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Girard N, Ponce Aix S, Cedres S, Berghmans T, Burgers S, Toffart AC, Popat S, Janssens A, Gervais R, Hochstenbag M, Silva M, Burger IA, Prosch H, Stahel R, Xenophontos E, Pretzenbaher Y, Neven A, Peters S. Efficacy and safety of nivolumab for patients with pre-treated type B3 thymoma and thymic carcinoma: results from the EORTC-ETOP NIVOTHYM phase II trial. ESMO Open 2023; 8:101576. [PMID: 37285717 DOI: 10.1016/j.esmoop.2023.101576] [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: 02/03/2023] [Revised: 04/07/2023] [Accepted: 04/24/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND Thymic malignancies are rare intrathoracic tumors, which may be aggressive and difficult to treat. They represent a therapeutic challenge in the advanced/metastatic setting, with limited treatment options after the failure of first-line platinum-based chemotherapy. They are frequently associated with autoimmune disorders that also impact oncological management. MATERIALS AND METHODS NIVOTHYM is an international, multicenter, phase II, two-cohort, single-arm trial evaluating the activity and safety of nivolumab [240 mg intravenously (i.v.) q2 weeks] alone or with ipilimumab (1 mg /kg i.v. q6 weeks) in patients with advanced/relapsed type B3 thymoma or thymic carcinoma, after exposure to platinum-based chemotherapy. The primary endpoint is progression-free survival rate at 6 months (PFSR-6) based on RECIST 1.1 as per independent radiological review. RESULTS From April 2018 to February 2020, 55 patients were enrolled in 15 centers from 5 countries. Ten patients (18%) had type B3 thymoma and 43 (78%) had thymic carcinoma. The majority were male (64%), and the median age was 58 years. Among the 49 eligible patients who started treatment, PFSR-6 by central review was 35% [95% confidence interval (CI) 22% to 50%]. The overall response rate and disease control rate were 12% (95% CI 5% to 25%) and 63% (95% CI 48% to 77%), respectively. Using the Kaplan-Meier method, median progression-free survival and overall survival by local assessment were 6.0 (95% CI 3.1-10.4) months and 21.3 (95% CI 11.6-not estimable) months, respectively. In the safety population of 54 patients, adverse events (AEs) of grade 1/2 were observed in 22 (41%) patients and grade 3/4 in 31 (57%) patients. Treatment-related AEs of grade 4 included one case of neutropenia, one case of immune-mediated transaminitis, and two cases of myocarditis. CONCLUSIONS Nivolumab monotherapy demonstrated an acceptable safety profile and objective activity, although it has been insufficient to meet its primary objective. The second cohort of NIVOTHYM is currently ongoing to assess the combination of nivolumab plus ipilimumab.
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Affiliation(s)
- N Girard
- Thorax Institute Curie Montsouris, Institut Curie, Paris, France and Paris Saclay University, UVSQ, Versailles, France.
| | - S Ponce Aix
- Hospital Universitario 12 De Octubre, Madrid, Spain
| | - S Cedres
- Hospital Universitari Vall d'Hebron-Vall d'Hebron Institut Oncologia, Barcelona, Spain
| | - T Berghmans
- Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - S Burgers
- The Netherlands Cancer Institute-Antoni Van Leeuwenhoekziekenhuis, Amsterdam, The Netherlands
| | - A-C Toffart
- CHU de Grenoble-La Tronche-Hôpital A. Michallon, Grenoble, France
| | - S Popat
- Royal Marsden Hospital-Chelsea, London, UK
| | - A Janssens
- Universitair Ziekenhuis Antwerpen, Antwerp, Belgium
| | - R Gervais
- Centre Francois Baclesse (CLCC), Caen, France
| | - M Hochstenbag
- Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands
| | - M Silva
- Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy
| | | | - H Prosch
- Medical University of Vienna, Vienna, Austria
| | - R Stahel
- ETOP IBCSG Partners Foundation, Berne, Switzerland
| | | | | | - A Neven
- Luxembourg Institute of Health, Competence Center for Methodology and Statistics, Strassen, Luxembourg
| | - S Peters
- Centre Hospitalier Universitaire Vaudois, Lausanne University, Lausanne, Switzerland
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Vogel-Claussen J, Prosch H, Herold C. [Mediastinum and hilum-imaging updates]. Radiologie (Heidelb) 2023; 63:153. [PMID: 36821047 DOI: 10.1007/s00117-023-01120-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/12/2023] [Indexed: 02/24/2023]
Affiliation(s)
| | - H Prosch
- Universitätsklinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
| | - C Herold
- Universitätsklinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich.
