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Hamm CA, Baumgärtner GL, Padhani AR, Froböse KP, Dräger F, Beetz NL, Savic LJ, Posch H, Lenk J, Schallenberg S, Maxeiner A, Cash H, Günzel K, Hamm B, Asbach P, Penzkofer T. Reduction of false positives using zone-specific prostate-specific antigen density for prostate MRI-based biopsy decision strategies. Eur Radiol 2024:10.1007/s00330-024-10700-z. [PMID: 38538841 DOI: 10.1007/s00330-024-10700-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 02/19/2024] [Accepted: 02/22/2024] [Indexed: 04/18/2024]
Abstract
OBJECTIVES To develop and test zone-specific prostate-specific antigen density (sPSAD) combined with PI-RADS to guide prostate biopsy decision strategies (BDS). METHODS This retrospective study included consecutive patients, who underwent prostate MRI and biopsy (01/2012-10/2018). The whole gland and transition zone (TZ) were segmented at MRI using a retrained deep learning system (DLS; nnU-Net) to calculate PSAD and sPSAD, respectively. Additionally, sPSAD and PI-RADS were combined in a BDS, and diagnostic performances to detect Grade Group ≥ 2 (GG ≥ 2) prostate cancer were compared. Patient-based cancer detection using sPSAD was assessed by bootstrapping with 1000 repetitions and reported as area under the curve (AUC). Clinical utility of the BDS was tested in the hold-out test set using decision curve analysis. Statistics included nonparametric DeLong test for AUCs and Fisher-Yates test for remaining performance metrics. RESULTS A total of 1604 patients aged 67 (interquartile range, 61-73) with 48% GG ≥ 2 prevalence (774/1604) were evaluated. By employing DLS-based prostate and TZ volumes (DICE coefficients of 0.89 (95% confidence interval, 0.80-0.97) and 0.84 (0.70-0.99)), GG ≥ 2 detection using PSAD was inferior to sPSAD (AUC, 0.71 (0.68-0.74)/0.73 (0.70-0.76); p < 0.001). Combining PI-RADS with sPSAD, GG ≥ 2 detection specificity doubled from 18% (10-20%) to 43% (30-44%; p < 0.001) with similar sensitivity (93% (89-96%)/97% (94-99%); p = 0.052), when biopsies were taken in PI-RADS 4-5 and 3 only if sPSAD was ≥ 0.42 ng/mL/cc as compared to all PI-RADS 3-5 cases. Additionally, using the sPSAD-based BDS, false positives were reduced by 25% (123 (104-142)/165 (146-185); p < 0.001). CONCLUSION Using sPSAD to guide biopsy decisions in PI-RADS 3 lesions can reduce false positives at MRI while maintaining high sensitivity for GG ≥ 2 cancers. CLINICAL RELEVANCE STATEMENT Transition zone-specific prostate-specific antigen density can improve the accuracy of prostate cancer detection compared to MRI assessments alone, by lowering false-positive cases without significantly missing men with ISUP GG ≥ 2 cancers. KEY POINTS • Prostate biopsy decision strategies using PI-RADS at MRI are limited by a substantial proportion of false positives, not yielding grade group ≥ 2 prostate cancer. • PI-RADS combined with transition zone (TZ)-specific prostate-specific antigen density (PSAD) decreased the number of unproductive biopsies by 25% compared to PI-RADS only. • TZ-specific PSAD also improved the specificity of MRI-directed biopsies by 9% compared to the whole gland PSAD, while showing identical sensitivity.
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Affiliation(s)
- Charlie A Hamm
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
- Berlin Institute of Health (BIH), Berlin, Germany.
