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Zhou K, Strunk H, Dimitrov D, Vidal-Jove J, Gonzalez-Carmona MA, Essler M, Jin C, Mei Z, Zhu H, Marinova M. US-guided high-intensity focused ultrasound in pancreatic cancer treatment: a consensus initiative between Chinese and European HIFU centers. Int J Hyperthermia 2023; 41:2295812. [PMID: 38159562 DOI: 10.1080/02656736.2023.2295812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 12/12/2023] [Indexed: 01/03/2024] Open
Abstract
Purpose: Ultrasound-guided high-intensity focused ultrasound (USgHIFU) represents a safe and effective non-invasive thermoablative technique for managing inoperable pancreatic cancer. This treatment method significantly alleviates disease-related symptoms and reduces pancreatic tumor volume. However, the current body of evidence is constrained by a lack of randomized controlled trials. The utilization of USgHIFU is primarily indicated for patients with unresectable, locally advanced, or metastatic pancreatic cancer, particularly those experiencing symptoms due to a locally advanced primary tumor.Methods: This collaborative consensus paper, involving European and Chinese HIFU centers treating pancreatic cancer, delineates criteria for patient selection, focusing on those most likely to benefit from USgHIFU treatment. Consideration is given to endpoints encompassing symptom alleviation, local response rates, other oncological outcomes, as well as overall and progression-free survival. Additionally, this paper defines relevant contraindications, side effects, and complications associated with USgHIFU. The publication also explores the feasibility and role of USgHIFU within the context of palliative care, including standard systemic chemotherapy.Results: The non-invasive local treatment of advanced pancreatic cancer using HIFU should be regarded as an adjunctive option alongside systemic chemotherapy or best supportive care for managing this aggressive disease. Based on the ability of USgHIFU therapy to mitigate pain and reduce primary tumor volume, it should be considered as a complementary therapy for symptomatic patients with inoperable pancreatic cancer and as a potential means of tumor debulking. The underutilized yet promising USgHIFU exhibits the potential to enhance patients' quality of life by alleviating cancer-related pain. Experts in the field should evaluate this treatment option be evaluated by experts in this field, with this consensus paper potentially serving as a guiding resource for the medical community.Conclusions: US-guided HIFU for advanced pancreatic cancer addresses treatment goals, available options, success rates, and limitations. As a non-invasive, effective local therapy, complementary to chemotherapy and best supportive care, it plays a pivotal role in pain relief, reducing of tumor volume, and potentially improving survival rates.
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Affiliation(s)
- Kun Zhou
- Clinical Center for Tumor Therapy, 2nd Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | | | - Dobromir Dimitrov
- Department of Surgical Propedeutics, HIFU Center University Hospital St. Marina, Medical University Peleven, Pleven, Bulgaria
| | - Joan Vidal-Jove
- Institute Khuab, Comprehensive Tumor Center Barcelona, Barcelona, Spain
| | | | - Markus Essler
- Department of Nuclear Medicine, University Hospital Bonn, Germany
| | - Chengbin Jin
- Clinical Center for Tumor Therapy, 2nd Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Zhechuan Mei
- Department of Gastroenterology and Hepatology, 2nd Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Hui Zhu
- Clinical Center for Tumor Therapy, 2nd Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Milka Marinova
- Department of Nuclear Medicine, University Hospital Bonn, Germany
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Egger EK, Buchen MA, Recker F, Stope MB, Strunk H, Mustea A, Marinova M. Predicting incomplete cytoreduction in patients with advanced ovarian cancer. Front Oncol 2022; 12:1060006. [PMID: 36591482 PMCID: PMC9798233 DOI: 10.3389/fonc.2022.1060006] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 11/21/2022] [Indexed: 12/23/2022] Open
Abstract
Purpose The most important prognostic factor for survival in ovarian cancer patients is complete cytoreduction. The preoperative prediction of suboptimal cytoreduction, considered as any residual disease at the end of surgery, could prevent futile surgery and morbidity. Here, we aimed to identify markers in the preoperative abdominal CT scans of an unselected cohort of patients with ovarian cancer that are predictive of incomplete cytoreduction. Methods This is a single-institution retrospective analysis of 105 epithelial ovarian cancer (EOC) patients treated with surgical cytoreduction between 2010 and 2020. Twenty-two variables on preoperative abdominal CT scans were compared to the intraoperative macroscopic findings by Fisher's exact test. Parameters with a significant correlation between intraoperative findings and imaging were analyzed by multivariate binary logistic regression analysis regarding the surgical outcome of complete versus incomplete cytoreduction. Results Complete cytoreduction (CC), indicated by the absence of macroscopic residual disease, was achieved in 79 (75.2%) of 105 patients and 46 (63.9%) of 72 International Federation of Gynecology and Obstetrics (FIGO) stage III and IV patients. Twenty patients (19%) were incompletely cytoreduced due to miliary carcinomatosis of the small bowel, and six patients (5.7%) had various locations of residual disease. Thirteen variables showed a significant correlation between imaging and surgical findings. Large-volume ascites, absence of numerically increased small lymph nodes at the mesenteric root, and carcinomatosis of the transverse colon in FIGO stage III and IV patients decreased the rate of CC to 26.7% in the multivariate analysis. Conclusion Large-volume ascites, the absence of numerically increased small lymph nodes at the mesenteric root, and carcinomatosis of the transverse colon are markers in preoperative CT scans predicting a low chance for complete cytoreduction in unselected ovarian cancer patients in a real-world setting.
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Affiliation(s)
- Eva K. Egger
- Department of Gynecology and Gynecological Oncology, University Hospital Bonn, Bonn, Germany
| | - Marie Antonia Buchen
- Department of Gynecology and Gynecological Oncology, University Hospital Bonn, Bonn, Germany
| | - Florian Recker
- Department of Gynecology and Gynecological Oncology, University Hospital Bonn, Bonn, Germany
| | - Matthias B. Stope
- Department of Gynecology and Gynecological Oncology, University Hospital Bonn, Bonn, Germany
| | - Holger Strunk
- Medicine Center Bonn, Medical Care Center, Bonn, Germany
| | - Alexander Mustea
- Department of Gynecology and Gynecological Oncology, University Hospital Bonn, Bonn, Germany
| | - Milka Marinova
- Department of Nuclear Medicine, University Hospital Bonn, Bonn, Germany
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Recker F, Thudium M, Strunk H, Tonguc T, Dohmen S, Luechters G, Bette B, Welz S, Salam B, Wilhelm K, Egger EK, Wüllner U, Attenberger U, Mustea A, Conrad R, Marinova M. Multidisciplinary management to optimize outcome of ultrasound-guided high-intensity focused ultrasound (HIFU) in patients with uterine fibroids. Sci Rep 2021; 11:22768. [PMID: 34815488 PMCID: PMC8611035 DOI: 10.1038/s41598-021-02217-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 11/08/2021] [Indexed: 12/22/2022] Open
Abstract
Little is known about the specific anaesthesiological and multidisciplinary management of high-intensity focused ultrasound (HIFU) in uterine fibroids. This observational single-center study is the first reporting on an interdisciplinary approach to optimize outcome following ultrasound (US)-guided HIFU in German-speaking countries. A sample of forty patients with symptomatic uterine fibroids was treated by HIFU. Relevant treatment parameters such as total treatment time for intervention, anaesthesia, and sonication time as well as total energy, body temperature, peri-interventional medication and complications were analyzed. Interventional variables did not correlate significantly either with opioid dose or with body temperature. The average fibroid volume reduction rate was 37.8% ± 23.5%, 48.5% ± 22.0% and 70.2% ± 25.5% after 3, 6 and 12 months, respectively. No major anaesthesiological complications occurred apart from an epileptic seizure prior to HIFU treatment in one patient. Peri-procedural hyperthermia (> 37.5 °C) occurred in two patients. Post-procedural two patients experienced a sciatic nerve irritation up to one year; one patient with very large treated fibroid experienced strong short-lasting post-procedural pain. There were two complication-free pregnancies of HIFU-treated patients. Multidisciplinary management is crucial to optimize safety and outcome of US-guided HIFU for uterine fibroids. Peri-procedural pain and temperature management are critical points where an adequate collaboration between anesthesiologist and interventionalist is mandatory.