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voigt W, Prosch H, Silva M. EP01.04-006 Clinical Scores, Biomarkers and It Tools in Lung Cancer Screening - Can an Integrated Approach Overcome Current Challenges? J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Gompelmann D, Sinn K, Brugger J, Bernitzky D, Mosleh B, Prosch H, Geleff S, Blessing A, Tiefenbacher A, Hoetzenecker K, Idzko M, Hoda MA. Correlation of PD-L1 expression on tumour cells between diagnostic biopsies and surgical specimens of lung cancer in real life with respect to biopsy techniques and neoadjuvant treatment. J Cancer Res Clin Oncol 2022; 149:1747-1754. [PMID: 35708777 PMCID: PMC10097774 DOI: 10.1007/s00432-022-04080-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 02/09/2022] [Accepted: 05/19/2022] [Indexed: 12/25/2022]
Abstract
PURPOSES Programmed death-ligand 1 (PD-L1) testing is performed mainly on biopsy specimens in patients with advanced lung cancer. It is questionable whether the small amount of tissue analysed in biopsies may represent the true PD-L1 expression of a tumour. METHODS In this retrospective study, PD-L1 expression on tumour cells derived from bronchoscopy brush cytology, endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA), endobronchial biopsy, transbronchial biopsy (TBB) and computed tomography (CT)-guided transthoracic biopsy was compared to the PD-L1 expression of the corresponding surgical resection in lung cancer patients with regard to neoadjuvant treatment in-between. RESULTS A quantitative comparison between the diagnostic biopsy of the primary tumour with corresponding resected surgical specimens in a total of 113 lung cancer patients (60% male, mean age 65 ± 9 years) revealed a statistically significant correlation of PD-L1 expression on tumour cells (r = 0.58, p< 0.001), for patients without neoadjuvant treatment in-between and for patients who underwent neoadjuvant treatment (both p < 0.001). Using a cut-off value of ≥ 50% PD-L1 TPS for comparing the biopsy samples and resected specimens, the concordance rate was 78% with a Cohen's Kappa of 0.45. CONCLUSION A statistically significant concordance for PD-L1 expression on tumour cells between biopsies from primary lung tumour and resected specimen was found, but of uncertain clinical accuracy. The use of a cut-off value of ≥ 50% PD-L1 TPS resulted only in a moderate agreement. Therefore, the interpretation of the PD-L1 determined form biopsy specimens status should only be considered with caution for treatment decisionsQuery.
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Affiliation(s)
- D Gompelmann
- Division of Pulmonology, Department of Internal Medicine II, Medical University Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
| | - K Sinn
- Department of Thoracic Surgery, Medical University Vienna, Vienna, Austria
| | - J Brugger
- Department for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - D Bernitzky
- Division of Pulmonology, Department of Internal Medicine II, Medical University Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - B Mosleh
- Department of Thoracic Surgery, Medical University Vienna, Vienna, Austria
| | - H Prosch
- Department for Biomedical Imaging and Image-Guided Therapy, Medical University Vienna, Vienna, Austria
| | - S Geleff
- Department of Pathology, Medical University Vienna, Vienna, Austria
| | - A Blessing
- Department of Pathology, Medical University Vienna, Vienna, Austria
| | - A Tiefenbacher
- Department of Pathology, Medical University Vienna, Vienna, Austria
| | - K Hoetzenecker
- Department of Thoracic Surgery, Medical University Vienna, Vienna, Austria
| | - M Idzko
- Division of Pulmonology, Department of Internal Medicine II, Medical University Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - M A Hoda
- Department of Thoracic Surgery, Medical University Vienna, Vienna, Austria
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Martini K, Larici AR, Revel MP, Ghaye B, Sverzellati N, Parkar AP, Snoeckx A, Screaton N, Biederer J, Prosch H, Silva M, Brady A, Gleeson F, Frauenfelder T. COVID-19 pneumonia imaging follow-up: when and how? A proposition from ESTI and ESR. Eur Radiol 2021; 32:2639-2649. [PMID: 34713328 PMCID: PMC8553396 DOI: 10.1007/s00330-021-08317-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [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: 06/29/2021] [Revised: 08/20/2021] [Accepted: 09/04/2021] [Indexed: 12/26/2022]
Abstract
Abstract This document from the European Society of Thoracic Imaging (ESTI) and the European Society of Radiology (ESR) discusses the role of imaging in the long-term follow-up of COVID-19 patients, to define which patients may benefit from imaging, and what imaging modalities and protocols should be used. Insights into imaging features encountered on computed tomography (CT) scans and potential pitfalls are discussed and possible areas for future review and research are also included. Key Points • Post-COVID-19 pneumonia changes are mainly consistent with prior organizing pneumonia and are likely to disappear within 12 months of recovery from the acute infection in the majority of patients. • At present, with the longest series of follow-up examinations reported not exceeding 12 months, the development of persistent or progressive fibrosis in at least some individuals cannot yet be excluded. • Residual ground glass opacification may be associated with persisting bronchial dilatation and distortion, and might be termed “fibrotic-like changes” probably consistent with prior organizing pneumonia. Supplementary Information The online version contains supplementary material available at 10.1007/s00330-021-08317-7.
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Affiliation(s)
- K Martini
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland.