| | - Georg L Baumgärtner
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Anwar R Padhani
- Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, Middlesex, UK
| | - Konrad P Froböse
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Franziska Dräger
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Nick L Beetz
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
| | - Lynn J Savic
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
| | - Helena Posch
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Julian Lenk
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Simon Schallenberg
- Institute of Pathology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Andreas Maxeiner
- Department of Urology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Hannes Cash
- Department of Urology, Otto-von-Guericke-University Magdeburg, Germany and PROURO, Berlin, Germany
| | - Karsten Günzel
- Department of Urology, Vivantes Klinikum Am Urban, Berlin, Germany
| | - Bernd Hamm
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Patrick Asbach
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Tobias Penzkofer
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
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Baumgärtner GL, Hamm CA, Schulze-Weddige S, Ruppel R, Beetz NL, Rudolph M, Dräger F, Froböse KP, Posch H, Lenk J, Biessmann F, Penzkofer T. Metadata-independent classification of MRI sequences using convolutional neural networks: Successful application to prostate MRI. Eur J Radiol 2023; 166:110964. [PMID: 37453274 DOI: 10.1016/j.ejrad.2023.110964] [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: 05/03/2023] [Revised: 06/21/2023] [Accepted: 07/06/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE The ever-increasing volume of medical imaging data and interest in Big Data research brings challenges to data organization, categorization, and retrieval. Although the radiological value chain is almost entirely digital, data structuring has been widely performed pragmatically, but with insufficient naming and metadata standards for the stringent needs of image analysis. To enable automated data management independent of naming and metadata, this study focused on developing a convolutional neural network (CNN) that classifies medical images based solely on voxel data. METHOD A 3D CNN (3D-ResNet18) was trained using a dataset of 31,602 prostate MRI volumes with 10 different sequence types of 1243 patients. A five-fold cross-validation approach with patient-based splits was chosen for training and testing. Training was repeated with a gradual reduction in training data assessing classification accuracies to determine the minimum training data required for sufficient performance. The trained model and developed method were tested on three external datasets. RESULTS The model achieved an overall accuracy of 99.88 % ± 0.13 % in classifying typical prostate MRI sequence types. When being trained with approximately 10 % of the original cohort (112 patients), the CNN still achieved an accuracy of 97.43 % ± 2.10 %. In external testing the model achieved sensitivities of > 90 % for 10/15 tested sequence types. CONCLUSIONS The herein developed CNN enabled automatic and reliable sequence identification in prostate MRI. Ultimately, such CNN models for voxel-based sequence identification could substantially enhance the management of medical imaging data, improve workflow efficiency and data quality, and allow for robust clinical AI workflows.
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Affiliation(s)
- Georg L Baumgärtner
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Virchow Klinikum, Augustenburgerplatz 1, 13353 Berlin, Germany.
| | - Charlie A Hamm
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Virchow Klinikum, Augustenburgerplatz 1, 13353 Berlin, Germany; Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Straße 2, 10178 Berlin, Germany.
| | - Sophia Schulze-Weddige
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Virchow Klinikum, Augustenburgerplatz 1, 13353 Berlin, Germany.
| | - Richard Ruppel
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Virchow Klinikum, Augustenburgerplatz 1, 13353 Berlin, Germany.
| | - Nick L Beetz
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Virchow Klinikum, Augustenburgerplatz 1, 13353 Berlin, Germany.
| | - Madhuri Rudolph
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Virchow Klinikum, Augustenburgerplatz 1, 13353 Berlin, Germany.
| | - Franziska Dräger
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Virchow Klinikum, Augustenburgerplatz 1, 13353 Berlin, Germany.
| | - Konrad P Froböse
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Virchow Klinikum, Augustenburgerplatz 1, 13353 Berlin, Germany.
| | - Helena Posch
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Virchow Klinikum, Augustenburgerplatz 1, 13353 Berlin, Germany.
| | - Julian Lenk
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Virchow Klinikum, Augustenburgerplatz 1, 13353 Berlin, Germany.
| | - Felix Biessmann
- Faculty VI - Informatics and Media, Berliner Hochschule für Technik (BHT), Einstein Center Digital Future, 13353 Berlin, Germany.
| | - Tobias Penzkofer
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Virchow Klinikum, Augustenburgerplatz 1, 13353 Berlin, Germany; Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Straße 2, 10178 Berlin, Germany.
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Can E, Daum S, Lenk J, Paparoditis S, Hosse C, Elkilany A, de Bucourt M. Treatment of right hepatic artery stump bleeding after pylorus-preserving pancreaticoduodenectomy by covered stent endoprosthesis placement. Radiol Case Rep 2023; 18:1494-1497. [PMID: 36747908 PMCID: PMC9898279 DOI: 10.1016/j.radcr.2023.01.023] [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: 12/30/2022] [Accepted: 01/07/2023] [Indexed: 02/05/2023] Open
Abstract
Serious complications after pancreaticoduodenectomy include rupture of pseudoaneurysms arising from pancreatic fistula and pancreatojejunostomy leakage. We report a case of successful endovascular minimally invasive treatment using a covered stent endoprosthesis of a right hepatic artery stump bleeding following pylorus-preserving pancreaticoduodenectomy that was not suitable for coil or glue embolization due to an insufficiently short neck.