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Affiliation(s)
- Florian Recker
- Department of Gynaecology and Gynaecological Oncology, University Hospital Bonn, Bonn, Germany
| | - Marcus Thudium
- Department of Anaesthesiology, University Hospital Bonn, Bonn, Germany
| | - Holger Strunk
- Department of Radiology, Städtisches Klinikum Solingen, Solingen, Germany
| | - Tolga Tonguc
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn, Germany
| | - Sara Dohmen
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn, Germany
| | - Guido Luechters
- Center for Development Research (ZEF), University Bonn, Bonn, Germany
| | - Birgit Bette
- Department of Anaesthesiology, University Hospital Bonn, Bonn, Germany
| | - Simone Welz
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn, Germany
| | - Babak Salam
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn, Germany
| | - Kai Wilhelm
- Department of Radiology, Johanniter Krankenhaus Bonn, Bonn, Germany
| | - Eva K Egger
- Department of Gynaecology and Gynaecological Oncology, University Hospital Bonn, Bonn, Germany
| | - Ullrich Wüllner
- Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Ulrike Attenberger
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn, Germany
| | - Alexander Mustea
- Department of Gynaecology and Gynaecological Oncology, University Hospital Bonn, Bonn, Germany
| | - Rupert Conrad
- Clinic and Polyclinic for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Milka Marinova
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn, Germany. .,Clinic for Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
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Marinova M, Ghaei S, Recker F, Tonguc T, Kaverina O, Savchenko O, Kravchenko D, Thudium M, Pieper CC, Egger EK, Mustea A, Attenberger U, Conrad R, Hadizadeh DR, Strunk H. Efficacy of ultrasound-guided high-intensity focused ultrasound (USgHIFU) for uterine fibroids: an observational single-center study. Int J Hyperthermia 2021; 38:30-38. [PMID: 34420447 DOI: 10.1080/02656736.2021.1939444] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 10/20/2022] Open
Abstract
INTRODUCTION To evaluate treatment response of uterine fibroids after ultrasound guided high-intensity focused ultrasound (USgHIFU) with a special focus on fibroid size and characterization based on Funaki classification scheme, as well as clinical response to treatment of leading fibroid-associated symptoms. MATERIALS AND METHODS Uterine fibroids treated by USgHIFU were assigned to Funaki type 1-3 based on T2-w-MRI. Differences in size, non-perfused volume ratio (NPVR) and volume reduction over time were determined using T1-/T2-w MRI sequences and contrast-enhanced sonography. Treatment effects on three leading fibroid-associated symptoms were also evaluated. Measurements were compared by mixed model, Bland-Altman's plot and Spearman's correlation. RESULTS In this prospective single-center study, 35 patients with 44 symptomatic uterine fibroids were treated by USgHIFU (n = 22, n = 12 and n = 10 assigned to Funaki type 1, 2 and 3, respectively). NPVRs of Funaki type 1 and 2 fibroids were significantly higher compared to type 3 (p = .0023). A significant fibroid shrinkage was observed independent of Funaki type compared to baseline: 38.8 ± 26.9%, 46.7 ± 30.3% and 54.5 ± 29.3% at 3, 6 and 12 months, respectively (each p < .05). Moreover, patients experienced a significant improvement of fibroid-associated hypermenorrhea (3.9 ± 1.3 vs. 2.3 ± 1.3), pressure in the pelvic area (3.5 ± 1.3 vs. 2.1 ± 0.9) and frequent urination (2.8 ± 1.5 vs. 1.9 ± 0.8) one year post-procedure (each p < .05), regardless of fibroid Funaki type. CONCLUSION Following USgHIFU, a significant shrinkage of uterine fibroids and improvement of leading fibroid-associated symptoms were demonstrated regardless of the Funaki type.
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Affiliation(s)
- Milka Marinova
- Clinic for Diagnostic and Interventional Radiology, University Hospital Bonn, University Bonn, Bonn, Germany
| | - Shiwa Ghaei
- Clinic for Diagnostic and Interventional Radiology, University Hospital Bonn, University Bonn, Bonn, Germany
| | - Florian Recker
- Clinic of Gynaecology and Gynaecological Oncology, University Hospital Bonn, University Bonn, Bonn, Germany
| | - Tolga Tonguc
- Clinic for Diagnostic and Interventional Radiology, University Hospital Bonn, University Bonn, Bonn, Germany
| | - Olga Kaverina
- Clinic for Diagnostic and Interventional Radiology, University Hospital Bonn, University Bonn, Bonn, Germany
| | - Oleksandr Savchenko
- Clinic for Diagnostic and Interventional Radiology, University Hospital Bonn, University Bonn, Bonn, Germany
| | - Dmitrij Kravchenko
- Clinic for Diagnostic and Interventional Radiology, University Hospital Bonn, University Bonn, Bonn, Germany
| | - Marcus Thudium
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, University Bonn, Bonn, Germany
| | - Claus C Pieper
- Clinic for Diagnostic and Interventional Radiology, University Hospital Bonn, University Bonn, Bonn, Germany
| | - Eva K Egger
- Clinic of Gynaecology and Gynaecological Oncology, University Hospital Bonn, University Bonn, Bonn, Germany
| | - Alexander Mustea
- Clinic of Gynaecology and Gynaecological Oncology, University Hospital Bonn, University Bonn, Bonn, Germany
| | - Ulrike Attenberger
- Clinic for Diagnostic and Interventional Radiology, University Hospital Bonn, University Bonn, Bonn, Germany
| | - Rupert Conrad
- Clinic and Polyclinic for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, University Bonn, Bonn, Germany
| | - Dariusch R Hadizadeh
- Clinic for Diagnostic and Interventional Radiology, University Hospital Bonn, University Bonn, Bonn, Germany
| | - Holger Strunk
- Clinic for Diagnostic and Interventional Radiology, University Hospital Bonn, University Bonn, Bonn, Germany
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Tonguc T, Strunk H, Gonzalez-Carmona MA, Recker F, Lütjohann D, Thudium M, Conrad R, Becher MU, Savchenko O, Davidova D, Luechters G, Mustea A, Strassburg CP, Attenberger U, Pieper CC, Jenne J, Marinova M. US-guided high-intensity focused ultrasound (HIFU) of abdominal tumors: outcome, early ablation-related laboratory changes and inflammatory reaction. A single-center experience from Germany. Int J Hyperthermia 2021; 38:65-74. [PMID: 34420445 DOI: 10.1080/02656736.2021.1900926] [Citation(s) in RCA: 10] [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: 10/20/2022] Open
Abstract
INTRODUCTION High-intensity focused ultrasound (HIFU) is an innovative noninvasive procedure for local ablation of different benign and malignant tumors. Preliminary data of animal studies suggest an ablation-associated immune response after HIFU that is induced by cell necrosis and release of intracellular components. The aim of this study is to evaluate if a HIFU-induced early sterile inflammatory reaction is initiated after ablation of uterine fibroids (UF) and pancreatic carcinoma (PaC) which might contribute to the therapeutic effect. MATERIAL AND METHODS A hundred patients with PaC and 30 patients with UF underwent US-guided HIFU treatment. Serum markers of inflammation (leukocytes, CRP, IL-6) and LDH in both collectives as well as tumor markers CA 19-9, CEA and CYFRA in PaC patients were determined in sub-cohorts before and directly after HIFU (0, 2, 5 and 20 h post-ablation) as well as at 3, 6, 9 and 12 months follow-up. Peri-/post interventional imaging included contrast-enhanced MRI of both cohorts and an additional CT scan of PaC patients. RESULTS An early post-ablation inflammatory response was observed in both groups with a significant increase of leukocytes, CRP and LDH within the first 20 h after HIFU. Interestingly, IL-6 was increased at 20 h after HIFU in PaC patients. A significant reduction of tumor volumes was observed during one year follow-up (p < .001) for both tumor entities demonstrating effective treatment outcome. CONCLUSION Tumor ablation with HIFU induces an early sterile inflammation that might serve as a precondition for long-term tumor immunity and a sustainable therapeutic effect.
