgery, Saiseikai Central Hospital, Tokyo, Japan
| | - Makoto Utsunomiya
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo, Japan.,TOWN Homecare Clinic, Tokyo, Japan
| | - Francesco Bolstad
- Department of Clinical English, Nara Medical University, Nara, Japan
| | - Takahiro Nakai
- Department of Diagnostic and Interventional Radiology, Nara Medical University, 840 Shijyocho, Kashihara, Nara, 634-8521, Japan
| | - Shinichi Iwakoshi
- Department of Diagnostic and Interventional Radiology, Nara Medical University, 840 Shijyocho, Kashihara, Nara, 634-8521, Japan
| | - Toshihiro Tanaka
- Department of Diagnostic and Interventional Radiology, Nara Medical University, 840 Shijyocho, Kashihara, Nara, 634-8521, Japan
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Galanakis N, Maris TG, Kontopodis N, Tsetis K, Kehagias E, Tsetis D. Perfusion imaging techniques in lower extremity peripheral arterial disease. Br J Radiol 2022; 95:20211203. [PMID: 35522774 PMCID: PMC10996332 DOI: 10.1259/bjr.20211203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 04/17/2022] [Accepted: 04/21/2022] [Indexed: 11/05/2022] Open
Abstract
Lower limb peripheral arterial disease (PAD) characterizes the impairment of blood flow to extremities caused by arterial stenoses or occlusions. Evaluation of PAD is based on clinical examination, calculation of ankle-brachial index and imaging studies such as ultrasound, CT, MRI and digital subtraction angiography. These modalities provide significant information about location, extension and severity of macrovasular lesions in lower extremity arterial system. However, they can be also used to evaluate limb perfusion, using appropriate techniques and protocols. This information may be valuable for assessment of the severity of ischemia and detection of hypoperfused areas. Moreover, they can be used for planning of revascularization strategy in patients with severe PAD and evaluation of therapeutic outcome. These techniques may also determine prognosis and amputation risk in patients with PAD. This review gives a basic overview of the perfusion techniques for lower limbs provided by imaging modalities such as ultrasound, CT, MRI, digital subtraction angiography and scintigraphy and their clinical applications for evaluation of PAD and revascularization outcome.
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Affiliation(s)
- Nikolaos Galanakis
- Department of Medical Imaging, University Hospital Heraklion,
University of Crete Medical School,
Heraklion, Greece
| | - Thomas G Maris
- Department of Medical Physics, University Hospital Heraklion,
University of Crete Medical School,
Heraklion, Greece
| | - Nikolaos Kontopodis
- Vascular Surgery Unit, Department of Cardiothoracic and
Vascular Surgery, University Hospital Heraklion, University of Crete
Medical School, Heraklion,
Greece
| | - Konstantinos Tsetis
- Department of Medical Imaging, University Hospital Heraklion,
University of Crete Medical School,
Heraklion, Greece
| | - Elias Kehagias
- Department of Medical Imaging, University Hospital Heraklion,
University of Crete Medical School,
Heraklion, Greece
| | - Dimitrios Tsetis
- Department of Medical Imaging, University Hospital Heraklion,
University of Crete Medical School,
Heraklion, Greece
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6
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Wermelink B, Ma KF, Haalboom M, El Moumni M, de Vries JPPM, Geelkerken RH. A Systematic Review and Critical Appraisal of Peri-Procedural Tissue Perfusion Techniques and their Clinical Value in Patients with Peripheral Arterial Disease. Eur J Vasc Endovasc Surg 2021; 62:896-908. [PMID: 34674935 DOI: 10.1016/j.ejvs.2021.08.