| | - A R Larici
- Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - M P Revel
- Department of Radiology, Cochin Hospital, Université de Paris, Paris, France
| | - B Ghaye
- Department of Radiology, Cliniques Universitaires Saint Luc, Catholic University of Louvain, Brussels, Belgium
| | - N Sverzellati
- Scienze Radiologiche, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - A P Parkar
- Department of Radiology, Haraldsplass Deaconess Hospital and Department of Clinical Medicine, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
| | - A Snoeckx
- Department of Radiology, Antwerp University Hospital and University of Antwerp, Antwerp, Belgium
| | - N Screaton
- Department of Radiology, Royal Papworth Hospital, Cambridge, UK
| | - J Biederer
- Department of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, Heidelberg, Germany.,Member of the German Lung Research Center (DZL), Translational Lung Research Center Heidelberg (TLRC), Im Neuenheimer Feld 430, 69120, Heidelberg, Germany.,Faculty of Medicine, University of Latvia, Raina bulvaris 19, Riga, 1586, Latvia.,Faculty of Medicine, Christian-Albrechts-Universität Zu Kiel, 24098, Kiel, Germany
| | - H Prosch
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - M Silva
- Scienze Radiologiche, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - A Brady
- Department of Radiology, Mercy University Hospital, Cork, and University College Cork, Cork, Ireland
| | - F Gleeson
- Department of Oncology, University of Oxford, Oxford, UK
| | - T Frauenfelder
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
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Girard N, Ponce Aix S, Cedres S, Berghmans T, Burgers S, Toffart A, Popat S, Janssens A, Gervais R, Hochstenbag M, Silva M, Burger I, Prosch H, Stahel R, Govaerts AS, Pochesci A, Neven A, Peters S. LBA66 Efficacy and safety of nivolumab for patients with pre-treated type B3 thymoma and thymic carcinoma: Results from the EORTC-ETOP NIVOTHYM phase II trial. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.2147] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Kifjak D, Milos R, Jaksch P, Muraközy G, Hoetzenecker K, Prosch H. Erdheim-Chester Disease in a Patient after Double Lung Transplantation for Pulmonary Langerhans Cell Histiocytosis. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.2064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Koyyala V, Jajodia A, Beer L, Doval D, Talwar V, Goel V, Batra U, Goyal S, Gupta A, Chaturvedi A, Prosch H, Joga S, Domadia K, Medisetty P, Amrith B, La Mantia M, Pasricha S, Russo A, Mehta A. 215P Analysis of spatial heterogeneity of responses in metastatic sites with nivolumab in renal cell carcinoma. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.10.226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Koyyala V, Jajodia A, Gupta A, Chaturvedhi A, Rao A, Goyal S, Mehta A, Prosch H, Pasricha S, Choudhary A, La Mantia M, BP A, Gupta N, Singh S. P-189 Role of radiomics in clinical prognostication and prediction of survival among a cohort of metastatic intrahepatic cholangiocarcinoma. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.04.271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Parashar A, Jajodia A, Chaturvedi A, Rao A, Mehta A, Doval D, Bp A, Medisetty P, Koyyala V, Pasricha S, la Mantia M, Chllamma M, Leithner D, Mayerhoefer M, Russo A, Prosch H. 72P Non-mass like enhancement patterns on MR mammography and their pathological correlation. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.03.206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Jajodia A, Gupta A, Mehta A, Chaturvedi A, Rao A, Gupta G, Doval D, Bp A, Medisetty P, Bommera S, Koyyala V, Pasricha S, Mayerhoefer M, Prosch H, Chllamma M, la Mantia M, Russo A. 71P Role of radiomics in predicting molecular phenotypes of female breast cancer. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.03.205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Abstract
CLINICAL/METHODICAL ISSUE Artificial intelligence (AI) has the potential to improve diagnostic accuracy and management in patients with lung disease through automated detection, quantification, classification, and prediction of disease progression. STANDARD RADIOLOGICAL METHODS Owing to unspecific symptoms, few well-defined CT disease patterns, and varying prognosis, interstitial lungs disease represents a focus of AI-based research. METHODICAL INNOVATIONS Supervised and unsupervised machine learning can identify CT disease patterns using features which may allow the analysis of associations with specific diseases and outcomes. PERFORMANCE Machine learning on the one hand improves computer-aided detection of pulmonary nodules. On the other hand it enables further characterization of pulmonary nodules, which may improve resource effectiveness regarding lung cancer screening programs. ACHIEVEMENTS There are several challenges regarding AI-based CT data analysis. Besides the need for powerful algorithms, expert annotations and extensive training data sets that reflect physiologic and pathologic variability are required for effective machine learning. Comparability and reproducibility of AI research deserve consideration due to a lack of standardization in this emerging field. PRACTICAL RECOMMENDATIONS This review article presents the state of the art and the challenges concerning AI in lung imaging with special consideration of interstitial lung disease, and detection and consideration of pulmonary nodules.
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Affiliation(s)
- F Prayer
- Universitätsklinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
| | - S Röhrich
- Universitätsklinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
| | - J Pan
- Computational Imaging and Research Lab, Universitätsklinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Wien, Österreich
| | - J Hofmanninger
- Computational Imaging and Research Lab, Universitätsklinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Wien, Österreich
| | - G Langs
- Computational Imaging and Research Lab, Universitätsklinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Wien, Österreich
| | - H Prosch
- Universitätsklinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich.
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Tripathi R, Jajodia A, Chaturvedi A, Koyyala V, Pasricha S, Goyal S, Batra U, Mehta A, Prosch H. EP1.01-31 PET CT Radiogenomic Depiction in PDL1 Expression in Lung Cancer in Indian Population. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.2003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Jajodia A, Tripathi R, Chaturvedi A, Koyyala V, Pasricha S, Goyal S, Batra U, Mehta A, Prosch H. P2.01-77 PET CT Radiogenomic Depiction with EGFR and ALK Molecular Alterations in Lung Cancer Among Indian Population. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.1420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Prosch H. WS04.02 Challenges in Imaging Evaluation to Enter Data in the IASLC Database. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.2476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Machine learning is rapidly gaining importance in radiology. It allows for the exploitation of patterns in imaging data and in patient records for a more accurate and precise quantification, diagnosis, and prognosis. Here, we outline the basics of machine learning relevant for radiology, and review the current state of the art, the limitations, and the challenges faced as these techniques become an important building block of precision medicine. Furthermore, we discuss the roles machine learning can play in clinical routine and research and predict how it might change the field of radiology.
