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Linder N, Denecke T, Busse H. Body composition analysis by radiological imaging - methods, applications, and prospects. ROFO-FORTSCHR RONTG 2024. [PMID: 38569516 DOI: 10.1055/a-2263-1501] [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: 04/05/2024]
Abstract
BACKGROUND This review discusses the quantitative assessment of tissue composition in the human body (body composition, BC) using radiological methods. Such analyses are gaining importance, in particular, for oncological and metabolic problems. The aim is to present the different methods and definitions in this field to a radiological readership in order to facilitate application and dissemination of BC methods. The main focus is on radiological cross-sectional imaging. METHODS The review is based on a recent literature search in the US National Library of Medicine catalog (pubmed.gov) using appropriate search terms (body composition, obesity, sarcopenia, osteopenia in conjunction with imaging and radiology, respectively), as well as our own work and experience, particularly with MRI- and CT-based analyses of abdominal fat compartments and muscle groups. RESULTS AND CONCLUSION Key post-processing methods such as segmentation of tomographic datasets are now well established and used in numerous clinical disciplines, including bariatric surgery. Validated reference values are required for a reliable assessment of radiological measures, such as fatty liver or muscle. Artificial intelligence approaches (deep learning) already enable the automated segmentation of different tissues and compartments so that the extensive datasets can be processed in a time-efficient manner - in the case of so-called opportunistic screening, even retrospectively from diagnostic examinations. The availability of analysis tools and suitable datasets for AI training is considered a limitation. KEY POINTS · Radiological imaging methods are increasingly used to determine body composition (BC).. · BC parameters are usually quantitative and well reproducible.. · CT image data from routine clinical examinations can be used retrospectively for BC analysis.. · Prospectively, MRI examinations can be used to determine organ-specific BC parameters.. · Automated and in-depth analysis methods (deep learning or radiomics) appear to become important in the future.. CITATION FORMAT · Linder N, Denecke T, Busse H. Body composition analysis by radiological imaging - methods, applications, and prospects. Fortschr Röntgenstr 2024; DOI: 10.1055/a-2263-1501.
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Affiliation(s)
- Nicolas Linder
- Department of Diagnostic and Interventional Radiology, University of Leipzig Medical Center, Leipzig, Germany
- Division of Radiology and Nuclear Medicine, Kantonsspital St. Gallen, Sankt Gallen, Switzerland
| | - Timm Denecke
- Department of Diagnostic and Interventional Radiology, University of Leipzig Medical Center, Leipzig, Germany
| | - Harald Busse
- Department of Diagnostic and Interventional Radiology, University of Leipzig Medical Center, Leipzig, Germany
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Pfister F, Mehdorn M, Schwartner C, Seehofer D, Tautenhahn HM, Struck MF, Denecke T, Meyer HJ. Portal venous contrast enhancement ratio of the adrenal glands and spleen as prognostic marker of mortality in patients with acute mesenteric ischemia. Abdom Radiol (NY) 2024:10.1007/s00261-024-04247-2. [PMID: 38528270 DOI: 10.1007/s00261-024-04247-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 02/07/2024] [Accepted: 02/08/2024] [Indexed: 03/27/2024]
Abstract
PURPOSE Contrast enhancement of the adrenal gland defined by computed tomography (CT) was previously analyzed as a prognostic factor for critically ill patients in various diseases. However, no study investigated this quantitative parameter in patients with acute mesenteric ischemia. Therefore, the aim of this study was to evaluate the prognostic value of the contrast enhancement of the adrenal glands in patients with clinically suspected AMI. METHODS All patients with clinically suspected AMI were retrospectively assessed between 2016 and 2020. All patients underwent surgical exploration after CT imaging. Overall, 134 patients (52 female patients, 38.8%) with a mean age of 69.2 ± 12.4 years were included into the present analysis. For all patients, the preoperative CT was used to calculate the contrast media enhancement of the adrenal glands and the spleen. RESULTS A total of 27 patients (18.5%) died within the first 24 h and over the following 30-day 94 patients (68.6%) died. There were statistically significant differences regarding the mean values for adrenal-to-spleen ratio for 24-h mortality (p = 0.001) and 30-day mortality (p = 0.004), whereas the radiodensity of the inferior vena cava and the radiodensity of the spleen was statistically significant between survivors and non-survivors after 30 days (p = 0.037 and p = 0.028, respectively). In Cox regression analysis, mean adrenal radiodensity was associated with 24-h mortality (HR 1.09, 95% CI 1.02-1.16, p = 0.01) but not with 30-day mortality (HR 1.03, 95% CI 0.99-1.07, p = 0.13). CONCLUSION The contrast media enhancement of the adrenal gland is associated with the 24-h and 30-day mortality in patients with AMI. However, the prognostic relevance for translation into clinical routine needs to be validated in other cohorts.
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Affiliation(s)
- Felix Pfister
- Department of Diagnostic and Interventional Radiology, University of Leipzig, Leipzig, Germany
| | - Matthias Mehdorn
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University of Leipzig, Leipzig, Germany
| | - Christoph Schwartner
- Department of Diagnostic and Interventional Radiology, University of Leipzig, Leipzig, Germany
| | - Daniel Seehofer
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University of Leipzig, Leipzig, Germany
| | - Hans-Michael Tautenhahn
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University of Leipzig, Leipzig, Germany
| | - Manuel Florian Struck
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Leipzig, Leipzig, Germany
| | - Timm Denecke
- Department of Diagnostic and Interventional Radiology, University of Leipzig, Leipzig, Germany
| | - Hans-Jonas Meyer
- Department of Diagnostic and Interventional Radiology, University of Leipzig, Leipzig, Germany.
- Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Liebigstr. 20, 04103, Leipzig, Germany.
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Vetter S, Witt M, Hepp P, Schleichardt A, Schleifenbaum S, Roth C, Denecke T, Henkelmann J, Köhler HP. A 6-week randomized-controlled field study: effect of isokinetic eccentric resistance training on strength, flexibility and muscle structure of the shoulder external rotators in male junior handball players. Front Physiol 2024; 15:1368033. [PMID: 38516212 PMCID: PMC10955123 DOI: 10.3389/fphys.2024.1368033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 02/26/2024] [Indexed: 03/23/2024] Open
Abstract
Background: Team handball involves a tremendous amount of shoulder motion with high forces during repeated extended external range of motion. This causes shoulder complaints and overuse injuries. While eccentric training for the lower extremity shows preventive effects by improving strength, range of motion and fascicle length, there is a research gap for the shoulder joint and for advanced tissue characterization using diffusion tensor imaging. Objectives: To investigate the effects of 6-week eccentric isokinetic resistance training on strength, flexibility, and fiber architecture characteristics of the external rotators compared to an active control group in junior male handball players. Methods: 15 subjects were randomly assigned to the eccentric training group and 14 subjects to the active control group (conventional preventive training). Primary outcome measures were eccentric and concentric isokinetic strength of the external rotators, range of motion, and muscle fascicle length and fascicle volume. Results: The intervention group, showed significant changes in eccentric strength (+15%). The supraspinatus and infraspinatus muscles showed significant increases in fascicle length (+13% and +8%), and in fractional anisotropy (+9% and +6%), which were significantly different from the control group. Conclusion: Eccentric isokinetic training has a significant effect on the function and macroscopic structure of the shoulder external rotators in male junior handball players. While strength parameters and muscle structure improved, range of motion did not change. This research helps understanding the physiology of muscle and the role of eccentric training on shoulder function and muscle structure. Furthermore, DTI was found to be a promising tool for advanced tissue characterization, and the in vivo derived data can also serve as model input variables and as a possibility to extend existing ex-vivo muscle models. Future research is needed for functional and structural changes following convenient eccentric field exercises.
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Affiliation(s)
- Sebastian Vetter
- Department of Biomechanics in Sports, Leipzig University, Leipzig, Germany
| | - Maren Witt
- Department of Biomechanics in Sports, Leipzig University, Leipzig, Germany
| | - Pierre Hepp
- Department of Orthopaedics, Trauma and Plastic Surgery, Leipzig University, Leipzig, Germany
| | - Axel Schleichardt
- Department of Biomechanics, Institute for Applied Training Science, Leipzig, Germany
| | - Stefan Schleifenbaum
- Department of Orthopaedics, Trauma and Plastic Surgery, Leipzig University, Leipzig, Germany
| | - Christian Roth
- Department of Pediatric Radiology, Leipzig University, Leipzig, Germany
| | - Timm Denecke
- Department of Diagnostic and Interventional Radiology, Leipzig University, Leipzig, Germany
| | - Jeanette Henkelmann
- Department of Diagnostic and Interventional Radiology, Leipzig University, Leipzig, Germany
| | - Hans-Peter Köhler
- Department of Biomechanics in Sports, Leipzig University, Leipzig, Germany
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Ebel S, Kühn A, Köhler B, Behrendt B, Riekena B, Preim B, Denecke T, Grothoff M, Gutberlet M. Quantitative 4D flow MRI-derived thoracic aortic normal values of 2D flow MRI parameters in healthy volunteers. ROFO-FORTSCHR RONTG 2024; 196:273-282. [PMID: 37944940 DOI: 10.1055/a-2175-4165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
PURPOSE To utilize 4 D flow MRI to acquire normal values of "conventional 2 D flow MRI parameters" in healthy volunteers in order to replace multiple single 2 D flow measurements with a single 4 D flow acquisition. MATERIALS AND METHODS A kt-GRAPPA accelerated 4 D flow sequence was used. Flow volumes were assessed by forward (FFV), backward (BFV), and net flow volumes (NFV) [ml/heartbeat] and flow velocities by axial (VAX) and absolute velocity (VABS) [m/s] in 116 volunteers (58 females, 43 ± 13 years). The aortic regurgitant fraction (RF) was calculated. RESULTS The sex-neutral mean FFV, BFV, NFV, and RF in the ascending aorta were 93.5 ± 14.8, 3.6 ± 2.8, 89.9 ± 0.6 ml/heartbeat, and 3.9 ± 2.9 %, respectively. Significantly higher values were seen in males regarding FFV, BFV, NFV and RF, but there was no sex dependency regarding VAX and VABS. The mean maximum VAX was lower (1.01 ± 0.31 m/s) than VABS (1.23 ± 0.35 m/s). We were able to determine normal ranges for all intended parameters. CONCLUSION This study provides quantitative 4 D flow-derived thoracic aortic normal values of 2 D flow parameters in healthy volunteers. FFV, BFV, NFV, and VAX did not differ significantly from single 2 D flow acquisitions and could therefore replace time-consuming multiple single 2 D flow acquisitions. VABS should not be used interchangeably. KEY POINTS · 4 D flow MRI can be used to replace 2 D flow MRI measurements.. · The parameter absolute velocities can be assessed by 4 D flow MRI.. · There are sex-dependent differences regarding forward, backward, net aortic blood flow and the aortic valve regurgitant fraction..
