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Saberwal B, Patel K, Scully PR, Klotz E, Seraphim A, Augusto J, Vandermolen S, Knott K, Thornton GD, Haberland U, Sutcliffe J, Khanji MY, Moon JC, Treibel TA, Pugliese F. Computed tomography vs cardiovascular magnetic resonance imaging derived extracellular volume fraction in patients with stable new-onset chest pain. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0153] [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] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Computed tomography (CT) is increasingly recognised as a diagnostic modality across a range of cardiovascular conditions and is now first-line for the investigation of stable new-onset chest pain. Determination of the myocardial extracellular volume fraction (ECV) has been shown to correlate well with the identification and prognostication of disease. Cardiovascular magnetic resonance (CMR) imaging remains the gold standard for the measurement of myocardial ECVCMR using T1-mapping, but there is increasing evidence for the use of ECV by cardiac CT (ECVCT).
Purpose
To assess the performance of ECVCT against the reference standard of ECVCMR.
Methods
Patients with a history of chest pain and no previously documented coronary disease referred for invasive angiography were recruited as part of the EVINCI Heart-QIT study. A cohort of these patients (n=33) underwent CMR at 1.5T (Siemens Aera, Siemens Healthcare, Erlangen/Germany) with T1 mapping of a mid-ventricular short axis slice (by MOdified Look-Locker Inversion recovery [MOLLI]) before and 15 minutes after a bolus of gadolinium contrast (0.1 mmol/kg gadoterate meglumine), followed by whole-heart ECVCT quantification (Somatom Force, Siemens Healthcare, Erlangen/Germany) using a 5-min post-iodine-contrast acquisition protocol. To account for data clustering on a patient level and volumetric discrepancy on a modality level, comparisons were made using mid-ventricular pooled ECVCT and ECVCMR. Bland-Altman analysis was used to determine the limits of agreement and identify systematic differences between both measures.
Results
A total of 33 patients (70% male, mean age 56.8±12.6yr) underwent the combined CMR and CT. ECVCMR and ECVCT were then analysed retrospectively (Figure 1). The average pooled ECV for the 6 mid-ventricular segments for CMR and CT were (27.6±2.4 and 26.8±2.2 respectively). Bland-Altman analysis demonstrated a marginally higher CMR-ECV (0.8±2.1) vs CT-ECV, which is in keeping with the longer delay-time encountered in CMR protocols (Figure 2).
Conclusions
ECVCT obtained from 5-minute post-contrast CT protocols show good agreement with ECVCMR in a stable chest pain patient cohort.
Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Siemens Helthineers Educational Grant Figure 1. CMR (L) and CT (R) ECV mapsFigure 2. Bland-Altman plot
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Affiliation(s)
- B Saberwal
- Barts Heart Centre, Advanced Cardiovascular Imaging, London, United Kingdom
| | - K Patel
- University College Hospital, Institute of cardiovascular sciences, London, United Kingdom
| | - P R Scully
- University College Hospital, Institute of cardiovascular sciences, London, United Kingdom
| | - E Klotz
- Siemens Healthineers, Forchheim, Germany
| | - A Seraphim
- University College Hospital, Institute of cardiovascular sciences, London, United Kingdom
| | - J Augusto
- University College Hospital, Institute of cardiovascular sciences, London, United Kingdom
| | - S Vandermolen
- Barts Heart Centre, Advanced Cardiovascular Imaging, London, United Kingdom
| | - K Knott
- University College Hospital, Institute of cardiovascular sciences, London, United Kingdom
| | - G D Thornton
- Barts Heart Centre, Advanced Cardiovascular Imaging, London, United Kingdom
| | | | - J Sutcliffe
- Barts Heart Centre, Advanced Cardiovascular Imaging, London, United Kingdom
| | - M Y Khanji
- Barts Heart Centre, Advanced Cardiovascular Imaging, London, United Kingdom
| | - J C Moon
- University College Hospital, Institute of cardiovascular sciences, London, United Kingdom
| | - T A Treibel
- University College Hospital, Institute of cardiovascular sciences, London, United Kingdom
| | - F Pugliese
- Queen Mary University of London, Barts Heart Centre, Advanced Cardiovascular Imaging, London, United Kingdom
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Scully P, Patel KP, Augusto JB, Klotz E, Lloyd G, Kelion A, Kennon S, Ozkor M, Mullen M, Cavalcante JL, Menezes LJ, Hawkins PN, Moon JC, Pugliese F, Treibel TA. Myocardial fibrosis quantification by cardiac CT predicts outcome in severe aortic stenosis. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.230] [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] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): British Heart Foundation
Background
Myocardial extracellular volume (ECV) increases with fibrosis, oedema or infiltration. ECV by CMR predicts all-cause and cardiovascular mortality in severe AS after valve intervention. Previous studies have shown that ECV can be reliably quantified by computed tomography (ECVCT), but these studies have not differentiated between ECV elevation due to fibrosis or cardiac amyloid deposition (13-16% of patients with severe AS).
Purpose
We hypothesised that ECVCT quantification, performed as part of a transcatheter aortic valve implantation (TAVI) work-up CT, predicts survival in patients with severe AS without cardiac amyloid (lone AS).
Methods
Patients aged ≥75, with severe AS, referred for TAVI at Barts Heart Centre (as part of ATTRact-AS (NCT03029026)) underwent CT as part of their clinical work-up. All patients had 99mTc-3,3-diphosphono-1,2-propanodicarboxylic acid (DPD) scintigraphy and those with a positive result were excluded. CT was performed on a 128-slice dual-source 3rdgeneration scanner (Siemens Somatom FORCE) and ECVCT was acquired during the TAVI work-up CT using additional pre- and 3-minute post-contrast ‘axial shuttle mode’ acquisitions (no additional contrast). ECVCT was calculated from the Hounsfield units (HU) and a venous haematocrit (HCT): ECVCT = (1-HCT) x (ΔHUmyo/ΔHUblood).
Results
Following exclusion of 16 patients with cardiac uptake on DPD, 93 patients (41% male, aged 85 ± 5 years) were included in the study. All patients had severe AS (AV Vmax 4.12 ± 0.63m/s, mean AV gradient 42 ± 14mmHg, AVA 0.71 ± 0.23cm2). The mean HCT was 0.38 ± 0.04 and total dose-length product for additional research scans was 364 ± 41 mGy.cm. 76 patients (82%) underwent TAVI. ECVCT was 32 ± 3% in the entire cohort, which we then split into those with a ‘higher’ ECVCT (>34%, n = 23, representing the highest quartile) and those with a ‘lower’ ECVCT (≤34%, n = 70, representing the lower quartiles). Over a median follow-up of 25 months (IQR 17-34 months) there were 27 deaths (29%), of whom 11 did not undergo TAVI (41%). There were 10 deaths in the 23 patients (44%) with a higher ECVCT, compared to 17 in the 70 patients (24%) with a lower ECVCT (p = 0.03, figure 1). This mortality difference remained significant when those patients who did not undergo TAVI were excluded (p = 0.03).
Conclusions
Myocardial fibrosis quantified by ECVCT is associated with a significantly worse prognosis in lone AS, even after patients with AS-amyloid are excluded. ECVCT can be performed as a simple addition to the TAVI work-up CT and provides additional prognostic information.
Abstract Figure.
