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Martin S, Angolini E, Audi J, Bertini DE, Bruno LP, Coulter J, Ferlini A, Fortunato F, Frankova V, Garnier N, Grauman Å, Gross E, Hauber B, Hansson M, Kirschner J, Knieling F, Kyosovksa G, Ottombrino S, Novelli A, Raming R, Sansen S, Saier C, Veldwijk J. Patient preferences in genetic newborn screening for rare diseases: study protocol. BMJ Open 2024; 14:e081835. [PMID: 38643010 DOI: 10.1136/bmjopen-2023-081835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/22/2024] Open
Abstract
INTRODUCTION Rare diseases (RDs) collectively impact over 30 million people in Europe. Most individual conditions have a low prevalence which has resulted in a lack of research and expertise in this field, especially regarding genetic newborn screening (gNBS). There is increasing recognition of the importance of incorporating patients' needs and general public perspectives into the shared decision-making process regarding gNBS. This study is part of the Innovative Medicine Initiative project Screen4Care which aims at shortening the diagnostic journey for RDs by accelerating diagnosis for patients living with RDs through gNBS and the use of digital technologies, such as artificial intelligence and machine learning. Our objective will be to assess expecting parent's perspectives, attitudes and preferences regarding gNBS for RDs in Italy and Germany. METHODS AND ANALYSIS A mixed method approach will assess perspectives, attitudes and preferences of (1) expecting parents seeking genetic consultation and (2) 'healthy' expecting parents from the general population in two countries (Germany and Italy). Focus groups and interviews using the nominal group technique and ranking exercises will be performed (qualitative phase). The results will inform the treatment of attributes to be assessed via a survey and a discrete choice experiment (DCE). The total recruitment sample will be 2084 participants (approximatively 1000 participants in each country for the online survey). A combination of thematic qualitative and logit-based quantitative approaches will be used to analyse the results of the study. ETHICS AND DISSEMINATION This study has been approved by the Erlangen University Ethics Committee (22-246_1-B), the Freiburg University Ethics Committee (23-1005 S1-AV) and clinical centres in Italy (University of FerraraCE: 357/2023/Oss/AOUFe and Hospedale Bambino Gesu: No.2997 of 2 November 2023, Prot. No. _902) and approved for data storage and handling at the Uppsala University (2022-05806-01). The dissemination of the results will be ensured via scientific journal publication (open access).
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Affiliation(s)
- Sylvia Martin
- Center for Research and Bioethics, Uppsala Universitet, Uppsala, Sweden
| | - Emanuele Angolini
- Research Unit of Neuromuscular and Neurodegenerative Disease, Ospedale Pediatrico Bambino Gesù IRCCS, Roma, Lazio, Italy
| | - Jennifer Audi
- Takeda Pharmaceuticals International AG, Opfikon, Zürich, Switzerland
| | - Dr Enrico Bertini
- Research Unit of Neuromuscular and Neurodegenerative Disease, Ospedale Pediatrico Bambino Gesù IRCCS, Roma, Lazio, Italy
| | - Lucia Pia Bruno
- Medical Genetics, University of Siena, Siena, Italy
- Telethon Institute of Genetics and Medicine, Napoli, Campania, Italy
| | | | - Alessandra Ferlini
- Medical Genetics Unit, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Fernanda Fortunato
- Medical Genetics Unit, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Vera Frankova
- Institute for Medical Humanities, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | | | - Åsa Grauman
- Center for Research and Bioethics, Uppsala Universitet, Uppsala, Sweden
| | | | | | - Mats Hansson
- Center for Research and Bioethics, Uppsala Universitet, Uppsala, Sweden
| | - Janbernd Kirschner
- Department of Neuropediatrics and Muscle Disorders, Medical Center, University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | | | | | - Silvia Ottombrino
- Research Unit of Neuromuscular and Neurodegenerative Disease, Ospedale Pediatrico Bambino Gesù IRCCS, Roma, Lazio, Italy
| | - Antonio Novelli
- Research Unit of Neuromuscular and Neurodegenerative Disease, Ospedale Pediatrico Bambino Gesù IRCCS, Roma, Lazio, Italy
| | - Roman Raming
- Erlangen University Hospital, Erlangen, Bayern, Germany
| | | | - Christina Saier
- Department of Neuropediatrics and Muscle Disorders, Faculty of Medicine, Freiburg, Germany
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Schoeffl I, Raming R, Tratzky JP, Regensburger AP, Kraus C, Waellisch W, Trollmann R, Woelfle J, Dittrich S, Heiss R, Knieling F, Weigelt A. Cardiopulmonary function in paediatric post-COVID-19: a controlled clinical trial. Eur J Pediatr 2024; 183:1645-1655. [PMID: 38193996 PMCID: PMC11001705 DOI: 10.1007/s00431-024-05421-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 12/26/2023] [Accepted: 01/02/2024] [Indexed: 01/10/2024]
Abstract
Recently, the importance of post-COVID-19 in children has been recognized in surveys and retrospective chart analysis. However, objective data in the form of cardiopulmonary exercise test as performed in adults suffering from this condition are still lacking. This study aimed to investigate the cardiopulmonary effects of post-COVID-19 on children and adolescents. In this cross-sectional study (the FASCINATE study), children fulfilling the criteria of post-COVID-19 and an age- and sex-matched control group underwent cardiopulmonary exercise testing on a treadmill and completed a questionnaire with regard to physical activity before, during and after the infection with SARS-CoV-2. We were able to recruit 20 children suffering from post-COVID-19 (mean age 12.8 ± 2.4 years, 60% females) and 28 control children (mean age 11.7 ± 3.5 years, 50% females). All participants completed a maximal treadmill test with a significantly lowerV ˙ O 2 peak in the post-COVID-19 group (37.4 ± 8.8 ml/kg/min vs. 43.0 ± 6.7 ml/kg/min. p = 0.019). This significance did not persist when comparing the achieved percentage of predictedV ˙ O 2 peak . There were no significant differences for oxygen pulse, heart rate, minute ventilation or breathing frequency. Conclusion: This is the first study to investigate post-COVID-19 in children using the cardiopulmonary exercise test. Although there was a significantly reducedV ˙ O 2 peak in the post-COVID-19 group, this was not true for the percent of predicted values. No pathological findings with respect to cardiac or pulmonary functions could be discerned. Deconditioning was the most plausible cause for the experienced symptoms. Trial registration: clinicaltrials.gov, NCT054445531, Low-field Magnetic Resonance Imaging in Pediatric Post Covid-19-Full Text View-ClinicalTrials.gov. What is Known: • The persistence of symptoms after an infection with SARS-CoV 2, so-called post-COVID-19 exists also in children. • So far little research has been conducted to analyze this entity in the pediatric population. What is New: • This is the first study proving a significantly lower cardiopulmonary function in pediatric patients suffering from post-COVID-19 symptoms. • The cardiac and pulmonary function appear similar between children suffering from post-COVID-19 and those who don't, but the peripheral muscles seem affected.
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Affiliation(s)
- Isabelle Schoeffl
- Department of Pediatric Cardiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Loschgestrasse 15, 91054, Erlangen, Germany.
- School of Clinical and Applied Sciences, Leeds Beckett University, Leeds, LS13HE, UK.
| | - Roman Raming
- Department of Pediatrics, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Loschgestrasse 15, 91054, Erlangen, Germany
| | - Jan-Philipp Tratzky
- Department of Pediatric Cardiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Loschgestrasse 15, 91054, Erlangen, Germany
| | - Adrian P Regensburger
- Department of Pediatrics, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Loschgestrasse 15, 91054, Erlangen, Germany
| | - Calvin Kraus
- Department of Pediatrics, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Loschgestrasse 15, 91054, Erlangen, Germany
| | - Wolfgang Waellisch
- Department of Pediatric Cardiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Loschgestrasse 15, 91054, Erlangen, Germany
| | - Regina Trollmann
- Department of Pediatrics, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Loschgestrasse 15, 91054, Erlangen, Germany
| | - Joachim Woelfle
- Department of Pediatrics, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Loschgestrasse 15, 91054, Erlangen, Germany
| | - Sven Dittrich
- Department of Pediatric Cardiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Loschgestrasse 15, 91054, Erlangen, Germany
| | - Rafael Heiss
- Department of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Loschgestrasse 15, 91054, Erlangen, Germany
| | - Ferdinand Knieling
- Department of Pediatrics, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Loschgestrasse 15, 91054, Erlangen, Germany
| | - Annika Weigelt
- Department of Pediatric Cardiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Loschgestrasse 15, 91054, Erlangen, Germany.
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Nedoschill E, Wagner AL, Danko V, Buehler A, Raming R, Jüngert J, Neurath MF, Waldner MJ, Rother U, Woelfle J, Trollmann R, Knieling F, Regensburger AP. Monitoring spinal muscular atrophy with three-dimensional optoacoustic imaging. Med 2024:S2666-6340(24)00082-5. [PMID: 38531362 DOI: 10.1016/j.medj.2024.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 02/01/2024] [Accepted: 02/26/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND Spinal muscular atrophy is a progressive neuromuscular disorder and among the most frequent genetic causes of infant mortality. While recent advancements in gene therapy provide the potential to ameliorate the disease severity, there is currently no modality in clinical use to visualize dynamic pathophysiological changes in disease progression and regression after therapy. METHODS In this prospective diagnostic clinical study, ten pediatric patients with spinal muscular atrophy and ten age- and sex-matched controls have been examined with three-dimensional optoacoustic imaging and clinical standard examinations to compare the spectral profile of muscle tissue and correlate it with motor function (ClinicalTrials.gov: NCT04115475). FINDINGS We observed a reduced optoacoustic signal in muscle tissue of pediatric patients with spinal muscular atrophy. The reduction in signal intensity correlated with disease severity as assessed by grayscale ultrasound and standard motor function tests. In a cohort of patients who received disease-modifying therapy prior to the study, the optoacoustic signal intensity was similar to healthy controls. CONCLUSIONS This translational study provides early evidence that three-dimensional optoacoustic imaging could have clinical implications in monitoring disease activity in spinal muscular atrophy. By visualizing and quantifying molecular changes in muscle tissue, disease progression and effects of gene therapy can be assessed in real time. FUNDING The project was funded by ELAN Fonds (P055) at the University Hospital of the Friedrich-Alexander-Universität (FAU) Erlangen-Nurnberg to A.P.R.
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Affiliation(s)
- Emmanuel Nedoschill
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Erlangen, Germany
| | - Alexandra L Wagner
- Department of Pediatric Neurology, Center for Chronically Sick Children, Charité Berlin, Berlin, Germany
| | - Vera Danko
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Erlangen, Germany
| | - Adrian Buehler
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Erlangen, Germany
| | - Roman Raming
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Erlangen, Germany
| | - Jörg Jüngert
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Erlangen, Germany
| | - Markus F Neurath
- Medical Department 1, University Hospital Erlangen, Erlangen, Germany
| | | | - Ulrich Rother
- Department of Vascular Surgery, University Hospital Erlangen, Erlangen, Germany
| | - Joachim Woelfle
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Erlangen, Germany
| | - Regina Trollmann
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Erlangen, Germany
| | - Ferdinand Knieling
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Erlangen, Germany
| | - Adrian P Regensburger
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Erlangen, Germany.
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Noversa de Sousa R, Tascilar K, Corte G, Atzinger A, Minopoulou I, Ohrndorf S, Waldner M, Schmidkonz C, Kuwert T, Knieling F, Kleyer A, Ramming A, Schett G, Simon D, Fagni F. Metabolic and molecular imaging in inflammatory arthritis. RMD Open 2024; 10:e003880. [PMID: 38341194 PMCID: PMC10862311 DOI: 10.1136/rmdopen-2023-003880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 01/25/2024] [Indexed: 02/12/2024] Open
Abstract
It is known that metabolic shifts and tissue remodelling precede the development of visible inflammation and structural organ damage in inflammatory rheumatic diseases such as the inflammatory arthritides. As such, visualising and measuring metabolic tissue activity could be useful to identify biomarkers of disease activity already in a very early phase. Recent advances in imaging have led to the development of so-called 'metabolic imaging' tools that can detect these changes in metabolism in an increasingly accurate manner and non-invasively.Nuclear imaging techniques such as 18F-D-glucose and fibroblast activation protein inhibitor-labelled positron emission tomography are increasingly used and have yielded impressing results in the visualisation (including whole-body staging) of inflammatory changes in both early and established arthritis. Furthermore, optical imaging-based bedside techniques such as multispectral optoacoustic tomography and fluorescence optical imaging are advancing our understanding of arthritis by identifying intra-articular metabolic changes that correlate with the onset of inflammation with high precision and without the need of ionising radiation.Metabolic imaging holds great potential for improving the management of patients with inflammatory arthritis by contributing to early disease interception and improving diagnostic accuracy, thereby paving the way for a more personalised approach to therapy strategies including preventive strategies. In this narrative review, we discuss state-of-the-art metabolic imaging methods used in the assessment of arthritis and inflammation, and we advocate for more extensive research endeavours to elucidate their full field of application in rheumatology.
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Affiliation(s)
- Rita Noversa de Sousa
- Department of Internal Medicine 3, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
- Serviço de Medicina Interna, Hospital Pedro Hispano, Matosinhos, Portugal
- Deutsches Zentrum fuer Immuntherapie (DZI), Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Koray Tascilar
- Department of Internal Medicine 3, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
- Deutsches Zentrum fuer Immuntherapie (DZI), Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Giulia Corte
- Department of Internal Medicine 3, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
- Deutsches Zentrum fuer Immuntherapie (DZI), Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Armin Atzinger
- Department of Nuclear Medicine, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Ioanna Minopoulou
- Department of Internal Medicine 3, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
- Deutsches Zentrum fuer Immuntherapie (DZI), Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Sarah Ohrndorf
- Department of Rheumatology and Clinical Immunology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Maximilian Waldner
- Department of Internal Medicine 3, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Christian Schmidkonz
- Department of Nuclear Medicine, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
- Institute for Medical Engineering, Ostbayerische Technische Hochschule Amberg-Weiden, Amberg, Germany
| | - Torsten Kuwert
- Department of Nuclear Medicine, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Ferdinand Knieling
- Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Arnd Kleyer
- Department of Internal Medicine 3, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
- Department of Rheumatology and Clinical Immunology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Andreas Ramming
- Department of Internal Medicine 3, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
- Deutsches Zentrum fuer Immuntherapie (DZI), Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Georg Schett
- Department of Internal Medicine 3, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
- Deutsches Zentrum fuer Immuntherapie (DZI), Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - David Simon
- Department of Internal Medicine 3, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
- Department of Rheumatology and Clinical Immunology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Filippo Fagni
- Department of Internal Medicine 3, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
- Deutsches Zentrum fuer Immuntherapie (DZI), Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
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5
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Regensburger AP, Eckstein M, Wetzl M, Raming R, Paulus LP, Buehler A, Nedoschill E, Danko V, Jüngert J, Wagner AL, Schnell A, Rückel A, Rother U, Rompel O, Uder M, Hartmann A, Neurath MF, Woelfle J, Waldner MJ, Hoerning A, Knieling F. Multispectral optoacoustic tomography enables assessment of disease activity in paediatric inflammatory bowel disease. Photoacoustics 2024; 35:100578. [PMID: 38144890 PMCID: PMC10746560 DOI: 10.1016/j.pacs.2023.100578] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 11/01/2023] [Accepted: 11/29/2023] [Indexed: 12/26/2023]
Abstract
Multispectral optoacoustic tomography (MSOT) allows non-invasive molecular disease activity assessment in adults with inflammatory bowel disease (IBD). In this prospective pilot-study, we investigated, whether increased levels of MSOT haemoglobin parameters corresponded to inflammatory activity in paediatric IBD patients, too. 23 children with suspected IBD underwent MSOT of the terminal ileum and sigmoid colon with standard validation (e.g. endoscopy). In Crohn`s disease (CD) and ulcerative colitis (UC) patients with endoscopically confirmed disease activity, MSOT total haemoglobin (HbT) signals were increased in the terminal ileum of CD (72.1 ± 13.0 a.u. vs. 32.9 ± 15.4 a.u., p = 0.0049) and in the sigmoid colon of UC patients (62.9 ± 13.8 a.u. vs. 35.1 ± 16.3 a.u., p = 0.0311) as compared to controls, respectively. Furthermore, MSOT haemoglobin parameters correlated well with standard disease activity assessment (e.g. SES-CD and MSOT HbT (rs =0.69, p = 0.0075). Summarizing, MSOT is a novel technology for non-invasive molecular disease activity assessment in paediatric patients with inflammatory bowel disease.
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Affiliation(s)
- Adrian P. Regensburger
- Department of Paediatrics and Adolescent Medicine and German Center Immunotherapy (DZI), University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
- Paediatric Experimental and Translational Imaging Laboratory (PETI-Lab), Department of Paediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Markus Eckstein
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Matthias Wetzl
- Department of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Roman Raming
- Department of Paediatrics and Adolescent Medicine and German Center Immunotherapy (DZI), University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
- Paediatric Experimental and Translational Imaging Laboratory (PETI-Lab), Department of Paediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Lars-Philip Paulus
- Department of Paediatrics and Adolescent Medicine and German Center Immunotherapy (DZI), University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
- Paediatric Experimental and Translational Imaging Laboratory (PETI-Lab), Department of Paediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Adrian Buehler
- Department of Paediatrics and Adolescent Medicine and German Center Immunotherapy (DZI), University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
- Paediatric Experimental and Translational Imaging Laboratory (PETI-Lab), Department of Paediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Emmanuel Nedoschill
- Department of Paediatrics and Adolescent Medicine and German Center Immunotherapy (DZI), University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
- Paediatric Experimental and Translational Imaging Laboratory (PETI-Lab), Department of Paediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Vera Danko
- Department of Paediatrics and Adolescent Medicine and German Center Immunotherapy (DZI), University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
- Paediatric Experimental and Translational Imaging Laboratory (PETI-Lab), Department of Paediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Jörg Jüngert
- Department of Paediatrics and Adolescent Medicine and German Center Immunotherapy (DZI), University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Alexandra L. Wagner
- Paediatric Experimental and Translational Imaging Laboratory (PETI-Lab), Department of Paediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Alexander Schnell
- Department of Paediatrics and Adolescent Medicine and German Center Immunotherapy (DZI), University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Aline Rückel
- Department of Paediatrics and Adolescent Medicine and German Center Immunotherapy (DZI), University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Ulrich Rother
- Department of Vascular Surgery, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Oliver Rompel
- Department of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Michael Uder
- Department of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Arndt Hartmann
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Markus F. Neurath
- Department of Medicine 1 and German Center Immunotherapy (DZI), University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Joachim Woelfle
- Department of Paediatrics and Adolescent Medicine and German Center Immunotherapy (DZI), University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Maximilian J. Waldner
- Department of Medicine 1 and German Center Immunotherapy (DZI), University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - André Hoerning
- Department of Paediatrics and Adolescent Medicine and German Center Immunotherapy (DZI), University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Ferdinand Knieling
- Department of Paediatrics and Adolescent Medicine and German Center Immunotherapy (DZI), University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
- Paediatric Experimental and Translational Imaging Laboratory (PETI-Lab), Department of Paediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
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Träger AP, Günther JS, Raming R, Paulus LP, Lang W, Meyer A, Kempf J, Caranovic M, Li Y, Wagner AL, Tan L, Danko V, Trollmann R, Woelfle J, Klett D, Neurath MF, Regensburger AP, Eckstein M, Uter W, Uder M, Herrmann Y, Waldner MJ, Knieling F, Rother U. Hybrid ultrasound and single wavelength optoacoustic imaging reveals muscle degeneration in peripheral artery disease. Photoacoustics 2024; 35:100579. [PMID: 38312805 PMCID: PMC10835356 DOI: 10.1016/j.pacs.2023.100579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 10/18/2023] [Accepted: 11/29/2023] [Indexed: 02/06/2024]
Abstract
Peripheral arterial disease (PAD) leads to chronic vascular occlusion and results in end organ damage in critically perfused limbs. There are currently no clinical methods available to determine the muscular damage induced by chronic mal-perfusion. This monocentric prospective cross-sectional study investigated n = 193 adults, healthy to severe PAD, in order to quantify the degree of calf muscle degeneration caused by PAD using a non-invasive hybrid ultrasound and single wavelength optoacoustic imaging (US/SWL-OAI) approach. While US provides morphologic information, SWL-OAI visualizes the absorption of pulsed laser light and the resulting sound waves from molecules undergoing thermoelastic expansion. US/SWL-OAI was compared to multispectral data, clinical disease severity, angiographic findings, phantom experiments, and histological examinations from calf muscle biopsies. We were able to show that synergistic use of US/SWL-OAI is most likely to map clinical degeneration of the muscle and progressive PAD.