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 07/19/2021] [Accepted: 08/13/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Many techniques have been introduced to enable quantification of tissue perfusion in patients with peripheral arterial disease (PAD). Currently, none of these techniques is widely used to analyse real time tissue perfusion changes during endovascular or surgical revascularisation procedures. The aim of this systematic review was to provide an up to date overview of the peri-procedural applicability of currently available techniques, diagnostic accuracy of assessing tissue perfusion and the relationship with clinical outcomes. DATA SOURCES MEDLINE, Embase, CINAHL, and the Cochrane Central Register of Controlled Trials. REVIEW METHODS This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA) guidelines. Four electronic databases were searched up to 31 12 2020 for eligible articles: MEDLINE, Embase, CINAHL and the Cochrane Central Register of Controlled Trials. Eligible articles describing a perfusion measurement technique, used in a peri-procedural setting before and within 24 hours after the revascularisation procedure, with the aim of determining the effect of intervention in patients with PAD, were assessed for inclusion. The QUADAS-2 tool was used to assess the risk of bias and applicability of the studies. RESULTS An overview of 10 techniques found in 26 eligible articles focused on study protocols, research goals, and clinical outcomes is provided. Non-invasive techniques included laser speckle contrast imaging, micro-lightguide spectrophotometry, magnetic resonance imaging perfusion, near infrared spectroscopy, skin perfusion pressure, and plantar thermography. Invasive techniques included two dimensional perfusion angiography, contrast enhanced ultrasound, computed tomography perfusion imaging, and indocyanine green angiography. The results of the 26 eligible studies, which were mostly of poor quality according to QUADAS-2, were without exception, not sufficient to substantiate implementation in daily clinical practice. CONCLUSION This systematic review provides an overview of 10 tissue perfusion assessment techniques for patients with PAD. It seems too early to appoint one of them as a reference standard. The scope of future research in this domain should therefore focus on clinical accuracy, reliability, and validation of the techniques.
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Affiliation(s)
- Bryan Wermelink
- University of Twente, Multi-Modality Medical Imaging Group, TechMed Centre, Enschede, The Netherlands; Department of Vascular Surgery, Medisch Spectrum Twente, Enschede, The Netherlands.
| | - Kirsten F Ma
- Department of Surgery, Division of Vascular Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Marieke Haalboom
- Medical School Twente, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Mostafa El Moumni
- Department of Surgery, Division of Trauma Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Jean-Paul P M de Vries
- Department of Surgery, Division of Vascular Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Robert H Geelkerken
- University of Twente, Multi-Modality Medical Imaging Group, TechMed Centre, Enschede, The Netherlands; Department of Vascular Surgery, Medisch Spectrum Twente, Enschede, The Netherlands
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7
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Perfusion Digital Subtraction Angiography: Is it Time to Step Towards Functional Imaging of Endovascular Aneurysm Repair Patients? Eur J Vasc Endovasc Surg 2021; 62:821-822. [PMID: 34489169 DOI: 10.1016/j.ejvs.2021.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 07/06/2021] [Accepted: 07/25/2021] [Indexed: 11/22/2022]
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8
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Fang K, Zhao J, Luo M, Xue Y, Wang H, Ye L, Zhang X, Zheng L, Shu C. Quantitative analysis of renal blood flow during thoracic endovascular aortic repair in type B aortic dissection using syngo iFlow. Quant Imaging Med Surg 2021; 11:3726-3734. [PMID: 34341745 DOI: 10.21037/qims-20-992] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 04/09/2021] [Indexed: 11/06/2022]
Abstract
Background Currently, the thoracic endovascular aortic repair is the recommended clinical treatment for type B aortic dissections. Unfortunately, malperfusion or ischemia of the kidneys is a major complication of type B aortic dissections. Despite this, few studies have focused on the effects of thoracic endovascular aortic repair on blood flow in renal arteries and parenchyma. This current investigation used novel real-time imaging software to quantitatively analyze the hemodynamic changes in renal artery blood flow and perfusion before and after stent graft placement. Methods A total of 51 patients with type B aortic dissection undergoing thoracic endovascular aortic