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Affiliation(s)
- Sebastian Ebel
- Diagnostic and Interventional Radiology, Leipzig University, Leipzig, Germany
| | - Alexander Kühn
- Diagnostic and Interventional Radiology, Leipzig Heart Centre University Hospital, Leipzig, Germany
| | - Benjamin Köhler
- Simulation and Graphics, Otto von Guericke Universität Magdeburg, Germany
| | - Benjamin Behrendt
- Simulation and Graphics, Otto von Guericke Universität Magdeburg, Germany
| | - Boris Riekena
- Diagnostic and Interventional Radiology, Leipzig Heart Centre University Hospital, Leipzig, Germany
| | - Bernhard Preim
- Simulation and Graphics, Otto von Guericke Universität Magdeburg, Germany
| | - Timm Denecke
- Diagnostic and Interventional Radiology, Leipzig University, Leipzig, Germany
| | - Matthias Grothoff
- Diagnostic and Interventional Radiology, Leipzig Heart Centre University Hospital, Leipzig, Germany
| | - Matthias Gutberlet
- Diagnostic and Interventional Radiology, Leipzig Heart Centre University Hospital, Leipzig, Germany
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Olbrich A, Niemeyer J, Seiffert H, Ebel S, Gros O, Lordick F, Forstmeyer D, Seehofer D, Rademacher S, Denecke T, Matz-Soja M, Berg T, van Bömmel F. The GALAD score and the BALAD-2 score correlate with transarterial and systemic treatment response and survival in patients with hepatocellular carcinoma. J Cancer Res Clin Oncol 2024; 150:81. [PMID: 38319485 PMCID: PMC10847183 DOI: 10.1007/s00432-023-05526-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 11/09/2023] [Indexed: 02/07/2024]
Abstract
PURPOSE The GALAD score and the BALAD-2 score are biomarker-based scoring systems used to detect hepatocellular carcinoma (HCC). Both incorporate levels of alpha-fetoprotein (AFP), lens culinaris agglutinin-reactive AFP (AFP-L3), and des-gamma-carboxy prothrombin (DCP). Our objective was to examine the relationship between the GALAD score as well as the BALAD-2 score and treatment response to transarterial or systemic treatments in patients with HCC. METHODS A total of 220 patients with HCC treated with either transarterial (n = 121) or systemic treatments (n = 99; mainly Sorafenib) were retrospectively analyzed. The GALAD score and the BALAD-2 score were calculated based on AFP-L3, AFP, and DCP levels measured in serum samples collected before treatment. The results were correlated with 3-month treatment efficacy based on radiologic mRECIST criteria. RESULTS The GALAD score showed a strong correlation with BCLC stage (p < 0.001) and total tumor diameter before treatment (p < 0.001).The GALAD score at baseline was significantly lower in patients with a 3-month response to transarterial (p > 0.001) than in refractory patients. Among patients receiving systemic treatment, the median BALAD-2 score at baseline showed a strong association with response at month 3 (p < 0.001). In the transarterial treatment group, the GALAD score (AUC = 0.715; p < 0.001) as well as the BALAD score (AUC = 0.696; p < 0.001) were associated with overall survival, hereby outperforming AFP, AFP-L3 and DCP. CONCLUSION The GALAD score as well as the BALAD-2 score hold significant promise as a prognostic tool for patients with early or intermediate-stage HCC who are undergoing transarterial or systemic treatments.
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Affiliation(s)
- Anne Olbrich
- Laboratory for Clinical and Experimental Hepatology (LCEHep), Division of Hepatology, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany
| | - Johannes Niemeyer
- Laboratory for Clinical and Experimental Hepatology (LCEHep), Division of Hepatology, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany
- Division of Hepatology, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany
| | - Hendrik Seiffert
- Laboratory for Clinical and Experimental Hepatology (LCEHep), Division of Hepatology, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany
| | - Sebastian Ebel
- Department of Diagnostic and Interventional Radiology, Leipzig University Medical Center, Leipzig, Germany
- University Liver Tumor Center (ULTC), Leipzig University Medical Center, Leipzig, Germany
| | - Olga Gros
- Department of Anesthesia and Intensive Care, Helios Clinic Köthen, Köthen, Germany
| | - Florian Lordick
- University Cancer Center Leipzig (UCCL) and Division of Oncology, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany
| | - Dirk Forstmeyer
- University Cancer Center Leipzig (UCCL) and Division of Oncology, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany
| | - Daniel Seehofer
- Department of Visceral, Vascular, Thoracic and Transplant Surgery, Leipzig University Medical Center, Leipzig, Germany
- University Liver Tumor Center (ULTC), Leipzig University Medical Center, Leipzig, Germany
| | - Sebastian Rademacher
- Department of Visceral, Vascular, Thoracic and Transplant Surgery, Leipzig University Medical Center, Leipzig, Germany
- University Liver Tumor Center (ULTC), Leipzig University Medical Center, Leipzig, Germany
| | - Timm Denecke
- Department of Diagnostic and Interventional Radiology, Leipzig University Medical Center, Leipzig, Germany
- University Liver Tumor Center (ULTC), Leipzig University Medical Center, Leipzig, Germany
| | - Madlen Matz-Soja
- Laboratory for Clinical and Experimental Hepatology (LCEHep), Division of Hepatology, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany
- Rudolf-Schönheimer-Institute for Biochemistry, University of Leipzig, Leipzig, Germany
| | - Thomas Berg
- Laboratory for Clinical and Experimental Hepatology (LCEHep), Division of Hepatology, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany
- University Liver Tumor Center (ULTC), Leipzig University Medical Center, Leipzig, Germany
- Division of Hepatology, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany
| | - Florian van Bömmel
- Laboratory for Clinical and Experimental Hepatology (LCEHep), Division of Hepatology, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany.
- University Liver Tumor Center (ULTC), Leipzig University Medical Center, Leipzig, Germany.
- Division of Hepatology, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany.
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Pavel M, Lahner H, Hörsch D, Rinke A, Denecke T, Koch A, Regnault B, Helbig D, Hoffmanns P, Raderer M. Combined Lanreotide Autogel and Temozolomide Treatment of Progressive Pancreatic and Intestinal Neuroendocrine Tumors: The Phase II SONNET Study. Oncologist 2024:oyad325. [PMID: 38206830 DOI: 10.1093/oncolo/oyad325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 11/09/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND In advanced neuroendocrine tumors (NET), antiproliferative treatment options beyond somatostatin analogs remain limited. Temozolomide (TMZ) has shown efficacy in NET alone or combined with other drugs. MATERIALS AND METHODS SONNET (NCT02231762) was an open, multicenter, prospective, phase II study to evaluate lanreotide autogel 120 mg (LAN) plus TMZ in patients with progressive advanced/metastatic grade 1/2 gastroenteropancreatic (GEP) NET or of unknown primary. Patients could be enrolled at first-line or higher therapy line. The primary endpoint was disease control rate ([DCR], rate of stable disease [SD], partial [PR], and complete response [CR]) at 6 months of LAN and TMZ. Patients with nonfunctioning (NF) NET without progression at 6 months were randomized to 6-month LAN maintenance or watch and wait, patients with functioning (F)-NET with clinical benefit (PR, SD) continued on LAN. RESULTS Fifty-seven patients were recruited. The majority of patients received the study drug at second or higher treatment line and had an NET G2. DCR at 6 months LAN and TMZ was 73.5%. After 6 months of further LAN maintenance, 54.5% of patients with F-NET and 71.4% with NF-NET had SD or PR vs 41.7% with NF-NET on observation only. LAN and TMZ were effective in all subgroups analyzed. At 12 months of follow-up, median progression-free survival was 11.1 months. Median serum chromogranin A decreased except in NF-NET on observation. O6-methylguanine DNA methyltransferase promoter methylation appeared to better reflect TMZ response than loss of gene expression. During combination therapy, the most frequent treatment-emergent adverse events grade 3/4 reported were nausea (14%), thrombocytopenia (12.3%), and neutropenia (8.8%). Four deaths were reported resulting from severe adverse events not considered related to study medication. CONCLUSIONS LAN plus TMZ is a treatment option for patients with progressive GEP-NET with more aggressive biological profile showing a manageable safety profile.
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Affiliation(s)
- Marianne Pavel
- Department of Hepatology and Gastroenterology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany
- Department of Medicine 1, Friedrich Alexander University Erlangen-Nuernberg, University Hospital Erlangen, Erlangen, Germany
| | - Harald Lahner
- Department of Endocrinology and Metabolism, University Hospital Essen, Essen, Germany
| | - Dieter Hörsch
- Department of Gastroenterology/Endocrinology, Zentralklinik Bad Berka, Bad Berka, Germany
| | - Anja Rinke
- Department of Gastroenterology, University Hospital Gießen and Marburg, Marburg and Philipps University Marburg, Germany
| | - Timm Denecke
- Department of Radiology, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Department of Diagnostic and Interventional Radiology, University Medical Center Leipzig, Leipzig, Germany
| | - Arend Koch
- Department of Neuropathology, Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany
| | | | | | | | - Markus Raderer
- Medical University Vienna, Internal Medicine I, Division of Oncology, Vienna, Austria
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Kandels J, Richter S, Hagendorff A, Kragholm K, Tayal B, Laufs U, Denecke T, Stöbe S. Comparison of left ventricular deformation abnormalities by echocardiography with cardiac magnetic resonance imaging in patients with acute myocarditis and preserved left ventricular ejection fraction. Front Cardiovasc Med 2024; 10:1322145. [PMID: 38264261 PMCID: PMC10803407 DOI: 10.3389/fcvm.2023.1322145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 12/22/2023] [Indexed: 01/25/2024] Open
Abstract
Purpose Cardiac magnetic resonance imaging (cMRI) represents the gold standard to detect myocarditis. Left ventricular (LV) deformation imaging provides additional diagnostic options presumably exceeding conventional transthoracic echocardiography (TTE). The present study aimed to analyze the feasibility to detect myocarditis in patients (pts) with preserved LV ejection fraction (LVEF) by TTE compared to cMRI. It has been hypothesized that the number of pathological findings by deformation imaging correspond to findings in cMRI. Methods and results Between January 2018 and February 2020 102 pts with acute myocarditis according to the modified Lake Louise criteria and early gadolinium enhancement (EGE) by cMRI were identified at the department of cardiology at the University Hospital Leipzig. Twenty-six pts were included in this retrospective comparative study based on specific selection criteria. Twelve pts with normal cMRI served as a control group. LV deformation was analyzed by global and regional longitudinal strain (GLS, rLS), global and regional circumferential and radial strain (GCS, rCS, GRS, rRS), and LV rotation (including layer strain analysis). All parameters were compared to findings of edema, inflammation, and fibrosis by cMRI according to Lake Louise criteria. All pts with acute myocarditis diagnosed by cMRI showed pathological findings in TTE. Especially rCS and LV rotation analyzed by regional layer strain exhibit a high concordance with pathological findings in cMRI. In controls no LV deformation abnormalities were documented. Mean values of GLS, GRS, and GCS were not significantly different between pts with acute myocarditis and controls. Conclusion This retrospective analysis documents the feasibility of detecting regional deformation abnormalities by echocardiography in patients with acute myocarditis confirmed by cMRI. The detection of pathological findings due to myocarditis requires the determination of regional deformation parameters, particularly rCS and LV rotation. The assessment of global strain values does not appear to be of critical value.
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Affiliation(s)
- Joscha Kandels
- Department of Cardiology, Leipzig University Hospital, Leipzig, Germany
| | - Sarah Richter
- Department of Internal Medicine I, Martha-Maria Hospital Halle-Dölau, Halle (Saale), Germany
| | | | - Kristian Kragholm
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
- Unit of Clinical Biostatistics and Epidemiology, Aalborg University Hospital, Aalborg, Denmark
| | - Bhupendar Tayal
- Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, United States
| | - Ulrich Laufs
- Department of Cardiology, Leipzig University Hospital, Leipzig, Germany
| | - Timm Denecke
- Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Leipzig, Germany
| | - Stephan Stöbe
- Department of Cardiology, Leipzig University Hospital, Leipzig, Germany
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8
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Ambrosini V, Caplin M, Castaño JP, Christ E, Denecke T, Deroose CM, Dromain C, Falconi M, Grozinsky-Glasberg S, Hicks RJ, Hofland J, Kjaer A, Knigge UP, Kos-Kudla B, Koumarianou A, Krishna B, Lamarca A, Pavel M, Reed NS, Scarpa A, Srirajaskanthan R, Sundin A, Toumpanakis C, Prasad V. Use and perceived utility of [ 18 F]FDG PET/CT in neuroendocrine neoplasms: A consensus report from the European Neuroendocrine Tumor Society (ENETS) Advisory Board Meeting 2022. J Neuroendocrinol 2024; 36:e13359. [PMID: 38097193 DOI: 10.1111/jne.13359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 11/10/2023] [Accepted: 11/12/2023] [Indexed: 01/18/2024]
Abstract
Somatostatin receptor (SST) PET/CT is the gold standard for well-differentiated neuroendocrine tumours (NET) imaging. Higher grades of neuroendocrine neoplasms (NEN) show preferential [18F]FDG (FDG) uptake, and even low-grade NET may de-differentiate over time. FDG PET/CT's prognostic role is widely accepted; however, its impact on clinical decision-making remains controversial and its use varies widely. A questionnaire-based survey on FDG PET/CT use and perceived decision-making utility in NEN was submitted to the ENETS Advisory Board Meeting attendees (November 2022, response rate = 70%). In 3/15 statements, agreement was higher than 75%: (i) FDG was considered useful in NET, irrespective of grade, in case of mis-matched lesions (detectable on diagnostic CT but negative/faintly positive on SST PET/CT), especially if PRRT is contemplated (80%); (ii) in NET G3 if curative surgery is considered (82%); and (iii) in NEC prior to surgery with curative intent (98%). FDG use in NET G3, even in the presence of matched lesions, as a baseline for response assessment was favoured by 74%. Four statements obtained more than 60% consensus: (i) FDG use in NET G3 if locoregional therapy is considered (65%); (ii) in neuroendocrine carcinoma before initiating active therapy as a baseline for response assessment (61%); (iii) biopsy to re-assess tumour grade prior to a change in therapeutic management (68%) upon detection of FDG-positivity on the background of a prior G1-2 NET; (iv) 67% were in favour to reconsider PRRT to treat residual SST-positive lesions after achieving complete remission on FDG of the SST-negative disease component. Multidisciplinary opinion broadly supports the use of FDG PET/CT for characterisation of disease biology and to guide treatment selection across a range of indications, despite the lack of full consensus in many situations. This may reflect existing clinical access due to lack of reimbursement or experience with this investigation, which should be addressed by further research.