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Affiliation(s)
- G Langs
- Department of Biomedical Imaging and Image-Guided Therapy, Computational Imaging Research Lab, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
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Hoetzenecker K, Benazzo A, Stork T, Sinn K, Schwarz S, Baron D, Hager H, Faybik P, Bacher A, Krenn C, Prosch H, Klepetko. W. BLTX on Intraoperative ECMO Sets the New Benchmark for Postoperative Graft Function: Results of a Prospective Trial. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Schwarz S, Muckenhuber M, Benazzo A, Beer L, Gittler F, Bata O, Prosch H, Matilla J, Moser B, Lang G, Taghavi S, Klepetko W, Hoetzenecker K. Is the Current PGD Grading Still Valid in Modern Lung Transplantation? - A Retrospective Analysis of a High-Volume Center. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Schweiger T, Hoetzenecker K, Prosch H, Stork T, Hackl M, Oszvath B, Lang G, Klepetko W. F-055AN UNUSUAL CAUSE OF CARINAL STENOSIS: WHAT TO DO? Interact Cardiovasc Thorac Surg 2017. [DOI: 10.1093/icvts/ivx280.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
CLINICAL ISSUE Tuberculosis (TB) is a granulomatous disease caused by Mycobacterium tuberculosis and transmission is via an airborne route by droplet infection. In the majority of cases patients have thoracic TB, which most frequently presents with hilar lymphadenopathy and pulmonary manifestation. Due to the rise in incidence of TB in central Europe to be expected over the coming years, it is essential to be acquainted with the radiological manifestations of pulmonary TB, particularly to be able to discriminate active from inactive TB. Due to the use of molecular techniques entailing DNA fingerprinting, the traditional classification of TB in primary and postprimary TB is being challenged. These genetic studies have revealed that variations in the clinical and radiographic appearance of TB are mainly affected by the immune status of the patients. Due to the low prevalence of TB in central Europe and the wide variation of radiological presentations, the diagnosis and therapy of TB is often delayed. In this article, the radiographic manifestations of thoracic TB are summarized and discussed. STANDARD RADIOLOGICAL METHODS Together with the medical history and bacteriological tests, chest X‑ray imaging and computed tomography (CT) play a major role not only in the detection of TB but also in the follow-up during and after therapy. PRACTICAL RECOMMENDATIONS Chest X‑radiographs should be the primary diagnostic method in patients with suspected TB in screening as well as for diagnosis and therapy monitoring. The use of CT is more sensitive than chest radiographs and is frequently performed after chest radiographs to obtain detailed information about subtle parenchymal changes or lymph node manifestation. When active TB is suspected CT should be performed. Tree in bud, lobular consolidations, centrilobular nodules, cavities and ground-glass opacification are typical changes in active TB.
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Affiliation(s)
- D Kienzl-Palma
- Abteilung für Allgemeine Radiologie und Kinderradiologie, Universitätsklinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich.
| | - H Prosch
- Abteilung für Allgemeine Radiologie und Kinderradiologie, Universitätsklinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
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Abstract
CLINICAL/METHODICAL ISSUE Besides the lungs, tuberculosis (TB) can affect any organ system. In most cases, extrathoracic TB occurs in immunosuppressed patients as part of a severe illness via hematogenous spread. Extrathoracic involvement most commonly involves abdominal organs, especially the urogenital tract and less commonly the central nervous system (CNS) and the musculoskeletal system. Most frequently, computed tomography (CT) is used for detecting extrathoracic TB manifestations, except for CNS and musculoskeletal manifestations, where contrast-enhanced magnetic resonance imaging (MRI) is the gold standard. Extrathoracic manifestations of TB may be indistinguishable from inflammatory or malignant causes. Due to unspecific symptoms the diagnosis is often delayed. This article summarizes and discusses the various radiological manifestations of extrathoracic manifestation of TB. STANDARD RADIOLOGICAL METHODS Radiological modalities for screening extrathoracic TB are CT and MRI. Conventional X‑radiographs do not play a role in the diagnosis of extrathoracic TB. PRACTICAL RECOMMENDATIONS The possibility of extrathoracic TB should be considered particularly in immunosuppressed patients, such as the homeless, alcoholics or drug addicts or in patients with an immigrant background from the endemic areas of TB. The most likely site of extrathoracic TB is the abdomen; however, infections of the CNS or musculoskeletal systems and multisystem infections can also occur. In patients with suspected extrathoracic TB, radiological modalities for screening are CT, especially for abdominal infections and lymphadenopathy and MRI with contrast media for the musculoskeletal system and the CNS.
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Affiliation(s)
- D Kienzl-Palma
- Abteilung für Allgemeine Radiologie und Kinderradiologie, Universitätsklinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich.
| | - H Prosch
- Abteilung für Allgemeine Radiologie und Kinderradiologie, Universitätsklinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
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Abstract
Pulmonary carcinoids are rare low-grade malignant tumors, which arise from the neuroendocrine system. Approximately 80% of all pulmonary carcinoid tumors are the relatively low-grade typical carcinoids and 20% are the more aggressive atypical carcinoids. Most carcinoids arise from the central airways and only a minority of carcinoids are found in the lung periphery. While most of the peripheral carcinoids are asymptomatic, central carcinoids are symptomatic and present with hemoptysis, wheezing or bronchial obstruction. On computed tomography (CT), carcinoids frequently present as hypervascular pulmonary nodules in close proximity to the bronchial system. Due to the bronchial obstruction, many patients with pulmonary carcinoids present with post-obstructive pneumonia or atelectasis. While fluorodeoxyglucose positron emission tomography CT (FDG-PET/CT) is of limited value in typical carcinoids due to the high rate of false negatives, somatostatin analogs are promising tracers in staging as well as in the planning of peptide receptor radionuclide therapy.
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Affiliation(s)
- H Prosch
- Medizinische Universität Wien, Univ. Klinik für Radiologie und Nuklearmedizin, Allgemeines Krankenhaus Wien, Währingergürtel 18-22, 1090, Wien, Österreich.