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Affiliation(s)
- Tolga Tonguc
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, University Bonn, Bonn, Germany
| | - Holger Strunk
- Department of Radiology, Städtisches Klinikum Solingen, Solingen, Germany
| | | | - Florian Recker
- Department of Gynaecology and Gynaecological Oncology, University Hospital Bonn, University Bonn, Bonn, Germany
| | - Dieter Lütjohann
- Department of Clinical Pharmacology and Laboratory Medicine, University Hospital Bonn, University Bonn, Bonn, Germany
| | - Marcus Thudium
- Department of Anesthesiology, University Hospital Bonn, University Bonn, Bonn, Germany
| | - Rupert Conrad
- Clinic and Polyclinic for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, University Bonn, Bonn, Germany
| | - Marc U Becher
- Department of Internal Medicine I, University Hospital Bonn, University Bonn, Bonn, Germany
| | - Oleksandr Savchenko
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, University Bonn, Bonn, Germany
| | - Darya Davidova
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, University Bonn, Bonn, Germany
| | - Guido Luechters
- Center for Development Research (ZEF), University Bonn, Bonn, Germany
| | - Alexander Mustea
- Department of Gynaecology and Gynaecological Oncology, University Hospital Bonn, University Bonn, Bonn, Germany
| | - Christian P Strassburg
- Department of Internal Medicine I, University Hospital Bonn, University Bonn, Bonn, Germany
| | - Ulrike Attenberger
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, University Bonn, Bonn, Germany
| | - Claus C Pieper
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, University Bonn, Bonn, Germany
| | - Jürgen Jenne
- Fraunhofer Institute for Digital Medicine, MEVIS, Bremen, Germany
| | - Milka Marinova
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, University Bonn, Bonn, Germany
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Thudium M, Bette B, Tonguc T, Ghaei S, Conrad R, Becher MU, Mücke M, Luechters G, Strunk H, Marinova M. Multidisciplinary management and outcome in pancreatic cancer patients treated with high-intensity focused ultrasound. Int J Hyperthermia 2020; 37:456-462. [PMID: 32396479 DOI: 10.1080/02656736.2020.1762006] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Introduction: High-intensity focused ultrasound (HIFU) for pancreatic cancer is a growing therapeutic field which has been proven to reduce cancer pain and provide a local tumor control additionally to standard palliative care. However, less is known about the multidisciplinary and especially anesthesiological management of HIFU treatment although an interdisciplinary approach is crucial for treatment success.Material and methods: Anesthesiological and radiological records of 71 HIFU-treated pancreatic cancer patients were analyzed with regard to the following items: intervention time, sonication time, total energy, anesthesia time, peri-interventional medication, body temperature maximum and minimum, pain scores before and 1 day, 6 weeks and 3 months after intervention, peri-interventional complications. Effects on pain scores were estimated with a mixed panel data model. Bivariate associations between interventional variables were examined with the Spearman's correlation.Results: HIFU treatment was performed without major adverse events. Peri-procedural hyperthermia >37.5 °C occurred in 2 patients, hypothermia <35 °C in 8 cases. Interventional variables did not correlate significantly with pain scores, opioid dose, nor body temperature. 85.5% of patients experienced significant early pain relief within the first week after intervention. Post-interventional pain relief is associated with morphine equivalent opioid dose (p = 0.025) and treatment time (p = 0.040).Conclusion: While HIFU can be considered safe and effective treatment option, procedure-associated pain and temperature management represent challenges for the interdisciplinary HIFU intervention team. Especially short-term pain relief depends on the combined effort of the radiologist and anesthesiologist.
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Affiliation(s)
- Marcus Thudium
- Department of Anesthesiology, University Hospital Bonn, Bonn, Germany
| | - Birgit Bette
- Department of Anesthesiology, University Hospital Bonn, Bonn, Germany
| | - Tolga Tonguc
- Clinic for Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn, Germany
| | - Shiwa Ghaei
- Clinic for Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn, Germany
| | - Rupert Conrad
- Clinic and Polyclinic for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Marc U Becher
- Clinic and Polyclinic for Internal Medicine II, University Hospital Bonn, Bonn, Germany
| | - Martin Mücke
- Center for Rare Diseases, University Hospital Bonn, Bonn, Germany
| | - Guido Luechters
- Center for Development Research (ZEF), University Bonn, Bonn, Germany
| | - Holger Strunk
- Clinic for Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn, Germany
| | - Milka Marinova
- Clinic for Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn, Germany
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Marinova M, Huxold HC, Henseler J, Mücke M, Conrad R, Rolke R, Ahmadzadehfar H, Rauch M, Fimmers R, Luechters G, Cuhls H, Radbruch L, Schild HH, Strunk H. Clinical Effectiveness and Potential Survival Benefit of US-Guided High-Intensity Focused Ultrasound Therapy in Patients with Advanced-Stage Pancreatic Cancer. Ultraschall Med 2019; 40:625-637. [PMID: 29665583 DOI: 10.1055/a-0591-3386] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
PURPOSE Pancreatic cancer (PaC) is a life-limiting tumor with a wide range of incapacitating symptoms such as cancer pain in more than 80 % of patients. This prospective interventional study addresses the clinical effectiveness of ultrasound-guided high-intensity focused ultrasound (HIFU) treatment for patients with advanced-stage PaC, including pain perception, tumor size and survival benefit. MATERIALS AND METHODS 50 patients with late-stage PaC underwent HIFU. Clinical assessment included evaluation of tumor volume by imaging and pain burden (pain severity, pain sensation, interference with daily activities) using the Brief Pain Inventory at baseline and follow-up. Median overall survival, progression-free survival and time to local progression were estimated using Kaplan-Meier analysis. RESULTS In 84 % of patients, significant early relief of cancer-induced abdominal pain was achieved by HIFU independent of metastatic status; it persisted during follow-up. Tumor volume reduction was 37.8 ± 18.1 % after 6 weeks and 57.9 ± 25.9 % after 6 months. 21 % of HIFU-treated patients had local tumor progression with a median time of 14.4 months from intervention. The median overall survival and progression-free survival were 16.2 and 16.9 months from diagnosis and 8.3 and 6.8 months from intervention. CONCLUSION In patients with advanced pancreatic cancer and otherwise limited treatment options, HIFU resulted in significant early and long-lasting pain relief and tumor size reduction over time independent of metastatic status. Clinical data suggest an additional potential survival benefit.
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Affiliation(s)
- Milka Marinova
- Department of Radiology, Medical School and University Clinics Bonn, Germany
| | - Hannah C Huxold
- Department of Radiology, Medical School and University Clinics Bonn, Germany
| | - Jana Henseler
- Department of Radiology, Medical School and University Clinics Bonn, Germany
| | - Martin Mücke
- Department of Palliative Medicine, Department of General Practice and Family Medicine, Medical School and University Clinics Bonn, Germany
| | - Rupert Conrad
- Clinic and Polyclinic for Psychosomatic Medicine and Psychotherapy, Medical School and University Clinics Bonn, Germany
| | - Roman Rolke
- Department of Palliative Medicine, Medical School and University Clinics Aachen, Germany
| | - Hojjat Ahmadzadehfar
- Department of Nuclear Medicine, Medical School and University Clinics Bonn, Germany
| | - Maximilian Rauch
- Department of Radiology, Medical School and University Clinics Bonn, Germany
| | - Rolf Fimmers
- Institute of Medical biometry, Informatics and Epidemiology, Medical School and University Clinics Bonn, Germany
| | | | - Henning Cuhls
- Department of Palliative Medicine, Medical School and University Clinics Bonn, Germany
| | - Lukas Radbruch
- Department of Palliative Medicine, Medical School and University Clinics Bonn, Germany
| | - Hans H Schild
- Department of Radiology, Medical School and University Clinics Bonn, Germany
| | - Holger Strunk
- Department of Radiology, Medical School and University Clinics Bonn, Germany
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Gaertner F, Plum T, Kreppel B, Eppard E, Meisenheimer M, Strunk H, Bundschuh R, Sinnes J, Rösch F, Essler M. Clinical evaluation of [68Ga]Ga-DATA-TOC in comparison to [68Ga]Ga-DOTA-TOC in patients with neuroendocrine tumours. Nucl Med Biol 2019; 76-77:1-9. [DOI: 10.1016/j.nucmedbio.2019.08.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 08/07/2019] [Accepted: 08/26/2019] [Indexed: 01/20/2023]
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Strunk H, Tonguc T, Marinova M. Leserbrief zum Beitrag MRg-HIFU (doi:10.1055/a-0817-5645). ROFO-FORTSCHR RONTG 2019; 191:849. [PMID: 31430801 DOI: 10.1055/a-0973-8673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Holger Strunk
- Department of Radiology, University-Hospital Bonn, Germany
| | - Tolga Tonguc
- Department of Radiology, University-Hospital Bonn, Germany
| | - Milka Marinova
- Department of Radiology, University-Hospital Bonn, Germany
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Marinova M, Wilhelm-Buchstab T, Strunk H. Advanced Pancreatic Cancer: High-Intensity Focused Ultrasound (HIFU) and Other Local Ablative Therapies. ROFO-FORTSCHR RONTG 2019; 191:216-227. [DOI: 10.1055/a-0820-5564] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [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]
Abstract
Background Locally advanced pancreatic cancer is a life-limiting tumor with a wide range of incapacitating symptoms such as cancer-associated pain. Several local ablative therapies with both thermal and non-thermal sources have recently received significant attention as modern treatment options for local tumor control and symptomatic improvement. The following review article provides an overview of currently available techniques and their outcomes including our own experience with high-intensity focused ultrasound (HIFU) being one of the most exciting and innovative modalities.