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Affiliation(s)
- Anna P. Träger
- Department of Vascular Surgery, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Krankenhausstraße 12, D-91054 Erlangen, Germany
- Faculty of Medicine, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Krankenhausstraße 12, D-91054 Erlangen, Germany
| | - Josefine S. Günther
- Department of Vascular Surgery, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Krankenhausstraße 12, D-91054 Erlangen, Germany
- Faculty of Medicine, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Krankenhausstraße 12, D-91054 Erlangen, Germany
| | - Roman Raming
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nuremberg (FAU), Loschgestraße 15, D-91054 Erlangen, Germany
| | - Lars-Philip Paulus
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nuremberg (FAU), Loschgestraße 15, D-91054 Erlangen, Germany
| | - Werner Lang
- Department of Vascular Surgery, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Krankenhausstraße 12, D-91054 Erlangen, Germany
| | - Alexander Meyer
- Department of Vascular Surgery, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Krankenhausstraße 12, D-91054 Erlangen, Germany
| | - Julius Kempf
- Department of Vascular Surgery, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Krankenhausstraße 12, D-91054 Erlangen, Germany
- Faculty of Medicine, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Krankenhausstraße 12, D-91054 Erlangen, Germany
| | - Milenko Caranovic
- Department of Vascular Surgery, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Krankenhausstraße 12, D-91054 Erlangen, Germany
- Faculty of Medicine, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Krankenhausstraße 12, D-91054 Erlangen, Germany
| | - Yi Li
- Department of Vascular Surgery, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Krankenhausstraße 12, D-91054 Erlangen, Germany
- Faculty of Medicine, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Krankenhausstraße 12, D-91054 Erlangen, Germany
| | - Alexandra L. Wagner
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nuremberg (FAU), Loschgestraße 15, D-91054 Erlangen, Germany
| | - Lina Tan
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nuremberg (FAU), Loschgestraße 15, D-91054 Erlangen, Germany
| | - Vera Danko
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nuremberg (FAU), Loschgestraße 15, D-91054 Erlangen, Germany
| | - Regina Trollmann
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nuremberg (FAU), Loschgestraße 15, D-91054 Erlangen, Germany
| | - Joachim Woelfle
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nuremberg (FAU), Loschgestraße 15, D-91054 Erlangen, Germany
| | - Daniel Klett
- Department of Medicine 1, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Ulmenweg 18, D-91054 Erlangen, Germany
| | - Markus F. Neurath
- Department of Medicine 1, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Ulmenweg 18, D-91054 Erlangen, Germany
- Deutsches Zentrum für Immuntherapie (DZI), University Hospital Erlangen, Ulmenweg 18, D-91054 Erlangen, Germany
- Erlangen Graduate School in Advanced Optical Technologies (SAOT), Friedrich-Alexander-Universität Erlangen-Nürnberg, Paul-Gordan-Straße 6, D-91052 Erlangen, Germany
| | - Adrian P. Regensburger
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nuremberg (FAU), Loschgestraße 15, D-91054 Erlangen, Germany
| | - Markus Eckstein
- Department of Pathology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Krankenhausstrasse 8-10, D-91054 Erlangen, Germany
| | - Wolfgang Uter
- Department of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander-Universität Erlangen-Nürrnberg (FAU), Waldstraße 6, D-91054 Erlangen, Germany
| | - Michael Uder
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander, Universität Erlangen-Nürnberg (FAU), Maximiliansplatz 1, D-91054 Erlangen, Germany
| | - Yvonne Herrmann
- Department of Pediatric Cardiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Loschgestraße 15, D-91054 Erlangen, Germany
| | - Maximilian J. Waldner
- Department of Medicine 1, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Ulmenweg 18, D-91054 Erlangen, Germany
- Deutsches Zentrum für Immuntherapie (DZI), University Hospital Erlangen, Ulmenweg 18, D-91054 Erlangen, Germany
- Erlangen Graduate School in Advanced Optical Technologies (SAOT), Friedrich-Alexander-Universität Erlangen-Nürnberg, Paul-Gordan-Straße 6, D-91052 Erlangen, Germany
| | - Ferdinand Knieling
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nuremberg (FAU), Loschgestraße 15, D-91054 Erlangen, Germany
| | - Ulrich Rother
- Department of Vascular Surgery, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Krankenhausstraße 12, D-91054 Erlangen, Germany
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7
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Hoerning A, Jüngert J, Siebenlist G, Knieling F, Regensburger AP. Ultrasound in Pediatric Inflammatory Bowel Disease-A Review of the State of the Art and Future Perspectives. Children (Basel) 2024; 11:156. [PMID: 38397268 PMCID: PMC10887069 DOI: 10.3390/children11020156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 01/22/2024] [Accepted: 01/24/2024] [Indexed: 02/25/2024]
Abstract
Inflammatory bowel disease (IBD) comprises a group of relapsing, chronic diseases of the gastrointestinal tract that, in addition to adults, can affect children and adolescents. To detect relapses of inflammation, these patients require close observation, frequent follow-up, and therapeutic adjustments. While reference standard diagnostics include anamnestic factors, laboratory and stool sample assessment, performing specific imaging in children and adolescents is much more challenging than in adults. Endoscopic and classic cross-sectional imaging modalities may be invasive and often require sedation for younger patients. For this reason, intestinal ultrasound (IUS) is becoming increasingly important for the non-invasive assessment of the intestine and its inflammatory affection. In this review, we would like to shed light on the current state of the art and provide an outlook on developments in this field that could potentially spare these patients more invasive follow-up procedures.
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Affiliation(s)
- André Hoerning
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nürnberg, 91054 Erlangen, Germany
- German Center Immunotherapy (DZI), University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Jörg Jüngert
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Gregor Siebenlist
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Ferdinand Knieling
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Adrian P Regensburger
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nürnberg, 91054 Erlangen, Germany
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8
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Wachter F, Knieling F, Raming R, Simon D, Woelfle J, Hoerning A, Neubert A, Rauh M, Regensburger AP. Routine Surveillance of SARS-CoV-2 Serostatus in Pediatrics Allows Monitoring of Humoral Response. Microorganisms 2023; 11:2919. [PMID: 38138063 PMCID: PMC10745477 DOI: 10.3390/microorganisms11122919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 11/22/2023] [Accepted: 12/01/2023] [Indexed: 12/24/2023] Open
Abstract
The occurrence of SARS-CoV-2 infections during the pandemic was mainly based on PCR testing of symptomatic patients. However, with new variants, vaccinations, and the changing of the clinical disease severity, knowledge about general immunity is elusive. For public health systems, timely knowledge of these conditions is essential, but it is particularly scarce for the pediatric population. Therefore, in this study, we wanted to investigate the spike and nucleocapsid seroprevalence in pediatric patients using routine residual blood tests collected during the pandemic. This prospective observational study was conducted over seven one-month periods. Herein, the latest four time periods (November 2021, January 2022, March 2022, and May 2022) are depicted. Each patient of a tertiary-care center in Germany was anonymized after collection of clinical diagnosis (ICD-10) and then routinely tested for the respective spike and nucleocapsid SARS-CoV-2 antibody titer. A total of 3235 blood samples from four time periods were included. Spike seroprevalence rose from 37.6% to 51.9% to 70.5% to 85.1% and nucleocapsid seroprevalence from 11.6% to 17.0% to 36.7% to 58.1% in May 2022. In detail, significant changes in seroprevalence between age groups but not between sex or diagnosis groups were found. Quantitative measures revealed rising spike and constant nucleocapsid antibody levels over the pandemic with a half-life of 102 days for spike and 45 days for nucleocapsid antibodies. Routine laboratory assessment of SARS-CoV-2 in residual blood specimens of pediatric hospitals enables monitoring of the seroprevalence and may allow inferences about general immunity in this cohort.
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Affiliation(s)
- Felix Wachter
- Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander-University (FAU) Erlangen-Nürnberg, 91054 Erlangen, Germany; (F.W.); (R.R.)
| | - Ferdinand Knieling
- Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander-University (FAU) Erlangen-Nürnberg, 91054 Erlangen, Germany; (F.W.); (R.R.)
| | - Roman Raming
- Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander-University (FAU) Erlangen-Nürnberg, 91054 Erlangen, Germany; (F.W.); (R.R.)
| | - David Simon
- Department of Internal Medicine 3, Friedrich-Alexander-University (FAU) Erlangen-Nürnberg, 91054 Erlangen, Germany;
| | - Joachim Woelfle
- Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander-University (FAU) Erlangen-Nürnberg, 91054 Erlangen, Germany; (F.W.); (R.R.)
| | - André Hoerning
- Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander-University (FAU) Erlangen-Nürnberg, 91054 Erlangen, Germany; (F.W.); (R.R.)
| | - Antje Neubert
- Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander-University (FAU) Erlangen-Nürnberg, 91054 Erlangen, Germany; (F.W.); (R.R.)
| | - Manfred Rauh
- Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander-University (FAU) Erlangen-Nürnberg, 91054 Erlangen, Germany; (F.W.); (R.R.)
| | - Adrian P. Regensburger
- Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander-University (FAU) Erlangen-Nürnberg, 91054 Erlangen, Germany; (F.W.); (R.R.)
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9
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Assi H, Cao R, Castelino M, Cox B, Gilbert FJ, Gröhl J, Gurusamy K, Hacker L, Ivory AM, Joseph J, Knieling F, Leahy MJ, Lilaj L, Manohar S, Meglinski I, Moran C, Murray A, Oraevsky AA, Pagel MD, Pramanik M, Raymond J, Singh MKA, Vogt WC, Wang L, Yang S, Members of IPASC, Bohndiek SE. A review of a strategic roadmapping exercise to advance clinical translation of photoacoustic imaging: From current barriers to future adoption. Photoacoustics 2023; 32:100539. [PMID: 37600964 PMCID: PMC10432856 DOI: 10.1016/j.pacs.2023.100539] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 07/27/2023] [Accepted: 07/27/2023] [Indexed: 08/22/2023]
Abstract
Photoacoustic imaging (PAI), also referred to as optoacoustic imaging, has shown promise in early-stage clinical trials in a range of applications from inflammatory diseases to cancer. While the first PAI systems have recently received regulatory approvals, successful adoption of PAI technology into healthcare systems for clinical decision making must still overcome a range of barriers, from education and training to data acquisition and interpretation. The International Photoacoustic Standardisation Consortium (IPASC) undertook an community exercise in 2022 to identify and understand these barriers, then develop a roadmap of strategic plans to address them. Here, we outline the nature and scope of the barriers that were identified, along with short-, medium- and long-term community efforts required to overcome them, both within and beyond the IPASC group.
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Affiliation(s)
- Hisham Assi
- Department of Physics, Toronto Metropolitan University, Toronto, Canada
| | - Rui Cao
- Caltech Optical Imaging Laboratory, Andrew and Peggy Cherng Department of Medical Engineering, Department of Electrical Engineering, California Institute of Technology, Pasadena, CA, USA
| | - Madhura Castelino
- Department of Rheumatology, University College London Hospital, London, UK
| | - Ben Cox
- Department of Medical Physics and Bioengineering, University College London, London, UK
| | | | - Janek Gröhl
- Department of Physics, University of Cambridge, Cambridge, UK
- CRUK Cambridge Institute, University of Cambridge, Cambridge, UK
| | - Kurinchi Gurusamy
- Department of Surgical Biotechnology, University College London, London, UK
| | - Lina Hacker
- Department of Physics, University of Cambridge, Cambridge, UK
- CRUK Cambridge Institute, University of Cambridge, Cambridge, UK
| | - Aoife M. Ivory
- Department of Medical, Marine and Nuclear Physics, National Physical Laboratory, Teddington, UK
| | - James Joseph
- School of Science and Engineering, University of Dundee, Dundee, UK
| | - Ferdinand Knieling
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität, Erlangen-Nürnberg, Germany
| | - Martin J. Leahy
- School of Natural Sciences – Physics, University of Galway, Galway, Ireland
| | | | | | - Igor Meglinski
- College of Engineering and Physical Sciences, Aston University, Birmingham, UK
| | - Carmel Moran
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Andrea Murray
- Centre for Musculoskeletal Research, University of Manchester, Manchester Academic Health Science Centre (MAHSC), Salford Care Organisation, NCA NHS Foundation Trust, UK
| | | | - Mark D. Pagel
- Department of Cancer Systems Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Manojit Pramanik
- Department of Electrical and Computer Engineering, Iowa State University, Ames, IA, USA
| | - Jason Raymond
- Department of Engineering Science, University of Oxford, UK
| | | | - William C. Vogt
- Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD, USA
| | - Lihong Wang
- Caltech Optical Imaging Laboratory, Andrew and Peggy Cherng Department of Medical Engineering, Department of Electrical Engineering, California Institute of Technology, Pasadena, CA, USA
| | - Shufan Yang
- School of Computing, Edinburgh Napier University, UK
| | - Members of IPASC
- Department of Physics, University of Cambridge, Cambridge, UK
- CRUK Cambridge Institute, University of Cambridge, Cambridge, UK
| | - Sarah E. Bohndiek
- Department of Physics, University of Cambridge, Cambridge, UK
- CRUK Cambridge Institute, University of Cambridge, Cambridge, UK
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10
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Paulus L, Buehler A, Wagner AL, Raming R, Jüngert J, Simon D, Tascilar K, Schnell A, Rother U, Eckstein M, Lang W, Hoerning A, Schett G, Neurath MF, Waldner MJ, Trollmann R, Woelfle J, Bohndiek SE, Regensburger AP, Knieling F. Contrast-Enhanced Multispectral Optoacoustic Tomography for Functional Assessment of the Gastrointestinal Tract. Adv Sci (Weinh) 2023; 10:e2302562. [PMID: 37289088 PMCID: PMC10427354 DOI: 10.1002/advs.202302562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Indexed: 06/09/2023]
Abstract
Real-time imaging and functional assessment of the intestinal tract and its transit pose a significant challenge to conventional clinical diagnostic methods. Multispectral optoacoustic tomography (MSOT), a molecular-sensitive imaging technology, offers the potential to visualize endogenous and exogenous chromophores in deep tissue. Herein, a novel approach using the orally administered clinical-approved fluorescent dye indocyanine green (ICG) for bedside, non-ionizing evaluation of gastrointestinal passage is presented. The authors are able to show the detectability and stability of ICG in phantom experiments. Furthermore, ten healthy subjects underwent MSOT imaging at multiple time points over eight hours after ingestion of a standardized meal with and without ICG. ICG signals can be visualized and quantified in different intestinal segments, while its excretion is confirmed by fluorescent imaging of stool samples. These findings indicate that contrast-enhanced MSOT (CE-MSOT) provides a translatable real-time imaging approach for functional assessment of the gastrointestinal tract.
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Affiliation(s)
- Lars‐Philip Paulus
- Department of Pediatrics and Adolescent MedicineUniversity Hospital ErlangenFriedrich‐Alexander‐Universität (FAU) Erlangen‐Nürnberg91054ErlangenGermany
- Pediatric Experimental and Translational Imaging Laboratory (PETI‐Lab)Department of Pediatrics and Adolescent MedicineUniversity Hospital ErlangenFriedrich‐Alexander‐Universität (FAU) Erlangen‐Nürnberg91054ErlangenGermany
| | - Adrian Buehler
- Department of Pediatrics and Adolescent MedicineUniversity Hospital ErlangenFriedrich‐Alexander‐Universität (FAU) Erlangen‐Nürnberg91054ErlangenGermany
- Pediatric Experimental and Translational Imaging Laboratory (PETI‐Lab)Department of Pediatrics and Adolescent MedicineUniversity Hospital ErlangenFriedrich‐Alexander‐Universität (FAU) Erlangen‐Nürnberg91054ErlangenGermany
| | - Alexandra L. Wagner
- Department of Pediatrics and Adolescent MedicineUniversity Hospital ErlangenFriedrich‐Alexander‐Universität (FAU) Erlangen‐Nürnberg91054ErlangenGermany
- Pediatric Experimental and Translational Imaging Laboratory (PETI‐Lab)Department of Pediatrics and Adolescent MedicineUniversity Hospital ErlangenFriedrich‐Alexander‐Universität (FAU) Erlangen‐Nürnberg91054ErlangenGermany
- Department of Pediatric Neurology, Center for Chronically Sick ChildrenCharité BerlinBerlinGermany
| | - Roman Raming
- Department of Pediatrics and Adolescent MedicineUniversity Hospital ErlangenFriedrich‐Alexander‐Universität (FAU) Erlangen‐Nürnberg91054ErlangenGermany
- Pediatric Experimental and Translational Imaging Laboratory (PETI‐Lab)Department of Pediatrics and Adolescent MedicineUniversity Hospital ErlangenFriedrich‐Alexander‐Universität (FAU) Erlangen‐Nürnberg91054ErlangenGermany
| | - Jörg Jüngert
- Department of Pediatrics and Adolescent MedicineUniversity Hospital ErlangenFriedrich‐Alexander‐Universität (FAU) Erlangen‐Nürnberg91054ErlangenGermany
| | - David Simon
- Department of Medicine 3, University Hospital ErlangenFriedrich‐Alexander‐Universität (FAU) Erlangen‐Nürnberg91054ErlangenGermany
| | - Koray Tascilar
- Department of Medicine 3, University Hospital ErlangenFriedrich‐Alexander‐Universität (FAU) Erlangen‐Nürnberg91054ErlangenGermany
| | - Alexander Schnell
- Department of Pediatrics and Adolescent MedicineUniversity Hospital ErlangenFriedrich‐Alexander‐Universität (FAU) Erlangen‐Nürnberg91054ErlangenGermany
| | - Ulrich Rother
- Department of Vascular SurgeryUniversity Hospital ErlangenFriedrich‐Alexander Universität (FAU) Erlangen‐Nürnberg91054ErlangenGermany
| | - Markus Eckstein
- Insitute of PathologyUniversity Hospital ErlangenFriedrich‐Alexander‐Universität (FAU) Erlangen‐Nürnberg91054ErlangenGermany
| | - Werner Lang
- Department of Vascular SurgeryUniversity Hospital ErlangenFriedrich‐Alexander Universität (FAU) Erlangen‐Nürnberg91054ErlangenGermany
| | - André Hoerning
- Department of Pediatrics and Adolescent MedicineUniversity Hospital ErlangenFriedrich‐Alexander‐Universität (FAU) Erlangen‐Nürnberg91054ErlangenGermany
| | - Georg Schett
- Department of Medicine 3, University Hospital ErlangenFriedrich‐Alexander‐Universität (FAU) Erlangen‐Nürnberg91054ErlangenGermany
- German Center Immunotherapy (DZI)University Hospital ErlangenFriedrich‐Alexander‐Universität (FAU) Erlangen‐Nürnberg91054ErlangenGermany
| | - Markus F. Neurath
- German Center Immunotherapy (DZI)University Hospital ErlangenFriedrich‐Alexander‐Universität (FAU) Erlangen‐Nürnberg91054ErlangenGermany
- Department of Medicine 1University Hospital ErlangenFriedrich‐Alexander‐Universität (FAU) Erlangen‐Nürnberg91054ErlangenGermany
| | - Maximilian J. Waldner
- German Center Immunotherapy (DZI)University Hospital ErlangenFriedrich‐Alexander‐Universität (FAU) Erlangen‐Nürnberg91054ErlangenGermany
- Department of Medicine 1University Hospital ErlangenFriedrich‐Alexander‐Universität (FAU) Erlangen‐Nürnberg91054ErlangenGermany
| | - Regina Trollmann
- Department of Pediatrics and Adolescent MedicineUniversity Hospital ErlangenFriedrich‐Alexander‐Universität (FAU) Erlangen‐Nürnberg91054ErlangenGermany
| | - Joachim Woelfle
- Department of Pediatrics and Adolescent MedicineUniversity Hospital ErlangenFriedrich‐Alexander‐Universität (FAU) Erlangen‐Nürnberg91054ErlangenGermany
| | - Sarah E Bohndiek
- Department of PhysicsUniversity of CambridgeCambridgeCB3 0HEUK
- Cancer Research UK Cambridge InstituteUniversity of CambridgeCambridgeCB2 0REUK
| | - Adrian P. Regensburger
- Department of Pediatrics and Adolescent MedicineUniversity Hospital ErlangenFriedrich‐Alexander‐Universität (FAU) Erlangen‐Nürnberg91054ErlangenGermany
- Pediatric Experimental and Translational Imaging Laboratory (PETI‐Lab)Department of Pediatrics and Adolescent MedicineUniversity Hospital ErlangenFriedrich‐Alexander‐Universität (FAU) Erlangen‐Nürnberg91054ErlangenGermany
| | - Ferdinand Knieling
- Department of Pediatrics and Adolescent MedicineUniversity Hospital ErlangenFriedrich‐Alexander‐Universität (FAU) Erlangen‐Nürnberg91054ErlangenGermany
- Pediatric Experimental and Translational Imaging Laboratory (PETI‐Lab)Department of Pediatrics and Adolescent MedicineUniversity Hospital ErlangenFriedrich‐Alexander‐Universität (FAU) Erlangen‐Nürnberg91054ErlangenGermany
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11
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Buehler A, Brown E, Paulus L, Eckstein M, Thoma O, Oraiopoulou M, Rother U, Hoerning A, Hartmann A, Neurath MF, Woelfle J, Friedrich O, Waldner MJ, Knieling F, Bohndiek SE, Regensburger AP. Transrectal Absorber Guide Raster-Scanning Optoacoustic Mesoscopy for Label-Free In Vivo Assessment of Colitis. Adv Sci (Weinh) 2023; 10:e2300564. [PMID: 37083262 PMCID: PMC10288266 DOI: 10.1002/advs.202300564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 03/21/2023] [Indexed: 05/03/2023]
Abstract
Optoacoustic imaging (OAI) enables microscale imaging of endogenous chromophores such as hemoglobin at significantly higher penetration depths compared to other optical imaging technologies. Raster-scanning optoacoustic mesoscopy (RSOM) has recently been shown to identify superficial microvascular changes associated with human skin pathologies. In animal models, the imaging depth afforded by RSOM can enable entirely new capabilities for noninvasive imaging of vascular structures in the gastrointestinal tract, but exact localization of intra-abdominal organs is still elusive. Herein the development and application of a novel transrectal absorber guide for RSOM (TAG-RSOM) is presented to enable accurate transabdominal localization and assessment of colonic vascular networks in vivo. The potential of TAG-RSOM is demonstrated through application during mild and severe acute colitis in mice. TAG-RSOM enables visualization of transmural vascular networks, with changes in colon wall thickness, blood volume, and OAI signal intensities corresponding to colitis-associated inflammatory changes. These findings suggest TAG-RSOM can provide a novel monitoring tool in preclinical IBD models, refining animal procedures and underlines the capabilities of such technologies to address inflammatory bowel diseases in humans.