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Affiliation(s)
- Valentina Ambrosini
- Nuclear Medicine, Alma Mater Studiorum University of Bologna, Bologna, Italy
- Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Martyn Caplin
- Neuroendocrine Tumour Unit, Centre for Gastroenterology, Royal Free Hospital, London, UK
| | - Justo P Castaño
- Maimonides Institute for Biomedical Research of Cordoba (IMIBIC), Córdoba, Spain
- Department of Cell Biology, Physiology, and Immunology, University of Córdoba, Córdoba, Spain
- Reina Sofia University Hospital, Córdoba, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Córdoba, Spain
| | - Emanuel Christ
- Center of Endocrine and Neuroendocrine Tumors, ENETS Center of Excellence (CoE), Division of Endocrinology, Diabetology and Metabolism, University Hospital of Basel, Basel, Switzerland
| | - Timm Denecke
- Department of Diagnostic and Interventional Radiology, University Medical Center Leipzig, Leipzig, Germany
| | - Christophe M Deroose
- Nuclear Medicine and Molecular Imaging, Department of Imaging and Pathology, Nuclear Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Clarisse Dromain
- Department of Radiology, CHUV Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Massimo Falconi
- Pancreas Translational and Clinical Research Center, Pancreatic Surgery Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Simona Grozinsky-Glasberg
- Neuroendocrine Tumor Unit, ENETS Center of Excellence, Division of Medicine, Hadassah Medical Organization and Faculty of Medicine, the Hebrew University, Jerusalem, Israel
| | - Rodney J Hicks
- Department of Medicine, St Vincent's Hospital, The University of Melbourne, Melbourne, Australia
- Department of Medicine, Central Clinical School, the Alfred Hospital, Monash University, Melbourne, Australia
| | - Johannes Hofland
- Department of Internal Medicine, Section of Endocrinology, ENETS Centre of Excellence, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Andreas Kjaer
- Department of Clinical Physiology and Nuclear Medicine & Cluster for Molecular Imaging, Copenhagen University Hospital-Rigshospitalet & Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ulrich Peter Knigge
- Department of Surgery and Transplantation and Department of Endocrinology, Center of Cancer and Transplantation, ENETS Center of Excellence, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Beata Kos-Kudla
- Department of Endocrinology and Neuroendocrine Tumors, Medical University of Silesia, Katowice, Poland
| | - Anna Koumarianou
- Hematology Oncology Unit, Fourth Department of Internal Medicine, Attikon University Hospital, Medical School, ENETS Center of Excellence LAIKO, National and Kapodistrian University of Athens, Athens, Greece
| | - Balkundi Krishna
- Nuclear Medicine Department, Lilavati Hospital and Research Centre, Mumbai, India
| | - Angela Lamarca
- Department of Oncology-OncoHealth Institute-Instituto de Investigaciones Sanitarias FJD, Fundación Jiménez Díaz University Hospital, Madrid, Spain
- Department of Medical Oncology, The Christie NHS Foundation, Manchester; Division of Cancer Sciences, University of Manchester, Manchester, UK
| | - Marianne Pavel
- Department of Medicine 1, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
- Comprehensive Cancer Center CCC-EMN, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | | | - Aldo Scarpa
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
- ARC-NET Research Centre, University and Hospital Trust of Verona, Verona, Italy
| | | | - Anders Sundin
- Section for Radiology and Molecular Imaging, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Christos Toumpanakis
- Centre for Gastroenterology, Neuroendocrine Tumour Unit, ENETS Centre of Excellence, Royal Free Hospital, London, UK
| | - Vikas Prasad
- Division of Nuclear Medicine, Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, Missouri, USA
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Ehrengut C, Vogt J, Leonhardi J, Carabenciov E, Teske F, van Boemmel F, Berg T, Seehofer D, Lincke T, Sabri O, Gößmann H, Denecke T, Ebel S. Analysis of Periprocedural X-ray Exposure in Transarterial Radioembolization with Glass or Resin Microspheres. Diagnostics (Basel) 2023; 13:3609. [PMID: 38132193 PMCID: PMC10742723 DOI: 10.3390/diagnostics13243609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 12/03/2023] [Indexed: 12/23/2023] Open
Abstract
Background: Transarterial Radioembolization (TARE) is an effective treatment option for both primary and secondary liver malignancies. However, challenging anatomical conditions can lead to prolonged fluoroscopy times (FT), elevated doses of periprocedural X-radiation (DAP), and increased use of contrast agents (CAs). In this study, we examined the influence of our radiologists' experience and the choice of microspheres on X-ray exposure and CA doses in TARE. Material and Methods: Datasets comprising 161 TARE and 164 preprocedural evaluation angiographies (TARE-EVA) were analyzed. Our study focused on assessing DAP, FT, and CA concerning both microsphere types, the radiologist's experience, and whether the same radiologist performed both the TARE-EVA and the actual TARE. Results: In TARE, the use of resin microspheres resulted in significantly higher FT and CA compared to glass microspheres (14.3 ± 1.6 min vs. 10.6 ± 1.1 min and 43 ± 2.2 mL vs. 33.6 ± 2.1 mL, p < 0.05), with no notable differences in DAP (p = 0.13). Experienced radiologists demonstrated reduced FT/DAP, with a 19% decrease in DAP and 53% in FT during the evaluation angiography (p < 0.05) and a 49% reduction in DAP during the actual TARE (p < 0.05), with no statistical differences in FT. Performing TARE and TARE-EVA under the same radiologist led to a 43% reduction in DAP and a 25% decrease in FT (p < 0.05, respectively). Conclusions: To mitigate X-radiation exposure, it is advisable for radiologists to undergo thorough training, and, ideally, the same radiologist should conduct both the TARE and the TARE-EVA. While the use of glass spheres may decrease intraarterial CA, it does not significantly impact periprocedural X-ray exposure.
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Affiliation(s)
- Constantin Ehrengut
- Department of Diagnostic and Interventional Radiology, University of Leipzig Medical Center, 04103 Leipzig, Germany; (J.V.); (S.E.)
| | - Johanna Vogt
- Department of Diagnostic and Interventional Radiology, University of Leipzig Medical Center, 04103 Leipzig, Germany; (J.V.); (S.E.)
| | - Jakob Leonhardi
- Department of Diagnostic and Interventional Radiology, University of Leipzig Medical Center, 04103 Leipzig, Germany; (J.V.); (S.E.)
| | - Emma Carabenciov
- Department of Diagnostic and Interventional Radiology, University of Leipzig Medical Center, 04103 Leipzig, Germany; (J.V.); (S.E.)
| | - Felix Teske
- Department of Diagnostic and Interventional Radiology, University of Leipzig Medical Center, 04103 Leipzig, Germany; (J.V.); (S.E.)
| | - Florian van Boemmel
- Division of Hepatology, Department of Medicine II, University of Leipzig Medical Center, 04103 Leipzig, Germany
| | - Thomas Berg
- Division of Hepatology, Department of Medicine II, University of Leipzig Medical Center, 04103 Leipzig, Germany
| | - Daniel Seehofer
- Department of Visceral, Transplantation, Thoracic and Vascular Surgery, University of Leipzig Medical Center, 04103 Leipzig, Germany
| | - Thomas Lincke
- Department of Nuclear Medicine, University of Leipzig Medical Center, 04103 Leipzig, Germany
| | - Osama Sabri
- Department of Nuclear Medicine, University of Leipzig Medical Center, 04103 Leipzig, Germany
| | - Holger Gößmann
- Department of Diagnostic and Interventional Radiology, University of Leipzig Medical Center, 04103 Leipzig, Germany; (J.V.); (S.E.)
| | - Timm Denecke
- Department of Diagnostic and Interventional Radiology, University of Leipzig Medical Center, 04103 Leipzig, Germany; (J.V.); (S.E.)
| | - Sebastian Ebel
- Department of Diagnostic and Interventional Radiology, University of Leipzig Medical Center, 04103 Leipzig, Germany; (J.V.); (S.E.)
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10
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Mehdorn M, Schnarkowski B, Moulla Y, Pape J, Denecke T, Gockel I, Kassahun WT, Meyer HJ. Visceral obesity determined in routine preoperative CT scans predicts risk of postoperative burst abdomen. Sci Rep 2023; 13:21429. [PMID: 38052856 PMCID: PMC10697964 DOI: 10.1038/s41598-023-48714-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 11/29/2023] [Indexed: 12/07/2023] Open
Abstract
Burst abdomen (BA) remains a severe postoperative complication after abdominal surgery. Obesity is a known risk factor for postoperative complications but objective parameters such as body mass index fail to predict BA after abdominal surgery. In recent literature, CT-derived body composition assessment could predict obesity-related diseases and surgical site infections. We report data from the institutional wound register, comparing patients with BA to a subgroup of patients without BA. The CT images were evaluated for intraabdominal and subcutaneous fat tissues. Univariate and multivariate risk factor analysis was performed in order to evaluate CT-derived obesity parameters as risk factor for BA. 92 patients with BA were compared to 32 controls. Patients with BA had significantly more visceral obesity (VO; p < 0.001) but less subcutaneous obesity (SCO) on CT scans. VO and SCO both were positively correlated with BMI (r = 0.452 and 0.572) but VO and SCO were inversely correlated (r = -0.189). Multivariate analysis revealed VO as significant risk factor for postoperative BA (OR 1.257; 95% CI 1.084-1.459; p = 0.003). Our analysis of patients with postoperative BA revealed VO as major risk factor for postoperative BA. Thus, preoperative CT scans gives valuable information on possible risk stratification.
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Affiliation(s)
- Matthias Mehdorn
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany.
| | - Benedikt Schnarkowski
- Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Leipzig, Germany
| | - Yusef Moulla
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | - Johanna Pape
- Department of Pediatric Radiology, University Hospital Leipzig, Leipzig, Germany
| | - Timm Denecke
- Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Leipzig, Germany
| | - Ines Gockel
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | - Woubet Tefera Kassahun
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | - Hans-Jonas Meyer
- Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Leipzig, Germany
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11
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Ebel S, Köhler B, Aggarwal A, Preim B, Behrendt B, Jung B, Gohmann RF, Riekena B, Borger M, Lurz P, Denecke T, Grothoff M, Gutberlet M. Comparison of aortic blood flow rotational direction in healthy volunteers and patients with bicuspid aortic valves using volumetric velocity-sensitive cardiovascular magnetic resonance imaging. Quant Imaging Med Surg 2023; 13:7973-7986. [PMID: 38106267 PMCID: PMC10722022 DOI: 10.21037/qims-23-183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 09/13/2023] [Indexed: 12/19/2023]
Abstract
Background The rotational direction (RD) of helical blood flow can be classified as either a clockwise (RD+) or counter-clockwise (RD-) flow. We hypothesized that this simple classification might not be sufficient for analysis in vivo and a simultaneous existence of RD+/- may occur. We utilized volumetric velocity-sensitive cardiovascular magnetic resonance imaging (4D flow MRI) to analyze rotational blood flow in the thoracic aorta. Methods Forty volunteers (22 females; mean age, 41±16 years) and seventeen patients with bicuspid aortic valves (BAVs) (9 females; mean age, 42±14 years) were prospectively included. The RDs and the calculation of the rotating blood volumes (RBVs) in the thoracic aorta were performed using a pathline-projection strategy. Results We could confirm a mainly clockwise RD in the ascending, descending aorta and in the aortic arch. Furthermore, we found a simultaneous existence of RD+/RD-. The RD+/--volume in the ascending aorta was significantly higher in BAV patients, the mean RD+/RD- percentage was approximately 80%/20% vs. 60%/40% in volunteers (P<0.01). The maximum RBV always occurred during systole. There was significantly more clockwise than counter-clockwise rotational flow in the ascending aorta (P<0.01) and the aortic arch (P<0.01), but no significant differences in the descending aorta (P=0.48). Conclusions A simultaneous occurrence of RD+/RD- indicates that a simple categorization in either of both is insufficient to describe blood flow in vivo. Rotational flow in the ascending aorta and in the aortic arch differs significantly from flow in the descending aorta. BAV patients show significantly more clockwise rotating volume in the ascending aorta compared to healthy volunteers.