Method Our experiences with HIFU treatment are based on 89 pancreatic cancer patients (UICC III-IV). Outcomes such as treatment-related changes in symptoms particularly in cancer pain and quality of life as well as local tumor response, safety and survival were compared to reported studies concerning HIFU, radiofrequency and microwave ablation, cryoablation, irreversible electroporation and stereotactic body radiation therapy.
Results Even though all strategies appeared to be feasible, the unique feature of noninvasiveness represents a substantial advantage of the HIFU procedure. In 85 % of HIFU-treated patients, long-lasting pain relief was achieved. 50 % of patients did not require any analgesic treatment 6 weeks post-ablation. Unfortunately, pain palliation and quality-of-life outcomes are only rarely reported for other local treatment modalities. Tumor mass reduction could be achieved with all ablative therapies, with a mean tumor volume reduction of 60 % after 6 months in HIFU-treated pancreatic tumors. Differences in treatment-associated morbidity were reported. However, they are only partially comparable due to unbalanced study populations.
Conclusion Various local ablative treatment modalities are available and feasible for tumor mass reduction of advanced pancreatic cancer but with different symptomatic benefit for patients. An effective and long-lasting reduction of cancer-related pain was observed following HIFU without insertion of needles or electrodes. Randomized controlled studies for head-to-head comparison of these modalities are warranted in the near future.
Key points:
Citation Format
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Affiliation(s)
- Milka Marinova
- Department of Radiology, Medical School & Hospital, University of Bonn, Germany
| | - Timo Wilhelm-Buchstab
- Department of Radiology/Radiotherapy, Medical School & Hospital, University of Bonn, Germany
| | - Holger Strunk
- Department of Radiology, Medical School & Hospital, University of Bonn, Germany
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Strunk H, Stuckmann G, Marinova M. Champagner im Blut oder Mikrobläschen in Medizin und Gastronomie (eine nicht ganz so ernst gemeinte wissenschaftliche Betrachtung). ROFO-FORTSCHR RONTG 2018; 190:680-682. [DOI: 10.1055/a-0591-5807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Holger Strunk
- Department of Radiology, Radiologische Universitätsklinik Bonn, Germany
| | - Gerd Stuckmann
- Department of Radiology, Kantonsspital Winterthur, Switzerland
| | - Milka Marinova
- Department of Radiology, Radiologische Universitätsklinik Bonn, Germany
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Strunk H, Marinova M. Transjugular Intrahepatic Portosystemic Shunt (TIPS): Pathophysiologic Basics, Actual Indications and Results with Review of the Literature. ROFO-FORTSCHR RONTG 2018; 190:701-711. [PMID: 30045395 DOI: 10.1055/a-0628-7347] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Transjugular intrahepatic portosystemic shunt (TIPS) is a non-selective portosystemic shunt created using endovascular techniques. During recent years technical improvements and new insights into pathophysiology have modified indications for TIPS placement. In this article we therefore want to discuss current knowledge. METHOD A literature review was performed to review and discuss the pathophysiology, indications and results of the TIPS procedure. RESULTS Established TIPS indications are persistent bleeding despite combined pharmacological and endoscopic therapy and rebleeding during the first five days. A new indication in the European recommendations is early TIPS placement within 72 hours, ideally within 24 hours, in patients bleeding from esophageal or gastroesophageal varices at high risk for treatment failure (e. g. Child-Pugh class C < 14 points or Child-Pugh class B with active bleeding) after initial pharmacological and endoscopic therapy. For prevention of recurrent variceal hemorrhage in the recommendations, covered TIPS placement is the treatment of choice only after failed first-line therapy, although numerous TIPS studies show a prolonged time to rebleeding and a reduction of mortality. Similarly for secondary prophylaxis in patients with refractory ascites, covered TIPS placement may be considered only if the patient continues to be intolerant to NSBBs and is an appropriate TIPS candidate even though studies show that the TIPS procedure controls ascites, improves survival and renal function better than paracentesis. Potential indications for TIPS implantation are Budd-Chiari syndrome, acute portal vein thromboses, hydrothorax, hepatopulmonary and hepatorenal syndrome (Typ 2), portal hypertensive gastropathy (PHG) and prophylaxis of complications of abdominal surgery, very rarely bleeding in ectopic varices or in patients with chylothorax or chylous ascites. CONCLUSION TIPS placement is an established procedure with a new indication as "early TIPS". In the European recommendations it is only the second-line therapy for prevention of recurrent variceal hemorrhage and for secondary prophylaxis in patients with refractory ascites although several studies showed a clear benefit of the TIPS procedure compared to ligation and NSBBs. KEY POINTS · In addition to already established indications, new European recommendations suggest early TIPS placement in patients bleeding from esophageal or gastroesophageal varices at high risk for treatment failure.. CITATION FORMAT · Strunk H, Marinova M, . Transjugular Intrahepatic Portosystemic Shunt (TIPS): Pathophysiologic Basics, Actual Indications and Results with Review of the Literature. Fortschr Röntgenstr 2018; 190: 701 - 711.
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Affiliation(s)
- Holger Strunk
- Department of Radiology, Medical School & Hospital, University of Bonn, Germany
| | - Milka Marinova
- Department of Radiology, Medical School & Hospital, University of Bonn, Germany
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Abstract
CLINICAL/METHODICAL ISSUE Embolization of the testicular veins (Gat-Goren technique) is an interventional procedure for the treatment of benign prostatic hyperplasia (BPH). STANDARD RADIOLOGICAL METHODS In addition to standard urological procedures, such as transurethral resection of the prostate (TUR-P), arterial embolization of the prostate is considered as the interventional radiological method of choice. METHODICAL INNOVATIONS Embolization of the testicular veins is technically identical to the embolization of varicoceles in infertile men and represents a less invasive treatment. PERFORMANCE Embolization of the testicular veins can be performed as a low-risk intervention with low side effects. Variants of the venous anatomy can make the procedure more difficult. In current studies a good reduction of symptoms could be achieved in intermediate-term follow-up. ACHIEVEMENTS The medium-term results are promising but data on long-term results and comparisons with alternative treatments are missing. PRACTICAL RECOMMENDATIONS Embolization of the testicular veins is a minimally invasive method for the treatment of BPH. The procedure can be performed in an outpatient setting. In the intermediate course up to 6 months after treatment, promising results were demonstrated in recent studies. Randomized studies, data on long-term results and comparisons to alternative methods (e. g. arterial prostatic embolization and surgical procedures) are missing.
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Affiliation(s)
- M Rauch
- Radiologische Klinik, Universitätsklinikum Bonn, Sigmund-Freud-Straße 25, 53127, Bonn, Deutschland.
| | - H Strunk
- Radiologische Klinik, Universitätsklinikum Bonn, Sigmund-Freud-Straße 25, 53127, Bonn, Deutschland
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Rabe C, Pauleit D, Reichmann K, Menzel C, Grünwald F, Strunk H, Biersack HJ, Palmedo H, Risse JH. Therapy of hepatocellular carcinoma with iodine-131-lipiodol. Nuklearmedizin 2018. [DOI: 10.1055/s-0038-1625116] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
SummaryAim: To evaluate the efficacy and tolerance of iodine- 131-lipiodol (131I-lipiodol) for hepatocellular carcinoma (HCC) in German long term patients and comparison with medically treated controls. Patients, Methods: 38 courses of intra-arterial 131I-lipiodol therapy with a total activity up to 6.7 GBq were performed in 18 patients with HCC (6 with portal vein thrombosis). Liver and tumour volume and lipiodol deposition were measured by computed tomography and 131I activity by scintigraphy. Therapeutic efficacy was determined by tumour volume change and matched-pairs analysis in comparison to medically (i.e. tamoxifen or medical support) treated patients. Results: Tumour volume decreased in 20/32 index nodules (63%) after the first course. Repeated therapy frequently resulted in further tumour reduction. Overall response to treatment was partial in 11 nodules, minor response in 4 nodules, and disease was stable in 12 and progressive in 5. Significant response was associated with pretherapeutic nodule volume up to 150 ml (diameter of 6.6 cm). Survival rate after 3, 6, 9, 12, 24 and 36 months was 78, 61, 50, 39, 17, and 6%. Matched-pairs analysis of survival revealed 131I-lipiodol to be superior to medical treatment. The most important side effect was a pancreatitis-like syndrome whereas overall tolerance was good. Conclusion: The long term results confirm that HCC therapy with 131I-lipiodol is effective and probably superior to medical treatment. Tumour nodules of up to 6 cm diameter are well suited for this therapy even in the presence of portal vein thrombosis.