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Affiliation(s)
- Adrian Buehler
- Department of Pediatrics and Adolescent MedicineUniversity Hospital ErlangenFriedrich‐Alexander‐Universität (FAU) Erlangen‐Nürnberg91054ErlangenGermany
| | - Emma Brown
- Department of Physics and Cancer Research UK Cambridge InstituteUniversity of CambridgeCambridgeCB2 0REUK
| | - Lars‐Philip Paulus
- Department of Pediatrics and Adolescent MedicineUniversity Hospital ErlangenFriedrich‐Alexander‐Universität (FAU) Erlangen‐Nürnberg91054ErlangenGermany
| | - Markus Eckstein
- Institute of PathologyFriedrich‐Alexander‐Universität (FAU) Erlangen‐Nürnberg91054ErlangenGermany
| | - Oana‐Maria Thoma
- Department of Medicine 1University Hospital ErlangenFriedrich‐Alexander‐Universität (FAU) Erlangen‐Nürnberg91052ErlangenGermany
| | - Mariam‐Eleni Oraiopoulou
- Department of Physics and Cancer Research UK Cambridge InstituteUniversity of CambridgeCambridgeCB2 0REUK
| | - Ulrich Rother
- Department of Vascular SurgeryUniversity Hospital ErlangenFriedrich‐Alexander‐Universität (FAU) Erlangen‐Nürnberg91054ErlangenGermany
| | - André Hoerning
- Department of Pediatrics and Adolescent MedicineUniversity Hospital ErlangenFriedrich‐Alexander‐Universität (FAU) Erlangen‐Nürnberg91054ErlangenGermany
| | - Arndt Hartmann
- Institute of PathologyFriedrich‐Alexander‐Universität (FAU) Erlangen‐Nürnberg91054ErlangenGermany
| | - Markus F. Neurath
- Department of Medicine 1University Hospital ErlangenFriedrich‐Alexander‐Universität (FAU) Erlangen‐Nürnberg91052ErlangenGermany
| | - Joachim Woelfle
- Department of Pediatrics and Adolescent MedicineUniversity Hospital ErlangenFriedrich‐Alexander‐Universität (FAU) Erlangen‐Nürnberg91054ErlangenGermany
| | - Oliver Friedrich
- Institute of Medical BiotechnologyDepartment of Chemical and Biological EngineeringFriedrich‐Alexander‐Universität (FAU) Erlangen‐Nürnberg91052ErlangenGermany
| | - Maximilian J. Waldner
- Department of Medicine 1University Hospital ErlangenFriedrich‐Alexander‐Universität (FAU) Erlangen‐Nürnberg91052ErlangenGermany
| | - Ferdinand Knieling
- Department of Pediatrics and Adolescent MedicineUniversity Hospital ErlangenFriedrich‐Alexander‐Universität (FAU) Erlangen‐Nürnberg91054ErlangenGermany
| | - Sarah E. Bohndiek
- Department of Physics and Cancer Research UK Cambridge InstituteUniversity of CambridgeCambridgeCB2 0REUK
| | - Adrian P. Regensburger
- Department of Pediatrics and Adolescent MedicineUniversity Hospital ErlangenFriedrich‐Alexander‐Universität (FAU) Erlangen‐Nürnberg91054ErlangenGermany
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12
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Schnell A, Jüngert J, Klett D, Hober H, Kaiser N, Ruppel R, Geppert A, Tremel C, Sobel J, Plattner E, Schmitt-Grohé S, Zirlik S, Strobel D, Neurath MF, Knieling F, Rauh M, Woelfle J, Hoerning A, Regensburger AP. Increase of liver stiffness and altered bile acid metabolism after triple CFTR modulator initiation in children and young adults with cystic fibrosis. Liver Int 2023; 43:878-887. [PMID: 36797990 DOI: 10.1111/liv.15544] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 01/30/2023] [Accepted: 02/14/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND Novel cystic fibrosis transmembrane conductance regulator (CFTR) modulator therapies (elexacaftor/tezacaftor/ivacaftor-ETI) promise clinically significant and sustained improvements for patients with cystic fibrosis (CF). In this study, we investigated the impact of ETI therapy on liver stiffness and bile acid metabolism in a cohort of children and young adults with CF. METHODS A prospective observational study (NCT05576324) was conducted from September 2020 to November 2021 enrolling CF patients naive to ETI. Standard laboratory chemistry, sweat test, lung function, share wave velocity (SWV) derived by acoustic radiation force impulse imaging (ARFI) and serum bile acid profiles were assessed before and 6 months after induction of ETI therapy. RESULTS A total of 20 patients (10 aged <20 years) completed the study. While lung function and BMI improved after ETI therapy, ARFI SWV increased in CF patients <20 years of age (from 1.27 to 1.43 m/s, p = 0.023). Bile acid (BA) profiles revealed a decrease in unconjugated (5.75 vs 1.46, p = 0.007) and increase in glycine-conjugated derivatives (GCDCA) (4.79 vs 6.64 p = 0.016). There was a positive correlation between ARFI SWV values and GCDCA (r = 0.80, p < 0.0001). Glycine-conjugated BA provided high diagnostic accuracy to predict increased ARFI measurements (AUC 0.90) and clinical (Colombo) CFLD grading (AUC 0.97). CONCLUSIONS ARFI SWV and bile acid profiles provide evidence for early increase in liver stiffness and altered bile acid metabolism in young CF patients after initiation of ETI and may serve as synergistic measures for detection of hepatic complications during ETI therapy.
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Affiliation(s)
- Alexander Schnell
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Jörg Jüngert
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Daniel Klett
- Department of Medicine 1 and German Center Immunotherapy (DZI), University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Hannah Hober
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Natalie Kaiser
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Renate Ruppel
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Annika Geppert
- Department of Medicine 1 and German Center Immunotherapy (DZI), University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Christina Tremel
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Julia Sobel
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Erika Plattner
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Sabina Schmitt-Grohé
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Sabine Zirlik
- Department of Medicine 1 and German Center Immunotherapy (DZI), University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Deike Strobel
- Department of Medicine 1 and German Center Immunotherapy (DZI), University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Markus F Neurath
- Department of Medicine 1 and German Center Immunotherapy (DZI), University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Ferdinand Knieling
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
- Translational Experimental and Molecular Imaging Laboratory (PETI_Lab), Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Manfred Rauh
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Joachim Woelfle
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - André Hoerning
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Adrian P Regensburger
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
- Translational Experimental and Molecular Imaging Laboratory (PETI_Lab), Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
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Paulus LP, Wagner AL, Buehler A, Raming R, Jüngert J, Simon D, Tascilar K, Schnell A, Günther J, Rother U, Lang W, Hoerning A, Schett G, Neurath MF, Woelfle J, Waldner MJ, Knieling F, Regensburger AP. Multispectral optoacoustic tomography of the human intestine - temporal precision and the influence of postprandial gastrointestinal blood flow. Photoacoustics 2023; 30:100457. [PMID: 36824387 PMCID: PMC9942118 DOI: 10.1016/j.pacs.2023.100457] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 01/29/2023] [Accepted: 02/01/2023] [Indexed: 06/18/2023]
Abstract
Multispectral optoacoustic tomography (MSOT) holds great promise as a non-invasive diagnostic tool for inflammatory bowel diseases. Yet, reliability and the impact of physiological processes during fasting and after food intake on optoacoustic signals have not been studied. In the present investigator initiated trial (NCT05160077) the intestines of ten healthy subjects were examined by MSOT at eight timepoints on two days, one fasting and one after food intake. While within-timepoint and within-day reproducibility were good for single wavelength 800 nm and total hemoglobin (ICC 0.722-0.956), between-day reproducibility was inferior (ICC -0.137 to 0.438). However, temporal variability was smaller than variation between individuals (coefficients of variation 8.9%-33.7% vs. 17.0%-48.5%). After food intake and consecutive increased intestinal circulation, indicated by reduced resistance index of simultaneous Doppler ultrasound, optoacoustic signals did not alter significantly. In summary, this study demonstrates high reliability and temporal stability of MSOT for imaging the human intestine during fasting and after food intake.
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Affiliation(s)
- Lars-Philip Paulus
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
- Pediatric Experimental and Translational Imaging Laboratory (PETI-Lab), Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Alexandra L. Wagner
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
- Pediatric Experimental and Translational Imaging Laboratory (PETI-Lab), Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Adrian Buehler
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
- Pediatric Experimental and Translational Imaging Laboratory (PETI-Lab), Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Roman Raming
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
- Pediatric Experimental and Translational Imaging Laboratory (PETI-Lab), Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Jörg Jüngert
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - David Simon
- Department of Medicine 3 and German Center Immunotherapy (DZI), University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Koray Tascilar
- Department of Medicine 3 and German Center Immunotherapy (DZI), University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Alexander Schnell
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Josefine Günther
- Department of Vascular Surgery, University Hospital Erlangen, Friedrich-Alexander Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Ulrich Rother
- Department of Vascular Surgery, University Hospital Erlangen, Friedrich-Alexander Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Werner Lang
- Department of Vascular Surgery, University Hospital Erlangen, Friedrich-Alexander Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - André Hoerning
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Georg Schett
- Department of Medicine 3 and German Center Immunotherapy (DZI), University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Markus F. Neurath
- Department of Medicine 1 and German Center Immunotherapy (DZI), University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Joachim Woelfle
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Maximilian J. Waldner
- Department of Medicine 1 and German Center Immunotherapy (DZI), University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Ferdinand Knieling
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
- Pediatric Experimental and Translational Imaging Laboratory (PETI-Lab), Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Adrian P. Regensburger
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
- Pediatric Experimental and Translational Imaging Laboratory (PETI-Lab), Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
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Heiss R, Tan L, Schmidt S, Regensburger AP, Ewert F, Mammadova D, Buehler A, Vogel-Claussen J, Voskrebenzev A, Rauh M, Rompel O, Nagel AM, Lévy S, Bickelhaupt S, May MS, Uder M, Metzler M, Trollmann R, Woelfle J, Wagner AL, Knieling F. Pulmonary Dysfunction after Pediatric COVID-19. Radiology 2023; 306:e221250. [PMID: 36125379 PMCID: PMC9513839 DOI: 10.1148/radiol.221250] [Citation(s) in RCA: 29] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Long COVID occurs at a lower frequency in children and adolescents than in adults. Morphologic and free-breathing phase-resolved functional low-field-strength MRI may help identify persistent pulmonary manifestations after SARS-CoV-2 infection. Purpose To characterize both morphologic and functional changes of lung parenchyma at low-field-strength MRI in children and adolescents with post-COVID-19 condition compared with healthy controls. Materials and Methods Between August and December 2021, a cross-sectional clinical trial using low-field-strength MRI was performed in children and adolescents from a single academic medical center. The primary outcome was the frequency of morphologic changes at MRI. Secondary outcomes included MRI-derived functional proton ventilation and perfusion parameters. Clinical symptoms, the duration from positive reverse transcriptase-polymerase chain reaction test result, and serologic parameters were compared with imaging results. Nonparametric tests for pairwise and corrected tests for groupwise comparisons were applied to assess differences in healthy controls, recovered participants, and those with long COVID. Results A total of 54 participants after COVID-19 infection (mean age, 11 years ± 3 [SD]; 30 boys [56%]) and nine healthy controls (mean age, 10 years ± 3; seven boys [78%]) were included: 29 (54%) in the COVID-19 group had recovered from infection and 25 (46%) were classified as having long COVID on the day of enrollment. Morphologic abnormality was identified in one recovered participant. Both ventilated and perfused lung parenchyma (ventilation-perfusion [V/Q] match) was higher in healthy controls (81% ± 6.1) compared with the recovered group (62% ± 19; P = .006) and the group with long COVID (60% ± 20; P = .003). V/Q match was lower in patients with time from COVID-19 infection to study participation of less than 180 days (63% ± 20; P = .03), 180-360 days (63% ± 18; P = .03), and 360 days (41% ± 12; P < .001) as compared with the never-infected healthy controls (81% ± 6.1). Conclusion Low-field-strength MRI showed persistent pulmonary dysfunction in children and adolescents who recovered from COVID-19 and those with long COVID. Clinical trial registration no. NCT04990531 © RSNA, 2022 Supplemental material is available for this article. See also the editorial by Paltiel in this issue.
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Affiliation(s)
- Rafael Heiss
- From the Institute of Radiology (R.H., S.S., O.R., A.M.N., S.L., S.B., M.S.M., M.U.), Department of Pediatrics and Adolescent Medicine (L.T., A.P.R., F.E., D.M., A.B., M.R., M.M., R.T., J.W., A.L.W., F.K.), Pediatric Experimental and Translational Imaging Laboratory (PETI_Lab), Department of Pediatrics and Adolescent Medicine (A.P.R., A.B., A.L.W., F.K.), and Center for Social Pediatrics (F.E., D.M., R.T., J.W., A.L.W., F.K.), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Loschgestr 15, Erlangen 91054, Germany; and Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany (J.V.C., A.V.)
| | - Lina Tan
- From the Institute of Radiology (R.H., S.S., O.R., A.M.N., S.L., S.B., M.S.M., M.U.), Department of Pediatrics and Adolescent Medicine (L.T., A.P.R., F.E., D.M., A.B., M.R., M.M., R.T., J.W., A.L.W., F.K.), Pediatric Experimental and Translational Imaging Laboratory (PETI_Lab), Department of Pediatrics and Adolescent Medicine (A.P.R., A.B., A.L.W., F.K.), and Center for Social Pediatrics (F.E., D.M., R.T., J.W., A.L.W., F.K.), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Loschgestr 15, Erlangen 91054, Germany; and Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany (J.V.C., A.V.)
| | - Sandy Schmidt
- From the Institute of Radiology (R.H., S.S., O.R., A.M.N., S.L., S.B., M.S.M., M.U.), Department of Pediatrics and Adolescent Medicine (L.T., A.P.R., F.E., D.M., A.B., M.R., M.M., R.T., J.W., A.L.W., F.K.), Pediatric Experimental and Translational Imaging Laboratory (PETI_Lab), Department of Pediatrics and Adolescent Medicine (A.P.R., A.B., A.L.W., F.K.), and Center for Social Pediatrics (F.E., D.M., R.T., J.W., A.L.W., F.K.), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Loschgestr 15, Erlangen 91054, Germany; and Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany (J.V.C., A.V.)
| | - Adrian P Regensburger
- From the Institute of Radiology (R.H., S.S., O.R., A.M.N., S.L., S.B., M.S.M., M.U.), Department of Pediatrics and Adolescent Medicine (L.T., A.P.R., F.E., D.M., A.B., M.R., M.M., R.T., J.W., A.L.W., F.K.), Pediatric Experimental and Translational Imaging Laboratory (PETI_Lab), Department of Pediatrics and Adolescent Medicine (A.P.R., A.B., A.L.W., F.K.), and Center for Social Pediatrics (F.E., D.M., R.T., J.W., A.L.W., F.K.), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Loschgestr 15, Erlangen 91054, Germany; and Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany (J.V.C., A.V.)
| | - Franziska Ewert
- From the Institute of Radiology (R.H., S.S., O.R., A.M.N., S.L., S.B., M.S.M., M.U.), Department of Pediatrics and Adolescent Medicine (L.T., A.P.R., F.E., D.M., A.B., M.R., M.M., R.T., J.W., A.L.W., F.K.), Pediatric Experimental and Translational Imaging Laboratory (PETI_Lab), Department of Pediatrics and Adolescent Medicine (A.P.R., A.B., A.L.W., F.K.), and Center for Social Pediatrics (F.E., D.M., R.T., J.W., A.L.W., F.K.), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Loschgestr 15, Erlangen 91054, Germany; and Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany (J.V.C., A.V.)
| | - Dilbar Mammadova
- From the Institute of Radiology (R.H., S.S., O.R., A.M.N., S.L., S.B., M.S.M., M.U.), Department of Pediatrics and Adolescent Medicine (L.T., A.P.R., F.E., D.M., A.B., M.R., M.M., R.T., J.W., A.L.W., F.K.), Pediatric Experimental and Translational Imaging Laboratory (PETI_Lab), Department of Pediatrics and Adolescent Medicine (A.P.R., A.B., A.L.W., F.K.), and Center for Social Pediatrics (F.E., D.M., R.T., J.W., A.L.W., F.K.), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Loschgestr 15, Erlangen 91054, Germany; and Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany (J.V.C., A.V.)
| | - Adrian Buehler
- From the Institute of Radiology (R.H., S.S., O.R., A.M.N., S.L., S.B., M.S.M., M.U.), Department of Pediatrics and Adolescent Medicine (L.T., A.P.R., F.E., D.M., A.B., M.R., M.M., R.T., J.W., A.L.W., F.K.), Pediatric Experimental and Translational Imaging Laboratory (PETI_Lab), Department of Pediatrics and Adolescent Medicine (A.P.R., A.B., A.L.W., F.K.), and Center for Social Pediatrics (F.E., D.M., R.T., J.W., A.L.W., F.K.), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Loschgestr 15, Erlangen 91054, Germany; and Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany (J.V.C., A.V.)
| | - Jens Vogel-Claussen
- From the Institute of Radiology (R.H., S.S., O.R., A.M.N., S.L., S.B., M.S.M., M.U.), Department of Pediatrics and Adolescent Medicine (L.T., A.P.R., F.E., D.M., A.B., M.R., M.M., R.T., J.W., A.L.W., F.K.), Pediatric Experimental and Translational Imaging Laboratory (PETI_Lab), Department of Pediatrics and Adolescent Medicine (A.P.R., A.B., A.L.W., F.K.), and Center for Social Pediatrics (F.E., D.M., R.T., J.W., A.L.W., F.K.), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Loschgestr 15, Erlangen 91054, Germany; and Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany (J.V.C., A.V.)