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Affiliation(s)
- Sebastian Ebel
- Department of Diagnostic and Interventional Radiology, University of Leipzig – Heart Centre, Leipzig, Germany
- Department of Diagnostic and Interventional Radiology, University of Leipzig, Leipzig, Germany
| | - Benjamin Köhler
- Department of Simulation and Graphics, University of Magdeburg, Magdeburg, Germany
| | | | - Bernhard Preim
- Department of Simulation and Graphics, University of Magdeburg, Magdeburg, Germany
| | - Benjamin Behrendt
- Department of Simulation and Graphics, University of Magdeburg, Magdeburg, Germany
| | - Bernd Jung
- Department of Diagnostic, Interventional and Paediatric Radiology, University of Bern, Bern, Switzerland
| | - Robin F. Gohmann
- Department of Diagnostic and Interventional Radiology, University of Leipzig – Heart Centre, Leipzig, Germany
| | - Boris Riekena
- Department of Diagnostic and Interventional Radiology, University of Leipzig – Heart Centre, Leipzig, Germany
| | - Michael Borger
- Department of Cardiac Surgery, University Leipzig – Heart Centre, Leipzig, Germany
| | - Philipp Lurz
- Department of Cardiology, University Leipzig – Heart Centre, Leipzig, Germany
| | - Timm Denecke
- Department of Diagnostic and Interventional Radiology, University of Leipzig, Leipzig, Germany
| | - Matthias Grothoff
- Department of Diagnostic and Interventional Radiology, University of Leipzig – Heart Centre, Leipzig, Germany
| | - Matthias Gutberlet
- Department of Diagnostic and Interventional Radiology, University of Leipzig – Heart Centre, Leipzig, Germany
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12
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Schneider D, Eggebrecht T, Linder A, Linder N, Schaudinn A, Blüher M, Denecke T, Busse H. Abdominal fat quantification using convolutional networks. Eur Radiol 2023; 33:8957-8964. [PMID: 37436508 PMCID: PMC10667157 DOI: 10.1007/s00330-023-09865-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 04/21/2023] [Accepted: 05/03/2023] [Indexed: 07/13/2023]
Abstract
OBJECTIVES To present software for automated adipose tissue quantification of abdominal magnetic resonance imaging (MRI) data using fully convolutional networks (FCN) and to evaluate its overall performance-accuracy, reliability, processing effort, and time-in comparison with an interactive reference method. MATERIALS AND METHODS Single-center data of patients with obesity were analyzed retrospectively with institutional review board approval. Ground truth for subcutaneous (SAT) and visceral adipose tissue (VAT) segmentation was provided by semiautomated region-of-interest (ROI) histogram thresholding of 331 full abdominal image series. Automated analyses were implemented using UNet-based FCN architectures and data augmentation techniques. Cross-validation was performed on hold-out data using standard similarity and error measures. RESULTS The FCN models reached Dice coefficients of up to 0.954 for SAT and 0.889 for VAT segmentation during cross-validation. Volumetric SAT (VAT) assessment resulted in a Pearson correlation coefficient of 0.999 (0.997), relative bias of 0.7% (0.8%), and standard deviation of 1.2% (3.1%). Intraclass correlation (coefficient of variation) within the same cohort was 0.999 (1.4%) for SAT and 0.996 (3.1%) for VAT. CONCLUSION The presented methods for automated adipose-tissue quantification showed substantial improvements over common semiautomated approaches (no reader dependence, less effort) and thus provide a promising option for adipose tissue quantification. CLINICAL RELEVANCE STATEMENT Deep learning techniques will likely enable image-based body composition analyses on a routine basis. The presented fully convolutional network models are well suited for full abdominopelvic adipose tissue quantification in patients with obesity. KEY POINTS • This work compared the performance of different deep-learning approaches for adipose tissue quantification in patients with obesity. • Supervised deep learning-based methods using fully convolutional networks were suited best. • Measures of accuracy were equal to or better than the operator-driven approach.
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Affiliation(s)
- Daniel Schneider
- Department of Diagnostic and Interventional Radiology, Leipzig University Hospital, Liebigstr. 20, Haus 4, 04103, Leipzig, Germany
- Innovation Center Computer-Assisted Surgery (ICCAS), University of Leipzig, Semmelweisstr. 14, 04103, Leipzig, Germany
| | - Tobias Eggebrecht
- Department of Diagnostic and Interventional Radiology, Leipzig University Hospital, Liebigstr. 20, Haus 4, 04103, Leipzig, Germany
- Integrated Research and Treatment Center (IFB) Adiposity Diseases, Leipzig University Medical Center, Philipp-Rosenthal-Str. 27, 04103, Leipzig, Germany
| | - Anna Linder
- Department of Diagnostic and Interventional Radiology, Leipzig University Hospital, Liebigstr. 20, Haus 4, 04103, Leipzig, Germany
| | - Nicolas Linder
- Department of Diagnostic and Interventional Radiology, Leipzig University Hospital, Liebigstr. 20, Haus 4, 04103, Leipzig, Germany
- Integrated Research and Treatment Center (IFB) Adiposity Diseases, Leipzig University Medical Center, Philipp-Rosenthal-Str. 27, 04103, Leipzig, Germany
| | - Alexander Schaudinn
- Department of Diagnostic and Interventional Radiology, Leipzig University Hospital, Liebigstr. 20, Haus 4, 04103, Leipzig, Germany
| | - Matthias Blüher
- Integrated Research and Treatment Center (IFB) Adiposity Diseases, Leipzig University Medical Center, Philipp-Rosenthal-Str. 27, 04103, Leipzig, Germany
- Helmholtz Institute for Metabolic, Obesity and Vascular Research (HI-MAG) of the Helmholtz Center Munich at the University of Leipzig and University Hospital Leipzig, Philipp-Rosenthal-Str. 27, 04103, Leipzig, Germany
| | - Timm Denecke
- Department of Diagnostic and Interventional Radiology, Leipzig University Hospital, Liebigstr. 20, Haus 4, 04103, Leipzig, Germany
| | - Harald Busse
- Department of Diagnostic and Interventional Radiology, Leipzig University Hospital, Liebigstr. 20, Haus 4, 04103, Leipzig, Germany.
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13
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Kos-Kudła B, Castaño JP, Denecke T, Grande E, Kjaer A, Koumarianou A, de Mestier L, Partelli S, Perren A, Stättner S, Valle JW, Fazio N. European Neuroendocrine Tumour Society (ENETS) 2023 guidance paper for nonfunctioning pancreatic neuroendocrine tumours. J Neuroendocrinol 2023; 35:e13343. [PMID: 37877341 DOI: 10.1111/jne.13343] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 09/23/2023] [Accepted: 09/25/2023] [Indexed: 10/26/2023]
Abstract
This ENETS guidance paper for well-differentiated nonfunctioning pancreatic neuroendocrine tumours (NF-Pan-NET) has been developed by a multidisciplinary working group, and provides up-to-date and practical advice on the management of these tumours. Using the extensive experience of centres treating patients with NF-Pan-NEN, the authors of this guidance paper discuss 10 troublesome questions in everyday clinical practice. Our many years of experience in this field are still being verified in the light of the results of new clinical, which set new ways of proceeding in NEN. The treatment of NF-Pan-NEN still requires a decision of a multidisciplinary team of specialists in the field of neuroendocrine neoplasms.
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Affiliation(s)
- Beata Kos-Kudła
- Department of Endocrinology and Neuroendocrine Tumours, Department of Pathophysiology and Endocrinology, Medical University of Silesia, Katowice, Poland
| | - Justo P Castaño
- Maimonides Biomedical Research Institute of Córdoba, University of Córdoba, Hospital Universitario Reina Sofía, Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición, (CIBERobn), Córdoba, Spain
| | - Timm Denecke
- Department of Diagnostic and Interventional Radiology, University Medical Centre Leipzig, Leipzig, Germany
| | - Enrique Grande
- Medical Oncology Department, MD Anderson Cancer Centre Madrid, Madrid, Spain
| | - Andreas Kjaer
- Department of Clinical Physiology and Nuclear Medicine and Cluster for Molecular Imaging, Copenhagen University Hospital - Righospitalet and Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Anna Koumarianou
- Hematology Oncology Unit, Fourth Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Louis de Mestier
- Université Paris-Cité, Department of Pancreatology and Digestive Oncology, Beaujon Hospital (APHP.Nord) and INSERM U1149, Paris, France
| | - Stefano Partelli
- Pancreatic Translational and Clinical Research Centre, Pancreatic and Transplant Surgery Unit, Vita-Salute San Raffaele University, Milan, Italy
| | - Aurel Perren
- Institute of Pathology, University of Bern, Bern, Switzerland
| | - Stefan Stättner
- Department of General, Visceral and Vascular Surgery, Salzkammergut Klinikum, OÖG, Vöcklabruck, Austria
| | - Juan W Valle
- Division of Cancer Sciences, University of Manchester, Manchester, UK
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Nicola Fazio
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumours, European Institute of Oncology (IEO), IRCCS, Milan, Italy
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14
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Prasse G, Glaas A, Meyer HJ, Zebralla V, Dietz A, Hering K, Kuhnt T, Denecke T. A Radiomics-Based Machine Learning Perspective on the Parotid Gland as a Potential Surrogate Marker for HPV in Oropharyngeal Cancer. Cancers (Basel) 2023; 15:5425. [PMID: 38001684 PMCID: PMC10670647 DOI: 10.3390/cancers15225425] [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: 09/07/2023] [Revised: 11/05/2023] [Accepted: 11/07/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND In treatment of oropharyngeal squamous cell carcinoma (OPSCC), human papillomavirus status (HPV) plays a crucial role. The HPV-positive subtype tends to affect younger patients and is associated with a more favorable prognosis. HPV-associated lesions have been described in the parotid gland, which is included in routine imaging for OPSCC. This work aims to explore the ability of an ML system to classify HPV status based on imaging of the parotid gland, which is routinely depicted on staging imaging. METHODS Using a radiomics approach, we investigate the ability of five contemporary machine learning (ML) models to distinguish between HPV-positive and HPV-negative OPSCC based on non-contrast computed tomography (CT) data of tumor volume (TM), locoregional lymph node metastasis (LNM), and the parotid gland (Parotid). After exclusion of cases affected by streak artefacts, 53 patients (training set: 39; evaluation set: 14) were retrospectively evaluated. Classification performances were tested for significance against random optimistic results. RESULTS The best results are AUC 0.71 by XGBoost (XGB) for TM, AUC 0.82 by multi-layer perceptron (MLP) for LNM, AUC 0.76 by random forest (RF) for Parotid, and AUC 0.86 by XGB for a combination of all three regions of interest (ROIs). CONCLUSIONS The results suggest involvement of the parotid gland in HPV infections of the oropharyngeal region. While the role of HPV in parotid lesions is under active discussion, the migration of the virus from the oral cavity to the parotid gland seems plausible. The imaging of the parotid gland offers the benefit of fewer streak artifacts due to teeth and dental implants and the potential to screen for HPV in cases of an absent or unlocatable tumor. Future investigation can be directed to validation of the results in independent datasets and to the potential of improvement of current classification models by addition of information based on the parotid gland.
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Affiliation(s)
- Gordian Prasse
- Department of Radiology, University of Leipzig, 04103 Leipzig, Germany; (H.-J.M.); (T.D.)
| | - Agnes Glaas
- Department of Radiation Therapy, University of Leipzig, 04103 Leipzig, Germany (T.K.)
| | - Hans-Jonas Meyer
- Department of Radiology, University of Leipzig, 04103 Leipzig, Germany; (H.-J.M.); (T.D.)
| | - Veit Zebralla
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Leipzig, 04103 Leipzig, Germany
| | - Andreas Dietz
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Leipzig, 04103 Leipzig, Germany
| | - Kathrin Hering
- Department of Radiation Therapy, University of Leipzig, 04103 Leipzig, Germany (T.K.)
| | - Thomas Kuhnt
- Department of Radiation Therapy, University of Leipzig, 04103 Leipzig, Germany (T.K.)
| | - Timm Denecke
- Department of Radiology, University of Leipzig, 04103 Leipzig, Germany; (H.-J.M.); (T.D.)