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Affiliation(s)
- Elif Can
- Department of Diagnostic and Interventional Radiology, Charité-Universitätsmedizin Berlin, Hindenburgdamm 30, 12200, Berlin, Germany
- Corresponding author.
| | - Severin Daum
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department for Medicine (Gastroenterology, Infectious Diseases, Rheumatology), Hindenburgdamm 30, 12200, Berlin, Germany
| | - Julian Lenk
- Department of Diagnostic and Interventional Radiology, Charité-Universitätsmedizin Berlin, Hindenburgdamm 30, 12200, Berlin, Germany
| | - Sophia Paparoditis
- Department of Diagnostic and Interventional Radiology, Charité-Universitätsmedizin Berlin, Hindenburgdamm 30, 12200, Berlin, Germany
| | - Clarissa Hosse
- Department of Diagnostic and Interventional Radiology, Charité-Universitätsmedizin Berlin, Hindenburgdamm 30, 12200, Berlin, Germany
| | - Aboelyazid Elkilany
- Department of Diagnostic and Interventional Radiology, Charité-Universitätsmedizin Berlin, Hindenburgdamm 30, 12200, Berlin, Germany
| | - Maximilian de Bucourt
- Department of Diagnostic and Interventional Radiology, Charité-Universitätsmedizin Berlin, Hindenburgdamm 30, 12200, Berlin, Germany
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Luedemann WM, Zickler D, Kruse J, Koerner R, Lenk J, Erxleben C, Torsello GF, Fehrenbach U, Jonczyk M, Guenther RW, De Bucourt M, Gebauer B. Percutaneous Large-Bore Pulmonary Thrombectomy with the FlowTriever Device: Initial Experience in Intermediate-High and High-Risk Patients. Cardiovasc Intervent Radiol 2023; 46:35-42. [PMID: 36175655 PMCID: PMC9521880 DOI: 10.1007/s00270-022-03266-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 08/23/2022] [Indexed: 01/06/2023]
Abstract
OBJECTIVES This retrospective cohort study investigates outcomes of patients with intermediate-high and high-risk pulmonary embolism (PE) who were treated with transfemoral mechanical thrombectomy (MT) using the large-bore Inari FlowTriever aspiration catheter system. MATERIAL AND METHODS Twenty-seven patients (mean age 56.1 ± 15.3 years) treated with MT for PE between 04/2021 and 11/2021 were reviewed. Risk stratification was performed according to European Society of Cardiology (ESC) guidelines. Clinical and hemodynamic characteristics before and after the procedure were compared with the paired Student's t test, and duration of hospital stay was analyzed with the Kaplan-Meier estimator. Procedure-related adverse advents were assessed. RESULTS Of 27 patients treated, 18 were classified as high risk. Mean right-to-left ventricular ratio on baseline CT was 1.7 ± 0.6. After MT, a statistically significant reduction in mean pulmonary artery pressures from 35.9 ± 9.6 to 26.1 ± 9.0 mmHg (p = 0.002) and heart rates from 109.4 ± 22.5 to 82.8 ± 13.8 beats per minute (p < 0.001) was achieved. Two patients died of prolonged cardiogenic shock. Three patients died of post-interventional complications of which a paradoxical embolism can be considered related to MT. One patient needed short cardiopulmonary resuscitation during the procedure due to clot displacement. Patients with PE as primary driver of clinical instability had a median intensive care unit (ICU) stay of 2 days (0.5-3.5 days). Patients who developed PE as a complication of an underlying medical condition spent 11 days (9.5-12.5 days) in the ICU. CONCLUSION In this small study population of predominantly high-risk PE patients, large-bore MT without adjunctive thrombolysis was feasible with an acceptable procedure-related complication rate.
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Affiliation(s)
- W. M. Luedemann
- grid.6363.00000 0001 2218 4662Department of Diagnostic and Interventional Radiology, Charité Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - D. Zickler
- grid.6363.00000 0001 2218 4662Department of Diagnostic and Interventional Radiology, Charité Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany ,grid.6363.00000 0001 2218 4662Department of Nephrology and Medical Intensive Care, Charité Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - J. Kruse
- grid.6363.00000 0001 2218 4662Department of Diagnostic and Interventional Radiology, Charité Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany ,grid.6363.00000 0001 2218 4662Department of Nephrology and Medical Intensive Care, Charité Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - R. Koerner
- grid.6363.00000 0001 2218 4662Department of Diagnostic and Interventional Radiology, Charité Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany ,grid.6363.00000 0001 2218 4662Department of Nephrology and Medical Intensive Care, Charité Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - J. Lenk
- grid.6363.00000 0001 2218 4662Department of Diagnostic and Interventional Radiology, Charité Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - C. Erxleben
- grid.6363.00000 0001 2218 4662Department of Diagnostic and Interventional Radiology, Charité Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - G. F. Torsello
- grid.6363.00000 0001 2218 4662Department of Diagnostic and Interventional Radiology, Charité Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - U. Fehrenbach
- grid.6363.00000 0001 2218 4662Department of Diagnostic and Interventional Radiology, Charité Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - M. Jonczyk