| | - Andreas Voskrebenzev
- From the Institute of Radiology (R.H., S.S., O.R., A.M.N., S.L., S.B., M.S.M., M.U.), Department of Pediatrics and Adolescent Medicine (L.T., A.P.R., F.E., D.M., A.B., M.R., M.M., R.T., J.W., A.L.W., F.K.), Pediatric Experimental and Translational Imaging Laboratory (PETI_Lab), Department of Pediatrics and Adolescent Medicine (A.P.R., A.B., A.L.W., F.K.), and Center for Social Pediatrics (F.E., D.M., R.T., J.W., A.L.W., F.K.), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Loschgestr 15, Erlangen 91054, Germany; and Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany (J.V.C., A.V.)
| | - Manfred Rauh
- From the Institute of Radiology (R.H., S.S., O.R., A.M.N., S.L., S.B., M.S.M., M.U.), Department of Pediatrics and Adolescent Medicine (L.T., A.P.R., F.E., D.M., A.B., M.R., M.M., R.T., J.W., A.L.W., F.K.), Pediatric Experimental and Translational Imaging Laboratory (PETI_Lab), Department of Pediatrics and Adolescent Medicine (A.P.R., A.B., A.L.W., F.K.), and Center for Social Pediatrics (F.E., D.M., R.T., J.W., A.L.W., F.K.), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Loschgestr 15, Erlangen 91054, Germany; and Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany (J.V.C., A.V.)
| | - Oliver Rompel
- From the Institute of Radiology (R.H., S.S., O.R., A.M.N., S.L., S.B., M.S.M., M.U.), Department of Pediatrics and Adolescent Medicine (L.T., A.P.R., F.E., D.M., A.B., M.R., M.M., R.T., J.W., A.L.W., F.K.), Pediatric Experimental and Translational Imaging Laboratory (PETI_Lab), Department of Pediatrics and Adolescent Medicine (A.P.R., A.B., A.L.W., F.K.), and Center for Social Pediatrics (F.E., D.M., R.T., J.W., A.L.W., F.K.), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Loschgestr 15, Erlangen 91054, Germany; and Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany (J.V.C., A.V.)
| | - Armin M Nagel
- From the Institute of Radiology (R.H., S.S., O.R., A.M.N., S.L., S.B., M.S.M., M.U.), Department of Pediatrics and Adolescent Medicine (L.T., A.P.R., F.E., D.M., A.B., M.R., M.M., R.T., J.W., A.L.W., F.K.), Pediatric Experimental and Translational Imaging Laboratory (PETI_Lab), Department of Pediatrics and Adolescent Medicine (A.P.R., A.B., A.L.W., F.K.), and Center for Social Pediatrics (F.E., D.M., R.T., J.W., A.L.W., F.K.), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Loschgestr 15, Erlangen 91054, Germany; and Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany (J.V.C., A.V.)
| | - Simon Lévy
- From the Institute of Radiology (R.H., S.S., O.R., A.M.N., S.L., S.B., M.S.M., M.U.), Department of Pediatrics and Adolescent Medicine (L.T., A.P.R., F.E., D.M., A.B., M.R., M.M., R.T., J.W., A.L.W., F.K.), Pediatric Experimental and Translational Imaging Laboratory (PETI_Lab), Department of Pediatrics and Adolescent Medicine (A.P.R., A.B., A.L.W., F.K.), and Center for Social Pediatrics (F.E., D.M., R.T., J.W., A.L.W., F.K.), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Loschgestr 15, Erlangen 91054, Germany; and Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany (J.V.C., A.V.)
| | - Sebastian Bickelhaupt
- From the Institute of Radiology (R.H., S.S., O.R., A.M.N., S.L., S.B., M.S.M., M.U.), Department of Pediatrics and Adolescent Medicine (L.T., A.P.R., F.E., D.M., A.B., M.R., M.M., R.T., J.W., A.L.W., F.K.), Pediatric Experimental and Translational Imaging Laboratory (PETI_Lab), Department of Pediatrics and Adolescent Medicine (A.P.R., A.B., A.L.W., F.K.), and Center for Social Pediatrics (F.E., D.M., R.T., J.W., A.L.W., F.K.), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Loschgestr 15, Erlangen 91054, Germany; and Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany (J.V.C., A.V.)
| | - Matthias S May
- From the Institute of Radiology (R.H., S.S., O.R., A.M.N., S.L., S.B., M.S.M., M.U.), Department of Pediatrics and Adolescent Medicine (L.T., A.P.R., F.E., D.M., A.B., M.R., M.M., R.T., J.W., A.L.W., F.K.), Pediatric Experimental and Translational Imaging Laboratory (PETI_Lab), Department of Pediatrics and Adolescent Medicine (A.P.R., A.B., A.L.W., F.K.), and Center for Social Pediatrics (F.E., D.M., R.T., J.W., A.L.W., F.K.), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Loschgestr 15, Erlangen 91054, Germany; and Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany (J.V.C., A.V.)
| | - Michael Uder
- From the Institute of Radiology (R.H., S.S., O.R., A.M.N., S.L., S.B., M.S.M., M.U.), Department of Pediatrics and Adolescent Medicine (L.T., A.P.R., F.E., D.M., A.B., M.R., M.M., R.T., J.W., A.L.W., F.K.), Pediatric Experimental and Translational Imaging Laboratory (PETI_Lab), Department of Pediatrics and Adolescent Medicine (A.P.R., A.B., A.L.W., F.K.), and Center for Social Pediatrics (F.E., D.M., R.T., J.W., A.L.W., F.K.), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Loschgestr 15, Erlangen 91054, Germany; and Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany (J.V.C., A.V.)
| | - Markus Metzler
- From the Institute of Radiology (R.H., S.S., O.R., A.M.N., S.L., S.B., M.S.M., M.U.), Department of Pediatrics and Adolescent Medicine (L.T., A.P.R., F.E., D.M., A.B., M.R., M.M., R.T., J.W., A.L.W., F.K.), Pediatric Experimental and Translational Imaging Laboratory (PETI_Lab), Department of Pediatrics and Adolescent Medicine (A.P.R., A.B., A.L.W., F.K.), and Center for Social Pediatrics (F.E., D.M., R.T., J.W., A.L.W., F.K.), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Loschgestr 15, Erlangen 91054, Germany; and Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany (J.V.C., A.V.)
| | - Regina Trollmann
- From the Institute of Radiology (R.H., S.S., O.R., A.M.N., S.L., S.B., M.S.M., M.U.), Department of Pediatrics and Adolescent Medicine (L.T., A.P.R., F.E., D.M., A.B., M.R., M.M., R.T., J.W., A.L.W., F.K.), Pediatric Experimental and Translational Imaging Laboratory (PETI_Lab), Department of Pediatrics and Adolescent Medicine (A.P.R., A.B., A.L.W., F.K.), and Center for Social Pediatrics (F.E., D.M., R.T., J.W., A.L.W., F.K.), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Loschgestr 15, Erlangen 91054, Germany; and Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany (J.V.C., A.V.)
| | - Joachim Woelfle
- From the Institute of Radiology (R.H., S.S., O.R., A.M.N., S.L., S.B., M.S.M., M.U.), Department of Pediatrics and Adolescent Medicine (L.T., A.P.R., F.E., D.M., A.B., M.R., M.M., R.T., J.W., A.L.W., F.K.), Pediatric Experimental and Translational Imaging Laboratory (PETI_Lab), Department of Pediatrics and Adolescent Medicine (A.P.R., A.B., A.L.W., F.K.), and Center for Social Pediatrics (F.E., D.M., R.T., J.W., A.L.W., F.K.), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Loschgestr 15, Erlangen 91054, Germany; and Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany (J.V.C., A.V.)
| | - Alexandra L Wagner
- From the Institute of Radiology (R.H., S.S., O.R., A.M.N., S.L., S.B., M.S.M., M.U.), Department of Pediatrics and Adolescent Medicine (L.T., A.P.R., F.E., D.M., A.B., M.R., M.M., R.T., J.W., A.L.W., F.K.), Pediatric Experimental and Translational Imaging Laboratory (PETI_Lab), Department of Pediatrics and Adolescent Medicine (A.P.R., A.B., A.L.W., F.K.), and Center for Social Pediatrics (F.E., D.M., R.T., J.W., A.L.W., F.K.), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Loschgestr 15, Erlangen 91054, Germany; and Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany (J.V.C., A.V.)
| | - Ferdinand Knieling
- From the Institute of Radiology (R.H., S.S., O.R., A.M.N., S.L., S.B., M.S.M., M.U.), Department of Pediatrics and Adolescent Medicine (L.T., A.P.R., F.E., D.M., A.B., M.R., M.M., R.T., J.W., A.L.W., F.K.), Pediatric Experimental and Translational Imaging Laboratory (PETI_Lab), Department of Pediatrics and Adolescent Medicine (A.P.R., A.B., A.L.W., F.K.), and Center for Social Pediatrics (F.E., D.M., R.T., J.W., A.L.W., F.K.), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Loschgestr 15, Erlangen 91054, Germany; and Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany (J.V.C., A.V.)
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15
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Tascilar K, Fagni F, Kleyer A, Bayat S, Heidemann R, Steiger F, Krönke G, Bohr D, Ramming A, Hartmann F, Klett D, Federle A, Regensburger AP, Wagner AL, Knieling F, Neurath MF, Schett G, Waldner M, Simon D. Non-invasive metabolic profiling of inflammation in joints and entheses by multispectral optoacoustic tomography. Rheumatology (Oxford) 2023; 62:841-849. [PMID: 35699479 DOI: 10.1093/rheumatology/keac346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 06/10/2022] [Accepted: 06/10/2022] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE To explore the metabolic characteristics of arthritis and enthesitis using multispectral opto-acoustic tomography (MSOT), a technology using near-infrared multispectral laser to stimulate tissues and detect the emitted acoustic energy, enabling non-invasive quantification of tissue components in vivo based on differential absorbance at multiple wavelengths. METHODS We performed a cross-sectional study in patients with RA or PsA and healthy controls (HCs). Participants underwent clinical, ultrasonographic and MSOT examination of MCP and wrist joints as well as the entheses of the common extensor tendon at the lateral humeral epicondyles and of the patellar, quadriceps and Achilles tendon. MSOT-measured haemoglobin (Hb), oxygen saturation, collagen and lipid levels were quantified and scaled mean differences between affected and unaffected joints and entheses were calculated as defined by clinical examination or ultrasonography using linear mixed effects models. RESULTS We obtained 1535 MSOT and 982 ultrasonography scans from 87 participants (34 PsA, 17 RA, 36 HCs). Entheseal tenderness was not associated with significant metabolic changes, whereas enthesitis-related sonographic changes were associated with increased total Hb, oxygen saturation and collagen content. In contrast, the presence of arthritis-related clinical and sonographic findings showed increased Hb levels, reduced oxygen saturation and reduced collagen content. Synovial hypertrophy was associated with increased lipid content in the joints. CONCLUSION MSOT allows determination of distinct metabolic differences between arthritis and enthesitis in a non-invasive setting in humans in vivo.
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Affiliation(s)
- Koray Tascilar
- Department of Internal Medicine 3.,Deutsches Zentrum fuer Immuntherapie
| | - Filippo Fagni
- Department of Internal Medicine 3.,Deutsches Zentrum fuer Immuntherapie
| | - Arnd Kleyer
- Department of Internal Medicine 3.,Deutsches Zentrum fuer Immuntherapie
| | - Sara Bayat
- Department of Internal Medicine 3.,Deutsches Zentrum fuer Immuntherapie
| | - Robert Heidemann
- Department of Internal Medicine 3.,Deutsches Zentrum fuer Immuntherapie
| | - Florian Steiger
- Department of Internal Medicine 3.,Deutsches Zentrum fuer Immuntherapie
| | - Gerhard Krönke
- Department of Internal Medicine 3.,Deutsches Zentrum fuer Immuntherapie
| | - Daniela Bohr
- Department of Internal Medicine 3.,Deutsches Zentrum fuer Immuntherapie
| | - Andreas Ramming
- Department of Internal Medicine 3.,Deutsches Zentrum fuer Immuntherapie
| | - Fabian Hartmann
- Department of Internal Medicine 3.,Deutsches Zentrum fuer Immuntherapie
| | - Daniel Klett
- Deutsches Zentrum fuer Immuntherapie.,Department of Internal Medicine 1, Friedrich-Alexander University Erlangen-Nuremberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Anna Federle
- Deutsches Zentrum fuer Immuntherapie.,Department of Internal Medicine 1, Friedrich-Alexander University Erlangen-Nuremberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Adrian P Regensburger
- Deutsches Zentrum fuer Immuntherapie.,Department of Pediatrics and Adolescent Medicine
| | - Alexandra L Wagner
- Deutsches Zentrum fuer Immuntherapie.,Department of Pediatrics and Adolescent Medicine
| | - Ferdinand Knieling
- Deutsches Zentrum fuer Immuntherapie.,Department of Pediatrics and Adolescent Medicine
| | - Markus F Neurath
- Deutsches Zentrum fuer Immuntherapie.,Department of Internal Medicine 1, Friedrich-Alexander University Erlangen-Nuremberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Georg Schett
- Department of Internal Medicine 3.,Deutsches Zentrum fuer Immuntherapie
| | - Maximilian Waldner
- Deutsches Zentrum fuer Immuntherapie.,Department of Internal Medicine 1, Friedrich-Alexander University Erlangen-Nuremberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - David Simon
- Department of Internal Medicine 3.,Deutsches Zentrum fuer Immuntherapie
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16
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Danko V, Jüngert J, Schuessler S, Buehler A, Klett D, Federle A, Roos A, Lochmüller H, Neurath MF, Woelfle J, Trollmann R, Waldner MJ, Knieling F, Regensburger AP, Wagner AL. Hybrid reflected-ultrasound computed tomography versus B-mode-ultrasound for muscle scoring in spinal muscular atrophy. J Neuroimaging 2023; 33:393-403. [PMID: 36627228 DOI: 10.1111/jon.13081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 12/19/2022] [Accepted: 12/27/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND AND PURPOSE Novel light- and sound-based technologies like multispectral optoacoustic tomography (MSOT) with co-registered reflected-ultrasound computed tomography (RUCT) could add additional value to conventional ultrasound (US) for disease phenotyping in pediatric spinal muscular atrophy (SMA). The aim of this study was to investigate the quality of RUCT compared to US for qualitative and quantitative assessment of imaging neuromuscular disorders. METHODS Subanalyzing the MSOT SMA study, 288 RUCT and 276 US images from 10 SMA patients (mean age 9.0 ± 3.7) and 10 gender- and age-matched healthy volunteers (HV; mean age 8.7 ± 4.3) were analyzed for quantitative (grayscale levels [GSLs]) and qualitative (echogenicity, distribution pattern, Heckmatt scale, and muscle texture) muscle changes. RUCT and US measures were further correlated with clinical standard motor outcomes. RESULTS Quantitative agreement using GSLs revealed significantly higher GSLs in muscles of SMA patients compared to healthy muscles in both techniques (US mean GSL [SD] SMA vs. HV: 110.70 [27.8] vs. 68.85 [19.2], p < .0001; RUCT mean GSL [SD] SMA vs. HV: 91.81 [21.8] vs. 59.86 [8.2], p < .0001) with good correlation with motor outcome tests, respectively. Qualitative agreement between methods for muscle composition was excellent for differentiation of pathological versus healthy muscles, echogenicity, and distribution pattern, moderate for Heckmatt scale, and poor for muscle texture. CONCLUSIONS The data suggest that RUCT may allow the assessment of basic qualitative and quantitative measures for muscular diseases with comparable results to conventional US.
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Affiliation(s)
- Vera Danko
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nürnberg, Erlangen, Germany.,Pediatric Experimental and Translational Imaging Laboratory (PETI-Lab), University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Jörg Jüngert
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Stephanie Schuessler
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Adrian Buehler
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nürnberg, Erlangen, Germany.,Pediatric Experimental and Translational Imaging Laboratory (PETI-Lab), University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Daniel Klett
- Medical Department 1, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nürnberg, Erlangen, Germany.,German Center Immunotherapy, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Anna Federle
- Medical Department 1, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nürnberg, Erlangen, Germany.,German Center Immunotherapy, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Andreas Roos
- Department of Pediatric Neurology, Developmental Neurology and Social Pediatrics, University of Duisburg-Essen, Essen, Germany.,Children's Hospital of Eastern Ontario Research Institute; Division of Neurology, Department of Medicine, The Ottawa Hospital; and Brain and Mind Research Institute, University of Ottawa, Ottawa, Canada.,Department of Neurology, Heimer Institute for Muscle Research, University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany
| | - Hanns Lochmüller
- Children's Hospital of Eastern Ontario Research Institute; Division of Neurology, Department of Medicine, The Ottawa Hospital; and Brain and Mind Research Institute, University of Ottawa, Ottawa, Canada
| | - Markus F Neurath
- Medical Department 1, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nürnberg, Erlangen, Germany.,German Center Immunotherapy, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Joachim Woelfle
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Regina Trollmann
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Maximilian J Waldner
- Medical Department 1, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nürnberg, Erlangen, Germany.,German Center Immunotherapy, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Ferdinand Knieling
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nürnberg, Erlangen, Germany.,Pediatric Experimental and Translational Imaging Laboratory (PETI-Lab), University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Adrian P Regensburger
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nürnberg, Erlangen, Germany.,Pediatric Experimental and Translational Imaging Laboratory (PETI-Lab), University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Alexandra L Wagner
- Pediatric Experimental and Translational Imaging Laboratory (PETI-Lab), University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nürnberg, Erlangen, Germany.,Center for Chronically Sick Children, Charité-Universitätsmedizin Berlin, Berlin, Germany
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17
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Günther JS, Knieling F, Träger AP, Lang W, Meyer A, Regensburger AP, Wagner AL, Trollmann R, Woelfle J, Klett D, Uter W, Uder M, Neurath MF, Waldner MJ, Rother U. Targeting Muscular Hemoglobin Content for Classification of Peripheral Arterial Disease by Noninvasive Multispectral Optoacoustic Tomography. JACC Cardiovasc Imaging 2022; 16:719-721. [PMID: 36752442 DOI: 10.1016/j.jcmg.2022.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 10/12/2022] [Accepted: 11/17/2022] [Indexed: 01/13/2023]
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18
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Aguilar C, Regensburger AP, Knieling F, Wagner AL, Siebenlist G, Woelfle J, Koehler H, Hoerning A, Jüngert J. Pediatric Buried Bumper Syndrome: Diagnostic Validity of Transabdominal Ultrasound and Artificial Intelligence. Ultraschall Med 2022; 43:498-506. [PMID: 34034349 DOI: 10.1055/a-1471-3039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
PURPOSE Buried bumper syndrome (BBS) is a severe complication of percutaneous endoscopic gastrostomy (PEG) resulting from overgrowth of gastric mucosa and penetration of the inner holding plate into the gastric wall. The aim of this study was to evaluate the diagnostic value of transabdominal ultrasound (US) in comparison to an artificial intelligence (AI) model for the diagnosis of BBS in children. MATERIALS AND METHODS In this monocentric retrospective study, pediatric US data concerning BBS from a ten-year period (2009-2019) were analyzed. US findings were compared to a clinical multiparameter-based AI model and reference standard endoscopy. Clinical risk factors for the occurrence of pediatric BBS were determined. RESULTS In n = 121 independent examinations of n = 82 patients, the placement of the inner holding plate of the PEG was assessed by US. In n = 18 cases BBS was confirmed. Recall and precision rates were 100 % for US and 88 % for the AI-based assessment. Risk factors for the occurrence of BBS were mobilization problems of the PEG (rs = 0.66, p < 0.001), secretion/exudation (rs = 0.29, p = 0.002), time between 1st PEG placement and US (rs = 0.38, p < 0.001), and elevated leukocyte count (rs = 0.24, p = 0.016). CONCLUSION Transabdominal US enables correct, rapid, and noninvasive diagnosis of BBS in pediatric patients. Preceding AI models could aid during diagnostic workup. To avoid unnecessary invasive procedures, US could be considered as a primary diagnostic procedure in suspected BBS. .