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Herold C, Prosch H. Pneumonien. Radiologe 2017; 57:4-5. [DOI: 10.1007/s00117-016-0204-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Cantisani V, Dietrich CF, Badea R, Dudea S, Prosch H, Cerezo E, Nuernberg D, Serra AL, Sidhu PS, Radzina M, Piscaglia F, Bachmann Nielsen M, Ewertsen C, Săftoiu A, Calliada F, Gilja OH. EFSUMB Statement on Medical Student Education in Ultrasound [long version]. Ultrasound Int Open 2016; 2:E2-7. [PMID: 27689163 DOI: 10.1055/s-0035-1569413] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) recommends that ultrasound should be used systematically as an easy accessible and instructive educational tool in the curriculum of modern medical schools. Medical students should acquire theoretical knowledge of the modality and hands-on training should be implemented and adhere to evidence-based principles. In this paper we report EFSUMB policy statements on medical student education in ultrasound that in a short version is already published in Ultraschall in der Medizin 1.
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Affiliation(s)
- V Cantisani
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, University Sapienza, Rome, Italy
| | - C F Dietrich
- Medizinische Klinik 2, Caritas Krankenhaus Bad Mergentheim, Bad Mergentheim
| | - R Badea
- Department of Ultrasonography, 3rd Medical Clinic, Institute of Gastroenterology and Hepatology Octavian Fodor; Imaging Department, University of Medicine and Pharmacy Iuliu Hatieganu, Cluj Napoca, Romania
| | - S Dudea
- Radiology Department "Iuliu Hatieganu" Univ. Med. Pharm. Cluj-Napoca, Romania
| | - H Prosch
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna General Hospital, Austria
| | - E Cerezo
- Calle Francisco Silvela #124, lo 3 Madrid, Spain
| | - D Nuernberg
- Department of Gastroenterology, Brandenburg University of Medicine Theodor Fontane, Neuruppin
| | - A L Serra
- Department of Internal Medicine and Nephrology, Ultrasound Learning Center, Hirslanden Clinic, Zürich, Switzerland
| | - P S Sidhu
- Department of Radiology, King's College Hospital, London, UK
| | - M Radzina
- Diagnostic Radiology Institute, Paula Stradins Clinical University Hospital, Riga, Latvia
| | - F Piscaglia
- Unit of Internal Medicine, Department of Medical and Surgical Sciences, University of Bologna, Italy
| | - M Bachmann Nielsen
- Department of Radiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - C Ewertsen
- Department of Radiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - A Săftoiu
- Gastroenterology Department, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy Craiova, Romania
| | | | - O H Gilja
- National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen and Department of Clinical Medicine, University of Bergen, Norway
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Affiliation(s)
- S Diederich
- Institut für Diagnostische und Interventionelle Radiologie, Marien Hospital Düsseldorf, Akademisches Lehrkrankenhaus der Heinrich-Heine-Universität Düsseldorf, Rochusstraße 2, 40479, Düsseldorf, Deutschland.
| | - H Prosch
- Universitätsklinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Wien, Österreich
| | - C Herold
- Universitätsklinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Wien, Österreich
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Cantisani V, Dietrich CF, Badea R, Dudea S, Prosch H, Cerezo E, Nuernberg D, Serra AL, Sidhu PS, Radzina M, Piscaglia F, Bachmann Nielsen M, Calliada F, Gilja OH. EFSUMB statement on medical student education in ultrasound [short version]. Ultraschall Med 2016; 37:100-102. [PMID: 26871409 DOI: 10.1055/s-0035-1566959] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) recommends that ultrasound should be used systematically as an easy accessible and instructive educational tool in the curriculum of modern medical schools. Medical students should acquire theoretical knowledge of the modality and hands-on training should be implemented and adhere to evidence-based principles. In this paper we summarise EFSUMB policy statements on medical student education in ultrasound.
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Affiliation(s)
- V Cantisani
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, University Sapienza, Rome, Italy
| | - C F Dietrich
- Medizinische Klinik 2, Caritas Krankenhaus Bad Mergentheim, Germany
| | - R Badea
- Department of Ultrasonography, 3rd Medical Clinic, Institute of Gastroenterology and Hepatology Octavian Fodor; Imaging Department, University of Medicine and Pharmacy Iuliu Hatieganu, Cluj Napoca, Romania
| | - S Dudea
- Radiology Dept. "Iuliu Hatieganu" Univ. Med. Pharm. Cluj-Napoca, Romania
| | - H Prosch
- Dept. of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna General Hospital, Austria
| | - E Cerezo
- Calle Francisco Silvela #124, lo 3 Madrid, Spain
| | - D Nuernberg
- Department of Gastroenterology, Brandenburg University of Medicine Theodor Fontane, Neuruppin, Germany
| | - A L Serra
- Department of Internal Medicine and Nephrology, Ultrasound Learning Center, Hirslanden Clinic, Zürich, Switzerland
| | - P S Sidhu
- Department of Radiology, King's College Hospital, London, UK
| | - M Radzina
- Diagnostic Radiology Institute, Paula Stradins Clinical University Hospital, Riga, Latvia
| | - F Piscaglia
- Unit of Internal Medicine, Department of Medical and Surgical Sciences, University of Bologna, Italy
| | - M Bachmann Nielsen
- Department of Radiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - F Calliada
- Department of Radiology. Policlinico San Matteo, University Hospital, Pavia, Italy
| | - O H Gilja
- National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen and Department of Clinical Medicine, University of Bergen, Norway
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Abstract
Sarcoidosis is a systemic, inflammatory, granulomatous disease of unknown origin that can involve any organ. More than 90% of patients have thoracic sarcoidosis, which most frequently presents with bilateral hilar lymphadenopathy. In approximately 20% of patients with thoracic sarcoidosis there is involvement of the lung parenchyma as well as mostly asymptomatic cardiac sarcoidosis in up to 55% of patients. Most patients are asymptomatic and the diagnosis is an incidental finding on chest X-ray or during clarification of unspecific symptoms, such as fatigue or cough. In approximately two thirds of patients the disease undergoes spontaneous remission and in one third the disease follows a chronic or even progressive course. Furthermore, sarcoidosis can also be manifested in the abdominal organs, the central nervous system (CNS) and the musculoskeletal system. These manifestations are frequently subclinical and require targeted diagnostics when sarcoidosis is clinically suspected.
