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Melchior C, Isfort P, Braunschweig T, Witjes M, Van den Bosch V, Rashad A, Egger J, de la Fuente M, Röhrig R, Hölzle F, Puladi B. Development and validation of a cadaveric porcine Pseudotumor model for Oral Cancer biopsy and resection training. BMC Med Educ 2024; 24:250. [PMID: 38500112 PMCID: PMC10949621 DOI: 10.1186/s12909-024-05224-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 02/23/2024] [Indexed: 03/20/2024]
Abstract
OBJECTIVE The gold standard of oral cancer (OC) treatment is diagnostic confirmation by biopsy followed by surgical treatment. However, studies have shown that dentists have difficulty performing biopsies, dental students lack knowledge about OC, and surgeons do not always maintain a safe margin during tumor resection. To address this, biopsies and resections could be trained under realistic conditions outside the patient. The aim of this study was to develop and to validate a porcine pseudotumor model of the tongue. METHODS An interdisciplinary team reflecting various specialties involved in the oncological treatment of head and neck oncology developed a porcine pseudotumor model of the tongue in which biopsies and resections can be practiced. The refined model was validated in a final trial of 10 participants who each resected four pseudotumors on a tongue, resulting in a total of 40 resected pseudotumors. The participants (7 residents and 3 specialists) had an experience in OC treatment ranging from 0.5 to 27 years. Resection margins (minimum and maximum) were assessed macroscopically and compared beside self-assessed margins and resection time between residents and specialists. Furthermore, the model was evaluated using Likert-type questions on haptic and radiological fidelity, its usefulness as a training model, as well as its imageability using CT and ultrasound. RESULTS The model haptically resembles OC (3.0 ± 0.5; 4-point Likert scale), can be visualized with medical imaging and macroscopically evaluated immediately after resection providing feedback. Although, participants (3.2 ± 0.4) tended to agree that they had resected the pseudotumor with an ideal safety margin (10 mm), the mean minimum resection margin was insufficient at 4.2 ± 1.2 mm (mean ± SD), comparable to reported margins in literature. Simultaneously, a maximum resection margin of 18.4 ± 6.1 mm was measured, indicating partial over-resection. Although specialists were faster at resection (p < 0.001), this had no effect on margins (p = 0.114). Overall, the model was well received by the participants, and they could see it being implemented in training (3.7 ± 0.5). CONCLUSION The model, which is cost-effective, cryopreservable, and provides a risk-free training environment, is ideal for training in OC biopsy and resection and could be incorporated into dental, medical, or oncologic surgery curricula. Future studies should evaluate the long-term training effects using this model and its potential impact on improving patient outcomes.
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Affiliation(s)
- Claire Melchior
- Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
- Institute of Medical Informatics, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Peter Isfort
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, 52074, Aachen, Germany
| | - Till Braunschweig
- Institute of Pathology, RWTH Aachen University, 52074, Aachen, Germany
- Institute of Pathology, Faculty of Medicine, Ludwig Maximilians University (LMU), 80337, Munich, Germany
| | - Max Witjes
- Department of Oral and Maxillofacial Surgery, UMCG Groningen, 9713, GZ, Groningen, The Netherlands
| | - Vincent Van den Bosch
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, 52074, Aachen, Germany
| | - Ashkan Rashad
- Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Jan Egger
- Cancer Research Center Cologne Essen (CCCE), University Medicine Essen (AöR), 45147, Essen, Germany
- Institute of Artificial Intelligence in Medicine, Essen University Hospital, 45131, Essen, Germany
| | - Matías de la Fuente
- Chair of Medical Engineering, RWTH Aachen University, 52074, Aachen, Germany
| | - Rainer Röhrig
- Institute of Medical Informatics, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Frank Hölzle
- Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Behrus Puladi
- Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany.
- Institute of Medical Informatics, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany.
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Truhn D, Tayebi Arasteh S, Saldanha OL, Müller-Franzes G, Khader F, Quirke P, West NP, Gray R, Hutchins GGA, James JA, Loughrey MB, Salto-Tellez M, Brenner H, Brobeil A, Yuan T, Chang-Claude J, Hoffmeister M, Foersch S, Han T, Keil S, Schulze-Hagen M, Isfort P, Bruners P, Kaissis G, Kuhl C, Nebelung S, Kather JN. Encrypted federated learning for secure decentralized collaboration in cancer image analysis. Med Image Anal 2024; 92:103059. [PMID: 38104402 PMCID: PMC10804934 DOI: 10.1016/j.media.2023.103059] [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: 08/25/2022] [Revised: 04/28/2023] [Accepted: 12/05/2023] [Indexed: 12/19/2023]
Abstract
Artificial intelligence (AI) has a multitude of applications in cancer research and oncology. However, the training of AI systems is impeded by the limited availability of large datasets due to data protection requirements and other regulatory obstacles. Federated and swarm learning represent possible solutions to this problem by collaboratively training AI models while avoiding data transfer. However, in these decentralized methods, weight updates are still transferred to the aggregation server for merging the models. This leaves the possibility for a breach of data privacy, for example by model inversion or membership inference attacks by untrusted servers. Somewhat-homomorphically-encrypted federated learning (SHEFL) is a solution to this problem because only encrypted weights are transferred, and model updates are performed in the encrypted space. Here, we demonstrate the first successful implementation of SHEFL in a range of clinically relevant tasks in cancer image analysis on multicentric datasets in radiology and histopathology. We show that SHEFL enables the training of AI models which outperform locally trained models and perform on par with models which are centrally trained. In the future, SHEFL can enable multiple institutions to co-train AI models without forsaking data governance and without ever transmitting any decryptable data to untrusted servers.
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Affiliation(s)
- Daniel Truhn
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany.
| | - Soroosh Tayebi Arasteh
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Oliver Lester Saldanha
- Department of Medicine III, University Hospital RWTH Aachen, Aachen, Germany; Else Kroener Fresenius Center for Digital Health, Medical Faculty Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Gustav Müller-Franzes
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Firas Khader
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Philip Quirke
- Division of Pathology and Data Analytics, Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, United Kingdom
| | - Nicholas P West
- Division of Pathology and Data Analytics, Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, United Kingdom
| | - Richard Gray
- Clinical Trial Service Unit, University of Oxford, Oxford, United Kingdom
| | - Gordon G A Hutchins
- Division of Pathology and Data Analytics, Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, United Kingdom
| | - Jacqueline A James
- Precision Medicine Centre of Excellence, Health Sciences Building, The Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, United Kingdom; Regional Molecular Diagnostic Service, Belfast Health and Social Care Trust, Belfast, United Kingdom; The Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, United Kingdom
| | - Maurice B Loughrey
- The Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, United Kingdom; Department of Cellular Pathology, Belfast Health and Social Care Trust, Belfast, United Kingdom; Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom
| | - Manuel Salto-Tellez
- Precision Medicine Centre of Excellence, Health Sciences Building, The Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, United Kingdom; Regional Molecular Diagnostic Service, Belfast Health and Social Care Trust, Belfast, United Kingdom; The Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, United Kingdom
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany; Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany; German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Alexander Brobeil
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany; Tissue Bank, National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Heidelberg, Germany
| | - Tanwei Yuan
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany; Medical Faculty Heidelberg, Heidelberg University, Heidelberg, Germany
| | - Jenny Chang-Claude
- Cancer Epidemiology Group, University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Michael Hoffmeister
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Sebastian Foersch
- Institute of Pathology, University Medical Center Mainz, Mainz, Germany
| | - Tianyu Han
- Physics of Molecular Imaging Systems, Experimental Molecular Imaging, RWTH Aachen University, Aachen, Germany
| | - Sebastian Keil
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Maximilian Schulze-Hagen
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Peter Isfort
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Philipp Bruners
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Georgios Kaissis
- Institute of Diagnostic and Interventional Radiology, Technical University of Munich, Munich, Germany; Artificial Intelligence in Medicine and Healthcare, Technical University of Munich, Munich, Germany; Department of Computing, Imperial College London, London, United Kingdom
| | - Christiane Kuhl
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Sven Nebelung
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Jakob Nikolas Kather
- Department of Medicine III, University Hospital RWTH Aachen, Aachen, Germany; Else Kroener Fresenius Center for Digital Health, Medical Faculty Carl Gustav Carus, Technical University Dresden, Dresden, Germany; Division of Pathology and Data Analytics, Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, United Kingdom; Medical Oncology, National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Heidelberg, Germany
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Bucher AM, Henzel K, Meyer HJ, Ehrengut C, Müller L, Schramm D, Akinina A, Drechsel M, Kloeckner R, Isfort P, Sähn MJ, Fink M, More D, Melekh B, Meinel FG, Dreger F, May M, Siegler L, Münzfeld H, Ruppel R, Penzkofer T, Kim MS, Balzer M, Borggrefe J, Surov A. Pericardial Effusion Predicts Clinical Outcomes in Patients with COVID-19: A Nationwide Multicenter Study. Acad Radiol 2023:S1076-6332(23)00678-5. [PMID: 38155024 DOI: 10.1016/j.acra.2023.12.003] [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: 08/28/2023] [Revised: 11/25/2023] [Accepted: 12/01/2023] [Indexed: 12/30/2023]
Abstract
RATIONALE AND OBJECTIVES The prognostic role of pericardial effusion (PE) in Covid 19 is unclear. The aim of the present study was to estimate the prognostic role of PE in patients with Covid 19 in a large multicentre setting. MATERIALS AND METHODS This retrospective study is a part of the German multicenter project RACOON (Radiological Cooperative Network of the Covid 19 pandemic). The acquired sample comprises 1197 patients, 363 (30.3%) women and 834 (69.7%) men. In every case, chest computed tomography was analyzed for PE. Data about 30-day mortality, need for mechanical ventilation and need for intensive care unit (ICU) admission were collected. Data were evaluated by means of descriptive statistics. Group differences were calculated with Mann-Whitney test and Fisher exact test. Uni-and multivariable regression analyses were performed. RESULTS Overall, 46.4% of the patients were admitted to ICU, mechanical lung ventilation was performed in 26.6% and 30-day mortality was 24%. PE was identified in 159 patients (13.3%). The presence of PE was associated with 30-day mortality: HR= 1.54, CI 95% (1.05; 2.23), p = 0.02 (univariable analysis), and HR= 1.60, CI 95% (1.03; 2.48), p = 0.03 (multivariable analysis). Furthermore, density of PE was associated with the need for intubation (OR=1.02, CI 95% (1.003; 1.05), p = 0.03) and the need for ICU admission (OR=1.03, CI 95% (1.005; 1.05), p = 0.01) in univariable regression analysis. The presence of PE was associated with 30-day mortality in male patients, HR= 1.56, CI 95%(1.01-2.43), p = 0.04 (multivariable analysis). In female patients, none of PE values predicted clinical outcomes. CONCLUSION The prevalence of PE in Covid 19 is 13.3%. PE is an independent predictor of 30-day mortality in male patients with Covid 19. In female patients, PE plays no predictive role.
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Affiliation(s)
- Andreas Michael Bucher
- Institute of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfut, Germany (A.M.B., K.H.)
| | - Kristina Henzel
- Institute of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfut, Germany (A.M.B., K.H.)
| | - Hans Jonas Meyer
- Department of Radiology, University Hospital of Leipzig, Leipzig, Germany (H.J.M., C.E.)
| | - Constantin Ehrengut
- Department of Radiology, University Hospital of Leipzig, Leipzig, Germany (H.J.M., C.E.)
| | - Lukas Müller
- Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Mainz, Germany (L.M.)
| | - Dominik Schramm
- Department of Radiology University Hospital of Halle, Halle, Germany (D.S., A.A., M.D.)
| | - Alena Akinina
- Department of Radiology University Hospital of Halle, Halle, Germany (D.S., A.A., M.D.)
| | - Michelle Drechsel
- Department of Radiology University Hospital of Halle, Halle, Germany (D.S., A.A., M.D.)
| | - Roman Kloeckner
- Department of Radiology University Hospital Schleswig-Holstein-Campus Luebeck, Luebeck, Germany (R.K.)
| | - Peter Isfort
- Department of Radiology University Hospital of Aachen, Aachen, Germany (P.I., M.J.S.)
| | - Marwin-Jonathan Sähn
- Department of Radiology University Hospital of Aachen, Aachen, Germany (P.I., M.J.S.)
| | - Matthias Fink
- Clinic for Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany (M.F., D.M.)
| | - Dorottya More
- Clinic for Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany (M.F., D.M.)
| | - Bohdan Melekh
- Department of Radiology and Nuclear Medicine, University Hospital of Magdeburg, Magdeburg, Germany (B.M., A.S.)
| | - Felix G Meinel
- Department of Radiology University Hospital of Rostock, Rostock, Germany (F.G.M., F.D.)
| | - Franziska Dreger
- Department of Radiology University Hospital of Rostock, Rostock, Germany (F.G.M., F.D.)
| | - Matthias May
- Department of Radiology University Hospital of Erlangen, Erlangen, Germany (M.M., L.S.)
| | - Lisa Siegler
- Department of Radiology University Hospital of Erlangen, Erlangen, Germany (M.M., L.S.)
| | - Hanna Münzfeld
- Department of Radiology University Hospital of Berlin, Berlin, Germany (H.M., R.R., T.P.)
| | - Richard Ruppel
- Department of Radiology University Hospital of Berlin, Berlin, Germany (H.M., R.R., T.P.)
| | - Tobias Penzkofer
- Department of Radiology University Hospital of Berlin, Berlin, Germany (H.M., R.R., T.P.)
| | - Moon-Sung Kim
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany (M.S.K., B.M.)
| | - Miriam Balzer
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany (M.S.K., B.M.)
| | - Jan Borggrefe
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr-University-Bochum, Bochum, Germany (J.B., A.S.)
| | - Alexey Surov
- Department of Radiology and Nuclear Medicine, University Hospital of Magdeburg, Magdeburg, Germany (B.M., A.S.); Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr-University-Bochum, Bochum, Germany (J.B., A.S.).
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Tayebi Arasteh S, Kuhl C, Saehn MJ, Isfort P, Truhn D, Nebelung S. Enhancing domain generalization in the AI-based analysis of chest radiographs with federated learning. Sci Rep 2023; 13:22576. [PMID: 38114729 PMCID: PMC10730705 DOI: 10.1038/s41598-023-49956-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 12/13/2023] [Indexed: 12/21/2023] Open
Abstract
Developing robust artificial intelligence (AI) models that generalize well to unseen datasets is challenging and usually requires large and variable datasets, preferably from multiple institutions. In federated learning (FL), a model is trained collaboratively at numerous sites that hold local datasets without exchanging them. So far, the impact of training strategy, i.e., local versus collaborative, on the diagnostic on-domain and off-domain performance of AI models interpreting chest radiographs has not been assessed. Consequently, using 610,000 chest radiographs from five institutions across the globe, we assessed diagnostic performance as a function of training strategy (i.e., local vs. collaborative), network architecture (i.e., convolutional vs. transformer-based), single versus cross-institutional performance (i.e., on-domain vs. off-domain), imaging finding (i.e., cardiomegaly, pleural effusion, pneumonia, atelectasis, consolidation, pneumothorax, and no abnormality), dataset size (i.e., from n = 18,000 to 213,921 radiographs), and dataset diversity. Large datasets not only showed minimal performance gains with FL but, in some instances, even exhibited decreases. In contrast, smaller datasets revealed marked improvements. Thus, on-domain performance was mainly driven by training data size. However, off-domain performance leaned more on training diversity. When trained collaboratively across diverse external institutions, AI models consistently surpassed models trained locally for off-domain tasks, emphasizing FL's potential in leveraging data diversity. In conclusion, FL can bolster diagnostic privacy, reproducibility, and off-domain reliability of AI models and, potentially, optimize healthcare outcomes.