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Affiliation(s)
- P Scully
- University College London, London, United Kingdom of Great Britain & Northern Ireland
| | - KP Patel
- University College London, London, United Kingdom of Great Britain & Northern Ireland
| | - JB Augusto
- University College London, London, United Kingdom of Great Britain & Northern Ireland
| | - E Klotz
- Siemens Healthineers, Forccheim, Germany
| | - G Lloyd
- Barts Health NHS Trust, Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - A Kelion
- John Radcliffe Hospital, Oxford, United Kingdom of Great Britain & Northern Ireland
| | - S Kennon
- Barts Health NHS Trust, Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - M Ozkor
- Barts Health NHS Trust, Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - M Mullen
- Barts Health NHS Trust, Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - JL Cavalcante
- Minneapolis Heart Institute Foundation, Minneapolis, United States of America
| | - LJ Menezes
- Barts Health NHS Trust, Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - PN Hawkins
- National Amyloidosis Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - JC Moon
- University College London, London, United Kingdom of Great Britain & Northern Ireland
| | - F Pugliese
- Queen Mary University of London, London, United Kingdom of Great Britain & Northern Ireland
| | - TA Treibel
- University College London, London, United Kingdom of Great Britain & Northern Ireland
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Scully PR, Treibel TA, Klotz E, Augusto J, Herrey AS, Newton J, Sabharwal N, Kelion A, Kennon S, Ozkor M, Mullen M, Menezes LJ, Hawkins PN, Moon JC, Pugliese F. 24Amyloid-AS: detecting occult Cardiac Amyloid during TAVI work-up Computed Tomography. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- P R Scully
- Barts Health NHS Trust, Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - T A Treibel
- Barts Health NHS Trust, Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - E Klotz
- Siemens Healthineers, Forchheim, Germany
| | - J Augusto
- Barts Health NHS Trust, Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - A S Herrey
- Barts Health NHS Trust, Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - J Newton
- John Radcliffe Hospital, Oxford, United Kingdom of Great Britain & Northern Ireland
| | - N Sabharwal
- John Radcliffe Hospital, Oxford, United Kingdom of Great Britain & Northern Ireland
| | - A Kelion
- John Radcliffe Hospital, Oxford, United Kingdom of Great Britain & Northern Ireland
| | - S Kennon
- Barts Health NHS Trust, Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - M Ozkor
- Barts Health NHS Trust, Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - M Mullen
- Barts Health NHS Trust, Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - L J Menezes
- Barts Health NHS Trust, Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - P N Hawkins
- University College London, National Amyloidosis Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - J C Moon
- Barts Health NHS Trust, Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - F Pugliese
- Barts Health NHS Trust, Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
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Odisio B, Lin E, Chintalapani G, Mahvash A, Klotz E. Abstract No. 512 Intraarterial computed tomography–enhancement mapping for response assessment of hepatocellular carcinoma to transarterial chemoembolization: a preliminary analysis. J Vasc Interv Radiol 2018. [DOI: 10.1016/j.jvir.2018.01.557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Nagel G, Peter RS, Klotz E, Brozek W, Concin H. Bone mineral density and breast cancer risk: Results from the Vorarlberg Health Monitoring & Prevention Program and meta-analysis. Bone Rep 2017; 7:83-89. [PMID: 29018837 PMCID: PMC5626919 DOI: 10.1016/j.bonr.2017.09.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 09/13/2017] [Accepted: 09/20/2017] [Indexed: 01/25/2023] Open
Abstract
We investigated the association between bone mineral density (BMD) and breast cancer risk in a large prospective cohort and quantified the evidence in a meta-analysis of prospective studies. Baseline BMD has been measured by dual energy X-ray absorptiometry (DXA, N = 1418). Data on medication and lifestyle has been collected by questionnaire. Cox proportional Hazards models were applied to calculate Hazard Ratios for breast cancer. In addition, a meta-analysis on categorical and dose-response values including the current results has been performed applying random-effects models. During mean follow-up of 16.3 (SD 3.3) years of 1380 women (mean age 55.5 ± 6.3 years), 52 cases of invasive breast cancer were identified. We found no statistically significant association of BMD with breast cancer risk (per one z-score increase, HR 0.91, 95% CI 0.67–1.23). In the meta-analysis, however, breast cancer risk increased by 15% and 16% per 0.1 g/m2 increase in BMD at the lumbar spine (95% CI 0.99–1.33) and at the femoral neck (95% CI 1.02–1.32), respectively. Compared to the lowest, the HRs for breast cancer were statistically significant for the highest BMD category, i.e. 1.49 (95% CI 1.04–2.13) at the lumbar spine and 1.66 (95% CI 1.26–2.18) at the femur. We found no association between BMD (DXA) and breast cancer risk in our cohort. However, overall the present meta-analysis extends and confirms the statistically significant association between increasing BMD and increased breast cancer risk. In the VHM&PP BMD (DXA) was not associated with breast cancer risk. A meta-analysis showed a positive association between BMD and breast cancer risk in postmenopausal women. Per 0.1 g/m2 increase in BMD breast cancer risk increased by 15% at the lumbar spine and 16% at the femoral neck.
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Affiliation(s)
- G Nagel
- Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstrasse 22, 89081 Ulm, Germany.,Agency for Preventive and Social Medicine, Rheinstrasse 61, 6900 Bregenz, Austria
| | - R S Peter
- Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstrasse 22, 89081 Ulm, Germany
| | - E Klotz
- Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstrasse 22, 89081 Ulm, Germany
| | - W Brozek
- Ludwig Boltzmann Institute of Osteology at the Hanusch Hospital of the Vienna Health Insurance Fund (WGKK) and Trauma Center Meidling of the Austrian Workers' Compensation Board (AUVA), 1st Medical Department, Hanusch Hospital, Vienna, Austria
| | - H Concin
- Agency for Preventive and Social Medicine, Rheinstrasse 61, 6900 Bregenz, Austria
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Bruder H, Raupach R, Sunnegardh J, Allmendinger T, Klotz E, Stierstorfer K, Flohr T. Novel iterative reconstruction method with optimal dose usage for partially redundant CT-acquisition. Phys Med Biol 2015; 60:8567-82. [DOI: 10.1088/0031-9155/60/21/8567] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Dolatowski K, Malinova V, Frölich A, Schramm R, Haberland U, Klotz E, Mielke D, Knauth M, Schramm P. Volume perfusion CT (VPCT) for the differential diagnosis of patients with suspected cerebral vasospasm: Qualitative and quantitative analysis of 3D parameter maps. Eur J Radiol 2014; 83:1881-9. [DOI: 10.1016/j.ejrad.2014.06.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2014] [Accepted: 06/24/2014] [Indexed: 11/16/2022]
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Tijssen MPM, Hofman PAM, Stadler AAR, van Zwam W, de Graaf R, van Oostenbrugge RJ, Klotz E, Wildberger JE, Postma AA. The role of dual energy CT in differentiating between brain haemorrhage and contrast medium after mechanical revascularisation in acute ischaemic stroke. Eur Radiol 2013; 24:834-40. [PMID: 24258277 DOI: 10.1007/s00330-013-3073-x] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Revised: 10/19/2013] [Accepted: 11/01/2013] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To assess the feasibility of dual energy computed tomography (DE-CT) in intra-arterially treated acute ischaemic stroke patients to discriminate between contrast extravasation and intracerebral haemorrhage. METHODS Thirty consecutive acute ischaemic stroke patients following intra-arterial treatment were examined with DE-CT. Simultaneous imaging at 80 kV and 140 kV was employed with calculation of mixed images. Virtual unenhanced non-contrast (VNC) images and iodine overlay maps (IOM) were calculated using a dedicated brain haemorrhage algorithm. Mixed images alone, as "conventional CT", and DE-CT interpretations were evaluated and compared with follow-up CT. RESULTS Eight patients were excluded owing to a lack of follow-up or loss of data. Mixed images showed intracerebral hyperdense areas in 19/22 patients. Both haemorrhage and residual contrast material were present in 1/22. IOM suggested contrast extravasation in 18/22 patients; in 16/18 patients this was confirmed at follow-up. The positive predictive value (PPV) of mixed imaging alone was 25 %, with a negative predictive value (NPV) of 91 % and accuracy of 63 %. The PPV for detection of haemorrhage with DE-CT was 100 %, with an NPV of 89 % and accuracy improved to 89 %. CONCLUSIONS Dual energy computed tomography improves accuracy and diagnostic confidence in early differentiation between intracranial haemorrhage and contrast medium extravasation in acute stroke patients following intra-arterial revascularisation. KEY POINTS • Contrast material and haemorrhage have similar density on conventional 120-kV CT. • Contrast material hinders interpretation of CT in stroke patients after recanalisation. • Iodine and haemorrhage have different attenuation at lower kVs. • Dual energy CT improves accuracy in early differentiation of haemorrhage and contrast extravasation. • Early differentiation between iodine and haemorrhage helps to initiate therapy promptly.