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15
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Foldyna B, Basmagi S, Zangeneh FA, Wagner M, Doktorov K, Matveeva A, Denecke T, Gohmann RF, Lücke C, Gutberlet M, Lehmkuhl L. CT-derived coronary artery calcium density is affected by regional lesion distribution and image reconstruction parameters. Clin Imaging 2023; 103:109980. [PMID: 37677856 DOI: 10.1016/j.clinimag.2023.109980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 08/17/2023] [Accepted: 08/28/2023] [Indexed: 09/09/2023]
Abstract
PURPOSE The prognostic relevance of coronary artery calcium (CAC) density, assessed from cardiac CT scans, is established. However, the influence of CAC distribution, volume, image reconstruction, and clinical factors on CAC density warrants further examination. METHODS In this study, 120 patients underwent non-contrast ECG-gated cardiac CT scans using a prospectively defined CAC scoring protocol with 1-, 3-, and 5-mm thick image reconstructions, both with and without a 20% image overlap. We segmented CAC in all reconstructions and assessed the relationship between CAC density, volume, and number of detected calcifications/patient. RESULTS Overall, 75/120 (63%) patients (66% men, mean age 63 ± 11 years) presented CAC across 342 segments. CAC density, CAC volume, and the number of detected calcifications decreased with increasing slice thickness (p < 0.001 for all); these effects were slightly reduced by image overlap (p < 0.001 for all). Higher CAC density correlated with greater CAC volume (ρ = 0.62; p < 0.001) and more calcified segments per person (ρ = 0.32; p = 0.006). Higher CAC density was also associated with lower patient weight (beta: -0.6, 95%CI: -1.1--0.1, p = 0.022) and increased high-density lipoprotein (HDL) levels (beta: 0.7, 95%CI: 0.0-1.4, p = 0.046). In a multivariable analysis adjusted for clinical covariates, lower CAC density was associated with broader CAC distribution (i.e., a higher number of calcified segments at a given CAC volume; beta-coefficient: -58.9; 95%CI: -84.7 to -33.1; p < 0.001). CONCLUSION CAC density is significantly impacted by regional CAC distribution and image reconstruction, potentially confounding its prognostic value. Accounting for these factors may improve patient risk assessment, management, and cardiovascular health outcomes.
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Affiliation(s)
- Borek Foldyna
- Cardiovascular Imaging Research Center, Massachusetts General Hospital - Harvard Medical School, 165 Cambridge Street, Suite 400, 02114 Boston, USA; Clinic for Radiology, Heart Center Bad Neustadt a.d. Saale, Bad Neustadt a.d. Saale, Germany.
| | - Said Basmagi
- Clinic for Radiology, Heart Center Bad Neustadt a.d. Saale, Bad Neustadt a.d. Saale, Germany
| | | | - Matthias Wagner
- Clinic for Radiology, Heart Center Bad Neustadt a.d. Saale, Bad Neustadt a.d. Saale, Germany
| | - Kalin Doktorov
- Clinic for Radiology, Heart Center Bad Neustadt a.d. Saale, Bad Neustadt a.d. Saale, Germany
| | - Anna Matveeva
- Clinic for Radiology, Heart Center Bad Neustadt a.d. Saale, Bad Neustadt a.d. Saale, Germany
| | - Timm Denecke
- Clinic for Diagnostic and Interventional Radiology, University of Leipzig, Leipzig, Germany
| | - Robin F Gohmann
- Department of Diagnostic and Interventional Radiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Christian Lücke
- Department of Diagnostic and Interventional Radiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Matthias Gutberlet
- Department of Diagnostic and Interventional Radiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Lukas Lehmkuhl
- Clinic for Radiology, Heart Center Bad Neustadt a.d. Saale, Bad Neustadt a.d. Saale, Germany
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16
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Leonhardi J, Sabanov A, Schnarkowski B, Hoehn AK, Sucher R, Seehofer D, Denecke T, Meyer HJ. CT Texture Analysis and Node-RADS CT Score of Lymph Nodes in Patients With Perihilar Cholangiocarcinoma. Anticancer Res 2023; 43:5089-5097. [PMID: 37909955 DOI: 10.21873/anticanres.16709] [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: 07/30/2023] [Revised: 10/09/2023] [Accepted: 10/11/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND/AIM Texture analysis can provide quantitative imaging markers from computed tomography (CT) images. The Node-RADS classification was recently published as a classification system to better characterize lymph nodes in oncological imaging. The present analysis investigated the diagnostic benefit of CT texture analysis and the Node-RADS classification to categorize and stage lymph nodes in patients with perihilar cholangiocarcinoma. PATIENTS AND METHODS Overall, 25 patients (n=9 females, 36%) with a mean age of 72.4±8.1 years were included. All patients were surgically resected and the lymph nodes were histopathologically analyzed. CT-texture analysis was performed with the Mazda package. All investigated lymph nodes were scored in accordance with the Node-RADS classification. RESULTS Regarding lymph node discrimination (N- versus N+), Node-RADS classification achieved an area under the curve (AUC) of 0.86 resulting in a sensitivity of 78% and a specificity of 86%. Multiple investigated texture features were different between negative and positive lymph nodes. The "S(0,1)SumVarnc" achieved the best AUC of 0.75 resulting in a sensitivity of 0.91 and a specificity of 0.67. Correlation analysis showed various statistically significant associations between CT texture features and Node-RADS score. CONCLUSION Several CT texture features and the Node-RADS score derived from preoperative staging CT were associated with the malignancy of the hilar lymph nodes and might aid for preoperative staging. This could change surgical treatment planning in hilar cholangiocarcinoma.
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Affiliation(s)
- Jakob Leonhardi
- Department of Diagnostic and Interventional Radiology, University of Leipzig, Leipzig, Germany
| | - Arsen Sabanov
- Department of Visceral and Transplantation Surgery, University Hospital Leipzig, University of Leipzig, Leipzig, Germany
| | - Benedikt Schnarkowski
- Department of Diagnostic and Interventional Radiology, University of Leipzig, Leipzig, Germany
| | - Anne-Kathrin Hoehn
- Department of Pathology, University Hospital Leipzig, University of Leipzig, Leipzig, Germany
| | - Robert Sucher
- Department of Visceral and Transplantation Surgery, University Hospital Leipzig, University of Leipzig, Leipzig, Germany
| | - Daniel Seehofer
- Department of Visceral and Transplantation Surgery, University Hospital Leipzig, University of Leipzig, Leipzig, Germany
| | - Timm Denecke
- Department of Diagnostic and Interventional Radiology, University of Leipzig, Leipzig, Germany
| | - Hans-Jonas Meyer
- Department of Diagnostic and Interventional Radiology, University of Leipzig, Leipzig, Germany;
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Ehrengut C, Denecke T, Meyer HJ. Benefits of Dual-Layer Spectral CT Imaging in Staging and Preoperative Evaluation of Pancreatic Ductal Adenocarcinoma. J Clin Med 2023; 12:6145. [PMID: 37834789 PMCID: PMC10573525 DOI: 10.3390/jcm12196145] [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: 05/24/2023] [Revised: 09/10/2023] [Accepted: 09/20/2023] [Indexed: 10/15/2023] Open
Abstract
Imaging of pancreatic malignancies is challenging but has a major impact on the patients therapeutic approach and outcome. In particular with pancreatic ductal adenocarcinoma (PDAC), usually a hypovascularized tumor, conventional CT imaging can be prone to errors in determining tumor extent and presence of metastatic disease. Dual-layer spectral detector CT (SDCT) is an emerging technique for acquiring spectral information without the need for prospective patient selection or specific protocols, with a detector capable of differentiating high- and low-energy photons to acquire full spectral images. In this review, we present the diagnostic benefits and capabilities of modern SDCT imaging with a focus on PDAC. We highlight the most useful virtual reconstructions in oncologic imaging and their benefits in staging and assessment of resectability in PDAC, including the assessment of tumor extent, vascular infiltration, and metastatic disease. We present imaging examples on a latest-generation SDCT scanner.
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Affiliation(s)
| | | | - Hans-Jonas Meyer
- Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Leipzig, 04103 Leipzig, Germany; (C.E.)
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18
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Schwartner C, Mehdorn M, Gockel I, Struck MF, Leonhardi J, Rositzka M, Ebel S, Denecke T, Meyer HJ. Computed Tomography-Defined Body Composition as Prognostic Parameter in Acute Mesenteric Ischemia. Dig Surg 2023; 40:225-232. [PMID: 37708859 PMCID: PMC10716866 DOI: 10.1159/000534093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 09/09/2023] [Indexed: 09/16/2023]
Abstract
INTRODUCTION Body composition comprising low-skeletal muscle mass (LSMM) and subcutaneous and visceral adipose tissue (SAT and VAT) can be assessed by using cross-sectional imaging modalities. Previous analyses suggest that these parameters harbor prognostic relevance in various diseases. Aim of this study was to analyze possible associations of body composition parameters on mortality in patients with clinically suspected acute mesenteric ischemia (AMI). METHODS All patients with clinically suspected AMI were retrospectively assessed between 2016 and 2020. Overall, 137 patients (52 female patients, 37.9%) with a median age of 71 years were included in the present analysis. For all patients, the preoperative abdominal computed tomography (CT) was used to calculate LSMM, VAT, and SAT. RESULTS Overall, 94 patients (68.6%) of the patient cohort died within 30 days within a median of 2 days, range 1-39 days. Of these, 27 patients (19.7%) died within 24 h. According to the CT, 101 patients (73.7%) were classified as being visceral obese, 102 patients (74.5%) as being sarcopenic, and 69 patients (50.4%) as being sarcopenic obese. Skeletal muscle index (SMI) was lower in non-survivors compared to survivors (37.5 ± 12.4 cm2/m2 vs. 44.1 ± 13.9 cm2/m2, p = 0.01). There were no associations between body composition parameters with mortality in days (SMI r = 0.07, p = 0.48, SAT r = -0.03, p = 0.77, and VAT r = 0.04, p = 0.68, respectively). In Cox regression analysis, a nonsignificant trend for visceral obesity was observed (HR: 0.62, 95% CI: 0.36-1.05, p = 0.07). CONCLUSION SMI might be a valuable CT-based parameter, which could help discriminate between survivors and non-survivors. Further studies are needed to elucidate the associations between body composition and survival in patients with AMI.
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Affiliation(s)
- Christoph Schwartner
- Department of Diagnostic and Interventional Radiology, University of Leipzig, Leipzig, Germany
| | - Matthias Mehdorn
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University of Leipzig, Leipzig, Germany
| | - Ines Gockel
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University of Leipzig, Leipzig, Germany
| | - Manuel Florian Struck
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Leipzig, Leipzig, Germany
| | - Jakob Leonhardi
- Department of Diagnostic and Interventional Radiology, University of Leipzig, Leipzig, Germany
| | - Markus Rositzka
- Department of Diagnostic and Interventional Radiology, University of Leipzig, Leipzig, Germany
| | - Sebastian Ebel
- Department of Diagnostic and Interventional Radiology, University of Leipzig, Leipzig, Germany
| | - Timm Denecke
- Department of Diagnostic and Interventional Radiology, University of Leipzig, Leipzig, Germany
| | - Hans-Jonas Meyer
- Department of Diagnostic and Interventional Radiology, University of Leipzig, Leipzig, Germany
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Primavesi F, Maglione M, Cipriani F, Denecke T, Oberkofler CE, Starlinger P, Dasari BVM, Heil J, Sgarbura O, Søreide K, Diaz-Nieto R, Fondevila C, Frampton AE, Geisel D, Henninger B, Hessheimer AJ, Lesurtel M, Mole D, Öllinger R, Olthof P, Reiberger T, Schnitzbauer AA, Schwarz C, Sparrelid E, Stockmann M, Truant S, Aldrighetti L, Braunwarth E, D’Hondt M, DeOliveira ML, Erdmann J, Fuks D, Gruenberger T, Kaczirek K, Malik H, Öfner D, Rahbari NN, Göbel G, Siriwardena AK, Stättner S. E-AHPBA-ESSO-ESSR Innsbruck consensus guidelines for preoperative liver function assessment before hepatectomy. Br J Surg 2023; 110:1331-1347. [PMID: 37572099 PMCID: PMC10480040 DOI: 10.1093/bjs/znad233] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/09/2023] [Accepted: 07/04/2023] [Indexed: 08/14/2023]
Abstract
BACKGROUND Posthepatectomy liver failure (PHLF) contributes significantly to morbidity and mortality after liver surgery. Standardized assessment of preoperative liver function is crucial to identify patients at risk. These European consensus guidelines provide guidance for preoperative patient assessment. METHODS A modified Delphi approach was used to achieve consensus. The expert panel consisted of hepatobiliary surgeons, radiologists, nuclear medicine specialists, and hepatologists. The guideline process was supervised by a methodologist and reviewed by a patient representative. A systematic literature search was performed in PubMed/MEDLINE, the Cochrane library, and the WHO International Clinical Trials Registry. Evidence assessment and statement development followed Scottish Intercollegiate Guidelines Network methodology. RESULTS Based on 271 publications covering 4 key areas, 21 statements (at least 85 per cent agreement) were produced (median level of evidence 2- to 2+). Only a few systematic reviews (2++) and one RCT (1+) were identified. Preoperative liver function assessment should be considered before complex resections, and in patients with suspected or known underlying liver disease, or chemotherapy-associated or drug-induced liver injury. Clinical assessment and blood-based scores reflecting liver function or portal hypertension (for example albumin/bilirubin, platelet count) aid in identifying risk of PHLF. Volumetry of the future liver remnant represents the foundation for assessment, and can be combined with indocyanine green clearance or LiMAx® according to local expertise and availability. Functional MRI and liver scintigraphy are alternatives, combining FLR volume and function in one examination. CONCLUSION These guidelines reflect established methods to assess preoperative liver function and PHLF risk, and have uncovered evidence gaps of interest for future research.