- grid.6363.00000 0001 2218 4662Department of Diagnostic and Interventional Radiology, Charité Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - R. W. Guenther
- grid.6363.00000 0001 2218 4662Department of Diagnostic and Interventional Radiology, Charité Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - M. De Bucourt
- grid.6363.00000 0001 2218 4662Department of Diagnostic and Interventional Radiology, Charité Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - B. Gebauer
- grid.6363.00000 0001 2218 4662Department of Diagnostic and Interventional Radiology, Charité Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
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Auer J, Braun J, Lenk J, Gollrad J, Ro SR, Hamm B, de Bucourt M. Tunneled hemodialysis catheter insertion: Above, within, or below the right atrium-Where is the tip? Acta Radiol Open 2022; 11:20584601221122421. [PMID: 36134126 PMCID: PMC9483979 DOI: 10.1177/20584601221122421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 08/05/2022] [Indexed: 11/21/2022] Open
Abstract
Background One major challenge when inserting a tunneled, cuffed central venous catheter (CVC) for hemodialysis under fluoroscopy is to accurately place the catheter tip by assessing its position in relation to the cardiac silhouette to approximate the right atrium (RA). Purpose To investigate whether a weighted mean calculated from published results for two two-dimensional landmark reference distances may be useful in assessing CVC tip positions in relation to the RA. Material and Methods Central venous catheter tip positions attained under fluoroscopic imaging during insertion using the cardiac silhouette as approximation were retrospectively related to two reference distances (carina to cranial RA border and craniocaudal RA extent), which were used to group catheter tip locations above (1), within (2), or below (3) the RA (henceforth referred to as landmark technique approximation, LTA). The LTA-derived catheter tip locations were validated by correlation with postinterventional computed tomography (CT) datasets acquired shortly after implantation (if available). Results Based on LTA, 45 catheter tips (10.6%) were above, 179 (42.2%) within, and 200 (47.2%) below the RA. Postinterventional CT (n = 57; 13.4%) visualized 26.3% above, 66.7% within, and 7.0% below the RA. Conclusion The LTA reference distances appear to lead to a rather low categorization of the CVC tips, or the tips have been placed rather low in the study population. Validation using postinterventional CT indicated an underestimation of the RA in the LTA. Patient characteristics with a higher risk of false estimation through LTA have been defined.
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Affiliation(s)
- Jonas Auer
- Department of Radiology, Charité - University
Medicine, Berlin, Germany
- Jonas Auer, Department of Radiology,
Charité – University Medicine, Hindenburgdamm 30, Berlin 12203 Berlin.
| | - Joachim Braun
- Department of Radiology, Charité - University
Medicine, Berlin, Germany
| | - Julian Lenk
- Department of Radiology, Charité - University
Medicine, Berlin, Germany
| | - Johannes Gollrad
- Department of Radiation Oncology
and Radiotherapy, Charité - University
Medicine, Berlin, Germany
| | - Sa-Ra Ro
- Department of Radiology, Charité - University
Medicine, Berlin, Germany
| | - Bernd Hamm
- Department of Radiology, Charité - University
Medicine, Berlin, Germany
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Lee CH, Taupitz M, Asbach P, Lenk J, Haas M. Clinical utility of combined T2-weighted imaging and T2-mapping in the detection of prostate cancer: a multi-observer study. Quant Imaging Med Surg 2020; 10:1811-1822. [PMID: 32879859 DOI: 10.21037/qims-20-222] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background To evaluate the clinical utility of combined T2-weighted imaging and T2-mapping for the detection of prostate cancer. Methods Forty patients underwent multiparametric magnetic resonance imaging (mpMRI) and T2-mapping of the prostate. Three readers each reviewed two sets of images: T2-weighted fast spin-echo (FSE) sequence (standard T2), and standard T2 in combination with T2-mapping. Each reader assigned probability scores for malignancy to each zone [peripheral zone (PZ) or transition zone (TZ)]. Inter-observer variability for standard T2 and combined standard T2 with T2-mapping were assessed. Diagnostic accuracy was compared between standard T2 and combined standard T2 with T2-mapping. Results There was fair agreement between all three readers for standard T2 [intraclass correlation coefficient (ICC) =0.56] and combined standard T2 with T2-mapping (ICC =0.58). There was no significant difference in the area under the receiver operator characteristics curve for standard T2 compared to combined standard T2 with T2-mapping (0.89 vs. 0.82, P=0.31). Sensitivity (Sn) for combined standard T2 with T2-mapping was significantly higher compared to standard T2 alone (73.0% vs. 49.2%, P=0.006). Specificity (Sp) for combined standard T2 with T2-mapping was borderline significantly lower compared to standard T2 alone (89.3% vs. 94.9%, P=0.05). There was no significant differences between the negative predictive values (NPVs) and positive predictive values (PPVs) (P=0.07, P=0.45). Conclusions Combination of T2-weighted imaging and T2-mapping could potentially increase Sn for prostate malignancy compared to T2-weighted imaging alone.