repair between April 2017 and September 2019 were retrospectively recruited. The pre-and post-procedural digital subtraction angiography images were converted into color-coded maps using syngo iFlow for quantitative comparison. Time-intensity curves and related parameters, including the average peak ratio (avg.Pr), average delayed time to peak (avg.dTTP), and average area under the curve ratio (avg.AUCr) of the renal arteries and renal cortex were obtained and analyzed. Wilcoxon signed-rank test was used to compare iFlow parameters before and after endovascular repair. Spearman correlation analyses were performed to study iFlow parameters and renal function parameters and the estimated glomerular filtration rate (eGFR) and blood urea nitrogen (BUN). Results A total of 102 images including 51 pre-operative and 51 post-operative image datasets were successfully post-processed. Following endovascular repair, syngo iFlow showed a significant 33.0% increase in avg.Pr (P<0.001) and a significant 35.1% increase in avg.AUCr (P<0.001) in the renal artery. Additionally, there was a significant 12.2% decrease in the avg.dTTP (P=0.001), a significant 24.5% increase in avg.Pr (P=0.004), and a significant 38.3% increase in avg.AUCr (P=0.009) in the renal cortex. Spearman correlation analysis showed that after endovascular repair there was a significant correlation between the avg.Pr of the renal artery and eGFR (r=0.30; P=0.0349), the avg.Pr of the renal cortex and eGFR (r=0.30; P=0.0300), and the avg. AUCr of the renal cortex and BUN (r=0.31; P=0.0289). Conclusions syngo iFlow provided a novel quantitative method for evaluating renal hemodynamic changes in patients with type B aortic dissection undergoing endovascular treatment. Time-intensity curve parameters may facilitate the intraprocedural evaluation of renal blood flow and perfusion to complement the color-coded map.
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Affiliation(s)
- Kun Fang
- State Key Laboratory of Cardiovascular Disease, Center of Vascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiawei Zhao
- State Key Laboratory of Cardiovascular Disease, Center of Vascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Mingyao Luo
- State Key Laboratory of Cardiovascular Disease, Center of Vascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yunfei Xue
- State Key Laboratory of Cardiovascular Disease, Center of Vascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hui Wang
- Department of Vascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Luming Ye
- Department of Advanced Therapy, Siemens Healthineers, Beijing, China
| | - Xuelan Zhang
- School of Mathematics and Physics, University of Science and Technology Beijing, Beijing, China
| | - Liancun Zheng
- School of Mathematics and Physics, University of Science and Technology Beijing, Beijing, China
| | - Chang Shu
- State Key Laboratory of Cardiovascular Disease, Center of Vascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,Department of Vascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
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9
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Selecting Proper Region of Interest and Parameters Affects Feasibility of Two Dimensional Perfusion Angiography. Eur J Vasc Endovasc Surg 2021; 62:660. [PMID: 34112571 DOI: 10.1016/j.ejvs.2021.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 05/04/2021] [Indexed: 10/21/2022]
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10
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Meine TC, Maschke SK, Kirstein MM, Jaeckel E, Lena BS, Werncke T, Dewald CL, Wacker FK, Meyer BC, Hinrichs JB. Evaluation of perfusion changes using a 2D Parametric Parenchymal Blood Flow technique with automated vessel suppression following partial spleen embolization in patients with hypersplenism and portal hypertension. Medicine (Baltimore) 2021; 100:e24783. [PMID: 33607830 PMCID: PMC7899811 DOI: 10.1097/md.0000000000024783] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 01/26/2021] [Indexed: 01/05/2023] Open
Abstract