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Affiliation(s)
- M P M Tijssen
- Department of Radiology, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
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Rossi A, Dharampal A, Wragg A, Davies LC, van Geuns RJ, Anagnostopoulos C, Klotz E, Kitslaar P, Broersen A, Mathur A, Nieman K, Hunink MGM, de Feyter PJ, Petersen SE, Pugliese F. Diagnostic performance of hyperaemic myocardial blood flow index obtained by dynamic computed tomography: does it predict functionally significant coronary lesions? Eur Heart J Cardiovasc Imaging 2013; 15:85-94. [DOI: 10.1093/ehjci/jet133] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Helck A, Wessely M, Notohamiprodjo M, Schönermarck U, Klotz E, Fischereder M, Schön F, Nikolaou K, Clevert DA, Reiser M, Becker C. CT perfusion technique for assessment of early kidney allograft dysfunction: preliminary results. Eur Radiol 2013; 23:2475-81. [DOI: 10.1007/s00330-013-2862-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Revised: 03/12/2013] [Accepted: 03/30/2013] [Indexed: 10/26/2022]
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Sauter W, Spira D, Schulze M, Pfannenberg C, Hetzel J, Reimold M, Klotz E, Claussen C, Horger M. Relation between [18F]-FDG-PET/CT and volume perfusion-CT in primary tumors and mediastinal lymph nodes of non-small cell lung cancer. ROFO-FORTSCHR RONTG 2013. [DOI: 10.1055/s-0033-1346385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Thierfelder KM, Baumgarten LV, Klotz E, Baumann AB, Nikolaou K, Reiser MF, Sommer WH. Reabilität und Reproduzierbarkeit einer volumetrischen Auswertung von Perfusionsdefiziten in der CT-Ganzhirnperfusion bei Patienten mit akutem ischämischem Schlaganfall. ROFO-FORTSCHR RONTG 2013. [DOI: 10.1055/s-0033-1346449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Henzler T, Shi J, Apfaltrer P, Haberland U, Klotz E, Schönberg SO, Fink C. Dynamische CT Volumen Perfusion von Bronchialkarzinomen: Baseline Perfusions Charakteristika von verschiedenen Tumor Histologien. ROFO-FORTSCHR RONTG 2013. [DOI: 10.1055/s-0033-1346329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Frölich AM, Schrader D, Schramm R, Klotz E, Knauth M, Schramm P. Die zeitaufgelöste CT-Angiografie erlaubt eine präzisere Eingrenzung von Thromben in der Arteria cerebri media als die konventionelle CT-Angiografie. ROFO-FORTSCHR RONTG 2013. [DOI: 10.1055/s-0033-1346451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Frölich AMJ, Schrader D, Klotz E, Schramm R, Wasser K, Knauth M, Schramm P. 4D CT angiography more closely defines intracranial thrombus burden than single-phase CT angiography. AJNR Am J Neuroradiol 2013; 34:1908-13. [PMID: 23620073 DOI: 10.3174/ajnr.a3533] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND PURPOSE In patients with acute stroke, the location and extent of intravascular thrombi correlate with clinical and imaging outcomes and have been used to predict the success of intravenous thrombolysis. We hypothesized that 4D-CTA reconstructed from whole-brain CTP more closely outlines intracranial thrombi than conventional single-phase CTA. MATERIALS AND METHODS Sixty-seven patients with anterior circulation occlusion were retrospectively analyzed. For 4D-CTA, temporal maximum intensity projections were calculated that combine all 30 spiral scans of the CTP examination through temporal fusion. Thrombus extent was assessed by a semi-quantitative clot burden score (0-10; in which 0 = complete unilateral anterior circulation occlusion and 10 = patent vasculature). In patients with sufficient collateral flow, the length of the filling defect and corresponding hyperdense middle cerebral artery sign on NCCT were measured. RESULTS Clot burden on temporal maximum intensity projection (median clot burden score, 7.0; interquartile range, 5.1-8.0) was significantly lower than on single-phase CT angiography (median, 6.0; interquartile range, 4.5-7.0; P < .0001). The length of the hyperdense middle cerebral artery sign (14.30 ± 5.93 mm) showed excellent correlation with the filling defect in the middle cerebral artery on temporal maximum intensity projection (13.40 ± 6.40 mm); this filling defect was larger on single-phase CT angiography (18.08 ± 6.54 mm; P = .043). CONCLUSIONS As the result of an increased sensitivity for collateral flow, 4D-CTA temporal maximum intensity projection more closely outlines intracranial thrombi than conventional single-phase CT angiography. Our findings can be helpful when planning acute neurointervention. Further research is necessary to validate our data and assess the use of 4D-CTA in predicting response to different recanalization strategies.