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Affiliation(s)
- Chau Hung Lee
- Department of Radiology, Charite-Universitätsmedizin Berlin, Campus Benjamin Franklin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Department of Radiology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Matthias Taupitz
- Department of Radiology, Charite-Universitätsmedizin Berlin, Campus Benjamin Franklin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Patrick Asbach
- Department of Radiology, Charite-Universitätsmedizin Berlin, Campus Benjamin Franklin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Julian Lenk
- Department of Radiology, Charite-Universitätsmedizin Berlin, Campus Benjamin Franklin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Matthias Haas
- Department of Radiology, Charite-Universitätsmedizin Berlin, Campus Benjamin Franklin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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Mahjoub S, Baur ADJ, Lenk J, Lee CH, Hartenstein A, Rudolph MM, Cash H, Hamm B, Asbach P, Haas M, Penzkofer T. Optimizing size thresholds for detection of clinically significant prostate cancer on MRI: Peripheral zone cancers are smaller and more predictable than transition zone tumors. Eur J Radiol 2020; 129:109071. [PMID: 32531720 DOI: 10.1016/j.ejrad.2020.109071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 05/08/2020] [Accepted: 05/10/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE To evaluate if size-based cut-offs based on MR imaging can successfully assess clinically significant prostate cancer (csPCA). The goal was to improve the currently applied size-based differentiation criterion in PI-RADS. METHODS AND MATERIALS MRIs of 293 patients who had undergone 3 T MR imaging with subsequent confirmation of prostate cancer on systematic and targeted MRI/TRUS-fusion biopsy were re-read by three radiologists. All identifiable tumors were measured on T2WI for lesions originating in the transition zone (TZ) and on DWI for lesions from the peripheral zone (PZ) and tabulated against their Gleason grade. RESULTS 309 lesions were analyzed, 213 (68.9 %) in the PZ and 96 (31.1 %) in the TZ. ROC-Analysis showed a stronger correlation between lesion size and clinically significant (defined as Gleason Grade Group ≥ 2) prostate cancer (PCa) for the PZ (AUC = 0.73) compared to the TZ (AUC = 0.63). The calculated Youden index resulted in size cut-offs of 14 mm for PZ and 21 mm for TZ tumors. CONCLUSION Size cut-offs can be used to stratify prostate cancer with different optimal size thresholds in the peripheral zone and transition zone. There was a clearer separation of clinically significant tumors in peripheral zone cancers compared to transition zone cancers. Future iterations of PI-RADS could therefore take different size-based cut-offs for peripheral zone and transition zone cancers into account.
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Affiliation(s)
- Samy Mahjoub
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany; Department of Urology, Cologne University Hospital, Cologne, Germany.
| | - Alexander D J Baur
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Julian Lenk
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Chau Hung Lee
- Department of Radiology, Tan Tock Seng Hospital, Singapore
| | - Alexander Hartenstein
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Madhuri M Rudolph
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Hannes Cash
- Department of Urology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Bernd Hamm
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Patrick Asbach
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Matthias Haas
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Tobias Penzkofer
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany; Berlin Institute of Health (BIH), Anna-Louisa-Karsch 2, 10178 Berlin, Germany.
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Elsholtz FHJ, Ro SR, Shnayien S, Erxleben C, Bauknecht HC, Lenk J, Schaafs LA, Hamm B, Niehues SM. Inter- and Intrareader Agreement of NI-RADS in the Interpretation of Surveillance Contrast-Enhanced CT after Treatment of Oral Cavity and Oropharyngeal Squamous Cell Carcinoma. AJNR Am J Neuroradiol 2020; 41:859-865. [PMID: 32327436 DOI: 10.3174/ajnr.a6529] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 03/08/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND PURPOSE The Neck Imaging Reporting and Data System was introduced to assess the probability of recurrence in surveillance imaging after treatment of head and neck cancer. This study investigated inter- and intrareader agreement in interpreting contrast-enhanced CT after treatment of oral cavity and oropharyngeal squamous cell carcinoma. MATERIALS AND METHODS This retrospective study analyzed CT datasets of 101 patients. Four radiologists provided the Neck Imaging Reporting and Data System reports for the primary site and neck (cervical lymph nodes). The Kendall's coefficient of concordance (W), Fleiss κ (κF), the Kendall's rank correlation coefficient (τB), and weighted κ statistics (κw) were calculated to assess inter- and intrareader agreement. RESULTS Overall, interreader agreement was strong or moderate for both the primary site (W = 0.74, κF = 0.48) and the neck (W = 0.80, κF = 0.50), depending on the statistics applied. Interreader agreement was higher in patients with proved recurrence at the primary site (W = 0.96 versus 0.56, κF = 0.65 versus 0.30) or in the neck (W = 0.78 versus 0.56, κF = 0.41 versus 0.29). Intrareader agreement was moderate to strong or almost perfect at the primary site (range τB = 0.67-0.82, κw = 0.85-0.96) and strong or almost perfect in the neck (range τB = 0.76-0.86, κw = 0.89-0.95). CONCLUSIONS The Neck Imaging Reporting and Data System used for surveillance contrast-enhanced CT after treatment of oral cavity and oropharyngeal squamous cell carcinoma provides acceptable score reproducibility with limitations in patients with posttherapeutic changes but no cancer recurrence.