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Thomas L, Balmus C, Ahmadzadehfar H, Essler M, Strunk H, Bundschuh RA. Assessment of Bone Metastases in Patients with Prostate Cancer-A Comparison between 99mTc-Bone-Scintigraphy and [ 68Ga]Ga-PSMA PET/CT. Pharmaceuticals (Basel) 2017; 10:ph10030068. [PMID: 28758969 PMCID: PMC5620612 DOI: 10.3390/ph10030068] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 07/13/2017] [Accepted: 07/25/2017] [Indexed: 11/16/2022] Open
Abstract
Purpose: Bone scintigraphy is the standard of reference in bone metastases in prostate cancer patients. However, new radiotracers employed in prostate-specific membrane antigen (PSMA)-ligands has led to the growing importance of PET/CT as diagnostic tool. The aim of our study was to investigate the difference between bone scan and PSMA-PET/CT for the detection of bone metastases in prostate cancer. Methods: Thirty patients with bone metastases originating from prostate cancer were examined by 99mTc-MDP bone scan and 68Ga-PSMA-PET/CT within an average of 21 days. Bone scans were analyzed visually according to the number of lesions and using the software package ExiniBONE by Exini Diagnostics. PET/CT data was analyzed visually. Numbers of detected lesions were compared for the different methods for the whole patient and for different regions. In addition, results were compared to serum prostate-specific antigen (PSA), alkaline phosphatase (ALP), bone alkaline phosphatase (bALP), pro gastrin releasing peptide (pGRP) and eastern cooperative oncology group (ECOG) performance status. Results: In the bone scans, visual and semiautomatic lesion detection showed similar results with an average of 19.4 and 17.8 detected bone lesion per patient. However, in PSMA-PET/CT, on average double the numbers of lesions (40.0) were detected. The largest differences were found in the thorax and pelvis, which can be explained by the advantages of tomographic imaging. Bland-Altman analysis showed greater differences in patients with large numbers of bone metastases. Conclusion: No significant difference was found when using semiautomatic analysis compared to visual reading for bone scans. Fewer bone metastases were detected in bone scans than in PSMA-PET/CT. However, in none of our patients would the difference have led to clinical consequences. Therefore, it seems that for patients undergoing PSMA-PET/CT, there is no need to perform additional bone scans if the appropriate PET/CT protocols are applied.
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Affiliation(s)
- Lena Thomas
- Klinik und Poliklinik für Nuklearmedizin, Universitätsklinikum Bonn, Bonn D-53127, Germany.
| | - Caroline Balmus
- Klinik und Poliklinik für Nuklearmedizin, Universitätsklinikum Bonn, Bonn D-53127, Germany.
| | - Hojjat Ahmadzadehfar
- Klinik und Poliklinik für Nuklearmedizin, Universitätsklinikum Bonn, Bonn D-53127, Germany.
| | - Markus Essler
- Klinik und Poliklinik für Nuklearmedizin, Universitätsklinikum Bonn, Bonn D-53127, Germany.
| | - Holger Strunk
- Radiologische Klinik, Universitätsklinikum Bonn, Bonn D-53012, Germany.
| | - Ralph A Bundschuh
- Klinik und Poliklinik für Nuklearmedizin, Universitätsklinikum Bonn, Bonn D-53127, Germany.
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Rauch M, Marinova M, Schild HH, Strunk H. Cardiovascular Computed Tomography Findings after Pneumonectomy: Comparison to Lobectomy. Acad Radiol 2017; 24:860-866. [PMID: 28242102 DOI: 10.1016/j.acra.2017.01.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Revised: 01/26/2017] [Accepted: 01/27/2017] [Indexed: 12/20/2022]
Abstract
RATIONALE AND OBJECTIVES To identify and compare cardiovascular findings on computed tomography (CT) scans after pneumonectomy (PNX) with those after lobectomy (LOBX). MATERIALS AND METHODS Pre- and postoperative CT scans from 25 PNX patients were retrospectively analyzed and compared to those from 30 LOBX patients. The diameter of the main pulmonary artery (PA) and its ratio to the ascending aorta (PA/Ao) were determined. Cardiac morphometry values were ascertained by measuring maximum diameters of the right and left ventricle on axial (RVaxial, LVaxial) and four-chamber (RV4-ch, LV4-ch) views. RVaxial/LVaxial and RV4-ch/LV4-ch ratios were calculated. Vessel stumps were evaluated for thrombosis. RESULTS After PNX, PA (31.1 ± 5.8 mm vs 28.7 ± 5.4 mm, P = 0.003), PA/Ao (0.97 ± 0.15 vs 0.86 ± 0.12, P = 0.0001), and cardiac morphometry values significantly increased (RVaxial 43.6 ± 7.4 vs 39.4 ± 7.1, P = 0.029; RV4-ch 41.1 ± 6.3 vs 37.6 ± 5.7, P = 0.041; RVaxial/LVaxial 1.18 ± 0.27 vs 1.03 ± 0.22, P = 0.04; RV4-ch/LV4-ch 1.17 ± 0.21 vs 1.02 ± 0.16, P = 0.03). There were no significant differences between right and left PNX. One case of PA stump thrombosis was identified after right PNX. LOBX resulted in a significant increase in PA (30.6 ± 4.3 vs 28.7 ± 3.5, P = 0.005) and PA/Ao (0.90 ± 0.09 vs 0.85 ± 0.10, P = 0.017), whereas cardiac morphometry values were not significantly changed compared to baseline values. No vessel stump thrombosis was observed after LOBX. In comparison to LOBX, all ascertained values were significantly elevated after PNX. CONCLUSIONS Morphologic alterations of the cardiovascular system following PNX can be identified on CT scans. Alterations are more distinct after PNX compared to LOBX.
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Affiliation(s)
- Maximilian Rauch
- Department of Radiology, University Hospital Bonn, Sigmund-Freud-Strasse 25, 53105 Bonn, Germany.
| | - Milka Marinova
- Department of Radiology, University Hospital Bonn, Sigmund-Freud-Strasse 25, 53105 Bonn, Germany
| | - Hans Heinz Schild
- Department of Radiology, University Hospital Bonn, Sigmund-Freud-Strasse 25, 53105 Bonn, Germany
| | - Holger Strunk
- Department of Radiology, University Hospital Bonn, Sigmund-Freud-Strasse 25, 53105 Bonn, Germany
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Ahmadzadehfar H, Azgomi K, Hauser S, Wei X, Yordanova A, Gaertner FC, Kürpig S, Strunk H, Essler M. 68Ga-PSMA-11 PET as a Gatekeeper for the Treatment of Metastatic Prostate Cancer with 223Ra: Proof of Concept. J Nucl Med 2016; 58:438-444. [PMID: 27660148 DOI: 10.2967/jnumed.116.178533] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [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: 05/19/2016] [Accepted: 08/29/2016] [Indexed: 12/20/2022] Open
Abstract
We retrospectively evaluated the utility of 68Ga-PSMA-11 PET for planning 223RaCl2 therapy of patients with metastatic prostate cancer and its impact on the therapeutic response as determined by prostate-specific antigen (PSA) and alkaline phosphatase (ALP), as well as the correlation of PSA changes with the results of prostate-specific membrane antigen (PSMA) PET follow-up scans. Methods: Sixty-three patients with a median age of 73 y who underwent 307 cycles of therapy with 223RaCl2 were analyzed. In 31 patients, bone scanning and radiologic imaging were performed for pretherapeutic imaging (group 1). In 32 patients, bone scanning and PSMA PET were performed before therapy (group 2). Patients with small lymph node metastases and local recurrence were not excluded from treatment, consistent with current guidelines. PSA and ALP were measured before each treatment cycle and 4 wk after the final cycle. Thirteen patients from group 2, who underwent a second PSMA PET scan as a follow-up, were evaluated to determine the significance of PSA changes as a follow-up marker. Results: In group 1, 4 patients (12.9%) showed a PSA decline, of whom 2 patients and 1 patient showed a PSA decline of more than 30% and more than 50%, respectively. In contrast, in group 2, 14 patients (43.8%) showed a PSA decline, of whom 10 and 8 patients showed a decline of more than 30% and more than 50%, respectively (P = 0.007). Thirty-seven patients had a high ALP level (19 from group 1 and 18 from group 2). Twelve (63.2%) and 16 (88.9%) patients in groups 1 and 2, respectively, showed an ALP decline. This difference was not significant; however, 7 (36%) and 13 (72.2%) patients in groups 1 and 2, respectively, showed an ALP decline of more than 30% (P = 0.04). Considering any ALP decline as a response, no patient with increasing ALP showed a PSA response (P = 0.036). There was a significant correlation between the PSA changes and the therapeutic response according to follow-up PSMA PET. Conclusion: When PSMA PET is used as the gatekeeper in addition to bone scanning, radionuclide therapy with 223Ra may be more effective and have more success regarding changes in the PSA. An increase in PSA during therapy cycles occurs because of disease progression.