To evaluate the feasibility and potential value of 2D Parametric Parenchymal Blood Flow (2D-PPBF) for the assessment of perfusion changes following partial spleen embolization (PSE) in a retrospective observational study design.Overall, 12 PSE procedures in 12 patients were included in this study. The outcome of the study was the platelet response (PR), calculated as the percentage increase of platelet count (PLT), following PSE. To quantify perfusion changes using 2D-PPBF, the acquired digital subtraction angiography series were post-processed. A reference region-of-interest (ROI) was placed in the afferent splenic artery and a target ROI was positioned on the embolization territory of the spleen on digital subtraction angiography series pre- and post-embolization. The ratios of the target ROIs to the reference ROIs were calculated for the Wash-In-Rate (WIR), the Time-To-Peak (TTP) and the Area-Under-the-Curve (AUC). Comparisons between pre- and post-embolization data were made using Wilcoxon signed-rank test and Spearman's rank correlation coefficient (r). Afterwards, the study population was divided by the median of the TTP before PSE to analyze its value for the prediction of PR following PSE.Following PSE, PLT increased significantly from 43,000 ± 21,405 platelets/μL to 128,500 ± 66,083 platelets/μL with a PR of 255 ± 243% (P = .003). In the embolized splenic territory, the pre-/post-embolization 2D-PPBF parameter changed significantly: WIRpre-PSE 1.23 ± 2.42/WIRpost-PSE 0.09 ± 0.07; -64 ± 46% (p = 0.04), TTPpre-PSE 4.41 ± 0.99/TTPpost-PSE 5.67 ± 1.52 (P = .041); +34 ± 47% and AUCpost-PSE 0.81 ± 0.85/AUCpost-PSE 0.14 ± 0.08; -71 ± 18% (P = .002). A significant correlation of a 2D-PPBF parameter with the PLT was found for TTPpre-PSE/PLTpre-PSE r = -0.66 (P = .01). Subgroup analysis showed a significantly increased PR for the group with TTPpre-PSE >4.44 compared to the group with TTPpre-PSE ≤4.44 (404 ± 267% versus 107 ± 76%; P = .04).2D-PPBF is an objective approach to analyze the perfusion reduction of embolized splenic tissue. TTP derived from 2D-PPBF has the potential to predict the extent of PR during PSE.
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Affiliation(s)
- Timo C. Meine
- Department of Diagnostic and Interventional Radiology
| | | | - Martha M. Kirstein
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Elmar Jaeckel
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
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Non-occlusive mesenteric ischemia (NOMI): evaluation of 2D-perfusion angiography (2D-PA) for early treatment response assessment. Abdom Radiol (NY) 2020; 45:3342-3351. [PMID: 32103299 PMCID: PMC7455582 DOI: 10.1007/s00261-020-02457-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Purpose To evaluate the feasibility of 2D-perfusion angiography (2D-PA) for the analysis of intra-procedural treatment response after intra-arterial prostaglandin E1 therapy in patients with non-occlusive mesenteric ischemia (NOMI). Methods Overall, 20 procedures in 18 NOMI patients were included in this retrospective case–control study. To evaluate intra-procedural splanchnic circulation changes, post-processing of digital subtraction angiography (DSA) series was performed. Regions of interest (ROIs) were placed in the superior mesenteric artery (SMA; reference), the portal vein (PV; ROIPV), as well as the aorta next to the origin of the SMA (ROIAorta). Peak density (PD), time to peak (TTP), and area under the curve (AUC) were assessed, and parametric ratios ‘target ROIPD, TTP, AUC/reference ROI’ were computed and compared within treatment and control group. Additionally, a NOMI score was assessed pre- and post-treatment compared to 2D-PA. Results Vasodilator therapy leads to a significant decrease of the 2D-PA-derived values PDAorta (p = 0.04) and AUCAorta (p = 0.03). These findings correlated with changes of the simplified NOMI score, both for overall (4 to 1, p < 0.0001) and for each category. Prostaglandin application caused a significant increase of the AUCPV (p = 0.04) and TTPPV was accelerated without reaching statistical significance (p = 0.13). When compared to a control group, all 2D-PA values in the NOMI group (pre- and post-intervention) differed significantly (p < 0.05) with longer TTPAorta/PV and lower AUCAorta/PV and PD Aorta/PV. Conclusion 2D-PA offers an objective approach to analyze immediate flow and perfusion changes following vasodilatory therapies of NOMI patients and may be a valuable tool for assessing treatment response.