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Affiliation(s)
- Soroosh Tayebi Arasteh
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany.
| | - Christiane Kuhl
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Marwin-Jonathan Saehn
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Peter Isfort
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Daniel Truhn
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Sven Nebelung
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany
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Frackowiak B, Van den Bosch V, Tokoutsi Z, Baragona M, de Greef M, Elevelt A, Isfort P. Author Correction: First validation of a model-based hepatic percutaneous microwave ablation planning on a clinical dataset. Sci Rep 2023; 13:18918. [PMID: 37919462 PMCID: PMC10622408 DOI: 10.1038/s41598-023-45924-4] [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: 11/04/2023] Open
Affiliation(s)
- Bruno Frackowiak
- Philips Research, Data Science & Digital Twin, 5656 AE, Eindhoven, The Netherlands.
| | - Vincent Van den Bosch
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, 52074, Aachen, Germany
| | - Zoi Tokoutsi
- Philips Research, Data Science & Digital Twin, 5656 AE, Eindhoven, The Netherlands
| | - Marco Baragona
- Philips Research, Data Science & Digital Twin, 5656 AE, Eindhoven, The Netherlands
| | - Martijn de Greef
- Philips Research, Data Science & Digital Twin, 5656 AE, Eindhoven, The Netherlands
| | - Aaldert Elevelt
- Philips Research, Data Science & Digital Twin, 5656 AE, Eindhoven, The Netherlands
| | - Peter Isfort
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, 52074, Aachen, Germany
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6
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Frackowiak B, Van den Bosch V, Tokoutsi Z, Baragona M, de Greef M, Elevelt A, Isfort P. First validation of a model-based hepatic percutaneous microwave ablation planning on a clinical dataset. Sci Rep 2023; 13:16862. [PMID: 37803064 PMCID: PMC10558472 DOI: 10.1038/s41598-023-42543-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 09/12/2023] [Indexed: 10/08/2023] Open
Abstract
A model-based planning tool, integrated in an imaging system, is envisioned for CT-guided percutaneous microwave ablation. This study aims to evaluate the biophysical model performance, by comparing its prediction retrospectively with the actual ablation ground truth from a clinical dataset in liver. The biophysical model uses a simplified formulation of heat deposition on the applicator and a heat sink related to vasculature to solve the bioheat equation. A performance metric is defined to assess how the planned ablation overlaps the actual ground truth. Results demonstrate superiority of this model prediction compared to manufacturer tabulated data and a significant influence of the vasculature cooling effect. Nevertheless, vasculature shortage due to branches occlusion and applicator misalignment due to registration error between scans affects the thermal prediction. With a more accurate vasculature segmentation, occlusion risk can be estimated, whereas branches can be used as liver landmarks to improve the registration accuracy. Overall, this study emphasizes the benefit of a model-based thermal ablation solution in better planning the ablation procedures. Contrast and registration protocols must be adapted to facilitate its integration into the clinical workflow.
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Affiliation(s)
- Bruno Frackowiak
- Philips Research, Data Science & Digital Twin, 5656 AE, Eindhoven, The Netherlands.
| | - Vincent Van den Bosch
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, 52074, Aachen, Germany
| | - Zoi Tokoutsi
- Philips Research, Data Science & Digital Twin, 5656 AE, Eindhoven, The Netherlands
| | - Marco Baragona
- Philips Research, Data Science & Digital Twin, 5656 AE, Eindhoven, The Netherlands
| | - Martijn de Greef
- Philips Research, Data Science & Digital Twin, 5656 AE, Eindhoven, The Netherlands
| | - Aaldert Elevelt
- Philips Research, Data Science & Digital Twin, 5656 AE, Eindhoven, The Netherlands
| | - Peter Isfort
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, 52074, Aachen, Germany
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Linnemann B, Blank W, Doenst T, Erbel C, Isfort P, Janssens U, Kalka C, Klamroth R, Kotzerke J, Ley S, Meyer J, Mühlberg K, Müller OJ, Noppeney T, Opitz C, Riess H, Solomayer EF, Volk T, Beyer-Westendorf J. Diagnostics and Therapy of Venous Thrombosis and Pulmonary Embolism. The revised AWMF S2k Guideline. VASA 2023; 52:1-146. [PMID: 37904504 DOI: 10.1024/0301-1526/a001089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2023]
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8
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Frackowiak B, Van den Bosch V, Tokoutsi Z, Baragona M, de Greef M, Elevelt A, Isfort P. Model-based hepatic percutaneous microwaveablation planning. First validation on a clinical dataset. Res Sq 2023:rs.3.rs-2781339. [PMID: 37131766 PMCID: PMC10153367 DOI: 10.21203/rs.3.rs-2781339/v1] [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] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
A model-based planning tool, integrated in an imaging system, is envisioned for CT-guided percutaneous microwave ablation. This study aims to evaluate the biophysical model performance, by comparing its prediction retrospectively with the actualablation ground truth from a clinical data set in liver. The biophysical model uses a simplified formulation of heat depositionon the applicator and a heat sink related to vasculature to solve the bioheat equation. A performance metric is defined toassess how the planned ablation overlaps the actual ground truth. Results demonstrate superiority of this model predictioncompared to manufacturer tabulated data and a significant influence of the vasculature cooling effect. Nevertheless, vasculatureshortage due to branches occlusion and applicator misalignment due to registration error between scans affects the thermalprediction. With a more accurate vasculature segmentation, occlusion risk can be estimated, whereas branches can be usedas liver landmarks to improve the registration accuracy. Overall, this study emphasizes the benefit of a model-based thermalablation solution in better planning the ablation procedures. Contrast and registration protocols must be adapted to facilitate itsintegration into the clinical workflow.
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Affiliation(s)
- Bruno Frackowiak
- Philips Research, Data Science & Digital Twin,Eindhoven,5656AE, Netherlands
| | - Vincent Van den Bosch
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, 52074, Germany
| | - Zoi Tokoutsi
- Philips Research, Data Science & Digital Twin,Eindhoven,5656AE, Netherlands
| | - Marco Baragona
- Philips Research, Data Science & Digital Twin,Eindhoven,5656AE, Netherlands
| | - Martijn de Greef
- Philips Research, Data Science & Digital Twin,Eindhoven,5656AE, Netherlands
| | - Aaldert Elevelt
- Philips Research, Data Science & Digital Twin,Eindhoven,5656AE, Netherlands
| | - Peter Isfort
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, 52074, Germany
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Tayebi Arasteh S, Isfort P, Saehn M, Mueller-Franzes G, Khader F, Kather JN, Kuhl C, Nebelung S, Truhn D. Collaborative training of medical artificial intelligence models with non-uniform labels. Sci Rep 2023; 13:6046. [PMID: 37055456 PMCID: PMC10102221 DOI: 10.1038/s41598-023-33303-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 04/11/2023] [Indexed: 04/15/2023] Open
Abstract
Due to the rapid advancements in recent years, medical image analysis is largely dominated by deep learning (DL). However, building powerful and robust DL models requires training with large multi-party datasets. While multiple stakeholders have provided publicly available datasets, the ways in which these data are labeled vary widely. For Instance, an institution might provide a dataset of chest radiographs containing labels denoting the presence of pneumonia, while another institution might have a focus on determining the presence of metastases in the lung. Training a single AI model utilizing all these data is not feasible with conventional federated learning (FL). This prompts us to propose an extension to the widespread FL process, namely flexible federated learning (FFL) for collaborative training on such data. Using 695,000 chest radiographs from five institutions from across the globe-each with differing labels-we demonstrate that having heterogeneously labeled datasets, FFL-based training leads to significant performance increase compared to conventional FL training, where only the uniformly annotated images are utilized. We believe that our proposed algorithm could accelerate the process of bringing collaborative training methods from research and simulation phase to the real-world applications in healthcare.
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Affiliation(s)
- Soroosh Tayebi Arasteh
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Peter Isfort
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Marwin Saehn
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Gustav Mueller-Franzes
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Firas Khader
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Jakob Nikolas Kather
- Department of Medicine III, University Hospital RWTH Aachen, Aachen, Germany
- Medical Faculty Carl Gustav Carus, Else Kroener Fresenius Center for Digital Health, Technical University Dresden, Dresden, Germany
- Division of Pathology and Data Analytics, Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
- Medical Oncology, National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Heidelberg, Germany
| | - Christiane Kuhl
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Sven Nebelung
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Daniel Truhn
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany.
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Van den Bosch V, De Beukelaer F, Isfort P, Keil S, Kuhl CK, Bruners P, Pedersoli F. Long loop technique with bifemoral access as salvage technique for repositioning of dislodged port catheters. CVIR Endovasc 2022; 5:64. [PMID: 36512154 PMCID: PMC9748016 DOI: 10.1186/s42155-022-00341-y] [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: 08/24/2022] [Accepted: 11/19/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Repositioning of dislocated port systems' catheters is usually performed with a pigtail catheter and/or a goose snare. In case of an inaccessible port catheter tip due to thrombosis, this classic approach may be not successful. For these cases, we describe a long loop bailout technique with bifemoral access. TECHNIQUE Via a right transfemoral access, a first attempt to reposition the dislodged port catheter using pigtail catheter and goose snare was performed. After an unsuccessful attempt and delineation of thrombosis of the catheter tip, the contralateral femoral vein was subsequently punctured and a sheath was placed. Through both vascular sheaths, pigtail catheter and goose wire were advanced distally to the catheter. The guidewire in the pigtail catheter was snared, thus creating a "Long loop" configuration. Pulling down both catheters simultaneously with improved stability allowed to detach the catheter tip from the vessel wall and replacement into the superior vena cava was possible. Refinement of catheter tip position was done using the goose snare. This technique was applied on 5 patients with dislodged port catheters in the jugular vein (2/5), the innominate vein (1/5), the subclavian vein (1/5) and the azygos vein (1/5) with a technical success of 100%. No complications were observed. CONCLUSION The Long loop technique can be used as salvage approach to reposition a dislodged catheter in case of failure with pigtail catheter and goose snare.
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Affiliation(s)
- Vincent Van den Bosch
- grid.412301.50000 0000 8653 1507Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Frédéric De Beukelaer
- grid.412301.50000 0000 8653 1507Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Peter Isfort
- grid.412301.50000 0000 8653 1507Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Sebastian Keil
- grid.412301.50000 0000 8653 1507Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Christiane K. Kuhl
- grid.412301.50000 0000 8653 1507Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Philipp Bruners
- grid.412301.50000 0000 8653 1507Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Federico Pedersoli
- grid.412301.50000 0000 8653 1507Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany
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11
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Pedersoli F, Van den Bosch V, Keil S, Schulze-Hagen M, Isfort P, Kuhl KC, Bruners P. Stentgraftimplantation für die Behandlung von Pseudoaneurysmen der Arteria hepatica: Effektivität und Durchgängigkeit in Follow-up. ROFO-FORTSCHR RONTG 2022. [DOI: 10.1055/s-0042-1749834] [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: 11/06/2022]
Affiliation(s)
- F Pedersoli
- Uniklinik RWTH Aachen, Klinik für Diagnostische und Interventionelle Radiologie, Aachen
| | - V Van den Bosch
- Klinik für Diagnostische und Interventionelle Radiologie, Uniklinik RWTH Aachen, Aachen
| | - S Keil
- Klinik für Diagnostische und Interventionelle Radiologie, Uniklinik RWTH Aachen, Aachen
| | - M Schulze-Hagen
- Klinik für Diagnostische und Interventionelle Radiologie, Uniklinik RWTH Aachen, Aachen
| | - P Isfort
- Klinik für Diagnostische und Interventionelle Radiologie, Uniklinik RWTH Aachen, Aachen
| | - K C Kuhl
- Klinik für Diagnostische und Interventionelle Radiologie, Uniklinik RWTH Aachen, Aachen
| | - P Bruners
- Klinik für Diagnostische und Interventionelle Radiologie, Uniklinik RWTH Aachen, Aachen
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12
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Yüksel C, Sähn MJ, Kleines M, Brokmann JC, Kuhl CK, Truhn D, Ritter A, Isfort P, Schulze-Hagen MF. Possible Alterations of Imaging Patterns in Computed Tomography for Delta-VOC of SARS-CoV-2. ROFO-FORTSCHR RONTG 2022; 194:1229-1241. [PMID: 35850138 DOI: 10.1055/a-1826-0436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND So far, typical findings for COVID-19 in computed tomography (CT) have been described as bilateral, multifocal ground glass opacities (GGOs) and consolidations, as well as intralobular and interlobular septal thickening. On the contrary, round consolidations with the halo sign are considered uncommon and are typically found in fungal infections, such as invasive pulmonary aspergillosis. The authors recently observed several patients with COVID-19 pneumonia presenting with round, multifocal consolidations accompanied by a halo sign. As this may indicate alterations of CT morphology based on the virus variant, the aim of this study was to investigate this matter in more detail. METHODS 161 CT scans of patients with confirmed SARS-CoV-2 infection (RT-PCR within 2 days of CT) examined between January 2021 and September 15, 2021 were included. Follow-up examinations, patients with invasive ventilation at the time of CT, and patients with insufficient virus typing for variants of concern (VOC) were excluded. CT scans were assessed for vertical and axial distribution of pulmonary patterns, degree of involvement, uni- vs. bilaterality, reticulations, and other common findings. The mean density of representative lesions was assessed in Hounsfield units. Results were compared using Mann-Whitney U-tests, Student's t-rests, descriptive statistics, and Fisher's exact tests. RESULTS 75 patients did not meet the inclusion criteria. Therefore, 86/161 CT scans of unique patients were analyzed. PCR VOC testing confirmed manifestation of the Delta-VOC SARS-CoV-2 in 22 patients, 39 patients with Alpha-VOC and the remaining 25 patients with Non-VOC SARS-CoV-2 infections. Three patients with the Delta-VOC demonstrated multiple pulmonary masses or nodules with surrounding halo sign, whereas no patients with either Alpha-VOC (p = 0.043) or non-VOC (p = 0.095) demonstrated these findings. All three patients were admitted to normal wards and had no suspicion of a pulmonary co-infection. Patients with Delta-VOC were less likely to have ground glass opacities compared to Alpha-VOC (7/22 or 31.8 % vs. 4/39 or 10.3 %; p < 0.001), whereas a significant difference has not been observed between Delta-VOC and non-VOC (5/25 or 20 %; p = 0.348). The mean representative density of lesions did not show significant differences between the studied cohorts. CONCLUSION In this study 3 out of 22 patients (13.6 %) with Delta-VOC presented with bilateral round pulmonary masses or nodules with surrounding halo signs, which has not been established as a notable imaging pattern in COVID-19 pneumonia yet. Compared to the other cohorts, a lesser percentage of patients with Delta-VOC presented with ground glass opacities. Based on these results Delta-VOC might cause a divergence in CT-morphologic phenotype. KEY POINTS · Until recently, CT-morphologic signs of COVID-19 pneumonia have been presumed to be uncontroversially understood. Yet, recently the authors observed diverging pulmonary alterations in patients infected with Delta-VOC.. · These imaging alterations included round pulmonary masses or nodules with surrounding halo sign.. · These imaging alterations have not yet been established as typical for COVID-19 pneumonia, yet.. · Based on these results, Delta-VOC could impose a divergence of CT-morphologic phenotype.. CITATION FORMAT · Yüksel C, Sähn M, Kleines M et al. Possible Alterations of Imaging Patterns in Computed Tomography for Delta-VOC of SARS-CoV-2 . Fortschr Röntgenstr 2022; DOI: 10.1055/a-1826-0436.