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Affiliation(s)
- F H J Elsholtz
- From the Institute of Radiology (F.H.J.E., S.-R.R., S.S., C.E., J.L., L.-A.S., B.H., S.M.N.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - S-R Ro
- From the Institute of Radiology (F.H.J.E., S.-R.R., S.S., C.E., J.L., L.-A.S., B.H., S.M.N.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - S Shnayien
- From the Institute of Radiology (F.H.J.E., S.-R.R., S.S., C.E., J.L., L.-A.S., B.H., S.M.N.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - C Erxleben
- From the Institute of Radiology (F.H.J.E., S.-R.R., S.S., C.E., J.L., L.-A.S., B.H., S.M.N.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - H-C Bauknecht
- Institute of Neuroradiology (H.-C.B.), Charité -Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Campus Virchow Klinikum, Berlin, Germany
| | - J Lenk
- From the Institute of Radiology (F.H.J.E., S.-R.R., S.S., C.E., J.L., L.-A.S., B.H., S.M.N.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - L-A Schaafs
- From the Institute of Radiology (F.H.J.E., S.-R.R., S.S., C.E., J.L., L.-A.S., B.H., S.M.N.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - B Hamm
- From the Institute of Radiology (F.H.J.E., S.-R.R., S.S., C.E., J.L., L.-A.S., B.H., S.M.N.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - S M Niehues
- From the Institute of Radiology (F.H.J.E., S.-R.R., S.S., C.E., J.L., L.-A.S., B.H., S.M.N.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Campus Benjamin Franklin, Berlin, Germany
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Lenk J, Matthé E, Ventzke S, Pillunat LE, Sandner D. [Initial Clinical Experiences Using Ocriplasmin for the Treatment of Vitreomacular Traction with or without a Macular Hole]. Klin Monbl Augenheilkd 2017; 235:73-80. [PMID: 28282697 DOI: 10.1055/s-0042-124511] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE In vitreomacular traction (VMT), there is abnormal adhesion between the vitreous cortex and the retina, especially in the fovea. Symptoms of VMT include metamorphopsia and a decrease in visual acuity. Since 2013, ocriplasmin (Jetrea®) has been approved for treatment of symptomatic vitreomacular traction with or without macular holes (≤ 400 µm). METHODS We retrospectively examined twenty-three eyes of twenty-one patients who underwent intravitreal ocriplasmin treatment for symptomatic vitreomacular traction with or without macular holes. Best corrected visual acuity and central retinal thickness (CRT) were measured in advance and after ocriplasmin treatment. The numbers of resolved vitreomacular traction and closed macular holes were documented. RESULTS Vitreomacular traction was resolved in eight of twenty-three eyes (34.8 %); in fifteen eyes (65.2 %) it was persistent and two of four macular holes were found closed. The average best corrected visual acuity was 0.39 ± 0.25 logMAR at baseline and 0.41 ± 0.24 logMAR at the first follow-up visit after injection (p = 0.613). The average CRT was 453.3 ± 172.7 µm at baseline, with a slight decrease to 412.0 ± 212 µm (p = 0.124). CONCLUSION Intravitreal injection of ocriplasmin appears is an experimental therapy in patients with symptomatic vitreomacular traction. Patient selection seems to be critically important for the therapeutic outcome, whereas greater age, specific VMT morphology and missing chromatopsia seem to be negative predictors.