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Affiliation(s)
- H Prosch
- Univ. Klinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Allgemeines Krankenhaus Wien, Währingergürtel 18-22, 1090, Wien, Österreich.
| | | | - C Loewe
- Univ. Klinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Allgemeines Krankenhaus Wien, Währingergürtel 18-22, 1090, Wien, Österreich
| | - D Beitzke
- Univ. Klinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Allgemeines Krankenhaus Wien, Währingergürtel 18-22, 1090, Wien, Österreich
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Hojreh A, Prosch H, Karanikas G, Homolka P, Trattnig S. [Protection of the unborn child in diagnostic and interventional radiological procedures]. Radiologe 2015. [PMID: 26220128 DOI: 10.1007/s00117-015-2816-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The radiation exposure of an unborn child should be principally avoided, whenever it is medically reasonably possible; therefore, the identification of pregnant patients is the first and the most important step in radiation protection of the unborn child. However, in cases of emergency saving the life of the patient has a higher priority than the radiation protection of the unborn child. In this review article, we present a longitudinal section through the national and international literature and guidelines as a basis for radiological management of a (possibly) pregnant patient. We also list some radiological procedures recommended in the literature for a series of maternal indications considering the contraindications of each method during pregnancy and radiation protection of the unborn child.
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Affiliation(s)
- A Hojreh
- Universitätsklinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich,
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Hoda M, Waseda R, Klikovits T, Foesleitner O, Zoechbauer-Mueller S, Dieckmann K, Prosch H, Pirker R, Klepetko W. Trimodality Therapy Including Radical Resection for Pancoast Tumors: T4 is not a Contraindication for Radical Surgery. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv049.04] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
The finding of subsolid pulmonary nodules poses a frequent problem in the daily routine of the radiologist. The biological behavior of such subsolid lesions differs significantly from solid nodules. The risk of malignancy is significantly higher in subsolid nodules as compared to solid or purely ground glass opacities or nodules. The recommendations regarding the diagnostic management of subsolid nodules have been adapted according to the tendency of growth and the risk of malignancy. A benign etiology is also seen quite often in subsolid lesions and in this case they will show a reduction of size or disappear completely by the follow-up examination. Therefore, in many cases a short-term follow-up examination is primarily recommended. As the findings will often show no changes for a long period of time, further annual follow-up examinations over a longer, not yet specified period of time are recommended. Subsolid lesions that grow in size and/or show an increase in density or develop a solid part within a ground glass lesion should remain as suspected malignancies until proven otherwise.
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Affiliation(s)
- E Eisenhuber
- Institut für Röntgendiagnostik, Krankenhaus Göttlicher Heiland, Dornbacher Str. 20-28, 1170, Wien, Österreich,
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Prosch H. Komplikationen pulmonaler Infektionen: Rolle der Bildgebung. ROFO-FORTSCHR RONTG 2014. [DOI: 10.1055/s-0034-1373398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Eisenhuber E, Prosch H, Mostbeck G. Radiologische Diagnostik der pulmonalen Tuberkulose und der nicht typischen Mykobakteriosen. ACTA ACUST UNITED AC 2013. [DOI: 10.1055/s-0033-1358941] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Abstract
Lung cancer is one of the leading causes of death in Europe and the USA. A relatively good prognosis is limited to those patients in whom the tumor is detected at an early stage. As clinical symptoms of lung cancer are a late finding in the natural course of the disease, most of the patients are diagnosed at an advanced tumor stage when palliative care remains the only therapeutic option. For this reason, early diagnosis of lung cancer might save lives. The National Lung Screening Trial (NLST), in the U. S. A., provided evidence that screening with low-dose CT (LD-CT) is able to reduce lung cancer mortality by 20.0 %. The encouraging results of the NLST, however, could not be confirmed by the preliminary results of ongoing European trials. Even if the European trials are able to confirm a reduction in lung cancer mortality by LD-CT, a number of important questions must be answered before the implementation of nationwide screening programs. First of all, the population that might benefit from CT lung cancer screening has to be defined precisely. Furthermore, guidelines have to be established about how to manage screening participants with detected lung nodules, as the vast majority of these pulmonary nodules will prove to be benign. This review article summarizes the results of the NLST and the initial data from the European screening trials, and will discuss some of the major open questions in lung cancer screening with CT.
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Affiliation(s)
- H Prosch
- Universitätsklinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Österreich
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Firlinger I, Setinek U, Koller H, Feurstein P, Prosch H, Burghuber OC, Valipour A. A case of tracheobronchial amyloidosis treated with endoscopic debulking and external beam radiation therapy. Pneumologie 2013; 67:398-400. [PMID: 23828166 DOI: 10.1055/s-0033-1344186] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
We report on a 55-year-old patient who was admitted to hospital because of recurrent pneumonia. CT imaging provided airway narrowing and mural thickening of the distal trachea and mainstem bronchi, compatible with endobronchial polypoid, toric-shaped changes of the distal tracheal wall spreading into both the left and right bronchial system. Bronchoscopy was performed and biopsies revealed the diagnosis of tracheobronchial amyloidosis. We performed a combination of bronchoscopic debulking and consecutive external beam radiation therapy with the result of no further progression of the disease, stable endobronchial situation, and functional improvements at a follow up at 6 months.