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Affiliation(s)
- Can Yüksel
- Interventional and diagnostic Radiology, RWTH Aachen University, Aachen, Germany
| | - Marwin-Jonathan Sähn
- Interventional and diagnostic Radiology, RWTH Aachen University, Aachen, Germany
| | - Michael Kleines
- Laboratory Diagnostics Center, RWTH Aachen University, Aachen, Germany
| | | | - Christiane K Kuhl
- Interventional and diagnostic Radiology, RWTH Aachen University, Aachen, Germany
| | - Daniel Truhn
- Interventional and diagnostic Radiology, RWTH Aachen University, Aachen, Germany
| | - Andreas Ritter
- Interventional and diagnostic Radiology, RWTH Aachen University, Aachen, Germany
| | - Peter Isfort
- Interventional and diagnostic Radiology, RWTH Aachen University, Aachen, Germany
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Van den Bosch V, Salim HS, Chen NZ, Stroosma O, Bruners P, Kuhl CK, Pedersoli F, Isfort P. Augmented Reality-Assisted CT-Guided Puncture: A Phantom Study. Cardiovasc Intervent Radiol 2022; 45:1173-1177. [PMID: 35750863 PMCID: PMC9307551 DOI: 10.1007/s00270-022-03195-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 05/31/2022] [Indexed: 11/28/2022]
Abstract
Purpose To investigate the feasibility of a novel augmented reality system for CT-guided liver interventions and to compare it with free-hand interventions in a phantom setting. Methods and materials A newly developed augmented reality interface was used, with projection of CT-imaging in multiplanar reconstruction and live rendering of the needle position, a bull`s eye view of the needle trajectory and a visualization of the distance to the target. Punctures were performed on a custom-made abdominal phantom by three interventional radiologists with different levels of expertise. Time and needle placement accuracy were measured. Two-tailed Wilcoxon signed rank test (p < 0.05) was performed to evaluate intraparticipant difference. Results Intraparticipant puncture times were significantly shorter for each operator in the augmented reality condition (< 0.001 for the resident, < 0.001 for the junior staff member and 0.027 for the senior staff member). The junior staff member had an improvement in accuracy of 1 mm using augmented reality (p 0.026); the other two participants showed no significant improvement regarding accuracy. Conclusion In this small series, it appears that the novel augmented reality system may improve the speed of CT-guided punctures in the phantom model compared to the free-hand procedure while maintaining a similar accuracy. Supplementary Information The online version contains supplementary material available at 10.1007/s00270-022-03195-y.
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Affiliation(s)
- Vincent Van den Bosch
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany.
| | | | - Njin-Zu Chen
- Philips Research Europe, Eindhoven, The Netherlands
| | | | - Philipp Bruners
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Christiane K Kuhl
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Federico Pedersoli
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Peter Isfort
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
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14
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Lurje I, Czigany Z, Eischet S, Bednarsch J, Ulmer TF, Isfort P, Strnad P, Trautwein C, Tacke F, Neumann UP, Lurje G. The prognostic impact of preoperative body composition in perihilar and intrahepatic cholangiocarcinoma. Hepatol Commun 2022; 6:2400-2417. [PMID: 35616275 PMCID: PMC9426393 DOI: 10.1002/hep4.2004] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/31/2022] [Accepted: 04/22/2022] [Indexed: 11/25/2022] Open
Abstract
Cholangiocarcinoma (CCA) is a rare but highly aggressive malignancy of the biliary system. Although it is amenable to surgical resection in early disease, outcomes are frequently dismal. Here, we investigated the prevalence of body composition (BC) alterations and their prognostic role for surgical patients with intrahepatic (iCCA) and perihilar (pCCA) disease. Patients undergoing curative‐intent surgery for iCCA or pCCA between 2010 and 2019 at University Hospital Aachen were included. Axial computed tomography images were retrospectively assessed with a segmentation tool (3D Slicer) at the level of the third lumbar vertebra to determine lumbar skeletal muscle (SM) index, mean SM radiation attenuation, and visceral fat area. The related BC pathologies sarcopenia, myosteatosis, visceral obesity, and sarcopenic obesity were determined using previously described cutoffs. A total of 189 patients (86 with iCCA, 103 with pCCA) were included. Alterations of BC were highly prevalent in iCCA and pCCA, respectively: sarcopenia, 33% (28/86) and 39% (40/103); myosteatosis, 66% (57/86) and 66% (68/103); visceral obesity, 56% (48/86) and 67% (69/103); sarcopenic obesity, 11% (9/86) and 17% (17/103). Sarcopenia and myosteatosis did not have a significant prognostic role for disease‐free survival (DFS) and overall survival (OS). Patients with iCCA with sarcopenic obesity (n = 9) had significantly shorter OS than patients without sarcopenic obesity (n = 7; log‐rank p = 0.002; median OS, 11 months and 31 months; 1‐year mortality, 55.6% [5/9] and 22% [17/77]; 5‐year mortality, 88.9% [8/9] and 61% [47/77], respectively). In multivariable analysis, only tumor‐related risk factors remained prognostic for DFS and OS. Sarcopenic obesity may affect clinical outcomes after curative‐intent surgery for iCCA, indicating that imaging‐based analysis of BC may hold prognostic value for long‐term survival and could aid preoperative patient selection.
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Affiliation(s)
- Isabella Lurje
- Department of Hepatology and Gastroenterology, Campus Charité Mitte, Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Zoltan Czigany
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Aachen, Germany
| | - Sarah Eischet
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Aachen, Germany
| | - Jan Bednarsch
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Aachen, Germany
| | - Tom Florian Ulmer
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Aachen, Germany
| | - Peter Isfort
- Institute of Radiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Pavel Strnad
- Department of Internal Medicine III, University Hospital RWTH Aachen, Aachen, Germany
| | - Christian Trautwein
- Department of Internal Medicine III, University Hospital RWTH Aachen, Aachen, Germany
| | - Frank Tacke
- Department of Hepatology and Gastroenterology, Campus Charité Mitte, Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Department of Internal Medicine III, University Hospital RWTH Aachen, Aachen, Germany
| | - Ulf Peter Neumann
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Aachen, Germany.,Department of Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Georg Lurje
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Aachen, Germany
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15
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Pedersoli F, Wilkmann C, Penzkofer T, Disselhorst-Klug C, Schmitz-Rode T, Kuhl C, Bruners P, Isfort P. An accelerometer-based guidance device for CT-guided procedures: an improved wireless prototype. MINIM INVASIV THER 2021; 31:902-908. [PMID: 34865602 DOI: 10.1080/13645706.2021.2002363] [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] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The aim of the study was to demonstrate the feasibility of a prototype for accelerometer-based guidance for percutaneous CT-guided punctures and compare it with free-hand punctures. MATERIAL AND METHODS The prototype enabled alignment with the CT coordinate system and a wireless connectivity. Its feasibility was tested in a swine cadaver model: 20 out-of-plane device-assisted punctures performed without intermittent control scans (one-step punctures) were evaluated regarding deviation to target and difference between planned and obtained angle. Thereafter, 22 device-assisted punctures were compared with 20 free-hand punctures regarding distance to target, deviation from the planned angle, number of control scans and procedure time. Differences were compared with the Mann-Whitney U-test (p < .05). RESULTS The one-step punctures revealed a deviation to target of 0.26 ± 0.37 cm (axial plane) and 0.21 ± 0.19 cm (sagittal plane) and differences between planned and performed puncture angles of 0.9 ± 1.09° (axial plane) and 1.15 ± 0.91° (sagittal planes). In the comparative study, device-assisted punctures showed a significantly higher accuracy, 0.20 ± 0.17 cm vs. 0.30 ± 0.21 cm (p < .05) and lower number of required control scans, 1.3 ± 1.1 vs. 3.7 ± 0.9 (p < .05) compared with free-hand punctures. CONCLUSION The accelerometer-based device proved to be feasible and demonstrated significantly higher accuracy and required significantly less control scans compared to free-hand puncture.
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Affiliation(s)
- Federico Pedersoli
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Aachen, Germany
| | - Christoph Wilkmann
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Aachen, Germany.,Institute of Applied Medical Engineering, Deptartment of Rehabilitation & Prevention Engineering, RWTH Aachen University, Aachen, Germany
| | - Tobias Penzkofer
- Department of Radiology, Charité Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany
| | - Catherine Disselhorst-Klug
- Institute of Applied Medical Engineering, Deptartment of Rehabilitation & Prevention Engineering, RWTH Aachen University, Aachen, Germany
| | - Thomas Schmitz-Rode
- Institute of Applied Medical Engineering, Deptartment of Rehabilitation & Prevention Engineering, RWTH Aachen University, Aachen, Germany
| | - Christiane Kuhl
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Aachen, Germany
| | - Philipp Bruners
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Aachen, Germany
| | - Peter Isfort
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Aachen, Germany
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16
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Barzakova E, Senthilvel N, Bruners P, Keil S, Lurje G, Zimmermann M, Kuhl CK, Isfort P. Detectability of Target Lesion During CT-Guided Tumor Ablations: Impact on Ablation Outcome. ROFO-FORTSCHR RONTG 2021; 194:515-520. [PMID: 34794185 DOI: 10.1055/a-1669-9342] [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: 10/19/2022]
Abstract
PURPOSE Small hepatic malignancies scheduled for CT-guided percutaneous ablation may have been identified in the hepatobiliary phase of liver MRI or in a specific phase of multi-phase CT but may be occult on unenhanced CT used to guide the ablation. We investigated whether the detectability of the target lesion would impact the efficacy of CT-guided hepatic tumor ablations. MATERIALS AND METHODS We included 69 patients with 99 malignant liver lesions (25 primary, 44 metastases) who underwent IRE (n = 35), RFA (n = 41), or MWA (n = 23) between 01/2015 and 06/2018. All procedures were performed under CT guidance. Lesions not detectable on CT (NDL) were targeted through identification of anatomical landmarks on preinterventional contrast-enhanced CT or MRI. Rates of incomplete ablation, size of ablation zone, local tumor recurrence, intrahepatic progression-free survival (ihPFS), and adverse event rates were compared for detectable lesions (DL) vs. NDL. RESULTS 40 lesions were NDL, and 59 lesions were DL on unenhanced CT. The mean follow-up was 16.2 months (14.8 for DL and 18.2 for NDL). The mean diameter of NDL and DL was similar (12.9 mm vs. 14.9 mm). The mean ablation zone size was similar (37.1 mm vs. 38.8 mm). Incomplete ablation did not differ between NDL vs. DL (5.0 % [2/40; 0.6-16.9 %] vs. 3.4 % [2/59; 0.4-11.7 %]), nor did local tumor recurrence (15.4 % [6/39; 5.7 %-30.5 %] vs. 16.9 % [10/59; 8.4-29.0 %]), or median ihPFS (15.5 months vs. 14.3 months). CONCLUSION Target lesion detectability on interventional CT does not have a significant impact on outcome after percutaneous liver ablation when anatomical landmarks are used to guide needle placement. KEY POINTS · Liver tumors can be successfully ablated even if they are not detectable on the navigational CT scan.. · Anatomical landmarks should be used and compared to preinterventional imaging.. CITATION FORMAT · Barzakova E, Senthilvel N, Bruners P et al. Detectability of Target Lesion During CT-Guided Tumor Ablations: Impact on Ablation Outcome . Fortschr Röntgenstr 2021; DOI: 10.1055/a-1669-9342.
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Affiliation(s)
- Emona Barzakova
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Germany
| | - Niveditha Senthilvel
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Germany
| | - Philipp Bruners
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Germany
| | - Sebastian Keil
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Germany
| | - Georg Lurje
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Germany
| | - Markus Zimmermann
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Germany
| | - Christiane K Kuhl
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Germany
| | - Peter Isfort
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Germany
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17
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Pedersoli F, Van den Bosch V, Sieben P, Barzakova E, Schulze-Hagen M, Isfort P, Keil S, Wiltberger G, Kuhl CK, Bruners P. Stent Graft Placement by Pseudoaneurysm of the Hepatic Arteries: Efficacy and Patency Rate in Follow-up. Cardiovasc Intervent Radiol 2021; 45:21-28. [PMID: 34734334 PMCID: PMC8716354 DOI: 10.1007/s00270-021-02993-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 10/14/2021] [Indexed: 12/27/2022]
Abstract
Purpose To investigate efficacy and patency status of stent graft implantation in the treatment of hepatic artery pseudoaneurysm. Materials and Methods A retrospective analysis of patients who had undergone endovascular treatment of hepatic artery pseudoaneurysms between 2011 and 2020 was performed. Medical records were examined to obtain patients’ surgical histories and to screen for active bleeding. Angiographic data on vascular access, target vessel, material used and technical success, defined as the exclusion of the pseudoaneurysm by means of a stent graft with sufficient control of bleeding, were collected. Vessel patency at follow-up CT was analyzed and classified as short-term (< 6 weeks), mid-term (between 6 weeks and 1 year), and long-term patency (> 1 year). In case of stent occlusion, collateralization and signs of hepatic hypoperfusion were examined. Results In total, 30 patients were included and of these, 25 and 5 had undergone stent graft implantation and coiling, respectively. In patients with implanted stent grafts, technical success was achieved in 23/25 patients (92%). Follow-up CT scans were available in 16 patients, showing stent graft patency in 9/16 patients (56%). Short-term, mid-term, and long-term short-term stent patency was found in 81% (13/16), 40% (4/10), and 50% (2/4). In patients with stent graft occlusion, 86% (6/7) exhibited maintenance of arterial liver perfusion via collaterals and 14% (1/7) exhibited liver abscess during follow-up. Conclusion Stent graft provides an effective treatment for hepatic artery pseudoaneurysms. Even though patency rates decreased as a function of time, stent occlusion was mainly asymptomatic due to sufficient collateralization.