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12
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Kim TI, Schneider PA. New Innovations and Devices in the Management of Chronic Limb-Threatening Ischemia. J Endovasc Ther 2020; 27:524-539. [PMID: 32419596 DOI: 10.1177/1526602820921555] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
As the number of patients afflicted by chronic limb-threatening ischemia (CLTI) continues to grow, new solutions are necessary to provide effective, durable treatment options that will lead to improved outcomes. The diagnosis of CLTI remains mostly clinical, and endovascular revascularization remains mostly balloon-based. Multiple innovative techniques and technologies are in development or in early usage that may provide new solutions. This review categorizes areas of advancement, highlights recent developments in the management of CLTI and looks forward to novel devices that are currently under investigation.
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Affiliation(s)
- Tanner I Kim
- Division of Vascular Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Peter A Schneider
- Division of Vascular and Endovascular Surgery, University of California at San Francisco School of Medicine, San Francisco, CA, USA
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Pärsson HN, Lundin N, Lindgren H. 2D perfusion-angiography during endovascular intervention for critical limb threatening ischemia - A feasibility study. JRSM Cardiovasc Dis 2020; 9:2048004020915392. [PMID: 32284859 PMCID: PMC7133075 DOI: 10.1177/2048004020915392] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 02/05/2020] [Accepted: 02/27/2020] [Indexed: 12/22/2022] Open
Abstract
Purpose Two-dimensional perfusion angiography is a new method to quantify and evaluate tissue perfusion during endovascular intervention. The aim was to evaluate time-patterns and dynamics of contrast arrival and distribution before and after endovascular intervention in patients with critical limb threatening ischemia. Methods Data were collected from 37 patients with critical limb threatening ischemia due to infra-inguinal occlusive disease having a successful endovascular procedure. two-dimensional perfusion angiography was used as a post-processing software with analysis of numeric parameters related to arrival and distribution patterns of contrast. Results Thirty-three patients were successfully analysed whereas four patients were excluded due to motion artefacts. All patients were successfully treated with recanalization of the superficial femoral, popliteal, below the knee-vessels or a combination. Short-term improvement at 30-day follow-up was noted both clinically and by ankle-brachial index and toe pressure measurements. A significant reduction in contrast arrival time between pre-and post-angioplasty runs was noted as measured by arrival time median 3.2 and interquartile range (2.5–4.2) vs. 2.6 (1.6–3.4) and time-to-peak 4.1 (3.6–5.0) vs. 3.1 (2.3–3.9) p = 0.009. An increased wash-in rate was also observed 18.3 (12.6–21) vs. 30.1 (22–30.5) p = 0.001 between pre-and post-angioplasty runs. Conclusions The use of perfusion angiography for evaluation of foot-circulation during endovascular interventions provides new information regarding quantitative assessment of contrast inflow before and after endovascular intervention without the need for extra contrast or runs. No selective catheterisation is necessary. The technique is easily adopted in a clinical setting. Further studies are necessary to create robust clinical endpoints.