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Rossi A, Uitterdijk A, Dijkshoorn M, Klotz E, Dharampal A, van Straten M, van der Giessen WJ, Mollet N, van Geuns RJ, Krestin GP, Duncker DJ, de Feyter PJ, Merkus D. Quantification of myocardial blood flow by adenosine-stress CT perfusion imaging in pigs during various degrees of stenosis correlates well with coronary artery blood flow and fractional flow reserve. Eur Heart J Cardiovasc Imaging 2012; 14:331-8. [DOI: 10.1093/ehjci/jes150] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Schramm P, Klotz E. Comments on an article by Kamalian et al. AJNR Am J Neuroradiol 2012; 33:E94; author reply E95. [PMID: 22517284 DOI: 10.3174/ajnr.a3153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Wildberger J, Beets-Tan R, Verhaegen F, Landry G, de Ruysscher D, Klotz E, Das M. SP-0185 DUAL ENERGY CT: CURRENT CLINICAL STATUS. Radiother Oncol 2012. [DOI: 10.1016/s0167-8140(12)70524-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Abels B, Klotz E, Tomandl BF, Villablanca JP, Kloska SP, Lell MM. CT perfusion in acute ischemic stroke: a comparison of 2-second and 1-second temporal resolution. AJNR Am J Neuroradiol 2011; 32:1632-9. [PMID: 21816919 DOI: 10.3174/ajnr.a2576] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE CT perfusion data sets are commonly acquired using a temporal resolution of 1 image per second. To limit radiation dose and allow for increased spatial coverage, the reduction of temporal resolution is a possible strategy. The aim of this study was to evaluate the effect of reduced temporal resolution in CT perfusion scans with regard to color map quality, quantitative perfusion parameters, ischemic lesion extent, and clinical decision-making when using DC and MS algorithms. MATERIALS AND METHODS CTP datasets from 50 patients with acute stroke were acquired with a TR of 1 second. Two-second TR datasets were created by removing every second image. Various perfusion parameters (CBF, CBV, MTT, TTP, TTD) and color maps were calculated by using identical data-processing settings for 2-second and 1-second TR. Color map quality, quantitative region-of-interest-based perfusion measurements, and TAR/NVT lesions (indicated by CBF/CBV mismatch) derived from the 2-second and 1-second processed data were statistically compared. RESULTS Color map quality was similar for 2-second versus 1-second TR when using DC and was reduced when using MS. Regarding quantitative values, differences between 2-second and 1-second TR datasets were statistically significant by using both algorithms. Using DC, corresponding tissue-at-risk lesions were slightly smaller at 2-second versus 1-second TR (P < .05), whereas corresponding NVT lesions showed excellent agreement. With MS, corresponding tissue-at-risk lesions showed excellent agreement but more artifacts, whereas NVT lesions were larger (P < .001) compared with 1-second TR. Therapeutic decisions would have remained the same in all patients. CONCLUSIONS CTP studies obtained with 2-second TR are typically still diagnostic, and the same therapy would have been provided. However, with regard to perfusion quantitation and image-quality-based confidence, our study indicates that 1-second TR is preferable to 2-second TR.
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Affiliation(s)
- B Abels
- Department of Radiology, University of Erlangen-Nuremberg, Erlangen, Germany
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Flohr T, Klotz E, Krauß B, Schmidt B. Dual Energy CT und 4D CT. ROFO-FORTSCHR RONTG 2011. [DOI: 10.1055/s-0031-1278825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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D'Souza N, Loblaw DA, Mamedov A, Klotz E, Sugar L, Nam R. Got central prostate pathology review? A cross-sectional audit of 2009 versus 2003 outcomes. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.7_suppl.196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
196 Background: Prostate cancer is the most common non-cutaneous cancer in Canadian men; over 24,000 will be newly diagnosed and 4,300 will die from it in 2010. Estimating an individual's risk of disease spreading across the capsule and probability of recurrence with different treatment modalities is common practice in prostate cancer management and often drive the choice or extent of treatment options. A strong predictor of recurrence and organ confined disease is tumor grade. The literature recognizes differences in grading prostate cancer between genitourinary and non-specialized pathologists; we previously reported a 30% change in risk category (Low, GS 2-6; Int., GS 7; High, GS 8-10). However, this report was based on data from 2003/2004. A repeat audit was necessary given Gleason grading practice changes following the 2005 ISUP Consensus Conference. Methods: Log books from 2009/10 where our Genitourinary Pathologists (GUP) reviewed prostate needle core biopsies were used to identify cases; a retrospective chart review was completed. The following variables were extracted: 1° Gleason score; 2° Gleason score; number of sites; % Gleason 4/5 pattern (overall); perineural invasion (present/absent); extracapsular extension (present/absent). Descriptive statistics were used to summarize the results. Results: The charts of 132 patients having a GUP biopsy review were extracted. Seventeen percent (22/132) of cases changed risk category. Of the 47 low risk cases, 23% (11/47) were up-graded in risk category (21% by 1 category; 2% by 2 categories). Of the 46 intermediate risk cases, 15% (7/46) were up-graded and 2% (1/46) were down-graded. Of the 39 high risk cases, only 8% (3/39) were down-graded by 1 risk category. Comparatively, there was a 43% reduction in risk category change between 2003/04 (30%) and 2009/10 (17%). Conclusions: Despite this reduction, a clinically significant proportion of patients changed pathologic risk category upon GUP review. Thus, it is recommended that prostate cancer pathology be routinely reviewed by a GUP as a best practice to optimize management and quality of care. Strategies are still needed to address disparities in pathologic grading and represent a potential area for further investigation. No significant financial relationships to disclose.
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Affiliation(s)
- N. D'Souza
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - D. A. Loblaw
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - A. Mamedov
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - E. Klotz
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - L. Sugar
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - R. Nam
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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Affiliation(s)
- H. Dammann
- a Philips GmbH Forschungslaboratorium Hamburg, 2 Hamburg 54, BRD
| | - E. Klotz
- a Philips GmbH Forschungslaboratorium Hamburg, 2 Hamburg 54, BRD
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Affiliation(s)
- H. Weiss
- a Philips GmbH Forschungslaboratorium Hamburg, 2000 Hamburg 54, BRD
| | - E. Klotz
- a Philips GmbH Forschungslaboratorium Hamburg, 2000 Hamburg 54, BRD
| | - R. Linde
- a Philips GmbH Forschungslaboratorium Hamburg, 2000 Hamburg 54, BRD
| | - G. Rabe
- a Philips GmbH Forschungslaboratorium Hamburg, 2000 Hamburg 54, BRD
| | - U. Tiemens
- a Philips GmbH Forschungslaboratorium Hamburg, 2000 Hamburg 54, BRD
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Abels B, Klotz E, Tomandl BF, Kloska SP, Lell MM. Perfusion CT in acute ischemic stroke: a qualitative and quantitative comparison of deconvolution and maximum slope approach. AJNR Am J Neuroradiol 2010; 31:1690-8. [PMID: 20581066 DOI: 10.3174/ajnr.a2151] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE PCT postprocessing commonly uses either the MS or a variant of the DC approach for modeling of voxel-based time-attenuation curves. There is an ongoing discussion about the respective merits and limitations of both methods, frequently on the basis of theoretic reasoning or simulated data. We performed a qualitative and quantitative comparison of DC and MS by using identical source datasets and preprocessing parameters. MATERIALS AND METHODS From the PCT data of 50 patients with acute ischemic stroke, color maps of CBF, CBV, and various temporal parameters were calculated with software implementing both DC and MS algorithms. Color maps were qualitatively categorized. Quantitative region-of-interest-based measurements were made in nonischemic GM and WM, suspected penumbra, and suspected infarction core. Qualitative results, quantitative results, and PCT lesion sizes from DC and MS were statistically compared. RESULTS CBF and CBV color maps based on DC and MS were of comparably high quality. Quantitative CBF and CBV values calculated by DC and MS were within the same range in nonischemic regions. In suspected penumbra regions, average CBF(DC) was lower than CBF(MS). In suspected infarction core regions, average CBV(DC) was similar to CBV(MS). Using adapted tissue-at-risk/nonviable-tissue thresholds, we found excellent correlation of DC and MS lesion sizes. CONCLUSIONS DC and MS yielded comparable qualitative and quantitative results. Lesion sizes indicated by DC and MS showed excellent agreement when using adapted thresholds. In all cases, the same therapy decision would have been made.