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Affiliation(s)
- F Pedersoli
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany.
| | - V Van den Bosch
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - P Sieben
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - E Barzakova
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - M Schulze-Hagen
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - P Isfort
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - S Keil
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - G Wiltberger
- Department of General, Visceral, and Transplantation Surgery, University Hospital of RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - C K Kuhl
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - P Bruners
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
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18
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Benninghoff MJ, Isfort P, Baumann M. How to Support Students in Maximizing their Outcome with Online Cooperation? Current Directions in Biomedical Engineering 2021. [DOI: 10.1515/cdbme-2021-2066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
During the last year, student cooperation has shifted to the digital space. Chats, videoconferencing and online collaboration tools replace physical meetings and face-to-face interactions. While many online tools provide sophisticated technologies to share screens and co-edit manuscripts, the support of collaborative thinking, learning and even fooling around is still underdeveloped, but remains a valuable resource. This study traces whether the given level of instruction details influences the collaboration effectiveness among student working groups in a practical course in Biomedical Engineering. Within the semester’s practical course of Introduction into Medicine, participating students were divided into three groups (A, B and C) of each 4 to 6 students and had to collaborate on a clinical case. Groups A received detailed information and rules on online collaboration, B less detailed information and C only basic technical information. Each group was asked to fulfil an additional pre- and post-task before and after the semester’s practical course. These tasks consisted of solving combinatory puzzles based on isolated information bits and hints that were distributed among the group members. The groups differed only in the instructions they received to fulfil the task. During their work phases, all groups were observed. The study was conducted twice with different student cohorts. School grades were assigned representing 1 for the best up to 6 for the worst performance. The following averaged results were found: Groups B received the best grades (average 1,5 for winter term and average 1,6 for summer term). Second best performance was shown by the groups A (average 2,14 for winter term and average 1,75 for summer term) and finally groups C performed worst (average 2.10 for winter term and average 1,85 for summer term). In the taken times to solve the puzzle tasks, groups B showed up to be best in the summer term and groups A in the winter term. In all categories, groups C delivered the worst grades in average. The results of this study support that it is most reasonable to aid student online collaboration by providing detailed instructions or at least a few hints and instruct them to create their own rules for online collaboration. The results further support that the cooperation gets worse without suggesting any rules or instructions and that student age possesses a negligible influence.
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Affiliation(s)
- Mark J. Benninghoff
- Institute for Applied Medical Engineering, Helmholtz-Institute, RWTH Aachen University Hospital and RWTH Aachen University, Aachen , Germany
| | - Peter Isfort
- Clinic for Diagnostic and Interventional Radiology, RWTH Aachen University Hospital and RWTH Aachen University, Aachen , Germany
| | - Martin Baumann
- Institute for Applied Medical Engineering, Helmholtz-Institute, RWTH Aachen University Hospital and RWTH Aachen University, Aachen , Germany
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Sähn MJ, Yüksel C, Keil S, Zeisberger MP, Post M, Kleines M, Brokmann JC, Hübel C, Kuhl CK, Isfort P, Schulze-Hagen MF. Accuracy of Chest CT for Differentiating COVID-19 from COVID-19 Mimics. ROFO-FORTSCHR RONTG 2021; 193:1081-1091. [PMID: 33772486 DOI: 10.1055/a-1388-7950] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE To determine the performance of radiologists with different levels of expertise regarding the differentiation of COVID-19 from other atypical pneumonias. Chest CT to identify patients suffering from COVID-19 has been reported to be limited by its low specificity for distinguishing COVID-19 from other atypical pneumonias ("COVID-19 mimics"). Meanwhile, the understanding of the morphologic patterns of COVID-19 has improved and they appear to be fairly specific. MATERIALS AND METHODS Between 02/2020 and 04/2020, 60 patients with COVID-19 pneumonia underwent chest CT in our department. Cases were matched with a comparable control group of 60 patients of similar age, sex, and comorbidities, who underwent chest CT prior to 01/2020 for atypical pneumonia caused by other pathogens. Included were other viral, fungal, and bacterial pathogens. All 120 cases were blinded to patient history and were reviewed independently by two radiologists and two radiology residents. Readers rated the probability of COVID-19 pneumonia according to the COV-RADS classification system. Results were analyzed using Clopper-Pearson 95 % confidence intervals, Youden's Index for test quality criteria, and Fleiss' kappa statistics. RESULTS Overall, readers were able to correctly identify the presence of COVID-19 pneumonia in 219/240 (sensitivity: 91 %; 95 %-CI; 86.9 %-94.5 %), and to correctly attribute CT findings to COVID-19 mimics in 159/240 ratings (specificity: 66.3 %; 59.9 %-72.2 %), yielding an overall diagnostic accuracy of 78.8 % (378/480; 74.8 %-82.3 %). Individual reader accuracy ranged from 74.2 % (89/120) to 84.2 % (101/120) and did not correlate significantly with reader expertise. Youden's Index was 0.57. Between-reader agreement was moderate (κ = 0.53). CONCLUSION In this enriched cohort, radiologists were able to distinguish COVID-19 from "COVID-19 mimics" with moderate diagnostic accuracy. Accuracy did not correlate with reader expertise. KEY POINTS · In a scenario of direct comparison (no negative findings), CT allows the differentiation of COVID-19 from other atypical pneumonias ("COVID mimics") with moderate accuracy.. · Reader expertise did not significantly influence these results.. · Despite similar patterns and distributions of pulmonary findings, radiologists were able to estimate the probability of COVID-19 pneumonia using the COV-RADS classification in a standardized manner in the larger proportion of cases.. CITATION FORMAT · Sähn M, Yüksel C, Keil S et al. Accuracy of Chest CT for Differentiating COVID-19 from COVID-19 Mimics. Fortschr Röntgenstr 2021; 193: 1081 - 1091.
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Affiliation(s)
- Marwin-Jonathan Sähn
- Department of Diagnostic and Interventional Radiology, Universitätsklinikum Aachen, Germany
| | - Can Yüksel
- Department of Diagnostic and Interventional Radiology, Universitätsklinikum Aachen, Germany
| | - Sebastian Keil
- Department of Diagnostic and Interventional Radiology, Universitätsklinikum Aachen, Germany
| | - Marcel P Zeisberger
- Department of Diagnostic and Interventional Radiology, Universitätsklinikum Aachen, Germany
| | - Manuel Post
- Department of Diagnostic and Interventional Radiology, Universitätsklinikum Aachen, Germany
| | - Michael Kleines
- Laboratory Diagnostics Center, Universitätsklinikum Aachen, Germany
| | | | | | - Christiane K Kuhl
- Department of Diagnostic and Interventional Radiology, Universitätsklinikum Aachen, Germany
| | - Peter Isfort
- Department of Diagnostic and Interventional Radiology, Universitätsklinikum Aachen, Germany
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20
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Pedersoli F, Hitpass L, Isfort P, Zimmermann M, Schulze-Hagen M, Gombert A, Kuhl CK, Bruners P, Keil S. Recanalization and Stenting of the Celiac and the Superior Mesenteric Artery Supported by Use of a Steerable Introducer Sheath: Report on 2 Years' Experience. Vasc Endovascular Surg 2020; 55:158-163. [PMID: 33213286 DOI: 10.1177/1538574420975264] [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] [Indexed: 11/15/2022]
Abstract
PURPOSE To compare technical parameters and success of recanalization of celiac (CA) or superior mesenteric artery (SMA) with usage of steerable vs not steerable introducer sheaths. METHODS A retrospective analysis was performed on all consecutive patients who underwent recanalization with stent implantation of CA or SMA between 2015 and 2019. Data regarding technical success (successful stent placement with restoration of sufficient blood flow by the first attempt without changing kind of introducer sheath or access site), indication for treatment, vascular access, kind of introducer sheath, fluoroscopy time and radiation dose were collected. Preinterventional CT were analyzed to classify the difficulty of catheterization of target vessels. Technical parameters were compared with independent t-test (p ≤ 0.05). RESULTS 66 patients underwent recanalization of CA or SMA. Usage of steerable introducer sheaths was associated with higher technical success compared to not steerable introducer sheaths with transfemoral approach respectively of 8/8 vs 15/19 for the CA and 11/11 vs 17/20 for the SMA. Steerable introducer sheaths were used in recanalization considered more technically difficult compared to not steerable introducer sheaths (58% vs 33%). Usage of steerable introducer sheath showed a statistically significant reduction of radiation dose in the recanalization of the SMA (respectively 32035 ± 15716 cGy cm2 vs 60102 ± 28432 cGy cm2; p = 0.005). CONCLUSION Even if used in more difficult interventions, steerable introducer sheaths showed a higher technical success compared to not steerable introducer sheaths with transfemoral access.
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Affiliation(s)
- Federico Pedersoli
- Department of Diagnostic and Interventional Radiology, 39058RWTH University Hospital Aachen, Aachen, Germany
| | - Lea Hitpass
- Department of Diagnostic and Interventional Radiology, 39058RWTH University Hospital Aachen, Aachen, Germany
| | - Peter Isfort
- Department of Diagnostic and Interventional Radiology, 39058RWTH University Hospital Aachen, Aachen, Germany
| | - Markus Zimmermann
- Department of Diagnostic and Interventional Radiology, 39058RWTH University Hospital Aachen, Aachen, Germany
| | - Maximilian Schulze-Hagen
- Department of Diagnostic and Interventional Radiology, 39058RWTH University Hospital Aachen, Aachen, Germany
| | - Alexander Gombert
- Department of Vascular Surgery, 39058RWTH University Hospital Aachen, Aachen, Germany
| | - Christiane K Kuhl
- Department of Diagnostic and Interventional Radiology, 39058RWTH University Hospital Aachen, Aachen, Germany
| | - Philipp Bruners
- Department of Diagnostic and Interventional Radiology, 39058RWTH University Hospital Aachen, Aachen, Germany
| | - Sebastian Keil
- Department of Diagnostic and Interventional Radiology, 39058RWTH University Hospital Aachen, Aachen, Germany
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21
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Tamura M, Pedersoli F, Schulze-Hagen M, Zimmerman M, Isfort P, Kuhl CK, Schmitz-Rode T, Bruners P. Predictors of Occlusion of Hepatic Blood Vessels after Irreversible Electroporation of Liver Tumors. J Vasc Interv Radiol 2020; 31:2033-2042.e1. [PMID: 33267950 DOI: 10.1016/j.jvir.2020.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 08/04/2020] [Accepted: 08/05/2020] [Indexed: 12/25/2022] Open
Abstract
PURPOSE To examine predictors of midterm occlusion in portal and hepatic veins within or adjacent to the ablation zone after irreversible electroporation (IRE) of liver tumors. MATERIALS AND METHODS This retrospective cohort analysis included 39 patients who underwent CT-guided IRE of liver tumors. Vessels within or adjacent to the ablation zone were identified on CT images acquired immediately after the procedure, and the positional relationships with the ablation zone (within/adjacent), locations (proximal/distal), and diameters (< 4 mm or ≥ 4 mm) were evaluated. Using contrast-enhanced follow-up scans, each vessel was classified as patent, stenosed, or occluded. Associations between vessel occlusion and each variable were investigated. RESULTS Overall, 33 portal veins and 64 hepatic veins were analyzed. Follow-up scans showed occlusion in 12/33 (36.7%) portal veins and 17/64 (26.6%) hepatic veins. Vessels within the ablation zone were occluded significantly more frequently than vessels adjacent to the ablation zone (portal: 55.6% [10/18] vs 13.3% [2/15], P = .04; hepatic: 45.4% [15/33] vs 6.4% [2/31], P = .011). Vessels with a diameter < 4 mm were also occluded significantly more frequently than vessels with a diameter ≥ 4 mm (portal: 72.7% [8/11] vs 18.1% [4/22], P = .011; hepatic: 54.8% [17/31] vs 0% [0/33], P < .001). The respective positive and negative predictive values for occlusion of vessels categorized as both within and < 4 mm were 88% (7/8) and 82% (20/25) for portal veins and 79% (15/19) and 96% (43/45) for hepatic veins. CONCLUSIONS Midterm vessel occlusion after liver IRE could be predicted with relatively high accuracy by assessing ablation location and vessel diameter.
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Affiliation(s)
- Masashi Tamura
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Aachen, Germany; Institute of Applied Medical Engineering, Helmholtz Institute, RWTH Aachen University, Aachen, Germany; Department of Radiology, Keio University School of Medicine, Shinanomachi 35, Shinjuku-ku, Tokyo 160-8582, Japan.
| | - Federico Pedersoli
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Aachen, Germany
| | - Maximilian Schulze-Hagen
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Aachen, Germany
| | - Markus Zimmerman
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Aachen, Germany
| | - Peter Isfort
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Aachen, Germany
| | - Christiane K Kuhl
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Aachen, Germany
| | - Thomas Schmitz-Rode
- Institute of Applied Medical Engineering, Helmholtz Institute, RWTH Aachen University, Aachen, Germany
| | - Philipp Bruners
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Aachen, Germany
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22
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Pedersoli F, Schröder A, Zimmermann M, Schulze-Hagen M, Keil S, Ulmer TF, Neumann UP, Kuhl CK, Bruners P, Isfort P. Percutaneous transhepatic biliary drainage (PTBD) in patients with dilated vs. nondilated bile ducts: technical considerations and complications. Eur Radiol 2020; 31:3035-3041. [PMID: 33051733 PMCID: PMC8043937 DOI: 10.1007/s00330-020-07368-6] [Citation(s) in RCA: 13] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 09/10/2020] [Accepted: 10/01/2020] [Indexed: 12/20/2022]
Abstract
Objectives The aim of this study was to compare success, technical complexity, and complication rates of percutaneous transhepatic biliary drainage (PTBD) in patients with dilated vs. nondilated bile ducts. Methods In a retrospective analysis, we evaluated all consecutive PTBD performed in our department over a period of 5 years. Technical success, technical data (side, fluoroscopy time, radiation dose, amount of contrast media, use of disposable equipment), procedure-related complications and peri-interventional mortality were compared for patients with dilated vs. non-dilated bile ducts. Independent t test and χ2 test were used to evaluate the statistical significance. Results A total of 253 procedures were performed on 187 patients, of whom 101/253 had dilated bile ducts and 152/253 not. In total, 243/253 procedures were successful. PTBD was significantly more often successful in patients with dilated vs. nondilated bile ducts (150/153 vs. 93/101; p 0.02). Overall complication rate (13%) did not differ significantly between patients with dilated vs. nondilated bile ducts. Procedures in patients with normal, nondilated bile ducts were associated with a significantly higher rate of post-interventional bleeding (5/101 vs. 0/152). Mean fluoroscopy time (42:36 ± 35:39 h vs. 30:28 ± 25:10 h; p 0.002) and amount of contrast media (66 ± 40 ml vs. 52 ± 24 ml; p 0.07) or use of disposables were significantly higher in patients with nondilated ducts. A significantly lower fluoroscopy time and amount of contrast medium were used in left hepatic PTBD. Conclusion Despite the higher technical complexity, PTBD with nondilated bile ducts was associated with similar overall complication rates but higher bleeding complications compared with PTBD with dilated bile ducts. Key Points • PTBD was associated with similar overall complication rates in patients with dilated vs. nondilated bile ducts. • Although overall complication rates were low, PTBD in patients with nondilated bile ducts was associated with a higher incidence of post-interventional bleeding. • PTBD in patients with nondilated bile ducts is technically more complex.