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Affiliation(s)
- Florian Primavesi
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
- Department of General, Visceral and Vascular Surgery, Centre for Hepatobiliary Surgery, Vöcklabruck, Austria
| | - Manuel Maglione
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Federica Cipriani
- Hepatobiliary Surgery Division, San Raffaele Scientific Institute, Milan, Italy
| | - Timm Denecke
- Department of Diagnostic and Interventional Radiology, University Medical Centre Leipzig, Leipzig, Germany
| | - Christian E Oberkofler
- Swiss Hepatopancreatobiliary Transplant Centre, Department of Surgery, University Hospital Zürich, Zürich, Switzerland
- Vivévis AG—Visceral, Tumour and Robotic Surgery, Clinic Hirslanden Zürich, Zürich, Switzerland
| | - Patrick Starlinger
- Department of Surgery, Division of Hepatobiliary and Pancreatic Surgery, Mayo Clinic, Rochester, Minnesota, USA
- Centre of Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Bobby V M Dasari
- Department of Hepatobiliary–pancreatic and Liver Transplantation Surgery, University of Birmingham, Birmingham, UK
| | - Jan Heil
- Department of General, Visceral, Transplant and Thoracic Surgery, Goethe University Frankfurt, University Hospital, Frankfurt, Germany
| | - Olivia Sgarbura
- Department of Surgical Oncology, Cancer Institute of Montpellier, University of Montpellier, Montpellier, France
- IRCM, Institut de Recherche en Cancérologie de Montpellier, INSERM U1194, Université de Montpellier, Institut Régional du Cancer de Montpellier, Montpellier, France
| | - Kjetil Søreide
- Department of Gastrointestinal Surgery, Hepatopancreatobiliary Unit, Stavanger University Hospital, Stavanger, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Rafael Diaz-Nieto
- Liver Surgery Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Constantino Fondevila
- General and Digestive Surgery Service, Hospital Universitario La Paz, IdiPAZ, CIBERehd, Madrid, Spain
| | - Adam E Frampton
- Hepatopancreatobiliary Surgical Unit, Royal Surrey NHS Foundation Trust, Guildford, UK
- Section of Oncology, Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK
| | - Dominik Geisel
- Department of Radiology, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Benjamin Henninger
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Amelia J Hessheimer
- General and Digestive Surgery Service, Hospital Universitario La Paz, IdiPAZ, CIBERehd, Madrid, Spain
| | - Mickaël Lesurtel
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris Cité, Clichy, France
| | - Damian Mole
- Hepatopancreatobiliary Surgery Unit, Department of Clinical Surgery, University of Edinburgh, Edinburgh, UK
| | - Robert Öllinger
- Department of Surgery, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Pim Olthof
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
- Department of Surgery, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, the Netherlands
| | - Thomas Reiberger
- Division of Gastroenterology and Hepatology, Department of Medicine III and CD-Lab for Portal Hypertension and Liver Fibrosis, Medical University of Vienna, Vienna, Austria
| | - Andreas A Schnitzbauer
- Department of General, Visceral, Transplant and Thoracic Surgery, Goethe University Frankfurt, University Hospital, Frankfurt, Germany
| | - Christoph Schwarz
- Department of General Surgery, Division of Visceral Surgery, Medical University Vienna, Vienna, Austria
| | - Ernesto Sparrelid
- Department of Clinical Science, Intervention and Technology, Division of Surgery and Oncology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Martin Stockmann
- Department of Surgery, Charité–Universitätsmedizin Berlin, Berlin, Germany
- Department of General, Visceral and Vascular Surgery, Evangelisches Krankenhaus Paul Gerhardt Stift, Lutherstadt Wittenberg, Germany
| | - Stéphanie Truant
- Department of Digestive Surgery and Transplantation, CHU Lille, Lille University, Lille, France
- CANTHER Laboratory ‘Cancer Heterogeneity, Plasticity and Resistance to Therapies’ UMR-S1277, Team ‘Mucins, Cancer and Drug Resistance’, Lille, France
| | - Luca Aldrighetti
- Hepatobiliary Surgery Division, San Raffaele Scientific Institute, Milan, Italy
| | - Eva Braunwarth
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Mathieu D’Hondt
- Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital Kortrijk, Kortrijk, Belgium
| | - Michelle L DeOliveira
- Swiss Hepatopancreatobiliary Transplant Centre, Department of Surgery, University Hospital Zürich, Zürich, Switzerland
| | - Joris Erdmann
- Department of Surgery, Amsterdam UMC, Cancer Centre Amsterdam, the Netherlands
| | - David Fuks
- Department of Digestive, Hepatobiliary and Endocrine Surgery, Assistance Publique-Hôpitaux de Paris Centre Hopital Cochin, Paris, France
| | - Thomas Gruenberger
- Department of Surgery, Clinic Favoriten, Hepatopancreatobiliary Centre, Health Network Vienna and Sigmund Freud Private University, Vienna, Austria
| | - Klaus Kaczirek
- Department of General Surgery, Division of Visceral Surgery, Medical University Vienna, Vienna, Austria
| | - Hassan Malik
- Liver Surgery Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Dietmar Öfner
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Nuh N Rahbari
- Department of Surgery, University Hospital Mannheim, University of Heidelberg, Medical Faculty Mannheim, Mannheim, Germany
| | - Georg Göbel
- Department of Medical Statistics, Informatics, and Health Economics, Medical University of Innsbruck, Innsbruck, Austria
| | - Ajith K Siriwardena
- Regional Hepato-Pancreato-Biliary Unit, Manchester Royal Infirmary, Manchester, UK
| | - Stefan Stättner
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
- Department of General, Visceral and Vascular Surgery, Centre for Hepatobiliary Surgery, Vöcklabruck, Austria
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Jacobs PP, Ehrengut C, Bucher AM, Penzkofer T, Lukas M, Kleesiek J, Denecke T. Challenges in Implementing the Local Node Infrastructure for a National Federated Machine Learning Network in Radiology. Healthcare (Basel) 2023; 11:2377. [PMID: 37685411 PMCID: PMC10487228 DOI: 10.3390/healthcare11172377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 08/20/2023] [Accepted: 08/22/2023] [Indexed: 09/10/2023] Open
Abstract
Data-driven machine learning in medical research and diagnostics needs large-scale datasets curated by clinical experts. The generation of large datasets can be challenging in terms of resource consumption and time effort, while generalizability and validation of the developed models significantly benefit from variety in data sources. Training algorithms on smaller decentralized datasets through federated learning can reduce effort, but require the implementation of a specific and ambitious infrastructure to share data, algorithms and computing time. Additionally, it offers the opportunity of maintaining and keeping the data locally. Thus, data safety issues can be avoided because patient data must not be shared. Machine learning models are trained on local data by sharing the model and through an established network. In addition to commercial applications, there are also numerous academic and customized implementations of network infrastructures available. The configuration of these networks primarily differs, yet adheres to a standard framework composed of fundamental components. In this technical note, we propose basic infrastructure requirements for data governance, data science workflows, and local node set-up, and report on the advantages and experienced pitfalls in implementing the local infrastructure with the German Radiological Cooperative Network initiative as the use case example. We show how the infrastructure can be built upon some base components to reflect the needs of a federated learning network and how they can be implemented considering both local and global network requirements. After analyzing the deployment process in different settings and scenarios, we recommend integrating the local node into an existing clinical IT infrastructure. This approach offers benefits in terms of maintenance and deployment effort compared to external integration in a separate environment (e.g., the radiology department). This proposed groundwork can be taken as an exemplary development guideline for future applications of federated learning networks in clinical and scientific environments.
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Affiliation(s)
- Paul-Philipp Jacobs
- Department of Diagnostic and Interventional Radiology, University of Leipzig, 04109 Leipzig, Germany
| | - Constantin Ehrengut
- Department of Diagnostic and Interventional Radiology, University of Leipzig, 04109 Leipzig, Germany
| | - Andreas Michael Bucher
- Department of Diagnostic and Interventional Radiology, Johann-Wolfgang-v.-Goethe-Universität, 60629 Frankfurt, Germany
| | - Tobias Penzkofer
- Department of Radiology, Campus Virchow-Klinikum, Charité—Universitätsmedizin Berlin, 10117 Berlin, Germany
| | - Mathias Lukas
- Department of Diagnostic and Interventional Radiology, University of Leipzig, 04109 Leipzig, Germany
| | - Jens Kleesiek
- Institute for Artificial Intelligence in Medicine, University Hospital Essen (AöR), 45131 Essen, Germany
- Medical Faculty, University of Duisburg-Essen, 45122 Essen, Germany
| | - Timm Denecke
- Department of Diagnostic and Interventional Radiology, University of Leipzig, 04109 Leipzig, Germany
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21
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Struck MF, Werdehausen R, Kirsten H, Gössmann H, Veelken R, van Bömmel F, Stehr S, Denecke T, Ebel S. Prognostic Factors for Postoperative Bleeding Complications and Prolonged Intensive Care after Percutaneous Hepatic Chemosaturation Procedures with Melphalan. Cancers (Basel) 2023; 15:3776. [PMID: 37568592 PMCID: PMC10417144 DOI: 10.3390/cancers15153776] [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: 06/08/2023] [Revised: 07/21/2023] [Accepted: 07/23/2023] [Indexed: 08/13/2023] Open
Abstract
Percutaneous hepatic melphalan perfusion (chemosaturation) in patients with liver metastases is known to be associated with procedure-related hemodynamic depression and coagulation impairment, which may cause bleeding complications and/or a prolonged intensive care unit length of stay (ICU LOS). We retrospectively analyzed possible predictive factors for bleeding complications and an ICU LOS > 1 d in a cohort of 31 patients undergoing 90 chemosaturation procedures. Using a multivariable mixed-model approach, we identified the amount of perioperative fluid volume (OR 12.0, 95% CI 2.3-60.0, p = 0.003) and protamine (OR 0.065, 95% CI 0.007-0.55, p = 0.012) to be associated with bleeding complications. Furthermore, the amount of perioperative fluid volume was associated with an ICU LOS > 1 d (OR 5.2, 95% CI 1.4-19.0, p = 0.011). Heparin dosage, melphalan dosage, extracorporeal circulation time, and noradrenaline dosage had no significant effects on outcomes. Protamine use was not associated with anaphylactic or thromboembolic complications. Despite the limited sample size, these results suggest a restrictive perioperative fluid regime to be beneficial, and support the use of protamine for heparin reversal after chemosaturation procedures. Further prospective randomized trials are needed to confirm these findings.