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Affiliation(s)
- J Lenk
- Augenklinik, Universitätsklinikum Carl Gustav Carus, TU Dresden
| | - E Matthé
- Augenklinik, Universitätsklinikum Carl Gustav Carus, TU Dresden
| | - S Ventzke
- Augenklinik, Universitätsklinikum Carl Gustav Carus, TU Dresden
| | - L E Pillunat
- Augenklinik, Universitätsklinikum Carl Gustav Carus, TU Dresden
| | - D Sandner
- Augenklinik, Universitätsklinikum Carl Gustav Carus, TU Dresden
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Lenk J, Hermann C, Matthé E, Pillunat LE, Sandner D. [Methotrexate in Atypical Non-Arteritic Ischemic Optic Neuropathy]. Klin Monbl Augenheilkd 2016; 234:924-929. [PMID: 27508886 DOI: 10.1055/s-0042-107948] [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: 10/21/2022]
Abstract
Background: Optic nerve disease can occur from a variety of different causes, with vascular, inflammatory or toxic pathologies. In such cases, it is hardly possible to clarify the aetiology. These diseases of the optic nerve are usually accompanied by progressive loss of visual field and visual impairment. Patient: We report a case of a 74-year-old woman complaining of loss of visual acuity, visual and blurred vision in the left eye in 2010. We made the diagnosis of non-arteritic ischemic optic neuropathy (NAION). With steroid therapy, there was an improvement in both visual acuity and visual field defects. But if an attempt was made to reduce steroids, her condition progressed. Except for a very small optic disk and arterial hypotension, there were no typical risk factors for NAION. We started treatment with methotrexate (MTX), with a starting dose of 10 mg per week, and observed the patient over two years. Results: Using MTX therapy, the swelling of the optic nerve head and visual field loss were reversible, so we increased the dose of MTX up to 15 mg/week. Steroid therapy could be stopped and the patient's visual acuity and visual field have now been stable for two years. There was no visible pallor in the optic nerve head, as normally occurs after AION, so we considered different underlying pathologies, including autoimmune disease. There were no adverse events with MTX therapy. Conclusion: If the course of the disease is atypical, the pathology may include an autoimmune component. Immunosuppressive MTX therapy may be started in order to avoid long-term steroid use. It may then be possible to maintain a stable visual field and prevent remitting episodes.
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Affiliation(s)
- J Lenk
- Augenklinik, Universitätsklinikum Carl Gustav Carus, TU Dresden
| | - C Hermann
- Augenklinik, Universitätsklinikum Carl Gustav Carus, TU Dresden
| | - E Matthé
- Augenklinik, Universitätsklinikum Carl Gustav Carus, TU Dresden
| | - L E Pillunat
- Augenklinik, Universitätsklinikum Carl Gustav Carus, TU Dresden
| | - D Sandner
- Augenklinik, Universitätsklinikum Carl Gustav Carus, TU Dresden
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Schaafs LA, Lenk J, Hamm B, Niehues SM. Reducing the dose of CT of the paranasal sinuses: potential of an iterative reconstruction algorithm. Dentomaxillofac Radiol 2016; 45:20160127. [PMID: 27351346 DOI: 10.1259/dmfr.20160127] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [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: 11/05/2022] Open
Abstract
OBJECTIVE To evaluate the feasibility and image quality of low-dose CT of the paranasal sinuses using iterative reconstruction with adaptive-iterative dose reduction in three dimensions (AIDR 3D) in comparison with conventional image protocols of older scanner generations. METHODS Sinus CT scans of 136 patients were assessed retrospectively. Patients underwent CT either with low-dose settings (Protocol A: 80 kV, 30 mA s; Protocol B: 120 kV, 15 mA s or C: 80 kV, 90 mA s) reconstructed using AIDR 3D (Protocols A and B) or filtered back projection (FBP) (Protocol C) or with standard dose (Protocol D: 120 kV, 80 mA s) and FBP. Image quality was assessed in consensus by two blinded readers scoring the diagnostic image quality (from 1 = excellent to 5 = non-diagnostic) and conspicuity of important anatomic landmarks (from 0 = not visible to 2 = completely visible; maximum score of 16 points) as well as osseous structures (maximum score of 12 points). Dose-length product, effective dose (ED), CT dose index and scan length were retrieved for each scan and compared. RESULTS Mean ED could be lowered by 82% when using Protocol A. The best image quality was found using Protocol B (mean score = 2.1 ± 0.51). Conspicuity of relevant anatomic landmarks was best with Protocol A (mean score = 11.97 ± 1.88). Protocol B provided the highest conspicuity of osseous structures (mean score = 8.27 ± 1.58). Image noise was highest in images obtained using Protocol A. CONCLUSIONS AIDR 3D allows a significant dose reduction while maintaining a good diagnostic image quality and conspicuity of relevant anatomic structures.