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Affiliation(s)
- Caroline Aguilar
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nuremberg, Germany
| | - Adrian P Regensburger
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nuremberg, Germany
| | - Ferdinand Knieling
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nuremberg, Germany
| | - Alexandra L Wagner
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nuremberg, Germany
| | - Gregor Siebenlist
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nuremberg, Germany
| | - Joachim Woelfle
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nuremberg, Germany
| | - Henrik Koehler
- Children's Hospital, Cantonal Hospital Aarau, Switzerland
| | - André Hoerning
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nuremberg, Germany
| | - Jörg Jüngert
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nuremberg, Germany
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19
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Goebel CA, Brown E, Fahlbusch FB, Wagner AL, Buehler A, Raupach T, Hohmann M, Späth M, Burton N, Woelfle J, Schmidt M, Hartner A, Regensburger AP, Knieling F. High-resolution label-free mapping of murine kidney vasculature by raster-scanning optoacoustic mesoscopy: an ex vivo study. Mol Cell Pediatr 2022; 9:13. [PMID: 35788444 PMCID: PMC9253231 DOI: 10.1186/s40348-022-00144-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 05/06/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) is a global burden affecting both children and adults. Novel imaging modalities hold great promise to visualize and quantify structural, functional, and molecular organ damage. The aim of the study was to visualize and quantify murine renal vasculature using label-free raster scanning optoacoustic mesoscopy (RSOM) in explanted organs from mice with renal injury. MATERIAL AND METHODS For the experiments, freshly bisected kidneys of alpha 8 integrin knock-out (KO) and wildtype mice (WT) were used. A total of n=7 female (n=4 KO, n=3 WT) and n=6 male animals (n=2 KO, n=4 WT) aged 6 weeks were examined with RSOM optoacoustic imaging systems (RSOM Explorer P50 at SWL 532nm and/or ms-P50 imaging system at 532 nm, 555 nm, 579 nm, and 606 nm). Images were reconstructed using a dedicated software, analyzed for size and vascular area and compared to standard histologic sections. RESULTS RSOM enabled mapping of murine kidney size and vascular area, revealing differences between kidney sizes of male (m) and female (f) mice (merged frequencies (MF) f vs. m: 52.42±6.24 mm2 vs. 69.18±15.96 mm2, p=0.0156) and absolute vascular area (MF f vs. m: 35.67±4.22 mm2 vs. 49.07±13.48 mm2, p=0.0036). Without respect to sex, the absolute kidney area was found to be smaller in knock-out (KO) than in wildtype (WT) mice (WT vs. KO: MF: p=0.0255) and showed a similar trend for the relative vessel area (WT vs. KO: MF p=0.0031). Also the absolute vessel areas of KO compared to WT were found significantly different (MF p=0.0089). A significant decrease in absolute vessel area was found in KO compared to WT male mice (MF WT vs. KO: 54.37±9.35 mm2 vs. 34.93±13.82 mm2, p=0.0232). In addition, multispectral RSOM allowed visualization of oxygenated and deoxygenated parenchymal regions by spectral unmixing. CONCLUSION This study demonstrates the capability of RSOM for label-free visualization of differences in vascular morphology in ex vivo murine renal tissue at high resolution. Due to its scalability optoacoustic imaging provides an emerging modality with potential for further preclinical and clinical imaging applications.
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Affiliation(s)
- Colin A Goebel
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Emma Brown
- Department of Physics, University of Cambridge, Cambridge, UK.,Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, UK.,Washington University School of Medicine, St. Louis, USA
| | - Fabian B Fahlbusch
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Alexandra L Wagner
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Adrian Buehler
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Thomas Raupach
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Martin Hohmann
- Institute of Photonic Technologies, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.,Erlangen Graduate School in Advanced Optical Technologies, 91052, Erlangen, Germany
| | - Moritz Späth
- Institute of Photonic Technologies, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.,Erlangen Graduate School in Advanced Optical Technologies, 91052, Erlangen, Germany
| | | | - Joachim Woelfle
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Michael Schmidt
- Institute of Photonic Technologies, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.,Erlangen Graduate School in Advanced Optical Technologies, 91052, Erlangen, Germany
| | - Andrea Hartner
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Adrian P Regensburger
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Ferdinand Knieling
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany.
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20
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Tascilar K, Fagni F, Kleyer A, Bayat S, Heidemann R, Steiger F, Krönke G, Bohr D, Ramming A, Hartmann F, Klett D, Federle A, Regensburger A, Wagner AL, Knieling F, Neurath MF, Schett G, Waldner M, Simon D. POS1384 NON-INVASIVE IN VIVO METABOLIC PROFILING OF INFLAMMATION IN JOINTS AND ENTHESES BY OPTOACOUSTIC IMAGING. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundAn in-depth metabolic characterization of joints and entheses at the tissue level can help in the early diagnosis and treatment selection for patients with inflammatory arthritis [1]. However, current knowledge about the metabolic profiles of synovitis and enthesitis is limited. Multispectral optoacoustic tomography (MSOT), a novel metabolic imaging technology, could be used to undertake metabolic profiling of joints and entheses non-invasively using near-infrared multispectral laser to stimulate tissues and detect the emitted acoustic energy, enabling quantification of tissue components in vivo based on differential absorbance at multiple wavelengths [2, 3].ObjectivesTo explore the metabolic characteristics of arthritis and enthesitis using MSOT.MethodsWe performed a cross sectional study on healthy controls (HC) and patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA) (Table 1). Participants underwent clinical, ultrasound (US), and MSOT examination of metacarpophalangeal joints, wrists, entheses of lateral epicondyles, patellar, quadriceps and Achilles tendons. MSOT-derived hemoglobin, oxygen saturation, collagen and lipid levels were measured. We calculated scaled mean differences (SMD) between affected and unaffected joints and entheses as defined by clinical examination or US using linear mixed effects models.Table 1.Baseline characteristics.OverallHealthyPsARAN87363417Age, mean (SD)47.0 (15.7)34.7 (12.0)52.4 (11.5)62.5 (9.1)Sex, n (%) Female48 (55.2)18 (50.0)17 (50.0)13 (76.5) Male39 (44.8)18 (50.0)17 (50.0)4 (23.5)Tender joints, median (IQR)0 (0-2)0 (0-0)1 (0-5)2 (1-6)Swollen joints, median (IQR)0 (0-1)0 (0-0)0 (0-2)2 (1-6)Tender entheses, median (IQR)0 (0-2)0 (0-0)1 (0-3)0 (0-0)csDMARD, n (%)22 (25.3)-13 (38.3)9 (53.0)b-tsDMARD, n (%)31 (35.6)-20 (58.8)11 (64.7)SD, standard deviation; IQR, interquartile range; csDMARD, conventional synthetic disease modifying anti-rheumatic drug; b-tsDMARD, biologic or targeted synthetic disease modifying anti-rheumatic drug.ResultsWe obtained 1535 MSOT and 982 US scans from 87 participants (36 HC, 34 PsA, 17 RA). Entheseal tenderness was not associated with metabolic changes, whereas US enthesitis was associated with increased total hemoglobin, oxygen saturation and collagen content. In contrast, clinical and US arthritis showed increased hemoglobin levels but reduced oxygen saturation and reduced collagen content. Synovial hypertrophy was associated with increased lipid content in the joints (Figure 1).Figure 1.Scaled differences and 95% confidence intervals of MSOT-measured metabolite values by clinical and ultrasonographic findings of enthesitis (A-C) and arthritis (D-F). Two differences are plotted for each metabolite indicating two multispectral processing algorithms used for estimation. P values were adjusted for multiple testing using a false discovery rate of 5%. NS, not significant. sO2, oxygen saturation.ConclusionMSOT allows a non-invasive characterization of metabolic changes in arthritis and enthesitis. These findings can be interpreted as a reflection of increased synovial cellularity, collagen degradation, and metabolic demand in synovitis, and of an increased tissue apposition and vascularization in enthesitis. Our results suggest that synovitis and enthesitis do not only differ at the clinical and anatomical-functional level, but also exhibit divergent metabolic changes.References[1]Falconer J, et. al. Arthritis Rheumatol. 2018;70(7):984-99.[2]Regensburger AP, et. al. Biomedicines. 2021;9(5).[3]Regensburger AP, et al. Nature Medicine. 2019;25(12):1905-15.Conflict of InterestAR., FK, MW are co-inventors, together with iThera Medical GmbH, Germany on an EU patent application (no. EP 19 163 304.9) relating to a device and a method for analysis of optoacoustic data, an optoacoustic system and a computer program. All other authors declare no conflict of interest.AcknowledgementsWe thank Ms. Nairouz Al Ahmad, assistant medical technician (Department of Internal Medicine 3), for her assistance in conducting the study and Dr. Yi Qiu, PhD (iThera Medical GmbH) for her assistance in data analysis and interpretation.Disclosure of InterestsNone declared
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Knieling F, Cesnjevar R, Regensburger AP, Wagner AL, Purbojo A, Dittrich S, Münch F, Neubert A, Woelfle J, Jüngert J, Rüffer A. Transfontanellar Contrast-enhanced US for Intraoperative Imaging of Cerebral Perfusion during Neonatal Arterial Switch Operation. Radiology 2022; 304:164-173. [PMID: 35380495 DOI: 10.1148/radiol.212044] [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: 11/11/2022]
Abstract
Background Brain injury and subsequent neurodevelopmental disorders are major determinants for later-life outcomes in neonates with transposition of the great arteries (TGA). Purpose To quantitatively assess cerebral perfusion in neonates with TGA undergoing arterial switch operation (ASO) using transfontanellar contrast-enhanced US (T-CEUS). Materials and Methods In a prospective single-center cross-sectional diagnostic study, neonates with TGA scheduled for ASO were recruited from February 2018 to February 2020. Measurements were performed at five time points before, during, and after surgery (T1-T5), and 11 perfusion parameters were derived per cerebral hemisphere. Neonate clinical characteristics, heart rate, mean arterial pressure, central venous pressure, near-infrared spectroscopy, blood gas analyses, ventilation time, time spent in the pediatric intensive care unit, and time in hospital were correlated with imaging parameters. Analysis of variance or a mixed-effects model were used for groupwise comparisons. Results A total of 12 neonates (mean gestational age, 39 6/7 weeks ± 1/7 [SD]) were included and underwent ASO a mean of 6.9 days ± 3.4 after birth. When compared with baseline values, T-CEUS revealed a longer mean time-to-peak (right hemisphere, 4.3 seconds ± 2.1 vs 17 seconds ± 6.4 [P < .001]; left hemisphere, 4.0 seconds ± 2.3 vs 21 seconds ± 8.7 [P < .001]) and rise time (right hemisphere, 3.5 seconds ± 1.7 vs 11 seconds ± 5.1 [P = .002]; left hemisphere, 3.4 seconds ± 2.0 vs 22 seconds ± 7.8 [P = .004]) in both cerebral hemispheres during low-flow cardiopulmonary bypass and hypothermia (T4) for all neonates. Neonate age at surgery negatively correlated with T-CEUS parameters during ASO, as calculated with the area under the flow curve (AUC) during wash-in (R = -0.60, P = .020), washout (R = -0.82, P = .002), and both wash-in and washout (R = -0.79, P = .004). Mean AUC values were lower in neonates older than 7 days compared with younger neonates during wash-in ([87 arbitrary units {au} ± 77] × 102 vs [270 au ± 164] × 102, P = .049]), washout ([15 au ± 11] × 103 vs [65 au ± 38] × 103, P = .020]) and both wash-in and washout ([24 au ± 18] × 103 vs [92 au ± 53] × 103, P = .023). Conclusion Low-flow hypothermic conditions resulted in reduced cerebral perfusion, as measured with transfontanellar contrast-enhanced US, which inversely correlated with age at surgery. Clinical trial registration no. NCT03215628 © RSNA, 2022 Online supplemental material is available for this article.
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Affiliation(s)
- Ferdinand Knieling
- From the Departments of Pediatrics and Adolescent Medicine (F.K., A.P.R., A.L.W., A.N., J.W., J.J.), Congenital Heart Surgery (R.C., A.P., F.M.), and Pediatric Cardiology (S.D.), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Loschgestrasse 15, 91054 Erlangen, Germany; and Section for Congenital and Pediatric Cardiac Surgery, University Heart Center Hamburg, University Hospital Hamburg, Eppendorf, Hamburg, Germany (A.R.)
| | - Robert Cesnjevar
- From the Departments of Pediatrics and Adolescent Medicine (F.K., A.P.R., A.L.W., A.N., J.W., J.J.), Congenital Heart Surgery (R.C., A.P., F.M.), and Pediatric Cardiology (S.D.), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Loschgestrasse 15, 91054 Erlangen, Germany; and Section for Congenital and Pediatric Cardiac Surgery, University Heart Center Hamburg, University Hospital Hamburg, Eppendorf, Hamburg, Germany (A.R.)
| | - Adrian P Regensburger
- From the Departments of Pediatrics and Adolescent Medicine (F.K., A.P.R., A.L.W., A.N., J.W., J.J.), Congenital Heart Surgery (R.C., A.P., F.M.), and Pediatric Cardiology (S.D.), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Loschgestrasse 15, 91054 Erlangen, Germany; and Section for Congenital and Pediatric Cardiac Surgery, University Heart Center Hamburg, University Hospital Hamburg, Eppendorf, Hamburg, Germany (A.R.)
| | - Alexandra L Wagner
- From the Departments of Pediatrics and Adolescent Medicine (F.K., A.P.R., A.L.W., A.N., J.W., J.J.), Congenital Heart Surgery (R.C., A.P., F.M.), and Pediatric Cardiology (S.D.), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Loschgestrasse 15, 91054 Erlangen, Germany; and Section for Congenital and Pediatric Cardiac Surgery, University Heart Center Hamburg, University Hospital Hamburg, Eppendorf, Hamburg, Germany (A.R.)
| | - Ariawan Purbojo
- From the Departments of Pediatrics and Adolescent Medicine (F.K., A.P.R., A.L.W., A.N., J.W., J.J.), Congenital Heart Surgery (R.C., A.P., F.M.), and Pediatric Cardiology (S.D.), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Loschgestrasse 15, 91054 Erlangen, Germany; and Section for Congenital and Pediatric Cardiac Surgery, University Heart Center Hamburg, University Hospital Hamburg, Eppendorf, Hamburg, Germany (A.R.)
| | - Sven Dittrich
- From the Departments of Pediatrics and Adolescent Medicine (F.K., A.P.R., A.L.W., A.N., J.W., J.J.), Congenital Heart Surgery (R.C., A.P., F.M.), and Pediatric Cardiology (S.D.), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Loschgestrasse 15, 91054 Erlangen, Germany; and Section for Congenital and Pediatric Cardiac Surgery, University Heart Center Hamburg, University Hospital Hamburg, Eppendorf, Hamburg, Germany (A.R.)
| | - Frank Münch
- From the Departments of Pediatrics and Adolescent Medicine (F.K., A.P.R., A.L.W., A.N., J.W., J.J.), Congenital Heart Surgery (R.C., A.P., F.M.), and Pediatric Cardiology (S.D.), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Loschgestrasse 15, 91054 Erlangen, Germany; and Section for Congenital and Pediatric Cardiac Surgery, University Heart Center Hamburg, University Hospital Hamburg, Eppendorf, Hamburg, Germany (A.R.)
| | - Antje Neubert
- From the Departments of Pediatrics and Adolescent Medicine (F.K., A.P.R., A.L.W., A.N., J.W., J.J.), Congenital Heart Surgery (R.C., A.P., F.M.), and Pediatric Cardiology (S.D.), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Loschgestrasse 15, 91054 Erlangen, Germany; and Section for Congenital and Pediatric Cardiac Surgery, University Heart Center Hamburg, University Hospital Hamburg, Eppendorf, Hamburg, Germany (A.R.)
| | - Joachim Woelfle
- From the Departments of Pediatrics and Adolescent Medicine (F.K., A.P.R., A.L.W., A.N., J.W., J.J.), Congenital Heart Surgery (R.C., A.P., F.M.), and Pediatric Cardiology (S.D.), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Loschgestrasse 15, 91054 Erlangen, Germany; and Section for Congenital and Pediatric Cardiac Surgery, University Heart Center Hamburg, University Hospital Hamburg, Eppendorf, Hamburg, Germany (A.R.)
| | - Jörg Jüngert
- From the Departments of Pediatrics and Adolescent Medicine (F.K., A.P.R., A.L.W., A.N., J.W., J.J.), Congenital Heart Surgery (R.C., A.P., F.M.), and Pediatric Cardiology (S.D.), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Loschgestrasse 15, 91054 Erlangen, Germany; and Section for Congenital and Pediatric Cardiac Surgery, University Heart Center Hamburg, University Hospital Hamburg, Eppendorf, Hamburg, Germany (A.R.)
| | - André Rüffer
- From the Departments of Pediatrics and Adolescent Medicine (F.K., A.P.R., A.L.W., A.N., J.W., J.J.), Congenital Heart Surgery (R.C., A.P., F.M.), and Pediatric Cardiology (S.D.), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Loschgestrasse 15, 91054 Erlangen, Germany; and Section for Congenital and Pediatric Cardiac Surgery, University Heart Center Hamburg, University Hospital Hamburg, Eppendorf, Hamburg, Germany (A.R.)
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Stirm M, Fonteyne LM, Shashikadze B, Stöckl JB, Kurome M, Keßler B, Zakhartchenko V, Kemter E, Blum H, Arnold GJ, Matiasek K, Wanke R, Wurst W, Nagashima H, Knieling F, Walter MC, Kupatt C, Fröhlich T, Klymiuk N, Blutke A, Wolf E. Pig models for Duchenne muscular dystrophy – from disease mechanisms to validation of new diagnostic and therapeutic concepts. Neuromuscul Disord 2022; 32:543-556. [DOI: 10.1016/j.nmd.2022.04.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/22/2022] [Accepted: 04/22/2022] [Indexed: 12/13/2022]
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Regensburger AP, Wagner AL, Danko V, Jüngert J, Federle A, Klett D, Schuessler S, Buehler A, Neurath MF, Roos A, Lochmüller H, Woelfle J, Trollmann R, Waldner MJ, Knieling F. Multispectral optoacoustic tomography for non-invasive disease phenotyping in pediatric spinal muscular atrophy patients. Photoacoustics 2022; 25:100315. [PMID: 34849338 PMCID: PMC8607197 DOI: 10.1016/j.pacs.2021.100315] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 11/02/2021] [Accepted: 11/08/2021] [Indexed: 05/19/2023]
Abstract
Proximal spinal muscular atrophy (SMA) is a rare progressive, life limiting genetic motor neuron disease. While promising causal therapies are available, meaningful prognostic biomarkers for therapeutic monitoring are missing. We demonstrate handheld Multispectral Optoacoustic Tomography (MSOT) as a novel non-invasive imaging approach to visualize and quantify muscle wasting in pediatric SMA. While MSOT signals were distributed homogeneously in muscles of healthy volunteers (HVs), SMA patients showed moth-eaten optoacoustic signal patterns. Further signal quantification revealed greatest differences between groups at the isosbestic point for hemoglobin (SWL 800 nm). The SWL 800 nm signal intensities further correlated with clinical phenotype tested by standard motor outcome measures. Therefore, handheld MSOT could enable non-invasive assessment of disease burden in SMA patients.