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Affiliation(s)
- Federico Pedersoli
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany.
| | - Anja Schröder
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Markus Zimmermann
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Maximilian Schulze-Hagen
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Sebastian Keil
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Tom Florian Ulmer
- Department of General, Visceral and Transplant Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Ulf Peter Neumann
- Department of General, Visceral and Transplant Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Christiane K Kuhl
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Philipp Bruners
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Peter Isfort
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
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23
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Bednarsch J, Czigany Z, Sharmeen S, van der Kroft G, Strnad P, Ulmer TF, Isfort P, Bruners P, Lurje G, Neumann UP. ALPPS versus two-stage hepatectomy for colorectal liver metastases--a comparative retrospective cohort study. World J Surg Oncol 2020; 18:140. [PMID: 32580729 PMCID: PMC7315489 DOI: 10.1186/s12957-020-01919-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 06/15/2020] [Indexed: 02/07/2023] Open
Abstract
Abstract Background Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) and two stage hepatectomy with inter-stage portal vein embolization (TSH/PVE) are surgical maneuvers applied in patients with advanced malignancies considered unresectable by means of conventional liver surgery. The aim of this report is to compare the oncologic outcome and technical feasibility of ALPPS and TSH/PVE in the scenario of colorectal liver metastases (CRLM). Methods All consecutive patients who underwent either ALPPS or TSH/PVE for CRLM between 2011 and 2017 in one hepatobiliary center were analyzed and compared regarding perioperative and long-term oncologic outcome. Results A cohort of 58 patients who underwent ALPPS (n = 21) or TSH/PVE (n = 37) was analyzed. The median overall survival (OS) was 28 months and 34 months after ALPPS and TSH/PVE (p = 0.963), respectively. The median recurrence-free survival (RFS) was higher following ALPPS with 19 months than following TSH/PVE with 10 months, but marginally failed to achieve statistical significance (p = 0.05). There were no differences in morbidity and mortality after stages 1 and 2. Patients undergoing ALPPS due to insufficient hypertrophy after TSH/PVE (rescue-ALPPS) displayed similar oncologic outcome as patients treated by conventional ALPPS or TSH/PVE (p = 0.971). Conclusions ALPPS and TSH/PVE show excellent technical feasibility and comparable long-term oncologic outcome in CRLM. Rescue ALPPS appears to be a viable option for patients displaying insufficient hypertrophy after a TSH/PVE approach.
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Affiliation(s)
- Jan Bednarsch
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Zoltan Czigany
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Samara Sharmeen
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Gregory van der Kroft
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Pavel Strnad
- Department of Medicine III, University Hospital RWTH Aachen, Aachen, Germany
| | - Tom Florian Ulmer
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Peter Isfort
- Department of Radiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Philipp Bruners
- Department of Radiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Georg Lurje
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany. .,Department of Surgery, Campus Charité Mitte
- Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Berlin, Germany.
| | - Ulf Peter Neumann
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany.,Department of Surgery, Maastricht University Medical Centre (MUMC), Maastricht, Netherlands
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24
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Schulze-Hagen M, Truhn D, Duong F, Keil S, Pedersoli F, Kuhl CK, Lurje G, Neumann U, Isfort P, Bruners P, Zimmermann M. Correlation Between Sarcopenia and Growth Rate of the Future Liver Remnant After Portal Vein Embolization in Patients with Colorectal Liver Metastases. Cardiovasc Intervent Radiol 2020; 43:875-881. [PMID: 31974746 PMCID: PMC7225189 DOI: 10.1007/s00270-020-02416-6] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 01/09/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE To investigate whether sarcopenia and myosteatosis correlate with the degree of hypertrophy (DH) and kinetic growth rate (KiGR) of the future liver remnant (FLR) in patients with colorectal liver metastases undergoing portal vein embolization (PVE) in preparation for right hepatectomy. MATERIALS AND METHODS Forty-two patients were included. Total liver volume and FLR volume were measured before and 2-4 weeks after PVE. KiGR of the FLR was calculated. Sarcopenia was assessed using the total psoas muscle volume (PMV), the psoas muscle cross-sectional area (PMCS) and the total skeletal muscle index (L3SMI) at the level of 3rd lumbar vertebra. Degree of myosteatosis was assessed by mean muscle attenuation at L3 (L3MA). Correlations between muscle indices and DH and KiGR were assessed using simple linear regression analyses. RESULTS Mean DH was 8.9 ± 5.7%, and mean KiGR was 3.6 ± 2.3. Mean PMV was 55.56 ± 14.19 cm3/m3, mean PMCS was 8.76 ± 2.3 cm2/m2, mean L3SMI was 45.6 ± 9.89 cm2/m2, and mean L3MA was 27.9 ± 18.6 HU. There was a strong positive correlation between PMV and DH (R = 0.503, p = 0.001) and PMV and KiGR (R = 0.545, p < 0.001). Furthermore, there was a moderate correlation between PMCS and KiGR (R = 0.389, p = 0.014). L3SMI and L3MA were neither associated with DH (p = 0.390 and p = 0.768, respectively) nor with KiGR (p = 0.188 and p = 0.929, respectively). CONCLUSION We identified a positive correlation between PMV and PMCS, as markers for sarcopenia, and the KiGR of the FLR after PVE. PMV and PMCS might therefore aid to identify patients who are poor candidates for FLR augmentation using PVE alone.
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Affiliation(s)
- M Schulze-Hagen
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Aachen, DE, Germany.
| | - D Truhn
- Institute of Imaging and Computer Vision, RWTH Aachen University, Aachen, DE, Germany
| | - F Duong
- Institute of Imaging and Computer Vision, RWTH Aachen University, Aachen, DE, Germany
| | - S Keil
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Aachen, DE, Germany
| | - F Pedersoli
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Aachen, DE, Germany
| | - C K Kuhl
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Aachen, DE, Germany
| | - G Lurje
- Department of Surgery and Transplantation, RWTH Aachen University Hospital, Aachen, DE, Germany
| | - U Neumann
- Department of Surgery and Transplantation, RWTH Aachen University Hospital, Aachen, DE, Germany
| | - P Isfort
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Aachen, DE, Germany
| | - P Bruners
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Aachen, DE, Germany
| | - M Zimmermann
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Aachen, DE, Germany
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25
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Schulze-Hagen M, Hübel C, Meier-Schroers M, Yüksel C, Sander A, Sähn M, Kleines M, Isfort P, Cornelissen C, Lemmen S, Marx N, Dreher M, Brokmann J, Kopp A, Kuhl C. Low-Dose Chest CT for the Diagnosis of COVID-19—A Systematic, Prospective Comparison With PCR. Dtsch Arztebl Int 2020; 117:389-395. [PMID: 32762834 PMCID: PMC7465363 DOI: 10.3238/arztebl.2020.0389] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 04/21/2020] [Accepted: 05/12/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Only limited evidence has been available to date on the accuracy of systematic low-dose chest computed tomography (LDCT) use in the diagnosis of COVID-19 in patients with non-specific clinical symptoms. METHODS The COVID-19 Imaging Registry Study Aachen (COVID-19-Bildgebungs-Register Aachen, COBRA) collects data on imaging in patients with COVID-19. Two of the COBRA partner hospitals (RWTH Aachen University Hospital and Dueren Hospital) systematically perform reverse transcriptase polymerase chain reaction (RT-PCR) from nasopharyngeal swabs as well as LDCT in all patients presenting with manifestations that are compatible with COVID-19. In accordance with the COV-RADS protocol, the LDCT scans were prospectively evaluated before the RT-PCR findings were available in order to categorize the likelihood of COVID-19. RESULTS From 18 March to 5 May 2020, 191 patients with COVID-19 manifestations (117 male, age 65 ± 16 years) underwent RT-PCR testing and LDCT. The mean time from the submission of the sample to the availability of the RT-PCR findings was 491 minutes (interquartile range [IQR: 276-1066]), while that from the performance of the CT to the availability of its findings was 9 minutes (IQR: 6-11). A diagnosis of COVID-19 was made in 75/191 patients (39%). The LDCT was positive in 71 of these 75 patients and negative in 106 of the 116 patients without COVID-19, corresponding to 94.7% sensitivity (95% confidence interval [86.9; 98.5]), 91.4% specificity [84.7; 95.8], positive and negative predictive values of 87.7% [78.5; 93.9] and 96.4% [91.1; 98.6], respectively, and an AUC (area under the curve) of 0.959 [0.930; 0.988]. The initial RT-PCR test results were falsely negative in six patients, yielding a sensitivity of 92.0% [83.4; 97.0]; these six patients had positive LDCT findings. 47.4% of the LDCTs that were negative for COVID-19 (55/116) exhibited pathological pulmonary changes, including infiltrates, that were correctly distinguished from SARS-CoV-2 related changes. CONCLUSION In patients with symptoms compatible with COVID-19, LDCT can esablish the diagnosis of COVID-19 with comparable sensitivity to RT-PCR testing. In addition, it offers a high specificity for distinguishing COVID-19 from other diseases associated with the same or similar clinical symptoms. We propose the systematic use of LDCT in addition to RT-PCR testing because it helps correct false-negative RT-PCR results, because its results are available much faster than those of RT-PCRtesting, and because it provides additional diagnostic information useful for treatment planning regardless of the type of the infectious agent.
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Affiliation(s)
| | | | | | - Can Yüksel
- RWTH Aachen University Hospital: Department of Diagnostic and Interventional Radiology
| | - Anton Sander
- Hospital of Düren gGmbH, Department of Diagnostic and Interventional Radiology
| | - Marwin Sähn
- RWTH Aachen University Hospital: Department of Diagnostic and Interventional Radiology
| | - Michael Kleines
- Center of Laboratory Diagnostics, Department Virology/Serology
| | - Peter Isfort
- RWTH Aachen University Hospital: Department of Diagnostic and Interventional Radiology
| | | | | | - Nikolaus Marx
- Department of Cardiology, Angiology, and Internal Intensive Medicine (Med. Clinic 1)
| | - Michael Dreher
- Department of Pneumology and Internal Intensive Care Medicine (Med. Clinic V)
| | | | - Andreas Kopp
- Hospital of Düren gGmbH, Department of Diagnostic and Interventional Radiology
| | - Christiane Kuhl
- RWTH Aachen University Hospital: Department of Diagnostic and Interventional Radiology
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Pedersoli F, Zimmermann M, Schulze-Hagen M, Sieben P, Barzakova E, Goerg F, Keil S, Gombert A, Kuhl CK, Isfort P, Bruners P. Retrograde Recanalization of the Celiac Artery via the Pancreaticoduodenal Arcade as a Safe and Valid Alternative to Antegrade Access. Vasc Endovascular Surg 2020; 54:477-481. [PMID: 32419653 DOI: 10.1177/1538574420927132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The antegrade recanalization of an occlusion or high-grade stenosis of the celiac artery via the aorta often represents a technical challenge. A retrograde approach via the superior mesenteric artery and the pancreaticoduodenal arcade may be an alternative approach. Based on our experience, we assess the technical success and the short- and mid-term outcomes of this bailout procedure. METHODS We performed a retrospective analysis of all consecutive patients who underwent recanalization and stent implantation in the celiac artery between January 2010 and December 2018. Data on vascular access, the materials used including stents, as well as the length of the intervention, radiation exposure, and follow-up were assessed. RESULTS Recanalization in combination with stent implantation into the celiac artery was performed in 43 patients. In 39 (91%) of 43 patients, the recanalization was successful with an antegrade approach via the aorta, whereas in 4 (9%) of 43 patients the passage of the stenosis was possible only through a retrograde approach through the superior mesenteric artery and the pancreaticoduodenal arcade followed be advancement of the microwire through the celiac artery into the aorta. The tip of the microwire was captured in the aorta with a snare and pulled out in the femoral introducer sheath and used as a guide for the antegrade implantation of a balloon-expandable stent. CONCLUSIONS The retrograde recanalization of the celiac artery via the pancreaticoduodenal arcade may be technically challenging yet represents a feasible alternative in case of a failed antegrade approach.
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Affiliation(s)
- Federico Pedersoli
- Department of Diagnostic and Interventional Radiology, RWTH University Hospital Aachen, Aachen, Germany
| | - Markus Zimmermann
- Department of Diagnostic and Interventional Radiology, RWTH University Hospital Aachen, Aachen, Germany
| | - Maximilian Schulze-Hagen
- Department of Diagnostic and Interventional Radiology, RWTH University Hospital Aachen, Aachen, Germany
| | - Paul Sieben
- Department of Diagnostic and Interventional Radiology, RWTH University Hospital Aachen, Aachen, Germany
| | - Emona Barzakova
- Department of Diagnostic and Interventional Radiology, RWTH University Hospital Aachen, Aachen, Germany
| | - Fabian Goerg
- Department of Diagnostic and Interventional Radiology, RWTH University Hospital Aachen, Aachen, Germany
| | - Sebastian Keil
- Department of Diagnostic and Interventional Radiology, RWTH University Hospital Aachen, Aachen, Germany
| | - Alexander Gombert
- Clinic for Vascular Surgery, RWTH University Hospital Aachen, Aachen, Germany
| | - Christiane K Kuhl
- Department of Diagnostic and Interventional Radiology, RWTH University Hospital Aachen, Aachen, Germany
| | - Peter Isfort
- Department of Diagnostic and Interventional Radiology, RWTH University Hospital Aachen, Aachen, Germany
| | - Philipp Bruners
- Department of Diagnostic and Interventional Radiology, RWTH University Hospital Aachen, Aachen, Germany
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Liebl M, Schulze-Hagen M, Zimmermann M, Pedersoli F, Kuhl C, Bruners P, Isfort P. Microwave Ablation in the Proximity of Surgical Clips: Is there a Safety Issue? Cardiovasc Intervent Radiol 2020; 43:918-923. [PMID: 32236668 PMCID: PMC7225190 DOI: 10.1007/s00270-020-02453-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 11/25/2019] [Accepted: 03/12/2020] [Indexed: 12/22/2022]
Abstract
Purpose The purpose of this study was to evaluate the heat generation of surgical clips within the target area of MWA and the influences on the ablation volume. Materials and Methods In bovine liver tissue, 42 ex vivo microwave ablations (60 W; 180 s) were performed. During ablation, the temperature was measured continuously at 4 points of interest (POI), in a distance of 7.5 and 15 mm on each side of the microwave antenna, with a titanium surgical placed at one 7.5-mm POI. Ablation volumes containing large vessels (n = 10) were excluded. For every POI, the mean temperature of 32 ablations was calculated. The mean temperatures were compared between the 4 POI and statistically analyzed using the Student’s t test. Results The mean maximum temperatures at the side of the clip were 88.76 °C/ 195 s and 52.97 °C/ 195 s and at the side without clip 78.75 °C/ 195 s and 43.16 °C/ 195 s, respectively, at POI 7.5 mm and POI 15 mm. The maximum difference of mean temperatures for POI 7.5 mm was 12.91 °C at 84 s (p = 0.022) and for POI 15 mm 9.77 °C at 195 s (p = 0.009). No significant changes in size and shape of the ablation zone could be determined. Conclusions Our study demonstrated significantly higher temperatures adjacent to surgical clips. Also, the temperatures distal to the titanium clip were higher compared to the control location without clip. These findings suggest an increased risk of thermal damage to surrounding tissues during MWA, especially in case of immediate contact to surgical clips.
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Affiliation(s)
- Martin Liebl
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany.,Hôpital Kirchberg (Hôpitaux Robert Schuman), 9, Rue Edward Steichen, 2540, Luxembourg, Luxembourg
| | - Maximilian Schulze-Hagen
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Markus Zimmermann
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Federico Pedersoli
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Christiane Kuhl
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Philipp Bruners
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Peter Isfort
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany.