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Affiliation(s)
- Håkan N Pärsson
- Department of Experimental Medicine and Surgery, Medical faculty, Linköping University, Linkoping, Sweden
| | - Niklas Lundin
- Medicinska Fakulteten, Lunds Universitet, Malmö, Sweden
| | - Hans Lindgren
- Faculty of Medicine, Lunds University, Helsingborg, Sweden
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Quantitative Evaluation of Peripheral Arterial Blood Flow Using Peri-Interventional Fluoroscopic Parameters: An In Vivo Study Evaluating Feasibility and Clinical Utility. BIOMED RESEARCH INTERNATIONAL 2020; 2020:9526790. [PMID: 32190691 PMCID: PMC7071793 DOI: 10.1155/2020/9526790] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 12/16/2019] [Indexed: 11/17/2022]
Abstract
Purpose The purpose of this study was to evaluate various objective, quantitative, time-resolved fluoroscopic imaging parameters for use in the peri-interventional evaluation of stenotic peripheral arterial disease lesions. Material and Methods. Ten patients (median age, 64; age range, 52 to 79; 8 males, 2 females) with high-grade stenoses of either the superficial femoral or popliteal arteries who underwent endovascular treatment were included. During each intervention, two series of intraprocedural fluoroscopic images were collected, one preintervention and one postintervention. For each imaging series, four regions of interest (ROIs) were defined within the vessel lumen, with two ROIs being proximal (ROIs 1 and 2) and two being distal (ROIs 3 and 4) to the stenosis. The time-density curve (TDC) at each ROI was measured, and the resulting area under the curve (AUC), full width at half maximum (FWHM), and time-to-peak (TTP) were then calculated. Results The analysis of the TDC-derived parameters demonstrated significant differences between pre- and postinterventional flow rates in the ROI placed most distal to the stenosis, ROI 4. The AUC at ROI 4 (reported as a relative percentage of the AUC measured at ROI 1 proximal to the lesion) demonstrated a significant increase in the total flow (mean 67.84% vs. 128.68%, p=0.003). A significant reduction in FWHM at ROI 4 (mean 2.93 s vs. 1.87 s, p=0.003). A significant reduction in FWHM at ROI 4 (mean 2.93 s vs. 1.87 s, p=0.003). A significant reduction in FWHM at ROI 4 (mean 2.93 s vs. 1.87 s. Conclusion AUC, FWHM, and TTP are objective, reproducible, quantifiable tools for the peri-interventional fluoroscopic evaluation of vessel stenoses. When compared to the standard subjective interpretation of fluoroscopic imagery, AUC, FWHM, and TTP offer interventionalists the advantage of having an objective, complementary method of evaluating the success of a procedure, potentially allowing for more precisely targeted and quantitatively determined treatment goals and improved patient outcomes. This retrospective study was approved by the local ethics committee under the Number 372/2018BO2. The trial was registered at the German clinical trials register under the number DRKS00017813.
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15
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Ikeoka K, Watanabe T, Shinoda Y, Minamisaka T, Fukuoka H, Inui H, Ueno K, Hoshida S. Below-the-Ankle Arrival Time as a Novel Limb Tissue Perfusion Index: Two-dimensional Perfusion Angiography Evaluation. J Endovasc Ther 2020; 27:198-204. [DOI: 10.1177/1526602820905527] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: To identify lower limb 2-dimensional (2D) perfusion angiographic parameters that are related to skin perfusion pressure (SPP), a predictor of wound healing in patients with chronic limb-threatening ischemia (CLTI) undergoing below-the-knee (BTK) endovascular treatment (EVT). Materials and Methods: Thirty-three consecutive patients (mean age 74.5 years; 18 men) with 47 isolated BTK lesions in 33 limbs (Rutherford category 3–5) underwent EVT. Dorsal and plantar SPPs were measured before EVT and the day after. The indexed blood flow below the ankle was measured using 2D perfusion angiography before and after EVT to determine changes in perfusion parameters [arrival time (AT), time to peak, wash-in rate, mean transit time, and width and area under the time-density curve] at rest vs during hyperemia induced with a 20-mg intra-arterial papaverine infusion. Correlations between the 2D perfusion parameters and SPPs were assessed using the Pearson coefficient. The cutoff points to predict mean SPPs >40 mm Hg were analyzed using a receiver operating characteristic curve; outcomes are reported as the area under the curve (AUC) with 95% confidence interval (CI). Results: After EVT at rest and during hyperemia, only AT was significantly changed, although hyperemia produced significant changes in all the pre-/post-EVT 2D perfusion parameters except the wash-in rate. Dorsal and plantar SPPs after EVT were significantly increased and correlated with hyperemic AT and the AT ratio (hyperemia/at rest values) below the ankle. Hyperemic ATs <6.3 seconds and AT ratios <0.78 were predictive factors for a mean SPP >40 mm Hg, with AUCs of 0.83 (95% CI 0.67 to 0.99) and 0.78 (95% CI 0.61 to 0.95), respectively. Conclusion: Hyperemic ATs <6.3 seconds or AT ratios <0.78 below the ankle may be essential to obtain sufficient SPPs for limb salvage in BTK lesions. Thus, the use of 2D perfusion angiography enabled the monitoring of lower limb tissue perfusion throughout EVT and may thereby optimize treatment of CLTI.