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Affiliation(s)
| | - Kambiz Azgomi
- Department of Nuclear Medicine, University Hospital Bonn, Bonn, Germany
| | - Stefan Hauser
- Department of Urology, University Hospital Bonn, Bonn, Germany; and
| | - Xiao Wei
- Department of Nuclear Medicine, University Hospital Bonn, Bonn, Germany
| | - Anna Yordanova
- Department of Nuclear Medicine, University Hospital Bonn, Bonn, Germany
| | | | - Stefan Kürpig
- Department of Nuclear Medicine, University Hospital Bonn, Bonn, Germany
| | - Holger Strunk
- Department of Diagnostic Radiology, University Hospital Bonn, Bonn, Germany
| | - Markus Essler
- Department of Nuclear Medicine, University Hospital Bonn, Bonn, Germany
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Kramer L, Phiesel K, Strunk H. 60-jähriger Mann mit Husten und Dyspnoe nach Grippeschutzimpfung. Dtsch Med Wochenschr 2015; 140:1653. [DOI: 10.1055/s-0041-108706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
| | - Kathrin Phiesel
- Medizinische Klinik und Poliklinik I – Allgemeine Innere Medizin, Universitätsklinikum Bonn
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Affiliation(s)
- Maximilian Rauch
- University Hospital Bonn, Department of Radiology, Bonn, Germany.
| | - Milka Marinova
- University Hospital Bonn, Department of Radiology, Bonn, Germany
| | | | - Holger Strunk
- University Hospital Bonn, Department of Radiology, Bonn, Germany
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20
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Kramer L, Phiesel K, Strunk H. [60-year old man with progressive cough and dyspnea after seasonal flu shot]. Dtsch Med Wochenschr 2015; 140:1537. [PMID: 26445260 DOI: 10.1055/s-0041-103200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
| | - Kathrin Phiesel
- Medizinische Klinik und Poliklinik I - Allgemeine Innere Medizin, Universitätsklinikum Bonn
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Schild HH, Naehle CP, Wilhelm KE, Kuhl CK, Thomas D, Meyer C, Textor J, Strunk H, Willinek WA, Pieper CC. Lymphatic Interventions for Treatment of Chylothorax. ROFO-FORTSCHR RONTG 2015; 187:584-8. [PMID: 26090651 DOI: 10.1055/s-0034-1399438] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE To determine effectiveness of lymphatic interventional procedures for treatment of chylothorax. MATERIAL AND METHODS Analysis of interventions performed from 2001 to 2014. RESULTS In 21 patients with therapy resistant chylothorax a lymphatic radiological intervention was attempted, which could be performed in 19 cases: 17 thoracic duct embolizations (15 transabdominal, one transzervical and one retrograde transvenous procedure), 2 percutaneous destructions of lymphatic vessels, one CT-guided injection of ethanol next to a duplicated thoracic duct. Fourteen of seventeen (82.3 %) of the technically successful embolizations lead to clinical cure. This encluded three patients with prior unsuccessful surgical thoracic duct ligation. Also the injection of ethanol was clinically effective. Complications were a bile peritonitis requiring operation, and one clinical deterioration of unknown cause. CONCLUSION Interventional lymphatic procedures allow for effective treatment in many cases of chylothorax, and should be considered early during treatment. KEY POINTS • Thoracic duct embolization is an effective treatment method for chylothorax. • If embolization is impossible, percutaneous lymphatic destruction or injection of sclerosants/tissue adhesive next to the thoracic duct may be tried.
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Affiliation(s)
- H H Schild
- Department of Radiology, University Hospital, Bonn, Germany
| | - C P Naehle
- Department of Radiology, University Hospital, Bonn, Germany
| | - K E Wilhelm
- Department of Radiology, University Hospital, Bonn, Germany
| | - C K Kuhl
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Germany
| | - D Thomas
- Department of Radiology, University Hospital, Bonn, Germany
| | - C Meyer
- Department of Radiology, University Hospital, Bonn, Germany
| | - J Textor
- Department of Radiology, University Hospital, Bonn, Germany
| | - H Strunk
- Department of Radiology, University Hospital, Bonn, Germany
| | - W A Willinek
- Department of Radiology, University Hospital, Bonn, Germany
| | - C C Pieper
- Department of Radiology, University Hospital, Bonn, Germany
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Marinova M, Rauch M, Lakghomi A, Henseler J, Zhang L, Schild H, Strunk H. Nicht-invasive Tumorablation mit hoch-intensivem fokussierten Ultraschall (HIFU): erste klinische Therapieerfahrungen bei Patienten mit inoperablem Pankreaskarzinom. ROFO-FORTSCHR RONTG 2015. [DOI: 10.1055/s-0035-1551340] [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: 10/23/2022]
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Strunk H, Meier M, Schild H, Rauch M. Embolisation der Testikularvenen zur Behandlung der benignen Prostatahyperplasie – eine Zwischenbilanz. ROFO-FORTSCHR RONTG 2015. [DOI: 10.1055/s-0035-1551444] [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: 10/23/2022]
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Pieper C, Fischer S, Strunk H, Meyer C, Thomas D, Willinek W, Hauser S, Nadal J, Schild H, Wilhelm K. Perkutane CT-gesteuerte Radiofrequenz-Ablation von solitären Nierentumoren: Retrospektive Single Center Erfahrungen über 10 Jahre. ROFO-FORTSCHR RONTG 2015. [DOI: 10.1055/s-0035-1551045] [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: 10/23/2022]
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Pieper C, Fischer S, Strunk H, Meyer C, Thomas D, Willinek W, Hauser S, Nadal J, Schild H, Wilhelm K. Percutaneous CT-Guided Radiofrequency Ablation of Solitary Small Renal Masses: A Single Center Experience. ROFO-FORTSCHR RONTG 2015; 187:577-83. [DOI: 10.1055/s-0034-1399340] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- C. Pieper
- Department of Radiology, University of Bonn, Germany
| | - S. Fischer
- Department of Radiology, University of Bonn, Germany
| | - H. Strunk
- Department of Radiology, University of Bonn, Germany
| | - C. Meyer
- Department of Radiology, University of Bonn, Germany
| | - D. Thomas
- Department of Radiology, University of Bonn, Germany
| | - W. Willinek
- Department of Radiology, University of Bonn, Germany
| | - S. Hauser
- Department of Urology, University of Bonn, Germany
| | - J. Nadal
- Institute for Medical Biometry, Informatics and Epidemiology, University of Bonn, Germany
| | - H. Schild
- Department of Radiology, University of Bonn, Germany
| | - K. Wilhelm
- Department of Radiology, Johanniter GmbH, Johanniter Hospital Bonn, Germany
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Marinova M, Rauch M, Strunk H. Ultrasound-based therapies not mentioned. Dtsch Arztebl Int 2015; 112:60. [PMID: 25797427 DOI: 10.3238/arztebl.2015.0060a] [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: 11/27/2022]
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Strunk H, Meier M, Schild H, Rauch M. Treatment of Benign Prostatic Hyperplasia by Occlusion of the Impaired Urogenital Venous System – First Experience. ROFO-FORTSCHR RONTG 2014; 187:180-6. [DOI: 10.1055/s-0034-1385353] [Citation(s) in RCA: 2] [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: 10/24/2022]
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Abstract
INTRODUCTION To evaluate the feasibility of ultrasound-guided transnodal lymphangiography as an modified technique for visualization of the abdomino-thoracic lymphatic system for thoracic duct embolization in patients with chylothorax after thoracic surgery. METHODS 10 patients (six men and four women, mean age 53 y [range, 22-72 y]) with chylothorax after thoracic surgery underwent ultrasound-guided transnodal lymphangiography. An inguinal lymph node was accessed under ultrasound guidance with a 25-gauge spinal needle and lipiodol was injected. Opacification of the lymphatic system was intermittently controlled by fluoroscopy. The thoracic duct was percutaneously accessed and embolization was performed. Following mean times were assessed: for the procedure of inguinal puncture, number of inguinal punctures, time from start of lipiodol injection until inguinal lymphangiogram, volume of injected contrast media, duration of opacification of target lymphatics, number of percutaneous punctions and time for thoracic duct access, time for thoracic duct embolization and complications. Procedure times until initial lymphangiogram were compared with times of a control group (n=10) in patients who had undergone pedal lymphangiography. RESULTS The procedure of ultrasound guided lymph node puncture was successful in all cases (10 /10). Mean procedure times from inguinal access to initial lymphangiogram were 12.3 ± 2 minutes (pedal lymphangiography : 30.4 ± 5 minutes). Average of inguinal punctions was 1.3 (1-3). Small extravasation occurred in 4 of 10 patients. In 2 patients a contralateral inguinal punction was necessary because of lymphovenous shunts. In 10 /10 patients the lymphatic systems was opacified about 24.5 ± 9 minutes for thoracic duct embolization without required additional injection. Average of thoracic duct punctions were 1.5 (1-3). Procedure times until catheterization of the target lymphatics and until embolization of the thoracic duct were 19.3 ± 9 minutes and 14.5 ± 2 minutes respectively. CONCLUSION Ultrasound-guided transnodal lymphangiography is a less technically challenging technique for opacification of the abdomino-thoracal lymphatic system for subsequent thoracic duct embolization.