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Affiliation(s)
- Adrian P. Regensburger
- Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander-University (FAU) Erlangen-Nuremberg, Erlangen, Germany
| | - Alexandra L. Wagner
- Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander-University (FAU) Erlangen-Nuremberg, Erlangen, Germany
| | - Vera Danko
- Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander-University (FAU) Erlangen-Nuremberg, Erlangen, Germany
| | - Jörg Jüngert
- Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander-University (FAU) Erlangen-Nuremberg, Erlangen, Germany
| | - Anna Federle
- Medical Department 1, Friedrich-Alexander-University (FAU) Erlangen-Nuremberg, Erlangen, Germany
| | - Daniel Klett
- Medical Department 1, Friedrich-Alexander-University (FAU) Erlangen-Nuremberg, Erlangen, Germany
| | - Stephanie Schuessler
- Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander-University (FAU) Erlangen-Nuremberg, Erlangen, Germany
| | - Adrian Buehler
- Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander-University (FAU) Erlangen-Nuremberg, Erlangen, Germany
| | - Markus F. Neurath
- Medical Department 1, Friedrich-Alexander-University (FAU) Erlangen-Nuremberg, Erlangen, Germany
| | - Andreas Roos
- Department of Pediatric Neurology, Developmental Neurology and Social Pediatrics, University of Duisburg-Essen, Essen, Germany
| | - Hanns Lochmüller
- Brain and Mind Research Institute, University of Ottawa, Ottawa, Canada
- Division of Neurology, Department of Medicine, The Ottawa Hospital, Canada
- Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Canada
| | - Joachim Woelfle
- Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander-University (FAU) Erlangen-Nuremberg, Erlangen, Germany
| | - Regina Trollmann
- Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander-University (FAU) Erlangen-Nuremberg, Erlangen, Germany
| | - Maximilian J. Waldner
- Medical Department 1, Friedrich-Alexander-University (FAU) Erlangen-Nuremberg, Erlangen, Germany
| | - Ferdinand Knieling
- Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander-University (FAU) Erlangen-Nuremberg, Erlangen, Germany
- Correspondence to: Pediatric Experimental and Translational Imaging Laboratory (PETI-Lab) Department of Pediatrics and Adolescent Medicine Friedrich-Alexander-University (FAU) Erlangen-Nuremberg, Loschgestraße 15, 91054 Erlangen, Germany.
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Wachter F, Regensburger AP, Antonia Sophia Peter, Knieling F, Wagner AL, Simon D, Hoerning A, Woelfle J, Überla K, Neubert A, Rauh M. Continuous monitoring of SARS-CoV-2 seroprevalence in children using residual blood samples from routine clinical chemistry. Clin Chem Lab Med 2022; 60:941-951. [PMID: 35218170 DOI: 10.1515/cclm-2022-0037] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 02/14/2022] [Indexed: 12/19/2022]
Abstract
OBJECTIVES The assessment of SARS-CoV-2 infections in children is still challenging, but essential for appropriate political decisions. The aim of this study was to investigate whether residual blood samples can be used for SARS-CoV-2 seroprevalence monitoring in pediatrics. METHODS In this repeated cross-sectional cohort study, anonymous residual blood samples from pediatric patients aged 0-17 years were collected in three time-periods (Oct.-Nov. 2020, April 2021, and June-July 2021) and analyzed for SARS-CoV-2 Spike protein (anti-S) and nucleocapsid (anti-N) antibodies using commercial antibody assays. 28 reactive samples were used to compare antibody levels with a pseudotyped neutralization assay. The results were further compared to the official national COVID-19 surveillance data to calculate the number of unreported cases. RESULTS In total, n=2,626 individual blood samples were analyzed. In this unvaccinated pediatric cohort anti-S and anti-N antibody seroprevalence increased over the three time periods (anti-S: 1.38-9.16%, and 14.59%; anti-N: 1.26%, to 6.19%, and 8.56%). Compared to the national surveillance data this leads to a 3.93-5.66-fold increase in the number of unreported cases. However, a correlation between the cumulative incidence of the individual provinces and our assigned data was found (r=0.74, p=0.0151). In addition, reactive samples with anti-S and anti-N and samples with only anti-S showed neutralization capabilities (11/14 and 8/14, respectively). Anti-S levels were not significantly different between age groups and sexes (all p>0.05). CONCLUSIONS The present study suggests that residual blood samples from routine laboratory chemistry could be included in the estimation of the total SARS-CoV-2 seroprevalence in children.
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Affiliation(s)
- Felix Wachter
- Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander-University (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Adrian P Regensburger
- Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander-University (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Antonia Sophia Peter
- Institute of Clinical and Molecular Virology, Friedrich-Alexander University (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Ferdinand Knieling
- Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander-University (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Alexandra L Wagner
- Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander-University (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - David Simon
- Department of Internal Medicine 3, Friedrich-Alexander University (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - André Hoerning
- Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander-University (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Joachim Woelfle
- Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander-University (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Klaus Überla
- Institute of Clinical and Molecular Virology, Friedrich-Alexander University (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Antje Neubert
- Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander-University (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Manfred Rauh
- Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander-University (FAU) Erlangen-Nürnberg, Erlangen, Germany
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Späth M, Rohde M, Ni D, Knieling F, Stelzle F, Schmidt M, Klämpfl F, Hohmann M. The influence of the optical properties on the determination of capillary diameters. Sci Rep 2022; 12:270. [PMID: 34997168 PMCID: PMC8742127 DOI: 10.1038/s41598-021-04359-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 12/21/2021] [Indexed: 11/09/2022] Open
Abstract
Various clinically applicable scores and indices are available to help identify the state of a microcirculatory disorder in a patient. Several of these methods, however, leave room for interpretation and only provide clues for diagnosis. Thus, a measurement method that allows a reliable detection of impending or manifest circulatory malfunctions would be of great value. In this context, the optical and non-invasive method of shifted position-diffuse reflectance imaging (SP-DRI) was developed. It allows to determine the capillary diameter and thus to assess the state of the microcirculation. The aim of the present study is to investigate how the quantification of capillary diameters by SP-DRI behaves in different individuals, i.e. for a wide range of optical properties. For this, within Monte-Carlo simulations all optical properties (seven skin layers, hemoglobin) were randomly varied following a Gaussian distribution. An important finding from the present investigation is that SP-DRI works when the optical properties are chosen randomly. Furthermore, it is shown that appropriate data analysis allows calibration-free absolute quantification of the capillary diameter across individuals using SP-DRI. This underpins the potential of SP-DRI to serve as an early alert system for the onset of microcirculatory associated diseases.
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Affiliation(s)
- Moritz Späth
- Institute of Photonic Technologies, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91052, Erlangen, Germany. .,Erlangen Graduate School in Advanced Optical Technologies, 91052, Erlangen, Germany.
| | - Maximilian Rohde
- grid.411668.c0000 0000 9935 6525Department of Oral and Maxillofacial Surgery, University Hospital Erlangen, 91054 Erlangen, Germany ,grid.5330.50000 0001 2107 3311Erlangen Graduate School in Advanced Optical Technologies, 91052 Erlangen, Germany
| | - Dongqin Ni
- grid.5330.50000 0001 2107 3311Institute of Photonic Technologies, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91052 Erlangen, Germany ,grid.5330.50000 0001 2107 3311Erlangen Graduate School in Advanced Optical Technologies, 91052 Erlangen, Germany
| | - Ferdinand Knieling
- grid.411668.c0000 0000 9935 6525Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, 91054 Erlangen, Germany
| | - Florian Stelzle
- grid.5330.50000 0001 2107 3311Institute of Photonic Technologies, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91052 Erlangen, Germany ,grid.411668.c0000 0000 9935 6525Department of Oral and Maxillofacial Surgery, University Hospital Erlangen, 91054 Erlangen, Germany ,grid.5330.50000 0001 2107 3311Erlangen Graduate School in Advanced Optical Technologies, 91052 Erlangen, Germany
| | - Michael Schmidt
- grid.5330.50000 0001 2107 3311Institute of Photonic Technologies, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91052 Erlangen, Germany ,grid.5330.50000 0001 2107 3311Erlangen Graduate School in Advanced Optical Technologies, 91052 Erlangen, Germany
| | - Florian Klämpfl
- grid.5330.50000 0001 2107 3311Institute of Photonic Technologies, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91052 Erlangen, Germany ,grid.5330.50000 0001 2107 3311Erlangen Graduate School in Advanced Optical Technologies, 91052 Erlangen, Germany
| | - Martin Hohmann
- grid.5330.50000 0001 2107 3311Institute of Photonic Technologies, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91052 Erlangen, Germany ,grid.5330.50000 0001 2107 3311Erlangen Graduate School in Advanced Optical Technologies, 91052 Erlangen, Germany
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Rüffer A, Knieling F, Cesnjevar R, Regensburger A, Purbojo A, Dittrich S, Münch F, Wölfle J, Jüngert J. Equal cerebral perfusion during extended aortic coarctation repair. Eur J Cardiothorac Surg 2021; 61:299-306. [PMID: 34718510 DOI: 10.1093/ejcts/ezab415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 08/03/2021] [Accepted: 08/12/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Aortic coarctation with distal aortic arch hypoplasia can be effectively addressed by coarctation resection with extended end-to-end-anastomosis (REEEA). Particularly, when unilateral cerebral perfusion (UCP) is established by clamping of left-sided supra-aortic vessels, the extent of cerebral blood flow distribution during repair remains undetermined, so far. Transfontanellar contrast-enhanced ultrasound (T-CEUS) can be utilized for real-time visualization and quantitative evaluation of cerebral blood flow. This study quantitatively evaluates cerebral perfusion during REEEA by using intraoperative T-CEUS. METHODS In a prospective study, 9 infants with open fontanelle undergoing REEEA [median age: 13 days (range 1-34) and median weight 3.1 kg (range 2.2-4.4)] were intraoperatively examined with T-CEUS at 3 consecutive time-points: before skin incision, during UCP and after skin suture. A software-based analysis of 11 parameters was used for data evaluation. Absolute and relative blood flow in contralateral hemispheres was measured in side-by-side comparison, and referenced to baseline measurements. RESULTS No side-depend absolute or relative cerebral perfusion differences were found during REEEA, except for an increased relative 'wash-out-rate' (P = 0.0013) in favour of the right hemisphere after surgery. Compared to ipsilateral baseline levels, 'rise time' was transiently increased in right (P = 0.0277) and 'time-to-peak' in both hemispheres (right: P = 0.0403 and left: P = 0.0286), all during UCP. CONCLUSIONS The use of T-CEUS provided evidence for homogenous distribution of contrast agent in both hemispheres during UCP. T-CEUS can be utilized for the postprocedural evaluation of cerebral perfusion during congenital cardiac surgery. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov Unique, Identifier: NCT03215628.
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Affiliation(s)
- André Rüffer
- Department for Congenital Cardiac Surgery, University Hospital Aachen, Pauwelstsrasse 30, 52074 Aachen, Germany
| | - Ferdinand Knieling
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Robert Cesnjevar
- Department of Congenital Heart Surgery, University Hospital Erlangen, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Adrian Regensburger
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Ariawan Purbojo
- Department of Congenital Heart Surgery, University Hospital Erlangen, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Sven Dittrich
- Department of Pediatric Cardiology, University Hospital Erlangen, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Frank Münch
- Department of Congenital Heart Surgery, University Hospital Erlangen, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Joachim Wölfle
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Jörg Jüngert
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen, Germany
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Regensburger AP, Knieling F, Feldkamp A, Rascher W, Diesch K, Woelfle J, Prokosch HU, Jüngert J. Time Tracking of Standard Ultrasound Examinations in Pediatric Hospitals and Pediatric Medical Practices - A Multicenter Study by the Pediatric Section of the German Society of Ultrasound in Medicine (DEGUM). Ultraschall Med 2021; 42:379-387. [PMID: 31648348 DOI: 10.1055/a-1023-4024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
PURPOSE Ultrasonography is the primary imaging modality in pediatrics but still lacks sufficient reimbursement in Germany. In this multicenter study, national data for the duration of standard ultrasound in pediatrics were systematically documented in order to specify the actual time required. MATERIALS AND METHODS N = 10 hospitals (N = 5 university hospitals, N = 5 non-university hospitals) and N = 3 medical practices in Germany recorded the entire process of an ultrasound examination in a special protocol developed by the Pediatric Section of the DEGUM. The duration of each of seven single steps during ultrasonography (from data input to final discussion of the results) of different organ systems was logged. RESULTS In total, N = 2118 examinations from different organ systems were recorded. N = 10 organ systems were examined frequently (> 30 times). The total duration of an ultrasound examination was statistically significantly longer in hospitals compared to medical practices (median (IQR) 27 min. (18-38) vs. 12 min. (9-17), p < 0.001). The "hands-on" patient time was approximately one half of the total required time in both settings (49.9 % vs. 48.9 %). Ultrasonography of the abdomen and brain lasted longer in university hospitals than in non-university hospitals (p < 0.001, and p = 0.04, respectively). Cooperation and age did not uniformly correlate with the total duration. CONCLUSION This study provides novel comprehensive national data for the duration of standardized ultrasound examinations of children and adolescents in Germany. These data are essential for a further evaluation of the economic costs and should support better remuneration in the future.
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Affiliation(s)
- Adrian P Regensburger
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nuremberg, Germany
| | - Ferdinand Knieling
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nuremberg, Germany
| | - Axel Feldkamp
- Children's Hospital, Sana Duisburg Clinics, Duisburg, Germany
| | - Wolfgang Rascher
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nuremberg, Germany
| | - Katharina Diesch
- Center for Medical Information and Communication Technology, University Hospital Erlangen, Erlangen, Germany
| | - Joachim Woelfle
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nuremberg, Germany
| | - Hans-Ulrich Prokosch
- Center for Medical Information and Communication Technology, University Hospital Erlangen, Erlangen, Germany
| | - Jörg Jüngert
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nuremberg, Germany
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Wildner D, Heinzerling L, Scheulen ME, Kaempgen E, Schuler G, Strobel D, Janka R, Neurath MF, Sturm J, Knieling F. Assessment of sorafenib induced changes in tumor perfusion of uveal melanoma metastases with dynamic contrast-enhanced ultrasound (DCE-US). J Cancer Res Clin Oncol 2021; 148:955-965. [PMID: 34050396 PMCID: PMC8930795 DOI: 10.1007/s00432-021-03666-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 05/17/2021] [Indexed: 11/28/2022]
Abstract
Purpose Dynamic contrast-enhanced ultrasound (DCE-US) was used to monitor early response to sorafenib therapy in patients with liver metastases from uveal melanoma. Methods In total, 21 patients with liver metastases were recruited within a prospective trial and underwent daily sorafenib therapy. DCE-US of a target lesion was performed before initiation of treatment, on day 15 and 56. Two independent blinded investigators performed software analysis for DCE-US parameters and inter-observer-correlation was calculated. Response to treatment was evaluated on day 56. DCE-US parameters were correlated with clinical response and RECIST1.1 criteria. Results Inter-observer-correlation (r) of DCE-US parameters [time-to-peak (TTP), mean-transit-time (MTT), peak intensity (PI), regional blood volume (RBV), regional blood flow (RBF)] at baseline, day 15, and day 56 was highly significant (r-range 0.73–0.97, all p < 0.001). Out of 17 evaluable patients, 12 patients survived day 56 (clinical responders, cRE), whereas, five patients died before day 56 and were classified as non-responders (cNR). TTP values significantly increased in the cRE group 15 days after initiation of treatment for investigator 1 (p = 0.034) and at day 56 for both investigators (p = 0.028/0.028). MTT had increased significantly in the cRE group on day 56 (p = 0.037/0.022). In the cNR group changes for TTP and MTT remained insignificant. Thus, increase of the DCE-US parameters TTP and MTT are associated with response to treatment and prognosis. Conclusion An increase of TTP and MTT at frequent intervals could serve as a surrogate marker for early response evaluation to anti-angiogenic treatment of metastatic uveal melanoma. Supplementary Information The online version contains supplementary material available at 10.1007/s00432-021-03666-8.
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Affiliation(s)
- Dane Wildner
- Division of Ultrasound, Department of Internal Medicine 1, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg, Ulmenweg 18, 91054, Erlangen, Germany.
| | - Lucie Heinzerling
- Department of Dermatology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg, Ulmenweg 18, 91054, Erlangen, Germany
| | - Max E Scheulen
- Department of Internal Medicine (Tumor Research), University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Eckhart Kaempgen
- Department of Dermatology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg, Ulmenweg 18, 91054, Erlangen, Germany
| | - Gerold Schuler
- Department of Dermatology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg, Ulmenweg 18, 91054, Erlangen, Germany
| | - Deike Strobel
- Division of Ultrasound, Department of Internal Medicine 1, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg, Ulmenweg 18, 91054, Erlangen, Germany
| | - Rolf Janka
- Radiology Institute, University Hospital Erlangen, Maximiliansplatz 1, 91054, Erlangen, Germany
| | - Markus F Neurath
- Division of Ultrasound, Department of Internal Medicine 1, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg, Ulmenweg 18, 91054, Erlangen, Germany
| | - Joerg Sturm
- Division of Ultrasound, Department of Internal Medicine 1, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg, Ulmenweg 18, 91054, Erlangen, Germany
| | - Ferdinand Knieling
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg, Loschgestr. 15, 91054, Erlangen, Germany
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Regensburger AP, Brown E, Krönke G, Waldner MJ, Knieling F. Optoacoustic Imaging in Inflammation. Biomedicines 2021; 9:483. [PMID: 33924983 PMCID: PMC8145174 DOI: 10.3390/biomedicines9050483] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/20/2021] [Accepted: 04/21/2021] [Indexed: 12/11/2022] Open
Abstract
Optoacoustic or photoacoustic imaging (OAI/PAI) is a technology which enables non-invasive visualization of laser-illuminated tissue by the detection of acoustic signals. The combination of "light in" and "sound out" offers unprecedented scalability with a high penetration depth and resolution. The wide range of biomedical applications makes this technology a versatile tool for preclinical and clinical research. Particularly when imaging inflammation, the technology offers advantages over current clinical methods to diagnose, stage, and monitor physiological and pathophysiological processes. This review discusses the clinical perspective of using OAI in the context of imaging inflammation as well as in current and emerging translational applications.
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Affiliation(s)
- Adrian P. Regensburger
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Loschgestr. 15, D-91054 Erlangen, Germany;
| | - Emma Brown
- Department of Physics, University of Cambridge, JJ Thomson Avenue, Cambridge CB3 0HE, UK;
- Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Robinson Way, Cambridge CB2 0RE, UK
| | - Gerhard Krönke
- Department of Medicine 3, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Ulmenweg 18, D-91054 Erlangen, Germany;
| | - Maximilian J. Waldner
- Department of Medicine 1, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Ulmenweg 18, D-91054 Erlangen, Germany;
| | - Ferdinand Knieling
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Loschgestr. 15, D-91054 Erlangen, Germany;
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Wagner AL, Danko V, Federle A, Klett D, Simon D, Heiss R, Jüngert J, Uder M, Schett G, Neurath MF, Woelfle J, Waldner MJ, Trollmann R, Regensburger AP, Knieling F. Precision of handheld multispectral optoacoustic tomography for muscle imaging. Photoacoustics 2021; 21:100220. [PMID: 33318928 PMCID: PMC7723806 DOI: 10.1016/j.pacs.2020.100220] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 10/29/2020] [Accepted: 11/03/2020] [Indexed: 05/05/2023]
Abstract
Photo-or optoacoustic imaging (OAI) allows quantitative imaging of target tissues. Using multi-wavelength illumination with subsequent ultrasound detection, it may visualize a variety of different chromophores at centimeter depth. Despite its non-invasive, label-free advantages, the precision of repeated measurements for clinical applications is still elusive. We present a multilayer analysis of n = 1920 imaging datasets obtained from a prospective clinical trial (NCT03979157) in n = 10 healthy adult volunteers. All datasets were analyzed for 13 single wavelengths (SWL) between 660 nm-1210 nm and five MSOT-parameters (deoxygenated/oxygenated/total hemoglobin, collagen and lipid) by a semi-automated batch mode software. Intraclass correlation coefficients (ICC) were good to excellent for intrarater (SWL: 0.82-0.92; MSOT-parameter: 0.72-0.92) and interrater reproducibility (SWL: 0.79-0.87; MSOT-parameter: 0.78-0.86), with the exception for MSOT-parameter lipid (interrater ICC: 0.56). Results were stable over time, but exercise-related effects as well as inter-and intramuscular variability were observed. The findings of this study provide a framework for further clinical OAI implementation.
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Affiliation(s)
- Alexandra L. Wagner
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Vera Danko
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Anna Federle
- Department of Medicine 1, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Daniel Klett
- Department of Medicine 1, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - David Simon
- Department of Medicine 3, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Rafael Heiss
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Jörg Jüngert
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Michael Uder
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Georg Schett
- Department of Medicine 3, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Markus F. Neurath
- Department of Medicine 1, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Joachim Woelfle
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Maximilian J. Waldner
- Department of Medicine 1, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Regina Trollmann
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Adrian P. Regensburger
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Ferdinand Knieling
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nürnberg, Erlangen, Germany
- Corresponding author at: Pediatric Experimental and Translational Imaging Laboratory (PETI-Lab), Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander-University (FAU) Erlangen-Nürnberg, Loschgestraße 15, 91054, Erlangen, Germany.