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Affiliation(s)
- B Abels
- Department of Radiology, University of Erlangen-Nuremberg, Maximiliansplatz 1, Erlangen, Germany
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Mahnken AH, Klotz E, Pietsch H, Schmidt B, Allmendinger T, Haberland U, Kalender WA, Flohr TG. Quantitative kardiale CT-Stressperfusionsuntersuchung des Herzens zur nicht-invasiven Ischämiediagnostik: tierexperimentelle Untersuchungen. ROFO-FORTSCHR RONTG 2010. [DOI: 10.1055/s-0030-1252838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Mahnken AH, Klotz E, Chefdhotel C, Schreiber S, Wildberger J, Günther RW. Farbcodierte Analyse des hepatischen Perfusionsindex zur Vorhersage von Tumorrezidiven nach Radiofrequenzablation. ROFO-FORTSCHR RONTG 2010. [DOI: 10.1055/s-0030-1252698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Schramm P, Xyda A, Bock C, Schramm R, Klotz E, Knauth M. 4D-Volumen-Perfusionscomputertomographie von intraaxialen Tumoren. ROFO-FORTSCHR RONTG 2010. [DOI: 10.1055/s-0030-1252807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Ewald P, Klotz E. Arterielle Durchblutungsstörung des Armes als Spätfolge nach Klavikulafraktur. ROFO-FORTSCHR RONTG 2009. [DOI: 10.1055/s-0029-1229464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Helck A, Klotz E, Sommer WH, Reiser MF, Becker CR. Messung der glomerulären Filtrationsrate mithilfe der zeitaufgelösten Nieren-CT-Angiographie – gleichzeitige Erfassung von Funktion und Morphologie. ROFO-FORTSCHR RONTG 2009. [DOI: 10.1055/s-0029-1221447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Birnbaum J, Klotz E, Spies CD, Mueller J, Vargas Hein O, Feller J, Lehmann C. Impact of combined C1 esterase inhibitor/coagulation factor XIII or N-acetylcysteine/tirilazad mesylate administration on leucocyte adherence and cytokine release in experimental endotoxaemia. J Int Med Res 2008; 36:748-59. [PMID: 18652771 DOI: 10.1177/147323000803600417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We determined the effects of combinations of C1 esterase inhibitor (C1-INH) with factor XIII and of N-acetylcysteine (NAC) with tirilazad mesylate (TM) during lipo-polysaccharide (LPS)-induced endotoxaemia in rats. Forty Wistar rats were divided into four groups: the control (CON) group received no LPS; the LPS, C1-INH + factor XIII and NAC + TM groups received endotoxin infusions (5 mg/kg per h). After 30 min of endotoxaemia, 100 U/kg C1-INH + 50 U/kg factor XIII was administered to the C1-INH + factor XIII group, and 150 mg/kg NAC + 10 mg/kg TM was administered in the NAC + TM group. Administration of C1-INH + factor XIII and NAC + TM both resulted in reduced leucocyte adherence and reduced levels of interleukin-1beta (IL-1beta). The LPS-induced increase in IL-6 levels was amplified by both drug combinations. There was no significant effect on mesenteric plasma extravasation. In conclusion, the administration of C1-INH + factor XIII and NAC + TM reduced endothelial leucocyte adherence and IL-1beta plasma levels, but increased IL-6 levels.
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Affiliation(s)
- J Birnbaum
- Klinik für Anaesthesiologie und Operative Intensivmedizin, Charité Universitätsmedizin Berlin, Campus Charité Mitte and Campus Virchow-Klinikum, Berlin, Germany.
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Abstract
Despite the increasing use of ultrasound, electrical nerve stimulation is commonly used as the standard for both plexus and peripheral nerve blocks. Several recent randomized trials have contributed to a better understanding of physiological and clinical correlations. Traditionally used currents and impulse widths are better defined in relation to the distance between needle tip and nerves. Commercially available devices enable transcutaneous nerve stimulation and provide new opportunities for the detection of puncture sites and for training. The electrically ideal position of the needle usually is defined by motor responses which can not be interpreted without profound anatomical knowledge. For instance, interscalene blocks can be successful even after motor responses of deltoid or pectoral muscles. Infraclavicular blocks should be aimed at stimulation of the posterior fascicle (extension). In contrast to multiple single nerve blocks, axillary single-shot blocks more commonly result in incomplete anaesthesia. Blockade of the femoral nerve can be performed without any nerve stimulation if the fascia iliaca block is used. Independently of the various approaches to the sciatic nerve, inversion and plantar flexion are the best options for single-shot blocks. Further clinical trials are needed to define the advantages of stimulating catheters in continuous nerve blocks.
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Affiliation(s)
- J Birnbaum
- Universitätsklinik für Anästhesiologie und operative Intensivmedizin, Campus Charité Mitte und Campus Virchow-Klinikum,Charité-Universitätsmedizin Berlin, 10117 Berlin
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Birnbaum J, Lehmann C, Klotz E, Hein OV, Blume A, Jubin F, Polze N, Luther D, Spies CD. Effects of N-acetylcysteine and tirilazad mesylate on intestinal functional capillary density, leukocyte adherence, mesenteric plasma extravasation and cytokine levels in experimental endotoxemia in rats. Clin Hemorheol Microcirc 2008; 39:99-111. [PMID: 18503116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
INTRODUCTION The study's objective was to determine the effects of the administration of N-acetylcysteine (NAC) and of tirilazad mesylate (TM) on intestinal functional capillary density, mesenteric plasma extravasation, leukocyte adherence and on cytokine release during experimental endotoxemia in rats. METHODS In a prospective, randomized, controlled animal study, 80 male Wistar rats were examined in 2 test series. Both series were divided into 4 groups. Group 1 served as control group (CON group). Group 2 (LPS group), group 3 (NAC group) and group 4 (TM group) received endotoxin infusions (10 mg/kg over 2 h). In NAC group 150 mg/kg body weight NAC was administered after the first 30 minutes of endotoxemia intravenously. In TM group, 10 mg/kg body weight TM was administered after the first 30 minutes of endotoxemia intravenously. Animals of the series 1 underwent studies of leukocyte adherence on submucosal venular endothelium of the small bowel wall and intestinal functional capillary density (FCD) in the intestinal mucosa and the circular as well as the longitudinal muscle layer by intravital fluorescence microscopy (IVM). Plasma levels of interleukin 1beta (IL-1beta), interferone gamma (IFN-gamma) and soluble intercellular adhesion molecule1 (s-ICAM 1) as well as white blood cell count (WBC) were estimated. In the animals of the series 2 mesenteric plasma extravasation was determined by IVM and plasma levels of tumor necrosis factor alpha (TNF-alpha), IL-4, IL-6, IL-10 and malondialdehyde (MDA) were estimated. RESULTS After LPS administration, FCD in the villi intestinales was unchanged and in the longitudinal muscularis layer it was increased. There was no effect of NAC or TM administration on FCD.Although the plasma extravasation was not significantly influenced by LPS administration, TM administration resulted in a lower plasma extravasation in the TM group compared to the other groups. After endotoxin challenge, the firmly adherence of leukocytes to vascular endothelium as a parameter of leukocyte activation in endotoxemia was increased but NAC or TM administration had no influence on leukocyte adherence. The plasma levels of IL-1beta, IL-6, IL-10, TNF-alpha, IFN-gamma and sICAM-1 were increased in the endotoxemic groups (LPS group, NAC group and TM group) and the WBC was decreased compared to controls. IL-4 levels were unchanged during observation period. Plasma MDA levels were not influenced by LPS administration compared to controls. The administration of NAC resulted in lower sICAM-1 and MDA levels compared to the LPS group. The IL-1beta, IL-6, IL-10, TNF-alpha and IFN-gamma plasma levels were not influenced by NAC or TM administration. CONCLUSIONS In this posttreatment sepsis model in rats, NAC administration resulted in lower sICAM-1 and MDA levels compared to the LPS treated animals. TM administration reduced the plasma extravasation in this model.