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Affiliation(s)
- I Firlinger
- Department of Respiratory and Critical Care Medicine, Ludwig-Boltzmann-Institute for COPD and Respiratory Epidemiology, Otto Wagner Hospital, Vienna, Austria
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Prosch H, Schaefer-Prokop C. Radiologische Abklärung inzidenteller pulmonaler Rundherde. Radiologe 2013; 53:623-36; 637-8. [DOI: 10.1007/s00117-013-2530-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Mayerhoefer ME, Prosch H, Herold C, Weber M, Karanikas G. Erfassung pulmonaler Melanom-Metastasen mittels F-18-FDG PET/CT: welche PET-negativen Patienten benötigen eine weitere Abklärung zum definitiven Staging? ROFO-FORTSCHR RONTG 2013. [DOI: 10.1055/s-0033-1346647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Lakatos K, Kogler H, Minkov M, Prosch H. Heilungsdynamik der Skelettläsionen bei Langerhans-Zell-Histiozytose (LCH). ROFO-FORTSCHR RONTG 2012. [DOI: 10.1055/s-0032-1326810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Abstract
A profound knowledge of the various benign focal hepatic lesions and selection of the most suitable radiological examination modality is essential for achieving an accurate characterization of a hepatic lesion and in turn will determine the further patient management. This will avoid unnecessary agitation to both patient and the referring clinician and limits time-consuming, costly and risky biopsies to an absolute minimum. The following article will discuss the typical and atypical appearances of the most frequent and clinically relevant benign focal hepatic lesions with ultrasound, computed tomography and magnetic resonance imaging.
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Affiliation(s)
- S Baroud
- Universitätsklinik für Radiodiagnostik, AKH, Medizinische Universität Wien, Wien, Österreich.
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Abstract
Radiology has gained an exceptional position in medicine because a correct diagnosis is the most crucial issue in determining an accurate and personalized therapeutic strategy. This has a direct influence not only on the individual patient but also on the socio-economic aspects of healthcare services in terms of shortening the time interval to establish a diagnosis and to avoid risk-associated invasive diagnostic methods or long-term, cost-intensive follow-up. Magnetic resonance imaging (MRI) is an excellent example of this which due to continuous technological developments and emerging techniques allows a non-invasive diagnosis of the different hepatic diseases. In this article, we illustrate the direct correlation between the recent technical advances in MRI, such as 3.0 T, diffusion-weighted imaging, perfusion imaging, spectroscopy, texture analysis and MR elastography and obtaining a confident non-invasive diagnosis of focal and diffuse liver diseases.
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Affiliation(s)
- N Bastati-Huber
- Universitätsklinik für Radiodiagnostik, AKH, Medizinische Universität Wien, Wien, Österreich.
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Prosch H, Halbwachs C, Strobl C, Reisner LM, Hondl M, Weber M, Mostbeck GH. [Automated breast ultrasound vs. handheld ultrasound: BI-RADS classification, duration of the examination and patient comfort]. Ultraschall Med 2011; 32:504-510. [PMID: 21630181 DOI: 10.1055/s-0031-1273414] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
PURPOSE Automated breast ultrasound (ABUS) is a potentially valuable adjunct to mammography in breast cancer screening. The reliability and the inter-observer variability in the BI-RADS classification, compared to handheld ultrasound (US), as well as the duration of the examination and patient comfort have only been investigated in a limited number of papers to date. MATERIALS AND METHODS In a prospective study, we examined 148 breasts of 76 patients with handheld US and ABUS. The ABUS data were evaluated separately by two investigators. Patient comfort was assessed using a standardized questionnaire. RESULTS The inter-observer agreement for the BI-RADS classification among the two observers using ABUS was high (κ = 0,750), the agreement with handheld US was moderate. The sensitivity in the detection of breast cancer was 87.5 % for handheld US and 75 % for the ABUS evaluation by observer 1. The sensitivity was 87.5 % for the ABUS evaluation and 83 % for mammography by observer 2. The ABUS examination was rated as completely painless by 64 % of the patients. 25 % of the patients indicated minor pain, and 10 % indicated moderate pain. Handheld US was rated as completely painless by 66 % of the patients. 26 % of the patients indicated minor pain, and 8 % indicated moderate pain. CONCLUSION ABUS examinations focusing on the BIRADS classification have low inter-observer variability, compared to handheld US. The sensitivity of ABUS did not differ significantly from handheld US.
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Affiliation(s)
- H Prosch
- Abteilung für Allgemeine Radiologie und Kinderradiologie, Medizinische Universität Wien.
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Abstract
Focal liver lesions are a very common occurrence. The detection and differentiation of such lesions is particularly important for the management of oncology patients and is a core task for radiology. The early and conclusive detection of malignant liver processes in a cost-efficient manner and with a low radiation dose for the patient requires systematic and skillful use of the various radiological methods. This review explains the application of current radiological methods for the detection and differentiation of malignant liver lesions and the typical appearance of the most commonly found liver malignancies.
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Affiliation(s)
- T Moritz
- Univ.-Klinik für Radiodiagnostik, Allgemeines Krankenhaus, Medizinische Universität Wien, Wien, Österreich.