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Affiliation(s)
- Kuniyasu Ikeoka
- Department of Cardiovascular Medicine, Yao Municipal Hospital, Yao, Osaka, Japan
| | - Tetsuya Watanabe
- Department of Cardiovascular Medicine, Yao Municipal Hospital, Yao, Osaka, Japan
| | - Yukinori Shinoda
- Department of Cardiovascular Medicine, Yao Municipal Hospital, Yao, Osaka, Japan
| | - Tomoko Minamisaka
- Department of Cardiovascular Medicine, Yao Municipal Hospital, Yao, Osaka, Japan
| | - Hidetada Fukuoka
- Department of Cardiovascular Medicine, Yao Municipal Hospital, Yao, Osaka, Japan
| | - Hirooki Inui
- Department of Cardiovascular Medicine, Yao Municipal Hospital, Yao, Osaka, Japan
| | - Keisuke Ueno
- Department of Cardiovascular Medicine, Yao Municipal Hospital, Yao, Osaka, Japan
| | - Shiro Hoshida
- Department of Cardiovascular Medicine, Yao Municipal Hospital, Yao, Osaka, Japan
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16
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Garg N, Longo GM. Novel vascular laboratory technique in the assessment of peripheral artery occlusive disease. J Vasc Surg 2019; 71:250-251. [PMID: 31864647 DOI: 10.1016/j.jvs.2019.02.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 02/05/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Nitin Garg
- Section of Vascular Surgery, Department of Surgery, University of Nebraska Medical Center, Omaha, Neb
| | - G Matthew Longo
- Section of Vascular Surgery, Department of Surgery, University of Nebraska Medical Center, Omaha, Neb
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Chemosaturation Percutaneous Hepatic Perfusion (CS-PHP) with Melphalan: Evaluation of 2D-Perfusion Angiography (2D-PA) for Leakage Detection of the Venous Double-Balloon Catheter. Cardiovasc Intervent Radiol 2019; 42:1441-1448. [DOI: 10.1007/s00270-019-02243-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 05/08/2019] [Indexed: 12/19/2022]
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18
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Shahin Y, Rothman AM. Commentary on: evaluation of a newly developed 2D parametric parenchymal blood flow technique with an automated vessel suppression algorithm in patients with chronic thromboembolic pulmonary hypertension undergoing balloon pulmonary angioplasty. Clin Radiol 2019; 74:435-436. [PMID: 30910170 DOI: 10.1016/j.crad.2019.02.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Accepted: 02/12/2019] [Indexed: 11/25/2022]
Affiliation(s)
- Y Shahin
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK; Department of Clinical Radiology, Sheffield Teaching Hospitals, Sheffield, UK; INSIGNEO, Institute for in Silico Medicine, University of Sheffield, UK.