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Lurje I, Czigany Z, Isfort P, Lurje G. Acute complications in both recipients of a kidney allograft pair from the same donor. Am J Transplant 2019. [DOI: 10.1111/ajt.15568] [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: 12/01/2022]
Affiliation(s)
- Isabella Lurje
- Department of Surgery and Transplantation University Hospital RWTH Aachen Aachen Germany
| | - Zoltan Czigany
- Department of Surgery and Transplantation University Hospital RWTH Aachen Aachen Germany
| | - Peter Isfort
- Department of Diagnostic and Interventional Radiology University Hospital RWTH Aachen Aachen Germany
| | - Georg Lurje
- Department of Surgery and Transplantation University Hospital RWTH Aachen Aachen Germany
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Barzakova ES, Schulze-Hagen M, Zimmermann M, Lurje G, Bednarsch J, Pedersoli F, Isfort P, Kuhl C, Bruners P. Monitoring Liver Function of Patients Undergoing Transarterial Chemoembolization (TACE) by a 13C Breath Test (LiMAx). Cardiovasc Intervent Radiol 2019; 42:1702-1708. [PMID: 31535181 DOI: 10.1007/s00270-019-02325-3] [Citation(s) in RCA: 8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 08/23/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE Transarterial chemoembolization (TACE) is associated with the risk of deteriorating liver function, especially in patients with preexisting liver damage. Current liver function tests may fail to accurately predict the functional liver reserve. Aim of this study was to investigate whether changes of liver function caused by TACE are associated with detectable changes of LiMAx values. METHODS AND MATERIALS Forty patients with primary or secondary liver cancer underwent TACE and LiMAx test on the day before, the day after, and 4 weeks after TACE. LiMAx results were evaluated, referenced to liver volume (CT/MR volumetry), correlated with the respective TACE volume (subsegmental vs. segmental vs. lobar), established liver function tests, and Child-Pugh and ALBI scores. RESULTS The individual LiMAx values were significantly reduced by 10% (p = 0.01) on the day after TACE and fully recovered to baseline 1 month after treatment. Similar changes were observed regarding levels of bilirubin, transaminases, albumin, INR, and creatinine. LiMAx did not correlate significantly with the treated liver volume, but did correlate with the baseline liver volume (< 1200 ml vs. > 1200 ml; p < 0.01). No significant changes were observed in the Child-Pugh score or ALBI score. CONCLUSION LiMAx is capable of detecting changes in liver function, even modulations caused by superselective TACE procedures. Accordingly, it could be used as a tool for patient selection and monitoring of transarterial therapy. In comparison, Child-Pugh and ALBI scores did not reflect any of these changes. Some biochemical parameters also changed significantly after TACE, but they tend to be less specific in providing sufficient information on actual cellular dysfunction.
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Affiliation(s)
- Emona S Barzakova
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstreet 30, 52074, Aachen, Germany.
| | - Maximilian Schulze-Hagen
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstreet 30, 52074, Aachen, Germany
| | - Markus Zimmermann
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstreet 30, 52074, Aachen, Germany
| | - Georg Lurje
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Aachen, Germany
| | - Jan Bednarsch
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Aachen, Germany
| | - Federico Pedersoli
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstreet 30, 52074, Aachen, Germany
| | - Peter Isfort
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstreet 30, 52074, Aachen, Germany
| | - Christiane Kuhl
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstreet 30, 52074, Aachen, Germany
| | - Philipp Bruners
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstreet 30, 52074, Aachen, Germany
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Thüring J, Zimmermann M, Bruners P, Pedersoli F, Schulze-Hagen M, Barzakova E, Kuhl CK, Isfort P. Short-Term Oral Sorafenib for Therapy of Intratumoral Shunts of Hepatocellular Carcinoma to Enable Intraarterial Treatment. Cardiovasc Intervent Radiol 2019; 42:1494-1499. [PMID: 31363899 PMCID: PMC6715807 DOI: 10.1007/s00270-019-02294-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 05/22/2019] [Revised: 07/18/2019] [Accepted: 07/20/2019] [Indexed: 01/02/2023]
Abstract
INTRODUCTION Significant intratumoral shunts between tumor-supplying arteries and portal or liver veins are a contraindication for transarterial therapy of HCC because interventional treatment of these shunts is frequently insufficient. Sorafenib has anti-angiogenic effects and is indicated for palliative treatment of patients with HCC. Here, we report our experience with the use of sorafenib for the closure of intratumoral shunts in patients scheduled for transarterial therapy of HCC. MATERIALS AND METHODS Three patients with HCC, aged 65, 82 and 79 years, exhibited a significant intratumoral shunting from tumor artery to portal (n = 1) or liver veins (n = 2). In all cases, intratumoral shunting had already been suspected based on pre-interventional CT angiography, and DSA confirmed the shunt. Oral sorafenib (800 mg/day) was administered for at least four weeks, only and specifically to occlude the shunt. Hereafter, patients were re-evaluated by CT and DSA. RESULTS All patients tolerated the full prescribed dose for at least 4 weeks. In one case, therapy was prolonged with an adapted dose (400 mg/day) due to sorafenib-related hand-foot syndrome. After sorafenib treatment, CT and DSA confirmed a complete closure of intratumoral shunts for all patients. No tumor progression was observed. All three patients hereafter underwent successful transarterial treatment by TACE (n = 2) or TARE (n = 1) without complications. Progression-free survival according to mRECIST was 501, 397 and 599 days, respectively. CONCLUSION Even short-term oral sorafenib seems to effectively close intratumoral shunts in patients with HCC and thus might enable transarterial treatment of these patients.
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Affiliation(s)
- J Thüring
- Department of Diagnostic and Interventional Radiology, Aachen University Hospital, Pauwelsstreet 30, 52072, Aachen, Germany.
| | - M Zimmermann
- Department of Diagnostic and Interventional Radiology, Aachen University Hospital, Pauwelsstreet 30, 52072, Aachen, Germany
| | - P Bruners
- Department of Diagnostic and Interventional Radiology, Aachen University Hospital, Pauwelsstreet 30, 52072, Aachen, Germany
| | - F Pedersoli
- Department of Diagnostic and Interventional Radiology, Aachen University Hospital, Pauwelsstreet 30, 52072, Aachen, Germany
| | - M Schulze-Hagen
- Department of Diagnostic and Interventional Radiology, Aachen University Hospital, Pauwelsstreet 30, 52072, Aachen, Germany
| | - E Barzakova
- Department of Diagnostic and Interventional Radiology, Aachen University Hospital, Pauwelsstreet 30, 52072, Aachen, Germany
| | - C K Kuhl
- Department of Diagnostic and Interventional Radiology, Aachen University Hospital, Pauwelsstreet 30, 52072, Aachen, Germany
| | - P Isfort
- Department of Diagnostic and Interventional Radiology, Aachen University Hospital, Pauwelsstreet 30, 52072, Aachen, Germany
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Zimmermann M, Schulze-Hagen M, Pedersoli F, Isfort P, Heinzel A, Kuhl C, Bruners P. Y90-radioembolization via variant hepatic arteries: Is there a relevant risk for non-target embolization? World J Radiol 2019; 11:102-109. [PMID: 31396373 PMCID: PMC6682496 DOI: 10.4329/wjr.v11.i7.102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 07/03/2019] [Accepted: 07/25/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The hepatic arterial anatomy is highly variable, with the two most common variants being a replaced right hepatic artery (RHA) originating from the superior mesenteric artery (SMA) and a left hepatic artery (LHA) originating from the left gastric artery (LGA). These anatomical variants could potentially increase the risk for non-target embolization during Y90-Radioembolization due to the close proximity between hepatic and enteric vessel branches.
AIM To evaluate the safety of Yttrium-90 radioembolization (90Y-RE) with resin microspheres in patients with a variant hepatic arterial anatomy.
METHODS In this retrospective single-center observational study, 11 patients who underwent RE with 90Y-resin microspheres via a LHA originating from the LGA, and 13 patients via a RHA originating from the SMA were included. Patient and treatment data were reviewed regarding clinical and imaging evidence of non-target embolization of 90Y-resin microspheres to the GI tract. Positioning of the tip of the microcatheter in relationship to the last hepatoenteric side branch was retrospectively analyzed using angiographic images, cone-beam CT and pre-interventional CT-angiograms.
RESULTS None of the 24 patients developed clinical symptoms indicating a potential non-target embolization to the GI tract within the first month after 90Y-RE. On the postinterventional 90Y-bremsstrahlung images and/or 90Y-positron emission tomographies, no evidence of extrahepatic 90Y-activity in the GI tract was noted in any of the patients. The mean distance between the tip of the microcatheter and the last enteric side branch during delivery of the 90Y microspheres was 3.2 cm (range: 1.9-5 cm) in patients with an aberrant LHA originating from a LGA. This was substantially shorter than the mean distance of 5.2 cm (range: 2.9-7.7 cm) in patients with an aberrant right hepatic originating from the SMA.
CONCLUSION 90Y-RE via aberrant hepatic arteries appears to be safe; at least with positioning of the microcatheter tip no less than 1.9 cm distal to the last hepatoenteric side branch vessel.
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Affiliation(s)
- Markus Zimmermann
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Aachen 52074, Germany
| | - Maximilian Schulze-Hagen
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Aachen 52074, Germany
| | - Federico Pedersoli
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Aachen 52074, Germany
| | - Peter Isfort
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Aachen 52074, Germany
| | - Alexander Heinzel
- Department of Nuclear Medicine, RWTH Aachen University Hospital, Pauwelsstrasse 30, Aachen 52074, Germany
| | - Christiane Kuhl
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Aachen 52074, Germany
| | - Philipp Bruners
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Aachen 52074, Germany
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Reinartz SD, Imhoff M, Tolba R, Fischer F, Fischer EG, Teschner E, Koch S, Gärber Y, Isfort P, Gremse F. EIT monitors valid and robust regional ventilation distribution in pathologic ventilation states in porcine study using differential DualEnergy-CT (ΔDECT). Sci Rep 2019; 9:9796. [PMID: 31278297 PMCID: PMC6611907 DOI: 10.1038/s41598-019-45251-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 07/25/2018] [Accepted: 04/12/2019] [Indexed: 11/19/2022] Open
Abstract
It is crucial to precisely monitor ventilation and correctly diagnose ventilation-related pathological states for averting lung collapse and lung failure in Intensive Care Unit (ICU) patients. Although Electrical Impedance Tomography (EIT) may deliver this information continuously and non-invasively at bedside, to date there are no studies that systematically compare EIT and Dual Energy CT (DECT) during inspiration and expiration (ΔDECT) regarding varying physiological and ICU-typical pathological conditions such as atelectasis. This study aims to prove the accuracy of EIT through quantitative identification and monitoring of pathological ventilation conditions on a four-quadrant basis using ΔDECT. In a cohort of 13 pigs, this study investigated systematic changes in tidal volume (TV) and positive end-expiratory pressure (PEEP) under physiological ventilation conditions. Pathological ventilation conditions were established experimentally by single-lung ventilation and pulmonary saline lavage. Spirometric data were compared to voxel-based entire lung ΔDECT, and EIT intensities were compared to ΔDECT of a 12-cm slab of the lung around the EIT belt, the so called ΔDECTBelt. To validate ΔDECT data with spirometry, a Pearson’s correlation coefficient of 0.92 was found for 234 ventilation conditions. Comparing EIT intensity with ΔDECT(Belt), the correlation r = 0.84 was found. Normalized cross-correlation function (NCCF) between scaled global impedance (EIT) waveforms and global volume ventilator curves was r = 0.99 ± 0.003. The EIT technique correctly identified the ventilated lung in all cases of single-lung ventilation. In the four-quadrant based evaluation, which assesses the difference between end-expiratory lung volume (ΔEELV) and the corresponding parameter in EIT, i.e. the end-expiratory lung impedance (ΔEELI), the Pearson’s correlation coefficient of 0.94 was found. The respective Pearson’s correlation coefficients implies good to excellent concurrence between global and regional EIT ventilation data validated by ventilator spirometry and DECT imaging. By providing real-time images of the lung, EIT is a promising, EIT is a promising, clinically robust tool for bedside assessment of regional ventilation distribution and changes of end-expiratory lung volume.
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Affiliation(s)
- Sebastian D Reinartz
- Department of Diagnostic and Interventional Radiology, University Hospital, RWTH Aachen University, 52074, Aachen, Germany.
| | - Michael Imhoff
- Department for Medical Informatics, Biometry and Epidemiology, Ruhr University of Bochum, 44780, Bochum, Germany
| | - René Tolba
- Institute of Laboratory Animal Science, University Hospital, RWTH Aachen University, 52074, Aachen, Germany
| | - Felix Fischer
- Drägerwerk AG & Co. KGaA, Moislinger Allee 53-55, 23558, Lübeck, Germany
| | - Eike G Fischer
- Aix Scientifics CRO, Theaterstr. 7, 52062, Aachen, Germany
| | - Eckhard Teschner
- Drägerwerk AG & Co. KGaA, Moislinger Allee 53-55, 23558, Lübeck, Germany
| | - Sabine Koch
- Institute of Laboratory Animal Science, University Hospital, RWTH Aachen University, 52074, Aachen, Germany
| | - Yvo Gärber
- Drägerwerk AG & Co. KGaA, Moislinger Allee 53-55, 23558, Lübeck, Germany
| | - Peter Isfort
- Department of Diagnostic and Interventional Radiology, University Hospital, RWTH Aachen University, 52074, Aachen, Germany
| | - Felix Gremse
- Institute for Experimental Molecular Imaging, University Hospital, RWTH Aachen University, 52074, Aachen, Germany
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Barabasch A, von Stillfried S, Kuhl CK, Heinzel A, Sander A, Isfort P. Toward Transpulmonary Chemoembolization with Degradable Starch Microspheres: Systematic Analysis of Local and Systemic Effects in a Porcine Model. Cardiovasc Intervent Radiol 2019; 42:1475-1482. [PMID: 31119355 DOI: 10.1007/s00270-019-02246-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 05/13/2019] [Accepted: 05/14/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE To investigate local and systemic effects of transpulmonary chemoembolization (TPCE) with degradable starch microspheres (DSM) and doxorubicin. The long-term goal is to establish DSM-TPCE as a treatment option for pulmonary malignancies. MATERIALS AND METHODS Nine pigs underwent TPCE of either the right or left lower lobe pulmonary artery (LLPA) and bland embolization (TPE) of the contralateral LLPA. Before the procedures, macroaggregated albumin (MAA) particles were injected into both LLPAs, to exclude systemic shunting. Pulmonary arterial pressure, heart rate and oxygenation were recorded immediately before and at 1, 3, 5 and 10 min after treatment. To investigate possible nontarget embolization, animals underwent cerebral MRI (cMRI). We killed the animals after a contrast-enhanced chest computed tomography (CT) and performed a pathologic examination at 12 h (3), 24 h (3) and 72 h (3) after treatment. RESULTS All experiments were technically successful. Mean injected DSM dose until stasis was similar in TPCE and TPE (4.3 ± 1.4 vs. 4.0 ± 1.4 mL). Pulmonary arterial pressure increased significantly 3 min after treatment (TPE: 17 ± 5 vs. 27 ± 7 mmHg; TPCE: 22 ± 6 vs. 36 ± 8 mmHg). No significant changes in heart rate or peripheral oxygenation levels occurred. We observed no evidence of structural lung damage or permanent perfusion disruption on CT. MAA test injection and cMRI revealed no shunting or nontarget embolization. The pathologic assessment revealed nonspecific local inflammation of the lung parenchyma. CONCLUSION In this large-animal model, TPCE and TPE appear feasible and safe. We observed a mild increase in pulmonary arterial pressure. Nontarget embolization did not occur. TPCE, as well as TPE, did not cause structural damage to the normal lung parenchyma.