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Affiliation(s)
- Lars-Arne Schaafs
- Department of Radiology, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Julian Lenk
- Department of Radiology, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Bernd Hamm
- Department of Radiology, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Stefan Markus Niehues
- Department of Radiology, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Lenk J, Matthé E, Pillunat LE, Sandner D. [Effectiveness of Intravitreal Aflibercept Injections in Patients who had Received 10 and More Ranibizumab Injections in Advance]. Klin Monbl Augenheilkd 2015; 232:284-9. [PMID: 26562136 DOI: 10.1055/s-0041-107001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Since 2007, the standard treatment for age related macular degeneration has been intravitreal injection of ranibizumab. However, despite continuous treatment, some patients fail to achieve remission or stabilisation of the disease. Since 2012, the recombinant fusion protein aflibercept has been available as an alternative treatment. In this study, we investigated whether patients who appear to be resistant to ranibizumab would benefit from treatment with aflibercept. METHODOLOGY This retrospective study covered 83 eyes of 81 patients, for whom treatment switch from ranibizumab to aflibercept was indicated. Inclusion criteria were an age ≥ 50 years and at least 10 ranibizumab injections before a switch to aflibercept. Patients with severely impaired visual acuity were excluded. Primary outcomes were improvement or loss of visual acuity (VA) and evaluation of central macular thickness (CMT) via SD-OCT. Secondary endpoints were percentage of eyes without activity of the choroidal neovascular membrane after aflibercept injections and loss or gain of letters on the visual chart. Statistical analysis was performed using SPSS. RESULTS VA was 0.83 ± 0.34 logMAR before the first aflibercept injection, with a slight but not statistically significant improvement up to 0.79 ± 0.33 logMAR after the third aflibercept injection (p = 0.205). On the other hand, there was a clear reduction of CMT in OCT, from 451.4 ± 263.0 to 288.2 ± 128.2 µm (p = 0.0001). Overall, 73 % of eyes exhibited better or stable VA and 27 % of eyes lost VA. Interestingly, eyes with worse initial VA gained greater benefit from the switch to aflibercept (p = 0.001). CONCLUSION A switch to aflibercept may lead to stabilisation of choroidal neovascularisation and thus stabilise the visual acuity for patients who appear to be no longer responsive to treatment with ranibizumab.
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Affiliation(s)
- J Lenk
- Augenklinik, Universitätsklinikum Carl Gustav Carus, TU Dresden
| | - E Matthé
- Augenklinik, Universitätsklinikum Carl Gustav Carus, TU Dresden
| | - L E Pillunat
- Augenklinik, Universitätsklinikum Carl Gustav Carus, TU Dresden
| | - D Sandner
- Augenklinik, Universitätsklinikum Carl Gustav Carus, TU Dresden
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Opatz O, Trippel T, Lochner A, Werner A, Stahn A, Steinach M, Lenk J, Kuppe H, Gunga H. Temporal and spatial dispersion of human body temperature during deep hypothermia. Br J Anaesth 2013; 111:768-75. [DOI: 10.1093/bja/aet217] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [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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Bergner H, Schwandt H, Lenk J. [The determination of a gross utilization of 15N-lysine in laboratory rats. 2. Comparative testing with an antibiotic supplement to the diet]. Arch Tierernahr 1993; 43:3-16. [PMID: 8512448 DOI: 10.1080/17450399309386019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Wistar rats of a live weight of about 100 g received in 26 groups (4 animals/group) diets, each with a different lysine content. The rations given supplied the animals with 75%, 100% or 125% lysine of the calculated requirement. The source of protein in the diets was: barley (B), wheat (W), wheat gluten (WG), isolated soybean protein (assay protein) (S) or soybean meal (SM). For WG and S only the lysine levels 100% and 125% (SM = 116% and 125%) could be achieved. All diet groups were fed for 10 days with and without antibiotics (7 g Nebacitin/kg feed-DM). During the 7-day-period of the main experiment all 24 rations were supplemented with 0.5 g 15N-lysine/kg DM (48.3 atom-% 15N-excess, alpha-aminogroup 95% 15N-labelled). The nitrogen balance was improved only after feeding antibiotics with the diet S 100. It may be supposed that Nebacitin saved the second limiting amino acid methionine against microbial degradation in the digestion tract. The biological value (BV) of feed-proteins declined in the case of the diets B and W in the presence of antibiotics because the absorbed nitrogen was higher, this calculation basis for BV was therefore also higher without an improvement of the N-utilization. The 15N-excretion in faeces was significantly lower after feeding the diets B, W and WG with antibiotics. The 15N-excretion in urine was elevated in the most cases of the antibiotic supplement. The determination of a gross utilization of lysine and 15N-lysine resp. in relation to the lysine retention (availability) was not possible, neither using a labelling of diets with 15N-lysine.
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Affiliation(s)
- H Bergner
- Institut für Ernährungsphysiologie, Humboldt-Universität zu Berlin, Germany
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