| | - A M Rothman
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK; INSIGNEO, Institute for in Silico Medicine, University of Sheffield, UK
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Maschke SK, Winther HMB, Meine T, Werncke T, Olsson KM, Hoeper MM, Baumgart J, Wacker FK, Meyer BC, Renne J, Hinrichs JB. Evaluation of a newly developed 2D parametric parenchymal blood flow technique with an automated vessel suppression algorithm in patients with chronic thromboembolic pulmonary hypertension undergoing balloon pulmonary angioplasty. Clin Radiol 2019; 74:437-444. [PMID: 30890260 DOI: 10.1016/j.crad.2018.12.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 12/03/2018] [Indexed: 12/21/2022]
Abstract
AIM To evaluate the feasibility of two-dimensional parametric parenchymal blood flow (2D-PPBF) to quantify perfusion changes in the lung parenchyma following balloon pulmonary angioplasty (BPA) for treatment of chronic thromboembolic pulmonary hypertension. MATERIALS AND METHODS Overall, 35 consecutive interventions in 18 patients with 98 treated pulmonary arteries were included. To quantify changes in pulmonary blood flow using 2D-PPBF, the acquired digital subtraction angiography (DSA) series were post-processed using dedicated software. A reference region of interest (ROI; arterial inflow) in the treated pulmonary artery and a distal target ROI, including the whole lung parenchyma distal to the targeted stenosis, were placed in corresponding areas on DSA pre- and post-BPA. Half-peak density (HPD), wash-in rate (WIR), arrival to peak (AP), area under the curve (AUC), and mean transit time (MTT) were assessed. The ratios of the reference ROI to the target ROI (HPDparenchyma/HPDinflow, WIRparenchyma/WIRinflow; APparenchyma/APinflow, AUCparenchyma/AUCinflow, MTTparenchyma/MTTinflow) were calculated. The relative differences of the 2D-PPBF parameters were correlated to changes in the pulmonary flow grade score. RESULTS The pulmonary flow grade score improved significantly after BPA (1 versus 3; p<0.0001). Likewise, the mean HPDparenchyma/HPDinflow (-10.2%; p<0.0001), APparenchyma/APinflow (-24.4%; p=0.0007), and MTTparenchyma/MTTinflow (-3.5%; p=0.0449) decreased significantly, whereas WIRparenchyma/WIRinflow (+82.4%) and AUCparenchyma/AUCinflow (+58.6%) showed a significant increase (p<0.0001). Furthermore, a significant correlation between changes of the pulmonary flow grade score and changes of HPDparenchyma/HPDinflow (ρ=-0.21, p=0.04), WIRparenchyma/WIRinflow (ρ=0.43, p<0.0001), APparenchyma/APinflow (ρ=-0.22, p=0.03), AUCparenchyma/AUCinflow (ρ=0.48, p<0.0001), and MTTparenchyma/MTTinflow (ρ=-0.39, p<0.0001) could be observed. CONCLUSION The 2D-PPBF technique is feasible for the quantification of perfusion changes following BPA and has the potential to improve monitoring of BPA.
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Affiliation(s)
- S K Maschke
- Department of Diagnostic and Interventional Radiology, Member of the German Center for Lung Research (DZL), Hannover Medical School, Hannover, Germany
| | - H M B Winther
- Department of Diagnostic and Interventional Radiology, Member of the German Center for Lung Research (DZL), Hannover Medical School, Hannover, Germany
| | - T Meine
- Department of Diagnostic and Interventional Radiology, Member of the German Center for Lung Research (DZL), Hannover Medical School, Hannover, Germany
| | - T Werncke
- Department of Diagnostic and Interventional Radiology, Member of the German Center for Lung Research (DZL), Hannover Medical School, Hannover, Germany
| | - K M Olsson
- Clinic for Pneumology, Member of the German Center for Lung Research (DZL), Hannover Medical School, Hannover, Germany
| | - M M Hoeper
- Clinic for Pneumology, Member of the German Center for Lung Research (DZL), Hannover Medical School, Hannover, Germany
| | - J Baumgart
- Siemens Medical Solutions USA, Inc., Angiography, Fluoroscopic and Radiographic Systems, Hoffman Estates, IL, USA
| | - F K Wacker
- Department of Diagnostic and Interventional Radiology, Member of the German Center for Lung Research (DZL), Hannover Medical School, Hannover, Germany
| | - B C Meyer
- Department of Diagnostic and Interventional Radiology, Member of the German Center for Lung Research (DZL), Hannover Medical School, Hannover, Germany
| | - J Renne
- Department of Diagnostic and Interventional Radiology, Member of the German Center for Lung Research (DZL), Hannover Medical School, Hannover, Germany
| | - J B Hinrichs
- Department of Diagnostic and Interventional Radiology, Member of the German Center for Lung Research (DZL), Hannover Medical School, Hannover, Germany.
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