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Affiliation(s)
| | - H Strunk
- Radiologische Klinik, Universitätsklinikum Bonn
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Abstract
Diagnostic imaging of angiosarcoma and angiosarcoma metastasis has been described as confusing and challenging. We present a rare case of hepatic soft tissue angiosarcoma metastasis, which was diagnosed by contrast enhanced ultrasound (CEUS). The case further exemplifies the ability of CEUS to solve discrepancies between other imaging modalities.
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Affiliation(s)
| | - Hans H Schild
- Department of Radiology, University Hospital Bonn, Germany
| | - Holger Strunk
- Department of Radiology, University Hospital Bonn, Germany
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Strunk H, Delorme S. CEUS zur TU-Diagnostik: Charakterisierung und Detektion. ROFO-FORTSCHR RONTG 2014. [DOI: 10.1055/s-0034-1373432] [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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Strunk H. 3D/4D Techniken. ROFO-FORTSCHR RONTG 2014. [DOI: 10.1055/s-0034-1373444] [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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Kaschner M, Strunk H, Schild H. Bronchitis plastica mit chylösen Bronchialausgüssen. ROFO-FORTSCHR RONTG 2014; 186:963-5. [DOI: 10.1055/s-0034-1366258] [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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Ezziddin S, Wilhelm K, Fimmers R, Spengler U, Palmedo H, Strunk H, Schild HH, Biersack HJ, Risse J, Ahmadzadehfar H, Habibi E. Survival after 131I-labeled lipiodol therapy for hepatocellular carcinoma. Nuklearmedizin 2014; 53:46-53. [DOI: 10.3413/nukmed-0610-13-07] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
SummaryThis study investigated the efficacy of 131iod- ine-labeled lipiodol (1311-lipiodol) as a palliative therapy, evaluated overall survival (OS) across Barcelona Clinic Liver Cancer (BCLC) stages, and determined the main prognostic factors influencing OS in patients with hepatocellular carcinoma (HCC). Patients, methods: We retrospectively analyzed 57 (44 men; mean age, 65.7 years; mean activity per session, 1.6 GBq; mean cumulative activity in patients with >1 sessions, 3.9 GBq) HCC patients who underwent 1311-lipiodol therapy. A majority of patients exhibited Child-Pugh class B (53.6%) disease and a good Eastern Cooperative Oncology Group performance status (0-1; 72%). Multinodular disease was observed in 87.7% patients, bilobar disease in 73%, and portal vein occlusion (PVO) in 54%. Furthermore, 21.1% patients were staged as BCLC B and 59.6 % as BCLC C. All patients were followed until death. Results: The median OS was 6.4 months, which varied significantly with disease stage (median OS for BCLC A, B, C, and D was 29.4, 12.0, 4.6, and 2.7 months, respectively; p = 0.009); Child-Pugh score and class; presence of ascites, PVO, or extrahepatic disease; largest lesion size; favourable treatment response; international normalized ratio, baseline albumin and alpha-fetopro- tein levels. Patients with a Child-Pugh A liver disease had a longer OS. Conclusion: Currently, different treatment modalities for HCC include radioembolization, transarterial chemoemboliz- ation, and systemic therapy with sorafenib; however, 1311-lipiodol therapy remains a feasible alternative for patients without a favourable response to other therapies, particularly for patients with Child-Pugh A liver cirrhosis.
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Strunk H. CEUS zur TU-Diagnostik: Charakterisierung und Detektion. ROFO-FORTSCHR RONTG 2013. [DOI: 10.1055/s-0033-1346028] [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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Strunk H. Alles über Punktionstechnik und -orte: Vom Standardzugang bis zu komplexen Gefäß-Revaskularisationen. ROFO-FORTSCHR RONTG 2013. [DOI: 10.1055/s-0033-1345994] [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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Lutz P, Strunk H, Schild HH, Sauerbruch T. Transjugular intrahepatic portosystemic shunt in refractory chylothorax due to liver cirrhosis. World J Gastroenterol 2013; 19:1140-1142. [PMID: 23467463 PMCID: PMC3582004 DOI: 10.3748/wjg.v19.i7.1140] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [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: 10/20/2012] [Revised: 11/26/2012] [Accepted: 12/17/2012] [Indexed: 02/06/2023] Open
Abstract
A pleural effusion containing chylomicrons is termed chylothorax and results from leakage of lymph fluid into the pleural cavity. We report on the case of a 59-year-old woman with severe dyspnea due to a large chylothorax. She was known to have liver cirrhosis but no ascites. There was no history of trauma, cardiac function was normal and thorough diagnostic work-up did not reveal any signs of malignancy. In summary, no other etiology of the chylothorax than portal hypertension could be found. Therapy with diuretics as well as parenteral feeding failed to relieve symptoms. After a transjugular intrahepatic portosystemic shunt (TIPS) had successfully been placed, pleural effusion decreased considerably. Eight months later, TIPS revision had to be performed because of stenosis, resulting in remission from chylothorax. This case shows that even in the absence of ascites, chylothorax might be caused by portal hypertension and that TIPS can be an effective treatment option.