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Affiliation(s)
- Manuel Florian Struck
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Leipzig, Liebigstr. 20, 04103 Leipzig, Germany; (R.W.); (S.S.)
| | - Robert Werdehausen
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Leipzig, Liebigstr. 20, 04103 Leipzig, Germany; (R.W.); (S.S.)
| | - Holger Kirsten
- Institute for Medical Statistics, Informatics and Epidemiology, Medical Faculty, University of Leipzig, 04107 Leipzig, Germany;
| | - Holger Gössmann
- Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Liebigstr. 20, 04103 Leipzig, Germany; (H.G.); (T.D.); (S.E.)
| | - Rhea Veelken
- Division of Hepatology, Department of Gastroenterology, University Hospital Leipzig, Liebigstr. 20, 04103 Leipzig, Germany; (R.V.); (F.v.B.)
| | - Florian van Bömmel
- Division of Hepatology, Department of Gastroenterology, University Hospital Leipzig, Liebigstr. 20, 04103 Leipzig, Germany; (R.V.); (F.v.B.)
| | - Sebastian Stehr
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Leipzig, Liebigstr. 20, 04103 Leipzig, Germany; (R.W.); (S.S.)
| | - Timm Denecke
- Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Liebigstr. 20, 04103 Leipzig, Germany; (H.G.); (T.D.); (S.E.)
| | - Sebastian Ebel
- Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Liebigstr. 20, 04103 Leipzig, Germany; (H.G.); (T.D.); (S.E.)
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Lavall D, Vosshage NH, Geßner R, Stöbe S, Ebel S, Denecke T, Hagendorff A, Laufs U. Native T1 mapping for the diagnosis of cardiac amyloidosis in patients with left ventricular hypertrophy. Clin Res Cardiol 2023; 112:334-342. [PMID: 35355115 PMCID: PMC9998594 DOI: 10.1007/s00392-022-02005-2] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 03/03/2022] [Indexed: 01/15/2023]
Abstract
BACKGROUND Cardiac magnetic resonance (CMR) with parametric mapping can improve the characterization of myocardial tissue. We studied the diagnostic value of native T1 mapping to detect cardiac amyloidosis in patients with left ventricular (LV) hypertrophy. METHODS One hundred twenty-five patients with increased LV wall thickness (≥ 12 mm end-diastole) who received clinical CMR in a 3 T scanner between 2017 and 2020 were included. 31 subjects without structural heart disease served as controls. Native T1 was measured as global mean value from 3 LV short axis slices. The study was registered at German clinical trial registry (DRKS00022048). RESULTS Mean age of the patients was 66 ± 14 years, 83% were males. CA was present in 24 patients, 21 patients had hypertrophic cardiomyopathy (HCM), 80 patients suffered from hypertensive heart disease (HHD). Native T1 times were higher in patients with CA (1409 ± 59 ms, p < 0.0001) compared to healthy controls (1225 ± 21 ms), HCM (1266 ± 44 ms) and HHD (1257 ± 41 ms). HCM and HHD patients did not differ in their native T1 times but were increased compared to control (p < 0.01). ROC analysis of native T1 demonstrated an area under the curve for the detection of CA vs. HCM and HHD of 0.9938 (p < 0.0001), which was higher than that of extracellular volume (0.9876) or quantitative late gadolinium enhancement (0.9406; both p < 0.0001). The optimal cut-off value of native T1 to diagnose CA was 1341 ms (sensitivity 100%, specificity 97%). CONCLUSION Non-contrast CMR imaging with native T1 mapping provides high diagnostic accuracy to diagnose cardiac amyloidosis in patients with left ventricular hypertrophy.
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Affiliation(s)
- Daniel Lavall
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany.
| | - Nicola H Vosshage
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany
| | - Romy Geßner
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany
| | - Stephan Stöbe
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany
| | - Sebastian Ebel
- Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany
| | - Timm Denecke
- Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany
| | - Andreas Hagendorff
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany
| | - Ulrich Laufs
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany
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23
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Kliem P, Ebel S, Werdehausen R, Girrbach F, Bösemann D, van Bömmel F, Denecke T, Stehr S, Struck MF. [Anesthesiological and postinterventional management in percutaneous hepatic melphalan perfusion (chemosaturation)]. Anaesthesiologie 2023; 72:113-120. [PMID: 36477906 PMCID: PMC9892165 DOI: 10.1007/s00101-022-01235-3] [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] [Figures] [Subscribe] [Scholar Register] [Accepted: 11/06/2022] [Indexed: 12/13/2022]
Abstract
Percutaneous hepatic melphalan perfusion (PHMP) is a last-line treatment of inoperable primary or secondary liver tumors. Selective perfusion and saturation (chemosaturation) of the liver with the chemotherapeutic agent melphalan is performed via catheterization of the hepatic artery without affecting the rest of the body with its cytotoxic properties. Using an extracorporeal circulation and balloon occlusion of the inferior vena cava, the venous hepatic blood is filtered and returned using a bypass procedure. During the procedure, considerable circulatory depression and coagulopathy are frequent. The purpose of this article is to review the anesthesiological and postprocedural management of patients undergoing PHMP with consideration of the pitfalls and special circumstances.
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Affiliation(s)
- Peter Kliem
- Klinik und Poliklinik für Anästhesiologie und Intensivtherapie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Deutschland
| | - Sebastian Ebel
- Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Leipzig, Leipzig, Deutschland
| | - Robert Werdehausen
- Klinik und Poliklinik für Anästhesiologie und Intensivtherapie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Deutschland
| | - Felix Girrbach
- Klinik und Poliklinik für Anästhesiologie und Intensivtherapie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Deutschland
| | - Denis Bösemann
- Klinik für Herz- und Thoraxchirurgie, Kardiotechnik, Universitätsklinikum Jena, Jena, Deutschland
| | - Florian van Bömmel
- Klinik und Poliklinik für Onkologie, Gastroenterologie, Hepatologie, Pneumologie und Infektiologie, Bereich Hepatologie, Universitätsklinikum Leipzig, Leipzig, Deutschland
| | - Timm Denecke
- Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Leipzig, Leipzig, Deutschland
| | - Sebastian Stehr
- Klinik und Poliklinik für Anästhesiologie und Intensivtherapie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Deutschland
| | - Manuel F Struck
- Klinik und Poliklinik für Anästhesiologie und Intensivtherapie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Deutschland.
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Ebel S, Struck MF, van Boemmel F, Beeskow AB, Gößmann H, Denecke T. Chemosaturation of the Liver - an Update. ROFO-FORTSCHR RONTG 2023; 195:30-37. [PMID: 35977553 DOI: 10.1055/a-1858-3418] [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: 01/04/2023]
Abstract
BACKGROUND Percutaneous hepatic perfusion (CS-PHP) is a treatment option for primary and secondary liver neoplasms and subject of intensive research. This present article provides an overview of CS-PHP regarding patient safety, feasibility and effectiveness based on recent studies. METHOD We performed a PubMed search including the search terms chemosaturation, hepatic chemosaturation, percutaneous perfusion and melphalan. RESULTS AND CONCLUSION CS-PHP is a promising procedure for the treatment of uveal melanoma and cholangiocellular carcinoma. There are insufficient data regarding the effectiveness of CS-PHP with respect to other tumor entities. Since CS-PHP can be accompanied by multiple transient side effects and complications, close interdisciplinary cooperation is necessary. KEY POINTS · Chemosaturation of the liver is a safe procedure.. · CS-PHP is a potent therapy for hepatic metastatic ocular melanoma and cholangiocellular carcinoma.. · The procedure requires close interdisciplinary coordination.. · CS-PHP is a repeatable and thus long-term therapeutic option for some patients.. CITATION FORMAT · Ebel S, Struck MF, van Boemmel F et al. Chemosaturation of the Liver - an Update. Fortschr Röntgenstr 2023; 195: 30 - 37.
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Affiliation(s)
- Sebastian Ebel
- Klinik und Poliklinik für diagnostische und interventionelle Radiologie, Leipzig University, Leipzig, Germany
| | - Manuel Florian Struck
- Klinik und Poliklinik für Anästhesiologie und Intensivtherapie, Leipzig University, Leipzig, Germany
| | - Florian van Boemmel
- Klinik für Innere Medizin II, Sektion für Hepatologie, Leipzig University, Leipzig, Germany
| | - Anne Bettina Beeskow
- Klinik und Poliklinik für diagnostische und interventionelle Radiologie, Leipzig University, Leipzig, Germany
| | - Holger Gößmann
- Klinik und Poliklinik für diagnostische und interventionelle Radiologie, Leipzig University, Leipzig, Germany
| | - Timm Denecke
- Klinik und Poliklinik für diagnostische und interventionelle Radiologie, Leipzig University, Leipzig, Germany
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Meyer HJ, Schnarkowski B, Pappisch J, Kerkhoff T, Wirtz H, Höhn AK, Krämer S, Denecke T, Leonhardi J, Frille A. CT texture analysis and node-RADS CT score of mediastinal lymph nodes - diagnostic performance in lung cancer patients. Cancer Imaging 2022; 22:75. [PMID: 36567339 PMCID: PMC9791752 DOI: 10.1186/s40644-022-00506-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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 12/07/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Texture analysis derived from computed tomography (CT) can provide clinically relevant imaging biomarkers. Node-RADS is a recently proposed classification to categorize lymph nodes in radiological images. The present study sought to investigate the diagnostic abilities of CT texture analysis and Node-RADS to discriminate benign from malignant mediastinal lymph nodes in patients with lung cancer. METHODS Ninety-one patients (n = 32 females, 35%) with a mean age of 64.8 ± 10.8 years were included in this retrospective study. Texture analysis was performed using the free available Mazda software. All lymph nodes were scored accordingly to the Node-RADS classification. All primary tumors and all investigated mediastinal lymph nodes were histopathologically confirmed during clinical workup. RESULTS In discrimination analysis, Node-RADS score showed statistically significant differences between N0 and N1-3 (p < 0.001). Multiple texture features were different between benign and malignant lymph nodes: S(1,0)AngScMom, S(1,0)SumEntrp, S(1,0)Entropy, S(0,1)SumAverg. Correlation analysis revealed positive associations between the texture features with Node-RADS score: S(4,0)Entropy (r = 0.72, p < 0.001), S(3,0) Entropy (r = 0.72, p < 0.001), S(2,2)Entropy (r = 0.72, p < 0.001). CONCLUSIONS Several texture features and Node-RADS derived from CT were associated with the malignancy of mediastinal lymph nodes and might therefore be helpful for discrimination purposes. Both of the two quantitative assessments could be translated and used in clinical routine.