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Affiliation(s)
- J Birnbaum
- Klinik für Anästhesiologie und operative Intensivmedizin, Charité - Universitätsmedizin Berlin, Campus Charité Mitte und Campus Virchow-Klinikum, Berlin, Germany.
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Birnbaum J, Lehmann C, Klotz E, Hein OV, Blume A, Jubin F, Polze N, Luther D, Spies C. Effects of N-acetylcysteine and tirilazad mesylate on intestinal functional capillary density, leukocyte adherence, mesenteric plasma extravasation and cytokine levels in experimental endotoxemia in rats. Clin Hemorheol Microcirc 2008. [DOI: 10.3233/ch-2008-1073] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- J. Birnbaum
- Klinik für Anästhesiologie und operative Intensivmedizin, Charité – Universitätsmedizin Berlin, Campus Charité Mitte und Campus Virchow-Klinikum, Berlin, Germany
| | - Ch. Lehmann
- Departments of Anesthesia, Pharmacology, Microbiology and Immunology, Dalhousie University, Victoria General Hospital, Halifax, NS, Canada
| | - E. Klotz
- Klinik für Anästhesiologie und operative Intensivmedizin, Charité – Universitätsmedizin Berlin, Campus Charité Mitte und Campus Virchow-Klinikum, Berlin, Germany
| | - O. Vargas Hein
- Klinik für Anästhesiologie und operative Intensivmedizin, Charité – Universitätsmedizin Berlin, Campus Charité Mitte und Campus Virchow-Klinikum, Berlin, Germany
| | - A. Blume
- Klinik für Anästhesiologie und operative Intensivmedizin, Charité – Universitätsmedizin Berlin, Campus Charité Mitte und Campus Virchow-Klinikum, Berlin, Germany
| | - F. Jubin
- Klinik für Anästhesiologie und operative Intensivmedizin, Charité – Universitätsmedizin Berlin, Campus Charité Mitte und Campus Virchow-Klinikum, Berlin, Germany
| | - N. Polze
- Klinik für Anästhesiologie und operative Intensivmedizin, Charité – Universitätsmedizin Berlin, Campus Charité Mitte und Campus Virchow-Klinikum, Berlin, Germany
| | - D. Luther
- Klinik für Anästhesiologie und operative Intensivmedizin, Charité – Universitätsmedizin Berlin, Campus Charité Mitte und Campus Virchow-Klinikum, Berlin, Germany
| | - C.D. Spies
- Klinik für Anästhesiologie und operative Intensivmedizin, Charité – Universitätsmedizin Berlin, Campus Charité Mitte und Campus Virchow-Klinikum, Berlin, Germany
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Carmoi T, Verret C, Debonne JM, Klotz E. [Management of type 2 diabetes in subsaharan Africa: update and perspective]. Med Trop (Mars) 2007; 67:601-606. [PMID: 18300523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Management of type II diabetes in sub-Saharan Africa presents a number of aspects that must be analyzed successively. Regarding the continent of Africa, implementing a strategy to control diabetes will require extensive information and education campaigns not only for health care workers but also for the general population as well as the creation of adequate infrastructure to optimize the availability of treatment. Regarding care modalities in Africa, the overall principles of management are the same as anywhere in the world. However these modalities must be adapted to the sociocultural environment of the patient. Objectives must be simplified without compromising the scientific requirements. Regarding patients, African perceptions about the disease are very different from those taught in Western schools. The different ethnocultural components of the disease must be recognized in order to optimize overall patient management.
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Affiliation(s)
- T Carmoi
- Clinique Médicale, HIA Val de Grâce, Paris, France.
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Lell MM, Ditt H, Panknin C, Sayre JW, Ruehm SG, Klotz E, Tomandl BF, Villablanca JP. Bone-subtraction CT angiography: evaluation of two different fully automated image-registration procedures for interscan motion compensation. AJNR Am J Neuroradiol 2007; 28:1362-8. [PMID: 17698541 PMCID: PMC7977676 DOI: 10.3174/ajnr.a0558] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Bone-subtraction techniques have been shown to enhance CT angiography (CTA) interpretation, but motion can lead to incomplete bone removal. The aim of this study was to evaluate 2 novel registration techniques to compensate for patient motion. MATERIALS AND METHODS Fifty-four patients underwent bone-subtraction CTA (BSCTA) for the evaluation of the neck vessels with 64-section CT. We tested 3 different registration procedures: pure rigid registration (BSCTA), slab-based registration (SB-BSCTA), and a partially rigid registration (PR-BSCTA) approach. Subtraction quality for the assessment of different vascular segments was evaluated by 2 examiners in a blinded fashion. The Cohen kappa test was applied for interobserver variability, and the Wilcoxon signed rank test, for differences between the procedures. Motion between the corresponding datasets was measured and plotted against image-quality scores. RESULTS Algorithms with motion compensation revealed higher image-quality scores (SB-BSCTA, mean 4.31; PR-BSCTA, mean 4.43) than pure rigid registration (BSCTA, mean 3.88). PR-BSCTA was rated superior to SB-BSCTA for the evaluation of the cervical internal and external carotid arteries (P<.001), whereas there was no significant difference for the other vessels (P=.157-.655). Both algorithms were clearly superior to pure rigid registration for all vessels except the basilar and ophthalmic artery. Interobserver agreement was high (kappa=0.46-0.98). CONCLUSION Bone-subtraction algorithms with motion compensation provided higher image-quality scores than pure rigid registration methods, especially in cases with complex motion. PR-BSCTA was rated superior to SB-BSCTA in the visualization of the internal and external carotid arteries.
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Affiliation(s)
- M M Lell
- Department of Radiological Sciences, David Geffen School of Medicine at the University of California, Los Angeles, CA 90095, USA.
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Lell M, Anders K, Klotz E, Ditt H, Bautz W, Tomandi B. Clinical evaluation of bone-subtraction CT angiography (BSCTA) in head and neck imaging. Clin Imaging 2006. [DOI: 10.1016/j.clinimag.2006.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ebara M, Murayama Y, Saguchi T, Ishibashi T, Irie K, Takao H, Sadaoka S, Klotz E, Abe T. Balloon Test Occlusion with Perfusion CT Imaging Utilizing Intraarterial Contrast Injection. Interv Neuroradiol 2006; 12:241-5. [PMID: 20569640 DOI: 10.1177/15910199060120s144] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2005] [Accepted: 12/15/2005] [Indexed: 11/16/2022] Open
Abstract
SUMMARY Balloon Test Occlusion (BTO) is performed to evaluate the collateral flow when a permanent therapeutic occlusion of unilateral carotid artery is planned. BTO with neurological evaluation alone, however, has a rather high false negative rate. In order to improve the sensitivity, several adjunctive procedures such as induced hypotension or cerebral blood flow (CBF) measurement with various modalities have been combined. Perfusion CT (PCT) is another imaging modality that is mainly used for the diagnosis of acute stroke. In this study, we evaluate the efficacy and the safety of BTO combined with PCT in the same procedure utilizing intraarterial contrast injection from the catheter. Seven patients underwent BTO with PCT in our institution. All the procedures were performed in the angio/CT combination suite. BTO was performed in the usual fashion and when the patient passed the 30 minutes' BTO clinically, PCT was performed subsequently. Contrast material was injected from a Pig Tail catheter placed in the ascending aorta. The obtained data were transferred to a workstation and perfusion maps of CBF, cerebral blood volume (CBV), and time to peak (TTP) were generated using software. In three patients, single photon emission CT (SPECT) was also obtained with administering 99 mTc-ethyl cysteinate dimer (99 mTc-ECD) intravenously during BTO. Although all the patients had passed the BTO clinically, the CBF maps of three patients revealed significant decrease in the occluded hemisphere. There was no procedure-related morbidity. PCT using intraarterial contrast injection during BTO was performed successfully and safely. Intraarterial injection allowed us to obtain excellent time-attenuation curves by utilizing less contrast material and less radiation doze.