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Affiliation(s)
- A Barabasch
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - S von Stillfried
- Institute of Pathology, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - C K Kuhl
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - A Heinzel
- Department of Nuclear Medicine, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - A Sander
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - P Isfort
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074, Aachen, Germany.
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Czigany Z, Boecker J, Morales Santana DA, Bednarsch J, Meister FA, Amygdalos I, Isfort P, Liebl M, Neumann UP, Lurje G. Median Arcuate Ligament Compression in Orthotopic Liver Transplantation: Results from a Single-Center Analysis and a European Survey Study. J Clin Med 2019; 8:jcm8040550. [PMID: 31018577 PMCID: PMC6518097 DOI: 10.3390/jcm8040550] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 04/15/2019] [Accepted: 04/22/2019] [Indexed: 12/17/2022] Open
Abstract
Median arcuate ligament compression (MALC) potentially causes arterial complications in orthotopic liver transplantation (OLT). Here we aimed to investigate the incidence of MALC and its impact on clinical outcome after OLT. In addition, we performed an international survey among 52 European liver transplant centers to explore local protocols on the management of these patients. Data of 286 consecutive OLT recipients from a prospective database were analyzed retrospectively (05/2010-07/2017). Preoperative computed-tomography images were evaluated. Celiac axis stenosis due to MALC was found in 34 patients (12%). Intrinsic stenosis was present in 16 (6%) patients. Twenty-six patients (77%) with MALC underwent standard arterial revascularization with median arcuate ligament (MAL)-division. Patients treated for MALC had comparable baseline data and no difference was found in early- and long-term outcome compared to the rest of our cohort. Our survey found heterogeneous strategies regarding diagnosis and treatment of MALC. Only 29% of the centers reported the division of MAL in these patients as routine procedure. Even though there is no consensus on diagnosis and management of MALC among European centers, a surgical division of MAL is feasible and safe and should be considered in OLT recipients with MALC.
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Affiliation(s)
- Zoltan Czigany
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, 52074 Aachen, Germany.
| | - Joerg Boecker
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, 52074 Aachen, Germany.
| | | | - Jan Bednarsch
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, 52074 Aachen, Germany.
| | | | - Iakovos Amygdalos
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, 52074 Aachen, Germany.
| | - Peter Isfort
- Institute of Radiology, University Hospital RWTH Aachen, 52074 Aachen, Germany.
| | - Martin Liebl
- Institute of Radiology, University Hospital RWTH Aachen, 52074 Aachen, Germany.
| | - Ulf Peter Neumann
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, 52074 Aachen, Germany.
- Department of Surgery, Maastricht University Medical Centers (MUMC), 6202 AZ Maastricht, The Netherlands.
| | - Georg Lurje
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, 52074 Aachen, Germany.
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Ritter A, Bruners P, Isfort P, Barabasch A, Pfeffer J, Schmitz J, Pedersoli F, Baumann M. Electroporation of the Liver: More Than 2 Concurrently Active, Curved Electrodes Allow New Concepts for Irreversible Electroporation and Electrochemotherapy. Technol Cancer Res Treat 2019; 17:1533033818809994. [PMID: 30411673 PMCID: PMC6259055 DOI: 10.1177/1533033818809994] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Irreversible electroporation and electrochemotherapy are 2 innovative electroporation-based minimally invasive therapies for the treatment of cancer. Combining nonthermal effects of irreversible electroporation with local application of chemotherapy, electrochemotherapy is an established treatment modality for skin malignancies. Since the application of electrochemotherapy in solid organs is a promising approach, this article describes a novel electrode configuration and field generating method. For the treatment of hepatic malignancies, the shape of the electric field should resemble a spherical 3-dimensional geometry around the target tissue inside the liver. To adapt the actual shape of the field, the probe is designed in computer-aided design with a live link to a computer simulation software: Changes in design can be revalued quickly, regarding different quality criteria for field strength inside and outside the tumor. To rate these criteria, a set of formulas with weighting coefficients has been included. As a result of this design process, a needle-shaped prototype applicator has been built, designed for an intracorporal electroporation-based treatment. It can be used as percutaneous, image-guided, minimally invasive treatment option for malignant liver tumors. The shaft of the probe is used as central electrode and fitted with additional 4 expandable electrodes. These satellite electrodes are hollow, thus serving as injectors for chemotherapeutic agents within the area of the electric field. This configuration can be used for electrochemotherapy as well as irreversible electroporation. By placing 5 electrodes with just one needle, the procedure duration as well as the radiation dose can be reduced tremendously. Additionally, the probe offers an option to adapt the field geometry to the tumor geometry by connecting the 5 electrodes to 5 individually chosen electric potentials: By fine-tuning the ablation zone via the potentials instead of adjusting the location of the electrode(s), the procedure duration as well as the radiation dose will decrease further.
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Affiliation(s)
- Andreas Ritter
- 1 Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany.,2 Institute of Applied Medical Engineering (AME), Helmholtz Institute, RWTH Aachen University, Aachen, Germany
| | - Philipp Bruners
- 1 Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Peter Isfort
- 1 Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Alexandra Barabasch
- 1 Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Joachim Pfeffer
- 1 Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Jula Schmitz
- 1 Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Federico Pedersoli
- 1 Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Martin Baumann
- 2 Institute of Applied Medical Engineering (AME), Helmholtz Institute, RWTH Aachen University, Aachen, Germany
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Isfort P, Rauen P, Na HS, Ito N, von Stillfried S, Kuhl C, Bruners P. Does Drug-Eluting Bead TACE Enhance the Local Effect of IRE? Imaging and Histopathological Evaluation in a Porcine Model. Cardiovasc Intervent Radiol 2019; 42:880-885. [PMID: 30737544 DOI: 10.1007/s00270-019-02181-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 02/04/2019] [Indexed: 12/18/2022]
Abstract
OBJECTIVES We conducted an in vivo trial on swine to compare the ablation volumes of irreversible electroporation (IRE) followed by drug-eluting beads transarterial chemoembolization (DEB-TACE) versus IRE only. MATERIALS AND METHODS Nine swine underwent CT-guided IRE in one liver lobe and IRE immediately followed by DEB-TACE in a different liver lobe. For DEB-TACE, 100-300 µm beads (DC-Beads®) were loaded with 50 mg doxorubicin. For IRE, the NanoKnife® was used employing two electrodes according to the vendor's protocol. Imaging follow-up was performed including CT-based lesion volume assessment using contrast-enhanced CT (venous phase) on days 1, 3, and 7 after the procedure. Three animals were killed for histopathological analysis after each follow-up. RESULTS Ablation volumes in CT in the IRE + DEB-TACE group were 15.4 ± 10.5 ml on day 1, 8.7 ± 5.6 ml on day 3, and 1.6 ± 0.7 ml on day 7. In the IRE group, the corresponding values were 5.2 ± 5.2 ml on day 1, 1.0 ± 1.2 ml on day 3, and 0.1 ± 0.1 ml on day 7. On day 1 and day 3, ablation volumes of IRE + TACE group were significantly larger than in the IRE group (p < 0.05). 96% of beads were depicted in or around ablative lesions. 69% of these beads were found in the surrounding hemorrhagic infiltration and 31% within the ablative lesion itself. CONCLUSIONS Combination of IRE immediately followed by DEB-TACE resulted in larger ablation volumes compared to IRE alone, suggesting that local efficacy of IRE can be enhanced by post-IRE DEB-TACE.
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Affiliation(s)
- Peter Isfort
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074, Aachen, Germany.
| | - Philip Rauen
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Hong-Sik Na
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Nobutake Ito
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Saskia von Stillfried
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Christiane Kuhl
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Philipp Bruners
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074, Aachen, Germany
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Scheck J, Bruners P, Schindler D, Kuhl C, Isfort P. Comparison of Chronologic Change in the Size and Contrast-Enhancement of Ablation Zones on CT Images after Irreversible Electroporation and Radiofrequency Ablation. Korean J Radiol 2018; 19:560-567. [PMID: 29962862 PMCID: PMC6005936 DOI: 10.3348/kjr.2018.19.4.560] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Accepted: 12/18/2017] [Indexed: 12/18/2022] Open
Abstract
Objective To compare short-, mid-, and long-term follow-up ablation zone volume alterations as well as imaging features on contrast-enhanced computed tomography (CT) after irreversible electroporation (IRE) of primary and secondary liver tumors with findings subsequent to radiofrequency ablation (RFA). Materials and Methods Volume assessment of 39 ablation zones (19 RFA, 20 IRE) after intervention was performed at four time intervals (day 0 [t1; n = 39], day 1-7 [t2; n = 25], day 8-55 [t3; n = 28], after day 55 [t4; n = 23]) on dual-phase CT. Analysis of peripheral rim enhancement was conducted. Lesion's volume decrease relative to the volume at t1 was calculated and statistically analyzed with respect to patient's sex, age, ablation modality (IRE/RFA), and history of platinum-based chemotherapy (PCT). Results No influence of patient's sex or age on ablation volume was detected. The decrease in ablation zones' volume was significantly larger (p < 0.05 for all time intervals) after IRE (arterial phase, 7.5%; venous phase, 9.7% of initial volume) compared to RFA (arterial phase, 39.6%; venous phase, 45.3% of initial volume). After RFA, significantly smaller decreases in the ablation volumes, in general, were detected in patients treated with PCT in their history (p = 0.004), which was not detected after IRE (p = 0.288). In the arterial phase, peripheral rim enhancement was frequently detected after both IRE and RFA. In the venous phase, rim-enhancement was depicted significantly more often following IRE at t1 and t2 (pt1 = 0.003, pt2 < 0.001). Conclusion As per our analysis, ablation zone volume decreased significantly in a more rapid and more profound manner after IRE. Lesion's remodeling after RFA but not IRE seems to be influenced by PCT, possibly due to the type of cell death induced by the different ablation modalities.
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Affiliation(s)
- Jonas Scheck
- Department of Diagnostic and Interventional Radiology, Aachen University Hospital, RWTH Aachen University, Aachen 52074, Germany
| | - Philipp Bruners
- Department of Diagnostic and Interventional Radiology, Aachen University Hospital, RWTH Aachen University, Aachen 52074, Germany
| | - David Schindler
- Institute of Medical Statistics, Aachen University Hospital, RWTH Aachen University, Aachen 52074, Germany
| | - Christiane Kuhl
- Department of Diagnostic and Interventional Radiology, Aachen University Hospital, RWTH Aachen University, Aachen 52074, Germany
| | - Peter Isfort
- Department of Diagnostic and Interventional Radiology, Aachen University Hospital, RWTH Aachen University, Aachen 52074, Germany
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Penzkofer T, Na HS, Isfort P, Wilkmann C, Osterhues S, Besting A, Hänisch C, Bisplinghoff S, Jansing J, von Werder S, Gooding J, de la Fuente M, Mahnken AH, Disselhorst-Klug C, Schmitz-Rode T, Kuhl C, Bruners P. Electromagnetically Navigated In Situ Fenestration of Aortic Stent Grafts: Pilot Animal Study of a Novel Fenestrated EVAR Approach. Cardiovasc Intervent Radiol 2017; 41:170-176. [DOI: 10.1007/s00270-017-1769-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 08/09/2017] [Indexed: 01/20/2023]
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Distelmaier M, Barabasch A, Heil P, Kraemer NA, Isfort P, Keil S, Kuhl CK, Bruners P. Midterm Safety and Efficacy of Irreversible Electroporation of Malignant Liver Tumors Located Close to Major Portal or Hepatic Veins. Radiology 2017; 285:1023-1031. [PMID: 28799842 DOI: 10.1148/radiol.2017161561] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Purpose To investigate the efficacy and safety of irreversible electroporation (IRE) in the treatment of hepatic tumors not suitable for thermal ablation (radiofrequency ablation [RFA] or microwave ablation). Materials and Methods This was an institutional review board-approved prospective study in 29 patients (15 men, 14 women; mean age, 63 years ± 12 [standard deviation]) with 43 primary (n = 8) or secondary (n = 35) malignant liver tumors who underwent computed tomography (CT)-guided IRE. All target tumors were located immediately adjacent to major hepatic veins, portal veins, or both; thus, they were not considered suitable for RFA or microwave ablation. Patients underwent postinterventional CT and magnetic resonance (MR) imaging. Systematic follow-up MR imaging was performed for 24 months on average to assess complete ablation, intrahepatic tumor recurrence, and complications. The 95% confidence intervals (CIs) were determined for the rate of bile duct strictures, incomplete ablation, and tumor recurrence. Results Complete ablation was achieved in 40 (93%; 95% CI: 85, 100) of 43 target tumors, with a safety margin of 5-10 mm, and was confirmed at immediate postinterventional CT and MR imaging. In 13 (33%; 95% CI: 18, 47) of 40 completely ablated tumors, intrahepatic tumor recurrence was observed at 2-18 months. However, only two (15%; 95% CI: 0, 35) of these 13 tumors were observed within the ablation zone. In the remaining 11 (85%; 95% CI: 65, 100), tumor growth was observed alongside the needle tract. None of the two true local recurrences occurred at the site of the vessel. All adjacent vessels remained perfused at follow-up. Five (24%; 95% CI: 5, 39) of 21 patients with target tumors adjacent to portal veins developed mild to moderate cholestasis 2-6 weeks after IRE. Conclusion IRE is useful to avoid incomplete ablation secondary to heat-sink effects and damage to major blood vessels; however, needle tract seeding is observed in 26% of treated tumors, and IRE induces sufficient local heating to bile ducts in 24% of ablations. © RSNA, 2017.