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Hochmair MJ, Schalleschak J, Funk GC, Valipour A, Breyer MK, Kohansal R, Prosch H, Kaufmann M, Mashaal S, Burghuber OC. Diagnostic yield of a two-hour sedimentation of pleural effusion in patients with suspected malignancy. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e18111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Prosch H, Oschatz E, Eisenhuber E, Gahleitner S, Hochmair M, Mashaal S, Mostbeck GH. [Sonography of the liver following CT staging of patients with lung cancer: a retrospective analysis]. Ultraschall Med 2009; 30:551-557. [PMID: 19809967 DOI: 10.1055/s-0028-1109754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
PURPOSE Liver lesions are frequently detected in the CT staging of lung cancer patients and may require further investigation. The aim of our study was to assess the value of an ultrasound (US) examination of the liver in addition to routine CT staging. MATERIALS AND METHODS In this retrospective study we included 174 consecutive patients with lung cancer who underwent US of the liver in addition to contrast-enhanced CT of the thorax and upper abdomen. The reports of the examinations were evaluated for the presence of liver lesions. Based on CT and US standard criteria, liver lesions were grouped into unequivocal cysts, hemangiomas, metastases and undefined lesions. RESULTS With CT, liver lesions were detected in 56 / 174 patients (32 %). These included 24 cysts in 11 patients, 2 hemangiomas in 2 patients and 18 patients with liver metastases. In 31 patients, 66 small (< 1.5 cm) hypodense lesions were detected, which could not be further defined by CT. Using US, 21 of these 66 liver lesions were confirmed as benign (cysts, hemangiomas), and two lesions were diagnosed as metastases. In 2 patients US revealed metastases that were not visible on the CT scans. CONCLUSION The study demonstrates that a complementary US of the liver in patients with lung cancer may reveal information relevant for treatment. Therefore, liver US may play an important role in the staging of lung cancer. When equivocal small liver lesions are detected with CT, a complementary US examination may help to diagnose these lesions or detect metastases not visible on the single-phase staging CT of the liver.
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Affiliation(s)
- H Prosch
- Institut für Röntgendiagnostik, Otto-Wagner-Spital, Wien
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Dimou E, Booij J, Rodrigues M, Prosch H, Attems J, Knoll P, Zajicek B, Dudczak R, Mostbeck G, Kuntner C, Langer O, Bruecke T, Mirzaei S. Amyloid PET and MRI in Alzheimers Disease and Mild Cognitive Impairment. Curr Alzheimer Res 2009; 6:312-9. [DOI: 10.2174/156720509788486563] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Prosch H, Walter RM, Westermayer V, Mostbeck GH. [Sonographic localization of non-palpable implanon hormone implants]. Ultraschall Med 2008; 29 Suppl 5:239-244. [PMID: 19177287 DOI: 10.1055/s-2008-1027972] [Citation(s) in RCA: 4] [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: 05/27/2023]
Abstract
PURPOSE Implanon is a rod-shaped hormone implant which leads to reliable contraception. The rod is implanted in the subcutis of the upper arm and is usually removed easily after its effective period. In the scenario where the rod is not palpable, the removal of the rod can be difficult or impossible. The purpose of this study was to evaluate the reliability of US in locating non-palpable Implanon implants and to investigate the optimal technical parameters for determining the location. MATERIALS AND METHODS In a prospective study we evaluated 21 women between June 2004 and June 2008. In 14 patients previous examinations with US, radiography, CT and/or MRI were non-diagnostic. The US evaluation followed a standardized protocol in transverse and longitudinal sections. The technical parameters US frequency, position and number of focal zones and compound imaging were varied to define the optimal parameters for the visualization of the Implanon implant. RESULTS The Implanon implant was detected in all 21 patients. Reasons for negative palpability were mainly an intramuscular or subfascial location as well as a significant migration of the Implanon implant in 2 patients. The use of a high US frequency, the position of the focal zones in the near field and the deactivation of compound imaging all facilitate visualization of the characteristic US morphology of the plastic rod. CONCLUSION High resolution US is the method of choice for determining the location of non-palpable Implanon implants. Knowledge of US morphology and optimal technical settings as well as the use of high-resolution scan heads are essential for determining the correct location.
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Affiliation(s)
- H Prosch
- Institut für diagnostische und interventionelle Radiologie des Wilhelminenspitals mit Standort Otto Wagner Spital, Sanatoriumstrasse 1, 1160 Wien
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Affiliation(s)
- H Prosch
- Institut für diagnostische und interventionelle Röntgendiagnostik des Wilhelminenspitals im Standort Otto Wagner Spital, Wien, Osterreich.
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Prosch H, Tscherney R, Kriwanek S, Tscholakoff D. Radiographical imaging of the normal anatomy and complications after gastric banding. Br J Radiol 2008; 81:753-7. [PMID: 18508872 DOI: 10.1259/bjr/95353541] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Laparoscopic adjustable gastric banding is a surgical procedure that is increasingly being performed for the treatment of morbid obesity. As with any intervention, gastric banding is not free from complications. Complications after gastric banding can be divided into early and late complications. Early complications include band malposition and perforation of the stomach. Late complications comprise pouch dilatation, intraluminal band penetration and oesophageal dilatation. Understanding the principles of the intervention is essential for both the interpretation of the resulting radiographical findings and the diagnosis of potential complications. We report on the normal anatomy and the most frequent complications seen after gastric banding.
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Affiliation(s)
- H Prosch
- Department of Radiology, Rudolfstiftung Hospital, Juchgasse 25, 1030 Vienna, Austria
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Prosch H, Grois N, Prayer D. Reply:. AJNR Am J Neuroradiol 2008. [DOI: 10.3174/ajnr.a1050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Mirzaei S, Prosch H, Knoll P, Mostbeck G. Interatrial 18F-FDG uptake mimicking malignancy. Nuklearmedizin 2008; 47:N38. [PMID: 18763369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- S Mirzaei
- Institute of Nuclear Medicine, Wilhelminenspital, Vienna, Austria
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