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Affiliation(s)
- M Ebara
- Division of Endovascular Neurosurgery, the Jikei University School of Medicine; Tokyo, Japan -
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Mahnken AH, Klotz E, Lautenschläger M, Scheuering M, Rinck D, Mühlenbruch G, Günther RW, Wildberger JE. Myokardinfarktdarstellung inder MSCT mittels modellbasierter Segmentierung und perfusionsgewichteter Farbcodierung. ROFO-FORTSCHR RONTG 2006. [DOI: 10.1055/s-2006-940734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Tomandl BF, Hammen T, Klotz E, Ditt H, Stemper B, Lell M. Bone-subtraction CT angiography for the evaluation of intracranial aneurysms. AJNR Am J Neuroradiol 2006; 27:55-9. [PMID: 16418356 PMCID: PMC7976055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
PURPOSE CT angiography (CTA) has been established for detection and therapy planning of intracranial aneurysms. The analysis of aneurysms at the level of the skull base, however, remains difficult because bone prevents a free view. We report initial clinical results of an approach for automatic bone elimination from CTA data. MATERIAL AND METHODS Before the bone-removal process 2 datasets are acquired: nonenhanced spiral CT with reduced dose and contrast-enhanced CTA. The software automatically registers the nonenhanced data onto the CTA data and selectively removes bone. Vascular structures, as well as brain tissue, remain visible. In this study, we investigated 27 patients with 29 aneurysms, 13 of which were located at the skull base. 3D volume-rendered images with and without bone removal were reviewed and compared with digital subtraction angiography by 2 radiologists in consensus. RESULTS All supraclinoidal aneurysms were detected on 3D volume-rendered images of both CTA and bone-subtraction CT angiography (BSCTA). Four intracavernous and 3 paraclinoid aneurysms of the internal carotid artery were not visible or were only partially visible on conventional 3D CTA, whereas they could be optimally visualized with BSCTA. Bone removal was successful in all patients; the average additional time for postprocessing was 6.2 minutes. In 7 patients (26%), perfect bone removal without any artifacts was achieved. In most patients, some bone remnants were still present, though it did not disturb the 3D visualization of vascular structures. CONCLUSION BSCTA allows robust and fast selective elimination of bony structures, thus ascertaining a better analysis of arteries at the level of the skull base. This is useful for both detection and therapy planning of intracranial aneurysms.
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Affiliation(s)
- B F Tomandl
- Division of Neuroradiology, University of Erlangen-Nuremberg, Erlangen, Germany
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Lell M, Anders K, Klotz E, Ditt H, Bautz W, Tomandl BF. Clinical evaluation of bone-subtraction CT angiography (BSCTA) in head and neck imaging. Eur Radiol 2005; 16:889-97. [PMID: 16267665 DOI: 10.1007/s0330-005-0032-1] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2005] [Revised: 08/09/2005] [Accepted: 09/13/2005] [Indexed: 11/27/2022]
Abstract
Fifty-one patients were examined with bone subtraction CT angiography (BSCTA). Data were acquired on 4-and 64-slice spiral CT systems. The post-processing method is based on fully automatic registration of non-enhanced and contrast-enhanced CT data and subsequent selective bone removal. Vascular structures and brain tissue are retained with the original CTA noise level. Image quality and delineation of the pathologic process were assessed and artifacts introduced by the bone removal process recorded. The bone subtraction algorithm worked successfully in all examinations. The processing time was 6 min on average. Image quality was rated excellent in 20 (39%), good in 26 (51%) and acceptable in 5 (10%) patients. Ophthalmic arteries were visible in 12 (24%) patients bilaterally, in 13 (25%) patients unilaterally and in 26 (51%) patients at least at the origin. BSCTA improved visualization of the infraclinoid ICA and the vertebral arteries. The depiction of stenosis of the extracranial ICA and supraclinoid aneurysms was not significantly improved. In patients with suspicion of sinus thrombosis, BSCTA and conventional CTA yielded similar results. To conclude, BSCTA improves the visualization of vessels with close contact to bone and can improve the diagnostic accuracy and therapy planning of infraclinoid aneurysms.
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Affiliation(s)
- M Lell
- Institute of Diagnostic Radiology, University of Erlangen-Nuremberg, Germany.
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Wildberger JE, Klotz E, Ditt H, Mahnken AH, Spüntrup E, Günther RW. Multi-slice CT for Visualization of Acute Pulmonary Embolism: Single Breath-hold Subtraction Technique. ROFO-FORTSCHR RONTG 2005; 177:17-23. [PMID: 15657816 DOI: 10.1055/s-2004-813875] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE The purpose of our preliminary animal study was to evaluate the feasibility of a new subtraction technique for visualization of perfusion defects within the lung parenchyma in segmental and subsegmental pulmonary embolism (PE). MATERIALS AND METHODS In three healthy pigs, PE were artificially induced by fresh human clot material. Within a single breath-hold, CT angiography (CTA) was performed on a 16-slice multi-slice CT scanner (SOMATOM Sensation 16; Siemens, Forchheim, Germany) before and after intravenous application of 80 mL of contrast-medium, followed by a saline chaser. Scan parameters were 120 kV and 100 mAs (eff.), using a collimation of 16 x 1.5 mm and a table speed/rot. of 36 mm (pitch: 1.5; rotation time: 0.5 s). A new 3D subtraction technique was developed, which is based on automated segmentation, non-linear spatial filtering and non-rigid registration. Data were analysed using a color-encoded "compound view" of parenchymal enhancement and CTA information displayed in axial, coronal and sagittal orientation. RESULTS Subtraction was technically feasible in all three data sets. The mean scan time for each series was 4.7 s, interscan delay was 14.7 s, respectively. Therefore, an average breath-hold of approximately 24 s was required for the overall scanning procedure. Downstream of occluded segmental and subsegmental arteries, perfusion defects were clearly assessable, showing lower or missing enhancement compared to normally perfused lung parenchyma. In all pigs, additional peripheral areas with triangular shaped perfusion defects were delineated, considered typical for PE. CONCLUSIONS Our initial results from the animal model studied show that perfusion imaging of PE is feasible within a single breath-hold. It allows a comprehensive assessment of perfusion deficits as the direct proof of a pulmonary embolus, can be combined with an indirect visual quantification of the density changes in the adjacent lung tissue.
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Affiliation(s)
- J E Wildberger
- Department of Diagnostic Radiology, University of Technology, Aachen, Germany.