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Affiliation(s)
- Martina Distelmaier
- From the Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany
| | - Alexandra Barabasch
- From the Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany
| | - Philipp Heil
- From the Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany
| | - Nils A Kraemer
- From the Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany
| | - Peter Isfort
- From the Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany
| | - Sebastian Keil
- From the Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany
| | - Christiane K Kuhl
- From the Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany
| | - Philipp Bruners
- From the Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany
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Zimmermann M, Schulze-Hagen M, Liebl M, Pedersoli F, Goerg F, Ulmer TF, Heinzel A, Isfort P, Kuhl C, Bruners P. Safety and Efficacy of Y-90 Radioembolization After Prior Major Hepatic Resection. Cardiovasc Intervent Radiol 2017; 40:1206-1212. [DOI: 10.1007/s00270-017-1629-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 03/15/2017] [Indexed: 12/13/2022]
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Isfort P, Pedersoli F, Liebl M, Zimmermann M, Schulze-Hagen M, Scheck J, Kuhl C, Bruners P. Bildmorphologische Unterschiede nach irreversibler Elektroporation und Radiofrequenzablation im Follow-up mittels Mehrphasen-CT. ROFO-FORTSCHR RONTG 2017. [DOI: 10.1055/s-0037-1600278] [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: 10/19/2022]
Affiliation(s)
- P Isfort
- Universitätsklinikum RWTH Aachen, Klinik für Diagnostische und Interventionelle Radiologie, Aachen
| | - F Pedersoli
- Universitätsklinikum RWTH Aachen, Klinik für Diagnostische und Interventionelle Radiologie, Aachen
| | - M Liebl
- Universitätsklinikum RWTH Aachen, Klinik für Diagnostische und Interventionelle Radiologie, Aachen
| | - M Zimmermann
- Universitätsklinikum RWTH Aachen, Klinik für Diagnostische und Interventionelle Radiologie, Aachen
| | - M Schulze-Hagen
- Universitätsklinikum RWTH Aachen, Klinik für Diagnostische und Interventionelle Radiologie, Aachen
| | - J Scheck
- Universitätsklinikum RWTH Aachen, Klinik für Diagnostische und Interventionelle Radiologie, Aachen
| | - C Kuhl
- Universitätsklinikum RWTH Aachen, Klinik für Diagnostische und Interventionelle Radiologie, Aachen
| | - P Bruners
- Universitätsklinikum RWTH Aachen, Klinik für Diagnostische und Interventionelle Radiologie, Aachen
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Reinartz S, Imhoff M, Tolba R, Fischer F, Fischer E, Teschner E, Koch S, Gärber I, Isfort P, Gremse F. Elektrische Impedanz Tomografie (EIT) überwacht valide und robust globale und regionale Ventilation in physiologischen und pathologischen Beatmungszuständen im Schweinemodell. ROFO-FORTSCHR RONTG 2017. [DOI: 10.1055/s-0037-1600200] [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: 10/19/2022]
Affiliation(s)
- S Reinartz
- Universitätsklinikum Aachen, Klinik für Diagnostische und Interventionelle Radiologie, Aachen
| | | | | | | | | | | | | | | | - P Isfort
- Universitätsklinikum Aachen, Klinik für Diagnostische und Interventionelle Radiologie, Aachen
| | - F Gremse
- ExMI-Experimental Molecular Imaging, Aachen
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Liebl M, Zimmermann M, Schulze-Hagen M, Isfort P, Bruners P, Kuhl C. Der Einfluss von OP-Clips auf die Mikrowellenablation in der Leber – eine systematische in-vitro Untersuchung. ROFO-FORTSCHR RONTG 2017. [DOI: 10.1055/s-0037-1600285] [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: 10/19/2022]
Affiliation(s)
- M Liebl
- Uniklinikum Aachen, Radiologie, Aachen
| | | | | | | | | | - C Kuhl
- Uniklinik Aachen, Radiologie
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Schulze-Hagen MF, Pfeffer J, Zimmermann M, Liebl M, von Stillfried SF, Kuhl C, Bruners P, Isfort P. Development and Evaluation of a Novel Curved Biopsy Device for CT-Guided Biopsy of Lesions Unreachable Using Standard Straight Needle Trajectories. Cardiovasc Intervent Radiol 2017; 40:924-929. [PMID: 28175977 DOI: 10.1007/s00270-017-1597-1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 01/31/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE To evaluate the feasibility of a novel curved CT-guided biopsy needle prototype with shape memory to access otherwise not accessible biopsy targets. METHODS AND MATERIALS A biopsy needle curved by 90° with specific radius was designed. It was manufactured using nitinol to acquire shape memory, encased in a straight guiding trocar to be driven out for access of otherwise inaccessible targets. Fifty CT-guided punctures were conducted in a biopsy phantom and 10 CT-guided punctures in a swine corpse. Biposies from porcine liver and muscle tissue were separately gained using the biopsy device, and histological examination was performed subsequently. RESULTS Mean time for placement of the trocar and deployment of the inner biopsy needle was ~205 ± 69 and ~93 ± 58 s, respectively, with a mean of ~4.5 ± 1.3 steps to reach adequate biopsy position. Mean distance from the tip of the needle to the target was ~0.7 ± 0.8 mm. CT-guided punctures in the swine corpse took relatively longer and required more biopsy steps (~574 ± 107 and ~380 ± 148 s, 8 ± 2.6 steps). Histology demonstrated appropriate tissue samples in nine out of ten cases (90%). CONCLUSIONS Targets that were otherwise inaccessible via standard straight needle trajectories could be successfully reached with the curved biopsy needle prototype. Shape memory and preformed size with specific radius of the curved needle simplify the target accessibility with a low risk of injuring adjacent structures.
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Affiliation(s)
- Maximilian Franz Schulze-Hagen
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany.
| | - Jochen Pfeffer
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Markus Zimmermann
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Martin Liebl
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | | | - Christiane Kuhl
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Philipp Bruners
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Peter Isfort
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
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Zimmermann M, Liebl M, Schulze-Hagen M, Pedersoli F, Pfeffer J, Schmeding M, Isfort P, Kuhl CK, Bruners P. Preoperative Embolization of the Celiac Axis or Common Hepatic Artery before Distal Pancreatectomy with Resection of the Celiac Axis. J Vasc Interv Radiol 2017; 28:60-63. [DOI: 10.1016/j.jvir.2016.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 04/01/2016] [Accepted: 04/01/2016] [Indexed: 11/25/2022] Open
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Isfort P, Penzkofer T, Wilkmann C, Na HS, Kotzlowski C, Ito N, Pfeffer JG, Bisplinghoff S, Osterhues S, Besting A, Gooding J, Schmitz-Rode T, Kuhl C, Mahnken AH, Bruners P. Feasibility of electromagnetically guided transjugular intrahepatic portosystemic shunt procedure. MINIM INVASIV THER 2016; 26:15-22. [PMID: 27686414 DOI: 10.1080/13645706.2016.1214155] [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] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To develop an electromagnetic navigation technology for transjugular intrahepatic portosystemic shunt (TIPS) creation and translate it from phantom to an in-vivo large animal setting. MATERIAL AND METHODS A custom-designed device for TIPS creation consisting of a stylet within a 5 French catheter as well as a software prototype were developed that allow real-time tip tracking of both stylet and catheter using an electromagnetic tracking system. Feasibility of navigated TIPSS creation was tested in a phantom by two interventional radiologists (A/B) followed by in-vivo testing evaluation in eight domestic pigs. Procedure duration and number of attempts needed for puncture of the portal vein were recorded. RESULTS In the phantom setting, intervention time to gain access to the portal vein (PV) was 144 ± 67 s (A) and 122 ± 51 s (B), respectively. In the in-vivo trials, TIPS could be successfully completed in five out of eight animals. Mean time for the complete TIPS was 245 ± 205 minutes with a notable learning curve towards the last animal. CONCLUSIONS TIPS creation with the use of electromagnetic tracking technology proved to be feasible in-vitro as well as in-vivo. The system may be useful to facilitate challenging TIPSS procedures.
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Affiliation(s)
- Peter Isfort
- a Diagnostic and Interventional Radiology , RWTH Aachen University Hospital , Aachen , Germany
| | - Tobias Penzkofer
- a Diagnostic and Interventional Radiology , RWTH Aachen University Hospital , Aachen , Germany.,b Surgical Planning Laboratory , Brigham and Women's Hospital , Boston , MA , USA.,c Diagnostic and Interventional Radiology , Charité Universitätsmedizin Berlin , Berlin , Germany
| | - Christoph Wilkmann
- a Diagnostic and Interventional Radiology , RWTH Aachen University Hospital , Aachen , Germany
| | - Hong-Sik Na
- a Diagnostic and Interventional Radiology , RWTH Aachen University Hospital , Aachen , Germany
| | - Christian Kotzlowski
- a Diagnostic and Interventional Radiology , RWTH Aachen University Hospital , Aachen , Germany
| | - Nobutake Ito
- d Department of Radiology , Keio University , Tokyo , Japan.,e Applied Medical Engineering , RWTH Aachen University Hospital , Aachen , Germany
| | - Joachim Georg Pfeffer
- a Diagnostic and Interventional Radiology , RWTH Aachen University Hospital , Aachen , Germany
| | | | | | | | - Jorge Gooding
- e Applied Medical Engineering , RWTH Aachen University Hospital , Aachen , Germany
| | - Thomas Schmitz-Rode
- e Applied Medical Engineering , RWTH Aachen University Hospital , Aachen , Germany
| | - Christiane Kuhl
- a Diagnostic and Interventional Radiology , RWTH Aachen University Hospital , Aachen , Germany
| | - Andreas Horst Mahnken
- i Department of Diagnostic and Interventional Radiology , Philips University Hospital , Marburg , Germany
| | - Philipp Bruners
- a Diagnostic and Interventional Radiology , RWTH Aachen University Hospital , Aachen , Germany
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Zimmermann M, Pfeffer J, Na HS, Liebl M, Schulze-Hagen M, Kuhl CK, Isfort P, Bruners P. Endovascular placement of an extraluminal arterial bypass graft - in vitro feasibility study. MINIM INVASIV THER 2016; 25:323-328. [PMID: 27333262 DOI: 10.1080/13645706.2016.1190379] [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] [Indexed: 10/21/2022]
Abstract
PURPOSE A novel approach for arterial bypass grafting using exclusively endovascular techniques was established in-vitro in a phantom model. MATERIAL AND METHODS The experimental setting consisted of a gel-wax phantom with two embedded parallel fluid-filled silicon tubes simulating the superficial femoral vessels. Through an 8-French sheath, a re-entry catheter (OUTBACK®, Cordis) was placed in the simulated artery and used to puncture the vascular wall. Then a 0.014-inch guide wire was advanced into the extravascular space. With the curved needle of the re-entry catheter, the guide wire was steered on a course parallel to the vessel wall in the extravascular space for 5-10 cm. At the desired reentry site, the re-entry catheter was used to puncture the vascular wall again in order to regain access to the endovascular space. Once the tip of the guide wire had safely been placed in the vascular lumen, a self-expandable stent graft (VIABAHN® GORE®) was deployed to complete the extraluminal bypass. RESULTS Endovascular placement of an extraluminal bypass was successfully achieved in 20 attempts. The mean duration of the procedure amounted to 14:58 (minutes: seconds) (SD ± 3:56). CONCLUSIONS This in-vitro study suggests that endovascular placement of an extraluminal arterial bypass graft is technically feasible.
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Affiliation(s)
- Markus Zimmermann
- a Department of Diagnostic and Interventional Radiology , RWTH Aachen University Hospital , Aachen , Germany
| | - Jochen Pfeffer
- a Department of Diagnostic and Interventional Radiology , RWTH Aachen University Hospital , Aachen , Germany
| | - Hong-Sik Na
- a Department of Diagnostic and Interventional Radiology , RWTH Aachen University Hospital , Aachen , Germany
| | - Martin Liebl
- a Department of Diagnostic and Interventional Radiology , RWTH Aachen University Hospital , Aachen , Germany
| | - Maximilian Schulze-Hagen
- a Department of Diagnostic and Interventional Radiology , RWTH Aachen University Hospital , Aachen , Germany
| | - Christiane K Kuhl
- a Department of Diagnostic and Interventional Radiology , RWTH Aachen University Hospital , Aachen , Germany
| | - Peter Isfort
- a Department of Diagnostic and Interventional Radiology , RWTH Aachen University Hospital , Aachen , Germany
| | - Philipp Bruners
- a Department of Diagnostic and Interventional Radiology , RWTH Aachen University Hospital , Aachen , Germany
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Pedersoli F, Isfort P, Keil S, Goerg F, Zimmermann M, Liebl M, Schulze-Hagen M, Schmeding M, Kuhl CK, Bruners P. Stentgraft Implantation for the Treatment of Postoperative Hepatic Artery Pseudoaneurysm. Cardiovasc Intervent Radiol 2016; 39:575-81. [PMID: 26797022 DOI: 10.1007/s00270-015-1274-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 11/29/2015] [Indexed: 02/06/2023]
Abstract
PURPOSE Hepatic artery pseudoaneurysms are a rare but potentially life-threatening complication of major pancreaticobiliary surgery. We evaluated the safety and efficacy of endovascular stentgraft implantation for the management of such vascular lesions. MATERIALS AND METHODS Between May 2013 and October 2015, ten patients with postoperative hepatic artery pseudoaneurysm, of which eight presented with active hemorrhage, were treated with endovascular stentgraft implantation. All patients had undergone major pancreatic or hepatic surgery before (pylorus-preserving pancreaticoduodenectomy, pancreatectomy, hemihepatectomy, extended hemihepatectomy). The pseudoaneurysms were diagnosed 13-202 days after surgery and were associated with postsurgical complications (e.g., leakage of pancreaticojejunal anastomosis). RESULTS In 9/10 patients, the pseudoaneurysm was completely excluded via stentgraft implantation. In 1/10 patient, the pseudoaneurysm ruptured during the procedure and was successfully treated by immediate open surgery. In 1/10 patient, a second intervention was performed after 6 days because of rebleeding; this was successfully treated by implantation of a second overlapping stentgraft. Mean follow-up time is 51 days. None of the patients died due to stentgraft- or aneurysm-related complications. Further episodes of hemorrhage were not observed. In one patient, clinically asymptomatic complete occlusion of the stentgraft was discovered at follow-up imaging. CONCLUSION Stentgraft implantation is a safe and effective technique to treat hepatic artery pseudoaneurysms related to major pancreatic or hepatic surgery, especially in the setting of acute hemorrhage.
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Affiliation(s)
- F Pedersoli
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074, Aachen, Germany.
| | - P Isfort
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - S Keil
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - F Goerg
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - M Zimmermann
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - M Liebl
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - M Schulze-Hagen
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - M Schmeding
- Clinic for General, Visceral and Transplant Surgery, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - C K Kuhl
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - P Bruners
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074, Aachen, Germany
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Schumann C, Rieder C, Haase S, Teichert K, Süss P, Isfort P, Bruners P, Preusser T. Interactive multi-criteria planning for radiofrequency ablation. Int J Comput Assist Radiol Surg 2015; 10:879-89. [PMID: 25903775 DOI: 10.1007/s11548-015-1201-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 04/02/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE Image-guided radiofrequency ablation (RFA) is a broadly used minimally invasive method for the thermal destruction of focal liver malignancies using needle-shaped instruments. The established planning workflow is based on examination of 2D slices and manual definition of the access path. During that process, multiple criteria for all possible trajectories have to be taken into account. Hence, it demands considerable experience and constitutes a significant mental task. METHODS An access path determination method based on image processing and numerical optimization is proposed. Fast GPU-based simulation approximation is utilized to incorporate the heat distribution including realistic cooling effects from nearby blood vessels. A user interface for intuitive exploration of the optimization results is introduced. RESULTS The proposed methods are integrated into a clinical software assistant. To evaluate the suitability of the interactive optimization approach for the identification of meaningful therapy strategies, a retrospective study has been carried out. The system is able to propose clinically relevant trajectories to the target by incorporating multiple criteria. CONCLUSIONS A novel method for planning of image-guided radiofrequency ablation by means of interactive access path determination based on optimization is presented. A first retrospective study indicates that the method is suited to improve the classical planning of RFA.
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Affiliation(s)
- Christian Schumann
- Fraunhofer MEVIS, Fraunhofer-Gesellschaft, Universitätsallee 29, 28359, Bremen, Germany,
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Schulze-Hagen M, Pfeffer J, Zimmermann M, Na H, Freifrau von Stillfried S, Kuhl C, Isfort P, Bruners P. Entwicklung und in-vitro Untersuchung einer steuerbaren Nadel für die Biopsie von Läsionen, die nicht mittels geradem Punktionsweg erreichbar sind. ROFO-FORTSCHR RONTG 2015. [DOI: 10.1055/s-0035-1551044] [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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