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Heichler C, Scheibe K, Schmied A, Geppert CI, Schmid B, Wirtz S, Thoma OM, Kramer V, Waldner MJ, Büttner C, Farin HF, Pešić M, Knieling F, Merkel S, Grüneboom A, Gunzer M, Grützmann R, Rose-John S, Koralov SB, Kollias G, Vieth M, Hartmann A, Greten FR, Neurath MF, Neufert C. STAT3 activation through IL-6/IL-11 in cancer-associated fibroblasts promotes colorectal tumour development and correlates with poor prognosis. Gut 2020; 69:1269-1282. [PMID: 31685519 DOI: 10.1136/gutjnl-2019-319200] [Citation(s) in RCA: 154] [Impact Index Per Article: 38.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 09/22/2019] [Accepted: 10/08/2019] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Cancer-associated fibroblasts (CAFs) influence the tumour microenvironment and tumour growth. However, the role of CAFs in colorectal cancer (CRC) development is incompletely understood. DESIGN We quantified phosphorylation of STAT3 (pSTAT3) expression in CAFs of human colon cancer tissue using a tissue microarray (TMA) of 375 patients, immunofluorescence staining and digital pathology. To investigate the functional role of CAFs in CRC, we took advantage of two murine models of colorectal neoplasia and advanced imaging technologies. In loss-of-function and gain-of-function experiments, using genetically modified mice with collagen type VI (COLVI)-specific signal transducer and activator of transcription 3 (STAT3) targeting, we evaluated STAT3 signalling in fibroblasts during colorectal tumour development. We performed a comparative gene expression profiling by whole genome RNA-sequencing of fibroblast subpopulations (COLVI+ vs COLVI-) on STAT3 activation (IL-6 vs IL-11). RESULTS The analysis of pSTAT3 expression in CAFs of human TMAs revealed a negative correlation of increased stromal pSTAT3 expression with the survival of colon cancer patients. In the loss-of-function and gain-of-function approach, we found a critical role of STAT3 activation in fibroblasts in driving colorectal tumourigenesis in vivo. With different imaging technologies, we detected an expansion of activated fibroblasts in colorectal neoplasias. Comparative gene expression profiling of fibroblast subpopulations on STAT3 activation revealed the regulation of transcriptional patterns associated with angiogenesis. Finally, the blockade of proangiogenic signalling significantly reduced colorectal tumour growth in mice with constitutive STAT3 activation in COLVI+ fibroblasts. CONCLUSION Altogether our work demonstrates a critical role of STAT3 activation in CAFs in CRC development.
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Affiliation(s)
- Christina Heichler
- First Department of Medicine, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Kristina Scheibe
- First Department of Medicine, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Anabel Schmied
- First Department of Medicine, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Carol I Geppert
- Department of Pathology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Benjamin Schmid
- Optical Imaging Center, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Stefan Wirtz
- First Department of Medicine, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Oana-Maria Thoma
- First Department of Medicine, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsklinikum Erlangen, Erlangen, Germany.,Erlangen Graduate School of Advanced Optical Technologies (SAOT), Friedrich Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Viktoria Kramer
- First Department of Medicine, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Maximilian J Waldner
- First Department of Medicine, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Christian Büttner
- Institute of Human Genetics, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Henner F Farin
- German Cancer Consortium (DKTK), Heidelberg, Germany.,Institute for Tumor Biology and Experimental Therapy, Georg-Speyer-Haus, Frankfurt am Main, Germany
| | - Marina Pešić
- Institute for Tumor Biology and Experimental Therapy, Georg-Speyer-Haus, Frankfurt am Main, Germany
| | - Ferdinand Knieling
- First Department of Medicine, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsklinikum Erlangen, Erlangen, Germany.,Department of Pediatrics and Adolescent Medicine, Universitätsklinikum Erlangen Kinder- und Jugendklinik, Erlangen, Germany
| | - Susanne Merkel
- Chirurgische Klinik, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Anika Grüneboom
- Third Department of Medicine, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Matthias Gunzer
- Institute of Experimental Immunology and Imaging, University Duisburg-Essen and University Hospital Essen, Essen, Germany
| | - Robert Grützmann
- Chirurgische Klinik, Universitätsklinikum Erlangen, Erlangen, Germany
| | | | - Sergei B Koralov
- Department of Pathology, New York University School of Medicine, New York, New York, USA
| | - George Kollias
- Biomedical Sciences Research Center Alexander Fleming, Vari, Greece
| | - Michael Vieth
- Institute of Pathology, Klinikum Bayreuth, Bayreuth, Germany
| | - Arndt Hartmann
- Department of Pathology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Florian R Greten
- Institute for Tumor Biology and Experimental Therapy, Georg-Speyer-Haus, Frankfurt am Main, Germany
| | - Markus F Neurath
- First Department of Medicine, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Clemens Neufert
- First Department of Medicine, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsklinikum Erlangen, Erlangen, Germany
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Regensburger AP, Wagner AL, Claussen J, Waldner MJ, Knieling F. Shedding light on pediatric diseases: multispectral optoacoustic tomography at the doorway to clinical applications. Mol Cell Pediatr 2020; 7:3. [PMID: 32130546 PMCID: PMC7056767 DOI: 10.1186/s40348-020-00095-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 02/24/2020] [Indexed: 12/25/2022] Open
Abstract
Optoacoustic imaging (OAI), or photoacoustic imaging (PAI), has fundamentally influenced basic science by providing high-resolution visualization of biological mechanisms. With the introduction of multispectral optoacoustic tomography (MSOT), these technologies have now moved closer to clinical applications. MSOT utilizes short-pulsed near-infrared laser light to induce thermoelastic expansion in targeted tissues. This results in acoustic pressure waves, which are used to resolve specific endo- and exogenous chromophores. Especially in the pediatric population, this non-invasive imaging approach might hold fundamental advantages compared to conventional cross-sectional imaging modalities. As this technology allows the visualization of quantitative molecular tissue composition at high spatial resolution non-invasively in sufficient penetration depth, it paves the way to personalized medicine in pediatric diseases.
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Affiliation(s)
- Adrian P Regensburger
- Pediatric Experimental and Translational Imaging Laboratory (PETI-Lab), Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander-University (FAU) Erlangen-Nuremberg, Loschgestraße 15, 91054, Erlangen, Germany
| | - Alexandra L Wagner
- Pediatric Experimental and Translational Imaging Laboratory (PETI-Lab), Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander-University (FAU) Erlangen-Nuremberg, Loschgestraße 15, 91054, Erlangen, Germany
| | - Jing Claussen
- Pediatric Experimental and Translational Imaging Laboratory (PETI-Lab), Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander-University (FAU) Erlangen-Nuremberg, Loschgestraße 15, 91054, Erlangen, Germany
| | - Maximilian J Waldner
- Medical Department 1, Friedrich-Alexander-University (FAU) Erlangen-Nuremberg, Erlangen, Germany
| | - Ferdinand Knieling
- Pediatric Experimental and Translational Imaging Laboratory (PETI-Lab), Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander-University (FAU) Erlangen-Nuremberg, Loschgestraße 15, 91054, Erlangen, Germany.
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33
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Knieling F, Rüffer A, Cesnjevar R, Regensburger AP, Purbojo A, Dittrich S, Münch F, Neubert A, Meyer S, Strobel D, Rascher W, Woelfle J, Jüngert J. Transfontanellar Contrast-Enhanced Ultrasound for Monitoring Brain Perfusion During Neonatal Heart Surgery. Circ Cardiovasc Imaging 2020; 13:e010073. [PMID: 32114827 DOI: 10.1161/circimaging.119.010073] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 12/14/2022]
Affiliation(s)
- Ferdinand Knieling
- Department of Pediatrics and Adolescent Medicine (F.K., A.P.R., A.N., W.R., J.W., J.J.), Friedrich-Alexander-University (FAU) of Erlangen-Nuremberg, Erlangen, Germany
| | - André Rüffer
- Department of Congenital Heart Surgery (A.R., R.C., A.P., F.M.), Friedrich-Alexander-University (FAU) of Erlangen-Nuremberg, Erlangen, Germany
| | - Robert Cesnjevar
- Department of Congenital Heart Surgery (A.R., R.C., A.P., F.M.), Friedrich-Alexander-University (FAU) of Erlangen-Nuremberg, Erlangen, Germany
| | - Adrian P Regensburger
- Department of Pediatrics and Adolescent Medicine (F.K., A.P.R., A.N., W.R., J.W., J.J.), Friedrich-Alexander-University (FAU) of Erlangen-Nuremberg, Erlangen, Germany
| | - Ariawan Purbojo
- Department of Congenital Heart Surgery (A.R., R.C., A.P., F.M.), Friedrich-Alexander-University (FAU) of Erlangen-Nuremberg, Erlangen, Germany
| | - Sven Dittrich
- Department of Pediatric Cardiology (S.D.), Friedrich-Alexander-University (FAU) of Erlangen-Nuremberg, Erlangen, Germany
| | - Frank Münch
- Department of Congenital Heart Surgery (A.R., R.C., A.P., F.M.), Friedrich-Alexander-University (FAU) of Erlangen-Nuremberg, Erlangen, Germany
| | - Antje Neubert
- Department of Pediatrics and Adolescent Medicine (F.K., A.P.R., A.N., W.R., J.W., J.J.), Friedrich-Alexander-University (FAU) of Erlangen-Nuremberg, Erlangen, Germany
| | - Sebastian Meyer
- University Hospital Erlangen and Institute of Medical Informatics, Biometry, and Epidemiology (IMBE) (S.M.), Friedrich-Alexander-University (FAU) of Erlangen-Nuremberg, Erlangen, Germany
| | - Deike Strobel
- Department of Medicine 1 (D.S.), Friedrich-Alexander-University (FAU) of Erlangen-Nuremberg, Erlangen, Germany
| | - Wolfgang Rascher
- Department of Pediatrics and Adolescent Medicine (F.K., A.P.R., A.N., W.R., J.W., J.J.), Friedrich-Alexander-University (FAU) of Erlangen-Nuremberg, Erlangen, Germany
| | - Joachim Woelfle
- Department of Pediatrics and Adolescent Medicine (F.K., A.P.R., A.N., W.R., J.W., J.J.), Friedrich-Alexander-University (FAU) of Erlangen-Nuremberg, Erlangen, Germany
| | - Jörg Jüngert
- Department of Pediatrics and Adolescent Medicine (F.K., A.P.R., A.N., W.R., J.W., J.J.), Friedrich-Alexander-University (FAU) of Erlangen-Nuremberg, Erlangen, Germany
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Regensburger AP, Wagner AL, Hanslik G, Schüssler SC, Fahlbusch FB, Woelfle J, Jüngert J, Trollmann R, Knieling F. Ultra-high-frequency ultrasound in patients with spinal muscular atrophy: A retrospective feasibility study. Muscle Nerve 2020; 61:E18-E21. [PMID: 31884704 DOI: 10.1002/mus.26796] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 12/20/2019] [Accepted: 12/23/2019] [Indexed: 12/12/2022]
Affiliation(s)
- Adrian P Regensburger
- Department of Pediatrics and Adolescent Medicine, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Alexandra L Wagner
- Department of Pediatrics and Adolescent Medicine, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Gregor Hanslik
- Department of Pediatrics and Adolescent Medicine, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Stephanie C Schüssler
- Department of Pediatrics and Adolescent Medicine, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Fabian B Fahlbusch
- Department of Pediatrics and Adolescent Medicine, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Joachim Woelfle
- Department of Pediatrics and Adolescent Medicine, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Jörg Jüngert
- Department of Pediatrics and Adolescent Medicine, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Regina Trollmann
- Department of Pediatrics and Adolescent Medicine, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Ferdinand Knieling
- Department of Pediatrics and Adolescent Medicine, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
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Dilipkumar A, Al‐Shemmary A, Kreiß L, Cvecek K, Carlé B, Knieling F, Gonzales Menezes J, Thoma O, Schmidt M, Neurath MF, Waldner M, Friedrich O, Schürmann S. Label-Free Multiphoton Endomicroscopy for Minimally Invasive In Vivo Imaging. Adv Sci (Weinh) 2019; 6:1801735. [PMID: 31016109 PMCID: PMC6468963 DOI: 10.1002/advs.201801735] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 01/29/2019] [Indexed: 05/24/2023]
Abstract
Multiphoton microscopy of cellular autofluorescence and second harmonic generation from collagen facilitates imaging of living cells and tissues without the need for additional fluorescent labels. Here, a compact multiphoton endomicroscope for label-free in vivo imaging in small animals via side-viewing needle objectives is presented. Minimal invasive imaging at cellular resolution is performed in colonoscopy of mice without surgical measures and without fluorescent dyes as a contrast agent. The colon mucosa is imaged repeatedly in the same animal in a mouse model of acute intestinal inflammation to study the process of inflammation at the tissue level within a time period of ten days, demonstrating the capabilities of label-free endomicroscopy for longitudinal studies for the first time.
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Affiliation(s)
- Ashwathama Dilipkumar
- Institute of Medical BiotechnologyFriedrich‐Alexander‐Universität Erlangen‐Nürnberg (FAU)Paul‐Gordan‐Str. 391052ErlangenGermany
- Erlangen Graduate School in Advanced Optical TechnologiesFriedrich‐Alexander‐Universität Erlangen‐Nürnberg (FAU)Paul‐Gordan‐Str. 791052ErlangenGermany
| | - Alaa Al‐Shemmary
- Institute of Medical BiotechnologyFriedrich‐Alexander‐Universität Erlangen‐Nürnberg (FAU)Paul‐Gordan‐Str. 391052ErlangenGermany
- Erlangen Graduate School in Advanced Optical TechnologiesFriedrich‐Alexander‐Universität Erlangen‐Nürnberg (FAU)Paul‐Gordan‐Str. 791052ErlangenGermany
| | - Lucas Kreiß
- Institute of Medical BiotechnologyFriedrich‐Alexander‐Universität Erlangen‐Nürnberg (FAU)Paul‐Gordan‐Str. 391052ErlangenGermany
- Erlangen Graduate School in Advanced Optical TechnologiesFriedrich‐Alexander‐Universität Erlangen‐Nürnberg (FAU)Paul‐Gordan‐Str. 791052ErlangenGermany
| | - Kristian Cvecek
- Erlangen Graduate School in Advanced Optical TechnologiesFriedrich‐Alexander‐Universität Erlangen‐Nürnberg (FAU)Paul‐Gordan‐Str. 791052ErlangenGermany
- Institute of Photonic TechnologiesFriedrich‐Alexander‐Universität Erlangen‐Nürnberg (FAU)Konrad‐Zuse‐Str. 3–591052ErlangenGermany
| | - Birgitta Carlé
- Institute of Medical BiotechnologyFriedrich‐Alexander‐Universität Erlangen‐Nürnberg (FAU)Paul‐Gordan‐Str. 391052ErlangenGermany
- Erlangen Graduate School in Advanced Optical TechnologiesFriedrich‐Alexander‐Universität Erlangen‐Nürnberg (FAU)Paul‐Gordan‐Str. 791052ErlangenGermany
| | - Ferdinand Knieling
- Department of Internal Medicine 1University Hospital ErlangenUlmenweg 1891054ErlangenGermany
- Department of Pediatrics and Adolescent MedicineUniversity Hospital ErlangenLoschgestr. 1591054ErlangenGermany
| | - Jean Gonzales Menezes
- Department of Internal Medicine 1University Hospital ErlangenUlmenweg 1891054ErlangenGermany
| | - Oana‐Maria Thoma
- Erlangen Graduate School in Advanced Optical TechnologiesFriedrich‐Alexander‐Universität Erlangen‐Nürnberg (FAU)Paul‐Gordan‐Str. 791052ErlangenGermany
- Department of Internal Medicine 1University Hospital ErlangenUlmenweg 1891054ErlangenGermany
| | - Michael Schmidt
- Erlangen Graduate School in Advanced Optical TechnologiesFriedrich‐Alexander‐Universität Erlangen‐Nürnberg (FAU)Paul‐Gordan‐Str. 791052ErlangenGermany
- Institute of Photonic TechnologiesFriedrich‐Alexander‐Universität Erlangen‐Nürnberg (FAU)Konrad‐Zuse‐Str. 3–591052ErlangenGermany
| | - Markus F. Neurath
- Erlangen Graduate School in Advanced Optical TechnologiesFriedrich‐Alexander‐Universität Erlangen‐Nürnberg (FAU)Paul‐Gordan‐Str. 791052ErlangenGermany
- Department of Internal Medicine 1University Hospital ErlangenUlmenweg 1891054ErlangenGermany
| | - Maximilian Waldner
- Erlangen Graduate School in Advanced Optical TechnologiesFriedrich‐Alexander‐Universität Erlangen‐Nürnberg (FAU)Paul‐Gordan‐Str. 791052ErlangenGermany
- Department of Internal Medicine 1University Hospital ErlangenUlmenweg 1891054ErlangenGermany
| | - Oliver Friedrich
- Institute of Medical BiotechnologyFriedrich‐Alexander‐Universität Erlangen‐Nürnberg (FAU)Paul‐Gordan‐Str. 391052ErlangenGermany
- Erlangen Graduate School in Advanced Optical TechnologiesFriedrich‐Alexander‐Universität Erlangen‐Nürnberg (FAU)Paul‐Gordan‐Str. 791052ErlangenGermany
| | - Sebastian Schürmann
- Institute of Medical BiotechnologyFriedrich‐Alexander‐Universität Erlangen‐Nürnberg (FAU)Paul‐Gordan‐Str. 391052ErlangenGermany
- Erlangen Graduate School in Advanced Optical TechnologiesFriedrich‐Alexander‐Universität Erlangen‐Nürnberg (FAU)Paul‐Gordan‐Str. 791052ErlangenGermany
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Scheibe K, Kersten C, Schmied A, Vieth M, Primbs T, Carlé B, Knieling F, Claussen J, Klimowicz AC, Zheng J, Baum P, Meyer S, Schürmann S, Friedrich O, Waldner MJ, Rath T, Wirtz S, Kollias G, Ekici AB, Atreya R, Raymond EL, Mbow ML, Neurath MF, Neufert C. Inhibiting Interleukin 36 Receptor Signaling Reduces Fibrosis in Mice With Chronic Intestinal Inflammation. Gastroenterology 2019; 156:1082-1097.e11. [PMID: 30452921 DOI: 10.1053/j.gastro.2018.11.029] [Citation(s) in RCA: 130] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 11/08/2018] [Accepted: 11/09/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND & AIMS Intestinal fibrosis is a long-term complication in inflammatory bowel diseases (IBD) that frequently results in functional damage, bowel obstruction, and surgery. Interleukin (IL) 36 is a group of cytokines in the IL1 family with inflammatory effects. We studied the expression of IL36 and its receptor, interleukin 1 receptor like 2 (IL1RL2 or IL36R) in the development of intestinal fibrosis in human tissues and mice. METHODS We obtained intestinal tissues from 92 patients with Crohn's disease (CD), 48 patients with ulcerative colitis, and 26 patients without inflammatory bowel diseases (control individuals). Tissues were analyzed by histology to detect fibrosis and by immunohistochemistry to determine the distribution of fibroblasts and levels of IL36R ligands. Human and mouse fibroblasts were incubated with IL36 or control medium, and transcriptome-wide RNA sequences were analyzed. Mice were given neutralizing antibodies against IL36R, and we studied intestinal tissues from Il1rl2-/- mice; colitis and fibrosis were induced in mice by repetitive administration of DSS or TNBS. Bone marrow cells were transplanted from Il1rl2-/- to irradiated wild-type mice and intestinal tissues were analyzed. Antibodies against IL36R were applied to mice with established chronic colitis and fibrosis and intestinal tissues were studied. RESULTS Mucosal and submucosal tissue from patients with CD or ulcerative colitis had higher levels of collagens, including type VI collagen, compared with tissue from control individuals. In tissues from patients with fibrostenotic CD, significantly higher levels of IL36A were noted, which correlated with high numbers of activated fibroblasts that expressed α-smooth muscle actin. IL36R activation of mouse and human fibroblasts resulted in expression of genes that regulate fibrosis and tissue remodeling, as well as expression of collagen type VI. Il1rl2-/- mice and mice given injections of an antibody against IL36R developed less severe colitis and fibrosis after administration of DSS or TNBS, but bone marrow cells from Il1rl2-/- mice did not prevent induction of colitis and fibrosis. Injection of antibodies against IL36R significantly reduced established fibrosis in mice with chronic intestinal inflammation. CONCLUSION We found higher levels of IL36A in fibrotic intestinal tissues from patients with IBD compared with control individuals. IL36 induced expression of genes that regulate fibrogenesis in fibroblasts. Inhibition or knockout of the IL36R gene in mice reduces chronic colitis and intestinal fibrosis. Agents designed to block IL36R signaling could be developed for prevention and treatment of intestinal fibrosis in patients with IBD.