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Handschu R, Fateh-Moghadam S, Klotz E, Schmid A, Stemper B, Heckmann JG, Huk WJ, Neundörfer B, Tomandl BF. Multimodale Computertomographie beim akuten Hirninfarkt. Nervenarzt 2004; 75:564-76. [PMID: 15257380 DOI: 10.1007/s00115-003-1617-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Computed tomography (CT) is the standard method of brain imaging in acute stroke. To an experienced examiner, nonenhanced CT will exclude hemorrhage and may indicate early ischemic signs. Reliable description of an ischemic area and the underlying vascular disease is not possible in the acute phase but is possible, particularly within the first hours, when therapeutic decisions on matters such as systemic thrombolysis are to be made. For such rapid decision-making, imaging must provide more information. Novel, contrast-enhanced CT techniques can provide this information. Perfusion CT (CTP) can show brain perfusion, allowing one to distinguish between reversible and irreversible damage in an ischemic area. Also, CT angiography (CTA) can detect occlusion or stenosis in the relevant vasculature. Using a modern, multislice CT scanner, it is now possible to combine these modalities of imaging. In a fast protocol for emergency evaluation, all three methods can be performed and evaluated to provide the crucial information within 15 min. In the first 102 patients examined within 6 h of symptom onset using this protocol, multimodal CT contributed substantially to therapeutic decisions, even though there are some limitations in these methods.
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Affiliation(s)
- R Handschu
- Neurologische Klinik, Friedrich-Alexander-Universität Erlangen-Nürnberg.
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44
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Mahnken A, Klotz E, Henzler D, Hennemuth A, Hohl C, Wildberger JE, Schaller S, Günther RW. Computertomographische Bestimmung des Herzzeitvolumens aus einer Testbolusmessung: in-vitro und in-vivo Ergebnisse. ROFO-FORTSCHR RONTG 2004. [DOI: 10.1055/s-2004-827784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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45
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Tröscher-Weber R, Klotz E, Stemper B, Handschu R, Fateh-Moghadam S, Bison B, Huk WJ, Tomandl B. Umfassende Schlaganfalldiagnostik mit der Mehrschicht-CT (MSCT). ROFO-FORTSCHR RONTG 2004. [DOI: 10.1055/s-2004-828186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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46
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Dassel MS, Ditt H, Troescher-Weber R, Bison B, Huk W, Klotz E, Tomandl B. Knochen-Subtraktions-CT-Angiographie (BSCTA) zur verbesserten Darstellung von intrakraniellen Aneurysmen – Vergleich mit konventioneller CTA und DSA. ROFO-FORTSCHR RONTG 2004. [DOI: 10.1055/s-2004-827639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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47
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Rasche V, Schreiber B, Graeff C, Istel T, Schomberg H, Grass M, Koppe R, Klotz E, Rose G. Performance of image intensifier-equipped X-ray systems for three-dimensional imaging. ACTA ACUST UNITED AC 2003. [DOI: 10.1016/s0531-5131(03)00321-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Kirchhof K, Schramm P, Klotz E, Sartor K. [The value of multi-slice computed tomography for early diagnosis of focal cerebral ischemia]. ROFO-FORTSCHR RONTG 2002; 174:1089-95. [PMID: 12221565 DOI: 10.1055/s-2002-33930] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The aim of this survey is the characterization of the present value of multi-slice computed tomography (MSCT) for the assessment of hyperacute cerebral ischemia based on our experience and a review of the literature. MSCT is compared with single-slice CT (SSCT) as to the diagnostic value of standard cranial CT, CT angiography (CTA) and perfusion CT. CTA obtained with MSCT surpasses CTA obtained with SSCT. For perfusion CT, the value added by MSCT is small. With regard to standard cranial CT, MSCT and SSCT are considered equivalent. CTA and perfusion CT should be used in patients with acute stroke if the indication for thrombolysis is entertained but diffusion and perfusion weighted MRI cannot be carried out. This applies to both SSCT and MSCT. If advanced MRI and advanced CT are available, MRI continues to be the preferred imaging modality.
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Affiliation(s)
- K Kirchhof
- Abteilung Neuroradiologie, Neurologische Klinik, Universitätsklinikum Heidelberg
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Schoepf UJ, Kessler MA, Rieger CT, Herzog P, Klotz E, Wiesgigl S, Becker CR, Exarhos DN, Reiser MF. Multislice CT imaging of pulmonary embolism. Eur Radiol 2002; 11:2278-86. [PMID: 11702173 DOI: 10.1007/s003300100948] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2001] [Accepted: 03/29/2001] [Indexed: 10/27/2022]
Abstract
In recent years CT has been established as the method of choice for the diagnosis of central pulmonary embolism (PE) to the level of the segmental arteries. The key advantage of CT over competing modalities is the reliable detection of relevant alternative or additional disease causing the patient's symptoms. Although the clinical relevance of isolated peripheral emboli remains unclear, the alleged poor sensitivity of CT for the detection of such small clots has to date prevented the acceptance of CT as the gold standard for diagnosing PE. With the advent of multislice CT we can now cover the entire chest of a patient with 1-mm slices within one breath-hold. In comparison with thicker sections, the detection rate of subsegmental emboli can be significantly increased with 1-mm slices. In addition, the interobserver correlation which can be achieved with 1-mm sections by far exceeds the reproducibility of competing modalities. Meanwhile use of multislice CT for a combined diagnosis of PE and deep venous thrombosis with the same modality appears to be clinically accepted. In the vast majority of patients who receive a combined thoracic and venous multislice CT examination the scan either confirms the suspected diagnosis or reveals relevant alternative or additional disease. The therapeutic regimen is usually chosen based on the functional effect of embolic vascular occlusion. With the advent of fast CT scanning techniques, also functional parameters of lung perfusion can be non-invasively assessed by CT imaging. These advantages let multislice CT appear as an attractive modality for a non-invasive, fast, accurate, and comprehensive diagnosis of PE, its causes, effects, and differential diagnoses.
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Affiliation(s)
- U J Schoepf
- Institute of Clinical Radiology, University of Munich, Klinikum Grosshadern, Marchioninistrasse 15, 81377 Munich, Germany.
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Ohnesorge B, Flohr T, Fischbach R, Kopp AF, Knez A, Schröder S, Schöpf UJ, Crispin A, Klotz E, Reiser MF, Becker CR. Reproducibility of coronary calcium quantification in repeat examinations with retrospectively ECG-gated multisection spiral CT. Eur Radiol 2002; 12:1532-40. [PMID: 12042964 DOI: 10.1007/s00330-002-1394-2] [Citation(s) in RCA: 125] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2001] [Accepted: 02/11/2002] [Indexed: 12/22/2022]
Abstract
High reproducibility is a key requirement for coronary calcium scoring in follow-up examinations. We investigated the inter-examination reproducibility of calcium scoring with retrospectively ECG-gated multisection spiral CT (MSCT). Fifty patients were examined twice with MSCT. Slices were reconstructed with retrospective ECG gating in the diastolic phase with 3-mm slice width and up to 125-ms temporal resolution. We calculated the Agatston score, calcium volume with and without isotropic interpolation, and calcium mass, and derived the mean and median variability. We investigated the change of variability with use of 3-mm non-overlapping and overlapping increments (2, 1.5, 1 mm). Use of overlapping increment results in considerably reduced interscan variability. We observed a minimum mean variability of 12% and a minimum median variability of 9% for the Agatston score. For volume and mass quantification we obtained a minimum mean variability of 7.5% and a minimum median variability of 5%. Multisection spiral CT enables coronary calcium quantification with high reproducibility in follow-up examinations mainly founded on image data with reduced partial-volume errors due to overlapping increment.
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Affiliation(s)
- B Ohnesorge
- Siemens Medical Solutions, Division CT, CTS C, Siemensstrasse 1, 91301 Forchheim, Germany.
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