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Strunk H. CEUS bei Lebertumoren: Charakterisierung und Detektion. ROFO-FORTSCHR RONTG 2012. [DOI: 10.1055/s-0032-1310804] [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: 10/28/2022]
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Strunk H, Möhlenbruch M, Meyer C, Trebicka J, Streiff C, Wilhelm K, Schild H. Offenheitsraten und Überleben nach transjugulärem intrahepatischen porto-systemischen Stentshunt (TIPS): Ergebnisse eines Zentrums mit mehr als 500 mittels TIPS behandelten Patienten. ROFO-FORTSCHR RONTG 2012. [DOI: 10.1055/s-0032-1311144] [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: 10/28/2022]
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Strunk H. Ablative Therapie nicht-kolorektaler Lebermetastasen. ROFO-FORTSCHR RONTG 2012. [DOI: 10.1055/s-0032-1310767] [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: 10/28/2022]
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Kaschner MG, Meyer C, Boschewitz J, Andersson M, Ezziddin S, Ahmadzadehfar H, Strunk H, Schild H, Wilhelm K. Radioembolisation mit Yttrium-90 Mikrosphären bei Patientinnen mit hepatisch metastasiertem Mammakarzinom in hoch palliativer Situation. ROFO-FORTSCHR RONTG 2012. [DOI: 10.1055/s-0032-1311135] [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: 10/28/2022]
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Strunk H. Kontrastverstärkte Sonographie (CEUS) abdomineller Organe. ROFO-FORTSCHR RONTG 2012. [DOI: 10.1055/s-0032-1310724] [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: 10/28/2022]
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Strunk H. Kontrastmittelsonographie (CEUS): Grundlagen und Technik. ROFO-FORTSCHR RONTG 2012. [DOI: 10.1055/s-0032-1310799] [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: 10/28/2022]
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Marques N, Pingel S, Meyer C, Strunk H, Schaefer C, Verrel F, Schild H, Wilhelm K. TPEG Implantation bei infrarenalem Aortenaneurysma mittels Zenith Flex AAA Endovascular Graft: Erfahrung nach 80 Patienten. ROFO-FORTSCHR RONTG 2012. [DOI: 10.1055/s-0032-1311446] [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: 10/28/2022]
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Kaschner M, Strunk H. Thrombinembolisation eines Aneurysma spurium der Arteria lingualis nach stumpfem Halstrauma. ROFO-FORTSCHR RONTG 2011; 183:972-3. [DOI: 10.1055/s-0031-1273467] [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: 10/17/2022]
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Biecker E, Hausdörfer I, Grünhage F, Strunk H, Sauerbruch T. Critical flicker frequency as a marker of hepatic encephalopathy in patients before and after transjugular intrahepatic portosystemic shunt. Digestion 2011; 83:24-31. [PMID: 20847560 DOI: 10.1159/000288522] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2009] [Accepted: 02/10/2010] [Indexed: 02/04/2023]
Abstract
BACKGROUND Overt hepatic encephalopathy (HE) following insertion of a transjugular intrahepatic portosystemic shunt (TIPS) is a problem in some patients. In contrast to overt HE, minimal HE (MHE) following TIPS is studied to a limited degree only. We therefore evaluated the incidence of MHE in patients following TIPS insertion by determination of the critical flicker frequency (CFF). METHODS 45 cirrhotic patients (Child A/B/C: 7/24/14; Child-Pugh score 8.5 ± 2.0) underwent TIPS because of recurrent esophageal bleeding (n = 15), refractory ascites (n = 25) or a combination of bleeding and refractory ascites (n = 5). Hemodynamic parameters were recorded during TIPS insertion. CFF was determined using a portable analyzer 2 days before and 3, 28 and 84 days after TIPS. At these time points the number connection test and biochemical markers were recorded as well. RESULTS TIPS led to a reduction of the portal pressure gradient from 19.1 ± 5.9 to 9.3 ± 6.1 mm Hg together with a slight but significant increase in bilirubin from 1.5 ± 0.9 to 2.2 ± 1.9 mg/dl and in the international normalized ratio from 1.2 ± 0.3 to 1.4 ± 0.5. Creatinine decreased from 1.3 ± 0.6 to 1.1 ± 0.5 mg/dl. Pre-TIPS, 27 patients had normal CFF (>38 Hz, CFF 41.1 ± 2.4 Hz) and 18 patients had altered CFF (≤38 Hz, CFF 34.4 ± 3.0 Hz): 3 had grade I and 15 MHE. Three days post-TIPS, 3 of the 27 patients (11.1%) with normal CFF deteriorated to MHE, 1 of the patients with grade I HE deteriorated to grade II HE, 1 maintained grade I HE and the other improved. No patient with MHE deteriorated to overt HE. CONCLUSIONS Using the determination of the CFF, we were able to show that elective TIPS insertion in patients with preserved liver function causes a MHE in only the minority of patients. In addition, patients with preexisting MHE did not deteriorate to overt HE.
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Affiliation(s)
- Erwin Biecker
- Department of Internal Medicine I, University Hospital of Bonn, Bonn, Germany.
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Sabet A, Strunk H, Ahmadzadehfar H, Welz A, Biersack HJ, Ezziddin S. Bone erosion due to aortic prosthesis by 18F-FDG-PET/CT. Nuklearmedizin 2011; 50:N63. [PMID: 22138705] [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] [Received: 05/19/2011] [Accepted: 06/22/2011] [Indexed: 05/31/2023]
Affiliation(s)
- A Sabet
- Department of Nuclear Medicine, University Hospital, Bonn, Germany
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Sabet A, Strunk H, Ahmadzadehfar H, Welz A, Biersack HJ, Ezziddin S. Bone erosion due to aortic prosthesis by 18F-FDG-PET/CT. Nuklearmedizin 2011. [DOI: 10.1055/s-0037-1621651] [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: 10/28/2022]
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Seitz K, Bernatik T, Strobel D, Blank W, Friedrich-Rust M, Strunk H, Greis C, Kratzer W, Schuler A. Contrast-enhanced ultrasound (CEUS) for the characterization of focal liver lesions in clinical practice (DEGUM Multicenter Trial): CEUS vs. MRI--a prospective comparison in 269 patients. Ultraschall Med 2010; 31:492-499. [PMID: 20652854 DOI: 10.1055/s-0029-1245591] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
PURPOSE The aim of this prospective multicenter study was to assess the diagnostic role of CEUS in the diagnosis of newly discovered focal liver lesions in clinical practice. One important aspect is the comparison of CEUS with magnetic resonance imaging (MRI). MATERIALS AND METHODS From 05 / 2004 to 12 / 2006, standardized CEUS was performed prospectively on 1349 patients with focal liver lesions that had been newly detected by fundamental ultrasound in order to determine tumor differentiation and tumor entity. 269 patients had a standardized MRI after CEUS. In typical liver hemangioma and focal nodular hyperplasia (FNH), the definitive diagnosis was based on the MRI as the "diagnostic gold standard" and on clinical evidence and additional follow-up (subgroup A) or on histology (subgroup B). 262 patients met the diagnostic standard that had been set. RESULTS In the subcollective (n = 262), the tumor differentiation (malignant or benign) of CEUS and MRI was concordant in 225 cases (85.9%), and the assessment of tumor entity in 204 cases (77.9%). In subgroup A (n = 180), concordant results for tumor differentiation were obtained in 169 (93.2%) and for tumor entity in 160 (88.9%) cases. Liver hemangiomas (n = 122) and FNH (n = 43) were most frequent. Subgroup B (n = 82) comprised mainly malignant liver lesions (n = 55), with only a few of hemangiomas (n = 8) or FNH (n = 5). Tumor differentiation was concordant in 56 (68.3%) and tumor entity in 44 cases (53.7%). There were no statistically proven differences between CEUS and MRI. CONCLUSION CEUS and MRI are of equal value for the differentiation and specification of newly discovered liver tumors in clinical practice. CEUS and MRI are extremely reliable for the differentiation of benign and malignant lesions, the diagnosis of liver hemangiomas and FNH. The characterization of metastases and HCC is also very reliable.
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Affiliation(s)
- K Seitz
- Department of Internal Medicine, District Hospital Sigmaringen, Sigmaringen, Germany.
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Merz W, Van de Vondel P, Strunk H, Geipel A, Gembruch U. Diagnosis, treatment and application of color Doppler in conservative management of abnormally adherent placenta. Ultraschall Med 2009; 30:571-576. [PMID: 18773385 DOI: 10.1055/s-2008-1027701] [Citation(s) in RCA: 13] [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: 05/26/2023]
Abstract
PURPOSE Placenta ac-, in-, percreta is rare, but associated with high maternal morbidity. We report the results of diagnosis and management of patients with this condition at our institution. Serial color Doppler examinations were performed to investigate the pattern and duration of perfusion to abnormally adherent placenta after conservative treatment. The influence of these results on management decisions was evaluated. MATERIALS AND METHODS Women with placenta ac-, in-, percreta delivering within a three-year interval were included. Diagnosis was established by ultrasound, color Doppler, MRI, and histology specimen. B-mode ultrasound and color Doppler were applied post-operatively. RESULTS Fifteen cases of placenta ac-, in-, percreta occurred (0.29% of deliveries). 73.3% were associated with placenta previa, 66.6% had > or = 1 previous uterine surgery. Abnormal placentation was diagnosed antenatally in 5/15 cases; in these women complication rate (0/5 vs. 8/10, p = 0.12) and blood loss was significantly lower (mean 1.140 vs. 3.080 ml, p < 0.01). 8/15 women underwent Cesarean hysterectomy, 2 after embolization of uterine arteries. 7/15 women had conservative management. In 3 of these cases complete removal of the placenta was achieved; in the remaining 4 the entire (n = 2) or parts (n = 2) of the placenta were left in place, methotrexate was administered postoperatively, and close clinical and laboratory controls were performed. Serial color Doppler examinations revealed cessation of blood flow to the adherent tissue 9 - 13 weeks postoperatively, followed by complete resorption (n = 1)/expulsion (n = 1) of placental fragments. In two cases (placenta previa percreta) curettage was performed without major complications after negative blood flow. CONCLUSION The high maternal morbidity of placenta ac-, in-, percreta can be reduced with antenatal diagnosis and elective delivery. Conservative management of placenta percreta may be considered in selected cases, with embolization and/or methotrexate as an adjuvant therapy. Serial examinations of the perfusion in the retained placental tissue allow conclusions about the degree of involution and aid in determining the appropriate timing of curettage if necessary.
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Affiliation(s)
- W Merz
- Obstetrics and Prenatal Medicine, University Hospital, Bonn.
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