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Affiliation(s)
- Kristina Scheibe
- First Department of Medicine, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Christina Kersten
- First Department of Medicine, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Anabel Schmied
- First Department of Medicine, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Michael Vieth
- Institute of Pathology, Klinikum Bayreuth, Bayreuth, Germany
| | - Tatjana Primbs
- First Department of Medicine, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Birgitta Carlé
- Institute of Medical Biotechnology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Ferdinand Knieling
- First Department of Medicine, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Department of Pediatrics and Adolescent Medicine, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | | | | | - Jie Zheng
- Boehringer Ingelheim Pharmaceuticals Inc, Ridgefield, Connecticut
| | - Patrick Baum
- Boehringer Ingelheim Pharmaceuticals Inc, Ridgefield, Connecticut
| | - Sebastian Meyer
- Institute of Medical Informatics, Biometry, and Epidemiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Sebastian Schürmann
- Institute of Medical Biotechnology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Oliver Friedrich
- Institute of Medical Biotechnology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Maximilian J Waldner
- First Department of Medicine, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Timo Rath
- First Department of Medicine, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Stefan Wirtz
- First Department of Medicine, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - George Kollias
- Biomedical Sciences Research Center Alexander Fleming, Vari, Greece
| | - Arif B Ekici
- Institute of Human Genetics, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Raja Atreya
- First Department of Medicine, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Ernest L Raymond
- Boehringer Ingelheim Pharmaceuticals Inc, Ridgefield, Connecticut
| | - M Lamine Mbow
- Boehringer Ingelheim Pharmaceuticals Inc, Ridgefield, Connecticut
| | - Markus F Neurath
- First Department of Medicine, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.
| | - Clemens Neufert
- First Department of Medicine, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.
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Jung D, Heiss R, Kramer V, Thoma OM, Regensburger AP, Rascher W, Uder M, Neurath MF, Knieling F, Waldner MJ. Contrast-Enhanced µCT for Visualizing and Evaluating Murine Intestinal Inflammation. Am J Cancer Res 2018; 8:6357-6366. [PMID: 30613304 PMCID: PMC6299705 DOI: 10.7150/thno.26013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 10/14/2018] [Indexed: 12/11/2022] Open
Abstract
Rationale: To develop a simple and fast protocol for the assessment of acute and chronic experimental intestinal inflammation using contrast-enhanced µCT. Methods: For the imaging studies, an acute 2% and 3% dextran sodium sulfate (n = 15, female, 8-12 weeks) and a chronic adoptive transfer colitis model (n = 10, female, 8-9 weeks) were established over 9 days or 6 weeks, respectively. Throughout the experiments, longitudinal measurement of murine intestinal wall thickness and time dependent perfusion was performed on a small animal µCT system (90 kV, 160 μA, FOV: 60 mm, scan time: 17 s, image size: 512x512, layer thickness: 118 µm) between 0.5 and 30 min after intravenous bolus injection of an iodine contrast agent. Weight development, small animal endoscopy, and histological ex vivo analysis were compared to contrast-enhanced µCT imaging findings. Results: Murine intestinal wall thickness was significantly increased in inflamed colons of acute colitis at day 9 in comparison to pre-inflamed state. Perfusion analysis revealed a late contrast enhancement in acute inflamed colons and the renal medulla at day 9 compared to control mice. An increasing intestinal wall thickness was monitored 3, 5 and 6 weeks after on-set of chronic colitis in comparison to controls. A good correlation with endoscopic (r = 0.75, p < 0.0001) and histologic degree of inflammation (r = 0.83, p = 0.04) was found. Conclusion: Contrast-enhanced µCT is a simple and fast method to assess acute intestinal inflammation and to monitor disease progression in experimental models of chronic colitis. According to our findings, one single contrast-enhanced µCT-scan is a valid non-invasive modality to quantify the degree of inflammation in the entire digestive tract in murine inflammatory models.
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38
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Knieling F, Gonzales Menezes J, Claussen J, Schwarz M, Neufert C, Fahlbusch FB, Rath T, Thoma OM, Kramer V, Menchicchi B, Kersten C, Scheibe K, Schürmann S, Carlé B, Rascher W, Neurath MF, Ntziachristos V, Waldner MJ. Raster-Scanning Optoacoustic Mesoscopy for Gastrointestinal Imaging at High Resolution. Gastroenterology 2018; 154:807-809.e3. [PMID: 29309775 DOI: 10.1053/j.gastro.2017.11.285] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 11/27/2017] [Accepted: 11/28/2017] [Indexed: 01/08/2023]
Affiliation(s)
- Ferdinand Knieling
- Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany; Department of Medicine 1, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
| | - Jean Gonzales Menezes
- Department of Medicine 1, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
| | | | | | - Clemens Neufert
- Department of Medicine 1, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
| | - Fabian B Fahlbusch
- Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
| | - Timo Rath
- Department of Medicine 1, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany; Ludwig Demling Center of Excellence, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberg, Germany
| | - Oana-Maria Thoma
- Department of Medicine 1, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany; Erlangen Graduate School in Advanced Optical Technologies (SAOT), Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberg, Germany
| | - Viktoria Kramer
- Department of Medicine 1, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
| | - Bianca Menchicchi
- Department of Medicine 1, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
| | - Christina Kersten
- Department of Medicine 1, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
| | - Kristina Scheibe
- Department of Medicine 1, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
| | - Sebastian Schürmann
- Institute of Medical Biotechnology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberg, Germany
| | - Birgitta Carlé
- Institute of Medical Biotechnology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberg, Germany
| | - Wolfgang Rascher
- Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
| | - Markus F Neurath
- Department of Medicine 1, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany; Ludwig Demling Center of Excellence, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberg, Germany
| | - Vasilis Ntziachristos
- Institute for Biological and Medical Imaging, Helmholtz Zentrum München, München, Germany; Chair for Biological Imaging, TranslaTUM, Technische Universität München, München, Germany
| | - Maximilian J Waldner
- Department of Medicine 1, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany; Erlangen Graduate School in Advanced Optical Technologies (SAOT), Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberg, Germany.
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39
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Knieling F, Neufert C, Hartmann A, Claussen J, Urich A, Egger C, Vetter M, Fischer S, Pfeifer L, Hagel A, Kielisch C, Görtz RS, Wildner D, Engel M, Röther J, Uter W, Siebler J, Atreya R, Rascher W, Strobel D, Neurath MF, Waldner MJ. Multispectral Optoacoustic Tomography for Assessment of Crohn's Disease Activity. N Engl J Med 2017; 376:1292-1294. [PMID: 28355498 DOI: 10.1056/nejmc1612455] [Citation(s) in RCA: 179] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Dane Wildner
- University of Erlangen-Nuremberg, Erlangen, Germany
| | | | - Jens Röther
- University of Erlangen-Nuremberg, Erlangen, Germany
| | | | | | - Raja Atreya
- University of Erlangen-Nuremberg, Erlangen, Germany
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40
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Knieling F, Strobel D, Rompel O, Zapke M, Menendez-Castro C, Wölfel M, Schulz J, Rascher W, Jüngert J. Spectrum, Applicability and Diagnostic Capacity of Contrast-Enhanced Ultrasound in Pediatric Patients and Young Adults after Intravenous Application - A Retrospective Trial. Ultraschall Med 2016; 37:619-626. [PMID: 27300274 DOI: 10.1055/s-0042-108429] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Purpose: To investigate the spectrum, applicability and diagnostic capacity of intravenous contrast-enhanced ultrasound imaging (CEUS) in a pediatric population. Materials and Methods: From 08/2005 to 11/2015, n = 40 pediatric patients and young adults from 0 - 26 years (Ø 11.4 ± 7.5) and 3.0 - 85.3 kg (Ø 40.8 ± 25.6) with n = 55 investigations received n = 79 IV applications of ultrasound contrast agent (UCA). UCA dose and side effects were documented. Scanned organs were the liver (n = 42), spleen (n = 9), kidney (n = 3), and testis (n = 1). Histology, surgery or reference imaging was compared to CEUS and clinical follow-up. Results: The UCA dose < 20 kg was 0.4 ± 0.3 ml, (0.05 ± 0.02 ml/kg) and > 20 kg was 1.0 ± 0.4 ml (p< 0.0001) (0.02 ± 0.01 ml/kg, p< 0.0001). Adverse effects occurred in 2/79 applications (2.5 %). Agreement CEUS/gold standard resulted in 32/34 investigations. For liver diagnostics (gold standard: MRI, CT, histology, serology), n = 11 malignant and n = 15 benign focal liver lesions were included. The specificity was 100 % (95 % CI: 0.77 - 1.00), the sensitivity was 82 % (95 % CI: 0.48 - 0.98), the positive predictive value was 100 % (95 % CI: 0.69 - 1.00) and the negative predictive value was 88 % (95 % CI: 0.62 - 0.98, p< 0.0001). In n = 2 reference imaging misdiagnosed and CEUS was in accordance with clinical follow-up. All splenic/renal lesions were diagnosed correctly. In n = 1 an insufficient testicular perfusion was ruled out. The observation time was 30.4 ± 30.5 months. Conclusion: CEUS is a well-tolerated and diagnostically equivalent modality in pediatric care, providing fundamental advantages compared to currently approved imaging modalities for these age groups.
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Affiliation(s)
- F Knieling
- Department of Pediatrics, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - D Strobel
- Medical Department 1, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - O Rompel
- Department of Radiology, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - M Zapke
- Department of Pediatrics, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - C Menendez-Castro
- Department of Pediatrics, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - M Wölfel
- Department of Pediatrics, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - J Schulz
- Children's Hospital, Department for Pediatric Oncology and Hematology, Campus Virchow Clinic, Charité, Berlin, Germany
| | - W Rascher
- Department of Pediatrics, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - J Jüngert
- Department of Pediatrics, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
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41
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Waldner MJ, Knieling F, Egger C, Morscher S, Claussen J, Vetter M, Kielisch C, Fischer S, Pfeifer L, Hagel A, Goertz RS, Wildner D, Atreya R, Strobel D, Neurath MF. Multispectral Optoacoustic Tomography in Crohn's Disease: Noninvasive Imaging of Disease Activity. Gastroenterology 2016; 151:238-40. [PMID: 27269244 DOI: 10.1053/j.gastro.2016.05.047] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 05/13/2016] [Accepted: 05/18/2016] [Indexed: 01/19/2023]
Affiliation(s)
- Maximilian J Waldner
- Department of Medicine 1, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany; Erlangen Graduate School in Advanced Optical Technologies (SAOT), Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany; Ludwig Demling Center of Excellence, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany.
| | - Ferdinand Knieling
- Department of Medicine 1, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany; Department of Pediatrics, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
| | - Cornelia Egger
- Department of Medicine 1, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
| | | | | | - Marcel Vetter
- Department of Medicine 1, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
| | - Christian Kielisch
- Department of Medicine 1, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
| | - Sarah Fischer
- Department of Medicine 1, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
| | - Lukas Pfeifer
- Department of Medicine 1, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
| | - Alexander Hagel
- Department of Medicine 1, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
| | - Ruediger S Goertz
- Department of Medicine 1, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
| | - Dane Wildner
- Department of Medicine 1, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
| | - Raja Atreya
- Department of Medicine 1, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany; Ludwig Demling Center of Excellence, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
| | - Deike Strobel
- Department of Medicine 1, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
| | - Markus F Neurath
- Department of Medicine 1, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany; Ludwig Demling Center of Excellence, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
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Knieling F, Waldner MJ. Light and sound - emerging imaging techniques for inflammatory bowel disease. World J Gastroenterol 2016; 22:5642-5654. [PMID: 27433080 PMCID: PMC4932202 DOI: 10.3748/wjg.v22.i25.5642] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 05/02/2016] [Accepted: 05/23/2016] [Indexed: 02/06/2023] Open
Abstract
Patients with inflammatory bowel disease are known to have a high demand of recurrent evaluation for therapy and disease activity. Further, the risk of developing cancer during the disease progression is increasing from year to year. New, mostly non-radiant, quick to perform and quantitative methods are challenging, conventional endoscopy with biopsy as gold standard. Especially, new physical imaging approaches utilizing light and sound waves have facilitated the development of advanced functional and molecular modalities. Besides these advantages they hold the promise to predict personalized therapeutic responses and to spare frequent invasive procedures. Within this article we highlight their potential for initial diagnosis, assessment of disease activity and surveillance of cancer development in established techniques and recent advances such as wide-view full-spectrum endoscopy, chromoendoscopy, autofluorescence endoscopy, endocytoscopy, confocal laser endoscopy, multiphoton endoscopy, molecular imaging endoscopy, B-mode and Doppler ultrasound, contrast-enhanced ultrasound, ultrasound molecular imaging, and elastography.
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Machtaler S, Knieling F, Luong R, Tian L, Willmann JK. Assessment of Inflammation in an Acute on Chronic Model of Inflammatory Bowel Disease with Ultrasound Molecular Imaging. Am J Cancer Res 2015; 5:1175-86. [PMID: 26379784 PMCID: PMC4568446 DOI: 10.7150/thno.13048] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2015] [Accepted: 07/16/2015] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Ultrasound (US) molecular imaging has shown promise in assessing inflammation in preclinical, murine models of inflammatory bowel disease. These models, however, initiated acute inflammation on previously normal colons, in contrast to patients where acute exacerbations are often in chronically inflamed regions. In this study, we explored the potential of dual P- and E-selectin targeted US imaging for assessing acute inflammation on a murine quiescent chronic inflammatory background. METHODS Chronic colitis was induced using three cycles of 4% DSS in male FVB mice. Acute inflammation was initiated 2 weeks after the final DSS cycle through rectal administration of 1% TNBS. Mice at different stages of inflammation were imaged using a small animal ultrasound system following i.v. injection of microbubbles targeted to P- and E-selectin. In vivo imaging results were correlated with ex vivo immunofluorescence and histology. RESULTS Induction of acute inflammation resulted in an increase in the targeted US signal from 5.5 ± 5.1 arbitrary units (a.u.) at day 0 to 61.0 ± 45.2 a.u. (P < 0.0001) at day 1, 36.3 ± 33.1 a.u. at day 3, returning to levels similar to control at day 5. Immunofluorescence showed significant increase in the percentage of P- and E-selectin positive vessels at day 1 (P-selectin: 21.0 ± 7.1% of vessels; P < 0.05; E-selectin: 16.4 ±3.7%; P < 0.05) compared to day 0 (P-selectin: 10.3 ± 5.7%; E-selectin: 7.3 ± 7.0%). CONCLUSIONS Acute inflammation can be accurately measured in a clinically relevant murine model of chronic IBD using ultrasound molecular imaging with a dual P- and E- selectin-targeted contrast agent.
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Knieling F, Waldner MJ, Goertz RS, Zopf S, Wildner D, Neurath MF, Bernatik T, Strobel D. Early response to anti-tumoral treatment in hepatocellular carcinoma--can quantitative contrast-enhanced ultrasound predict outcome? Ultraschall Med 2013; 34:38-46. [PMID: 23258770 DOI: 10.1055/s-0032-1330387] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
PURPOSE In order to detect an early response to anti-angiogenic therapy, this study aims at analyzing specific effects of a sorafenib-based regime on intra-tumoral D-CEUS flow parameters of patients with HCC. MATERIALS AND METHODS Videos of the arterial phase were captured before initiation of a therapy with sorafenib and 1 and 3 months after (n = 9). Patients receiving a non-anti-angiogenic therapy (TACE, n = 10) served as a comparison group. Cross-sectional imaging was performed at the same time points and patients were followed up for 1 year. RESULTS In the responder group (RE), the absolute (percentage) TTP was 11.28 s ± 2.03 s (1.00) before treatment, 13.60 s ± 1.52 s (1.53 ± 0.08) after one month (p = 0.0405), and 16.17 s ± 2.35 s (1.46 ± 0.07) after three months of treatment (p = 0.0071). The TTP increased significantly in the RE group as early as 1 month after initiation of sorafenib compared to the non-responder group. There were no significant differences in the non-responder group or between the NR and the TACE group at any time point. D-CEUS values from all sorafenib-treated patients showed good accordance with RECICL (response evaluation criteria in cancer of the liver) criteria (R2 = 0.7154, p = 0.0001). CONCLUSIONS Quantitative CEUS reveals variations of dynamic parameters of blood flow during anti-tumoral therapy in liver cancer patients. Further investigations and clinical trails have to confirm that the TTP is a promising parameter in the prediction of early response to sorafenib-based therapy.
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Affiliation(s)
- F Knieling
- Medizinische Klinik 1-Gastroenterologie, Pneumologie und Endokrinologie, Universität Erlangen, Germany
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Knieling F, Waldner MJ, Goertz RS, Strobel D. Quantification of dynamic contrast-enhanced ultrasound in HCC: prediction of response to a new combination therapy of sorafenib and panobinostat in advanced hepatocellular carcinoma. BMJ Case Rep 2012; 2012:bcr-2012-007576. [PMID: 23257272 DOI: 10.1136/bcr-2012-007576] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Here, we report the case of a patient, who showed an antitumour response to a new combination therapy of sorafenib and the histon deacetylase inhibitor panobinostat (LBH-589). D-CEUS (Dynamic contrast-enhanced ultrasonography) was able to predict response to the new therapy regime and may be an interesting tool in the early evaluation of response to therapy. It might be especially useful to differentiate between responders and non-responders of new-targeted pharmaceuticals like multikinase inhibitors in hepatocellular carcinomas.
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Egger C, Goertz RS, Strobel D, Lell M, Neurath MF, Knieling F, Scharf M. Dynamic contrast-enhanced ultrasound (DCE-US) for easy and rapid evaluation of hepatocellular carcinoma compared to dynamic contrast-enhanced computed tomography (DCE-CT)--a pilot study. Ultraschall Med 2012; 33:587-592. [PMID: 23154871 DOI: 10.1055/s-0032-1325545] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
PURPOSE To check the feasibility of the easy quantification of tumor vascularization derived from dynamic contrast-enhanced ultrasound (DCE-US) in comparison to dynamic contrast-enhanced computed tomography (DCE-CT) in patients with hepatocellular carcinoma (HCC). MATERIALS AND METHODS 19 patients with cirrhosis and histologically proven HCC prospectively underwent CEUS (SonoVue) and CT (Imeron400). Following CEUS, the software ImageJ was used for the easy quantification of the echogenicity in HCC lesions and tumor-free liver parenchyma. For DCE-CT we used the software Hepacare and created arterial enhancement fraction color maps of the whole liver and HCC lesions. RESULTS Unifocal/multifocal HCCs were detected in 12/7 (US) and 10/9 patients (CT) and biopsied nodules were defined as a reference lesion with a median of 40 mm (US) and 42 mm (CT). CEUS showed HCC-typical hyper-/hypoenhancement in the arterial/late phase in 16/19 reference lesions, while all reference lesions showed an HCC-typical vascular pattern in CT. With DCE-US, quantitative assessment could not be performed in 3/19 patients due to respiratory motion or insufficient image quality. 13/16 reference lesions showed an HCC-typical vascular pattern. Quantitative assessment was possible with DCE-CT in all patients and all reference nodules showed HCC-typical values of the arterial enhancement fraction. There was no statistical difference between CEUS, DCE-US and DCE-CT in the quantitative assessment of contrast enhancement. CONCLUSION The quantitative evaluation of DCE-US was feasible in HCC without a statistical difference with respect to DCE-CT. Further studies with a larger study population including small nodules ≤ 2 cm are needed to assess whether this technique is helpful in routine ultrasound.
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Affiliation(s)
- C Egger
- Departement of Internal Medecine 1, University of Erlangen, Germany.
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Knieling F, Waldner M, Görtz RS, Neurath MF, Bernatik T, Strobel D. Dynamische kontrastmittelverstärkte Sonografie in der frühzeitigen Analyse des Therapieansprechens in der Therapie des HCC. Z Gastroenterol 2011. [DOI: 10.1055/s-0031-1284286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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