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Affiliation(s)
- Hans-Jonas Meyer
- grid.9647.c0000 0004 7669 9786Department of Diagnostic and Interventional Radiology, University of Leipzig, Leipzig, Germany
| | - Benedikt Schnarkowski
- grid.9647.c0000 0004 7669 9786Department of Diagnostic and Interventional Radiology, University of Leipzig, Leipzig, Germany
| | - Johanna Pappisch
- grid.411339.d0000 0000 8517 9062Department of Respiratory Medicine, University Hospital Leipzig, University of Leipzig, Leipzig, Germany
| | - Teresa Kerkhoff
- grid.411339.d0000 0000 8517 9062Department of Respiratory Medicine, University Hospital Leipzig, University of Leipzig, Leipzig, Germany
| | - Hubert Wirtz
- grid.411339.d0000 0000 8517 9062Department of Respiratory Medicine, University Hospital Leipzig, University of Leipzig, Leipzig, Germany
| | - Anne-Kathrin Höhn
- grid.411339.d0000 0000 8517 9062Department of Pathology, University Hospital Leipzig, University of Leipzig, Leipzig, Germany
| | - Sebastian Krämer
- grid.411339.d0000 0000 8517 9062Department of Thoracic Surgery, University Hospital Leipzig, University of Leipzig, Leipzig, Germany
| | - Timm Denecke
- grid.9647.c0000 0004 7669 9786Department of Diagnostic and Interventional Radiology, University of Leipzig, Leipzig, Germany
| | - Jakob Leonhardi
- grid.9647.c0000 0004 7669 9786Department of Diagnostic and Interventional Radiology, University of Leipzig, Leipzig, Germany
| | - Armin Frille
- grid.411339.d0000 0000 8517 9062Department of Respiratory Medicine, University Hospital Leipzig, University of Leipzig, Leipzig, Germany ,grid.483476.aIntegrated Research and Treatment Centre (IFB) Adiposity Diseases, University Medical Centre Leipzig, Leipzig, Germany
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Collettini F, Elkilany A, Seta MD, Steffen IG, Collettini JM, Penzkofer T, Schmelzle M, Denecke T. MR imaging of hepatocellular carcinoma: prospective intraindividual head-to-head comparison of the contrast agents gadoxetic acid and gadoteric acid. Sci Rep 2022; 12:18583. [PMID: 36329107 PMCID: PMC9633770 DOI: 10.1038/s41598-022-23397-1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 10/31/2022] [Indexed: 11/05/2022] Open
Abstract
The routine use of dynamic-contrast-enhanced MRI (DCE-MRI) of the liver using hepatocyte-specific contrast agent (HSCA) as the standard of care for the study of focal liver lesions is not widely accepted and opponents invoke the risk of a loss in near 100% specificity of extracellular contrast agents (ECA) and the need for prospective head-to-head comparative studies evaluating the diagnostic performance of both contrast agents. The Purpose of this prospective intraindividual study was to conduct a quantitative and qualitative head-to-head comparison of DCE-MRI using HSCA and ECA in patients with liver cirrhosis and HCC. Twenty-three patients with liver cirrhosis and proven HCC underwent two 3 T-MR examinations, one with ECA (gadoteric acid) and the other with HSCA (gadoxetic acid). Signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), wash-in, wash-out, image quality, artifacts, lesion conspicuity, and major imaging features of LI-RADS v2018 were evaluated. Wash-in and wash-out were significantly stronger with ECA compared to HSCA (P < 0.001 and 0.006, respectively). During the late arterial phase (LAP), CNR was significantly lower with ECA (P = 0.005), while SNR did not differ significantly (P = 0.39). In qualitative analysis, ECA produced a better overall image quality during the portal venous phase (PVP) and delayed phase (DP) compared to HSCA (P = 0.041 and 0.008), showed less artifacts in the LAP and PVP (P = 0.003 and 0.034) and a higher lesion conspicuity in the LAP and PVP (P = 0.004 and 0.037). There was no significant difference in overall image quality during the LAP (P = 1), in artifacts and lesion conspicuity during the DP (P = 0.078 and 0.073) or in the frequency of the three major LI-RADS v2018 imaging features. In conclusion, ECA provides superior contrast of HCC-especially hypervascular HCC lesions-in DCE-MR in terms of better perceptibility of early enhancement and a stronger washout.
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Affiliation(s)
- Federico Collettini
- grid.6363.00000 0001 2218 4662Department of Diagnostic and Interventional Radiology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany ,grid.484013.a0000 0004 6879 971XBerlin Institute of Health (BIH), Anna-Louisa-Karsch 2, 10178 Berlin, Germany
| | - Aboelyazid Elkilany
- grid.6363.00000 0001 2218 4662Department of Diagnostic and Interventional Radiology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Marta Della Seta
- grid.6363.00000 0001 2218 4662Department of Diagnostic and Interventional Radiology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Ingo G. Steffen
- grid.6363.00000 0001 2218 4662Department of Diagnostic and Interventional Radiology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Jasmin Maya Collettini
- grid.6363.00000 0001 2218 4662Department of Diagnostic and Interventional Radiology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Tobias Penzkofer
- grid.6363.00000 0001 2218 4662Department of Diagnostic and Interventional Radiology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany ,grid.484013.a0000 0004 6879 971XBerlin Institute of Health (BIH), Anna-Louisa-Karsch 2, 10178 Berlin, Germany
| | - Moritz Schmelzle
- grid.6363.00000 0001 2218 4662Department of General, Visceral and Transplantation Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Timm Denecke
- grid.411339.d0000 0000 8517 9062Department of Diagnostic and Interventional Radiology, Leipzig University Hospital, Leipzig, Germany
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Fischer J, Wellhöner S, Ebel S, Lincke T, Böhlig A, Gerhardt F, Veelken R, Goessmann H, Steinhoff KG, Denecke T, Sabri O, Berg T, van Bömmel F. The Liver Maximum Capacity Test (LiMAx) Is Associated with Short-Term Survival in Patients with Early Stage HCC Undergoing Transarterial Treatment. Cancers (Basel) 2022; 14:cancers14215323. [PMID: 36358742 PMCID: PMC9657475 DOI: 10.3390/cancers14215323] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 10/06/2022] [Accepted: 10/26/2022] [Indexed: 12/02/2022] Open
Abstract
Simple Summary The liver maximum capacity test (LiMAx) represents a useful tool to estimate liver function in patients with chronic liver disease. LiMAx results correlate with short-term survival in patients with early stage HCC after transarterial chemo- or radioembolization. Low LiMAx levels might enable the identification of patients with poor hepatic function and decreased short-term survival after treatment. Abstract Transarterial chemoembolization (TACE) and transarterial radioembolization (TARE) are recommended to treat patients with early or intermediate hepatocellular carcinoma (HCC). The liver maximum capacity test (LiMAx) has been supposed to predict the risk of post-interventional liver failure. We investigated the correlation of LiMAx with short-term survival as primary endpoint and the occurrence of adverse events after therapy as secondary endpoint. Our study cohort prospectively included 69 patients receiving TACE (n = 57) or TARE (n = 12). LiMAx test and serological analyses were performed on the day before and 4 weeks after treatment. Hepatic and extrahepatic complications were monitored for 4 weeks. The LiMAx results were not associated with altered liver function and the occurrence of adverse events. The survival rates of patients with BCLC A with LiMAx ≤ 150 μg/kg/h were lower after 30 days (75.0 ± 15.3% vs. 100%, p = 0.011), 90 days (62.5 ± 17.7% vs. 95.8 ± 4.1%, p = 0.011) and 180 days (50.0 ± 17.7% vs. 95.8 ± 4.1%, p = 0.001) compared to those with higher LiMAx levels. The LiMAx test is not suitable to predict liver function abnormalities or the occurrence of complications 4 weeks after therapy but enables the identification of patients with early stage HCC and reduced short-term survival after treatment.
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Affiliation(s)
- Janett Fischer
- Division of Hepatology, Department of Medicine II, Leipzig University Medical Center, 04103 Leipzig, Germany
- Correspondence:
| | - Stella Wellhöner
- Division of Hepatology, Department of Medicine II, Leipzig University Medical Center, 04103 Leipzig, Germany
| | - Sebastian Ebel
- Department of Diagnostic and Interventional Radiology, Leipzig University Medical Center, 04103 Leipzig, Germany
| | - Thomas Lincke
- Department of Nuclear Medicine, Leipzig University Medical Center, 04103 Leipzig, Germany
| | - Albrecht Böhlig
- Division of Hepatology, Department of Medicine II, Leipzig University Medical Center, 04103 Leipzig, Germany
| | - Florian Gerhardt
- Division of Hepatology, Department of Medicine II, Leipzig University Medical Center, 04103 Leipzig, Germany
| | - Rhea Veelken
- Division of Hepatology, Department of Medicine II, Leipzig University Medical Center, 04103 Leipzig, Germany
| | - Holger Goessmann
- Department of Diagnostic and Interventional Radiology, Leipzig University Medical Center, 04103 Leipzig, Germany
| | - Karen Geva Steinhoff
- Department of Nuclear Medicine, Leipzig University Medical Center, 04103 Leipzig, Germany
| | - Timm Denecke
- Department of Diagnostic and Interventional Radiology, Leipzig University Medical Center, 04103 Leipzig, Germany
| | - Osama Sabri
- Department of Nuclear Medicine, Leipzig University Medical Center, 04103 Leipzig, Germany
| | - Thomas Berg
- Division of Hepatology, Department of Medicine II, Leipzig University Medical Center, 04103 Leipzig, Germany
| | - Florian van Bömmel
- Division of Hepatology, Department of Medicine II, Leipzig University Medical Center, 04103 Leipzig, Germany
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Ebel S, Reinhardt M, Beeskow AB, Teske F, Struck MF, Veelken R, van Boemmel F, Berg T, Moche M, Gutberlet M, Gößmann H, Denecke T. Analysis of patient’s X-ray exposure in hepatic chemosaturation procedures: a single center experience. BMC Med Imaging 2022; 22:165. [PMID: 36100850 PMCID: PMC9469537 DOI: 10.1186/s12880-022-00887-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 08/23/2022] [Indexed: 11/28/2022] Open
Abstract
Background Hepatic chemosaturation is a technique in which a high dose of the chemotherapeutic agent melphalan is administered directly into the liver while limiting systemic side effects. We reviewed our institutional experience regarding patient’s X-ray exposure caused by the procedure. Methods Fifty-five procedures, performed between 2016 and 2020 in 18 patients by three interventional radiologists (radiologist), were analyzed regarding the patient’s exposure to radiation. Dose-area-product (DAP) and fluoroscopy time (FT) were correlated with the experience of the radiologist and whether the preprocedural evaluation (CS-EVA) and the procedure were performed by the same radiologist. Additionally, the impact of previous liver surgery on DAP/FT was analyzed. Results Experienced radiologist require less DAP/FT (50 ± 18 Gy*cm2/13.2 ± 3.84 min vs. 69 ± 20 Gy*cm2/15.77 ± 7.82 min; p < 0.001). Chemosaturations performed by the same radiologist who performed CS-EVA required less DAP/FT (41 ± 12 Gy*cm2/11.46 ± 4.41 min vs. 62 ± 11 Gy*cm2/15.55 ± 7.91 min; p < 0.001). Chemosaturations in patients with prior liver surgery with involvement of the inferior cava vein required significantly higher DAP/FT (153 ± 27 Gy*cm2/25.43 ± 4.57 min vs. 56 ± 25 Gy*cm2/14.44 ± 7.55 min; p < 0.001). Conclusion There is a significant learning curve regarding the procedure of hepatic chemosaturation. Due to dose reduction the evaluation and chemosaturation therapy should be performed by the same radiologist. Procedures in patients with previous liver surgery require higher DAP/FT.
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Doyscher RJ, Rühl L, Czichy B, Neumann K, Denecke T, Wolfarth B, Rodeo SA, Scheibel M. Bilateral glenohumeral internal rotation deficit (GIRD) in elite gymnasts. Arch Orthop Trauma Surg 2022; 143:2599-2608. [PMID: 35982278 PMCID: PMC10110687 DOI: 10.1007/s00402-022-04577-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 08/03/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The "Glenohumeral Internal Rotation Deficit (GIRD)" is known as the difference in internal rotation range of motion (IRRM) between the dominant and non-dominant shoulder of overhead athletes as a result of asymmetric loading. As in contrast loading pattern in gymnastics are quite symmetric and structural changes often occur bilaterally, the question arises if GIRD might develop bilaterally in gymnasts as one source of common bilateral shoulder pathologies and to search for underlying structural adaptations. MATERIALS AND METHODS A group of 35 elite gymnasts (8-24 years) were recruited from a local Olympic Training Centre and compared to a paired cohort of 28 non-overhead athletes. Clinical examinations, digital range of motion (ROM)-measurement, ultrasonographic humeral torsion measurement, and standardized MRI scans of both shoulders were obtained and examined for structural pathologies, cross-sectional areas (CSA) of the rotator cuff muscles and capsular thickness. RESULTS ROM-measurements showed significant decrease in IRRM in the gymnasts groups by age, with IRRM of 48.6° (SD: 8.4°, CI 95%: 43.0-54.3°) at age group 1 (8-10 years) and IRRM of 10° (SD: 11.4°; CI 95%: 0-22.0°) at age group 4 (18-26 years), that was statistically significant for the entire cohort (p = 0.017) compared to the controls. CSA were not significantly different between the cohorts, while there was a slightly increased humeral retrotorsion in the gymnasts as well as a statistically significant posterior capsular thickening. CONCLUSION A new bilateral form of GIRD was identified in higher age groups of youth and senior elite gymnasts enrolled in this study. Despite to former definition of GIRD there was no compensatory increase in external rotation range of motion (ERRM) but an association with posterior capsular thickening, while there was no periscapular muscle hypertrophy. Humeral retrotorsion was also slightly increased in the gymnasts group.
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Affiliation(s)
- Ralf J Doyscher
- Center for Musculoskeletal Surgery and Department of Sports Medicine, Charité - Universitaetsmedizin Berlin, Augustenburger Platz 1, Berlin, Germany.,Borussia VFL 1900 Moenchengladbach GmbH, Moenchengladbach, Germany
| | - Leopold Rühl
- Center for Musculoskeletal Surgery and Department of Sports Medicine, Charité - Universitaetsmedizin Berlin, Augustenburger Platz 1, Berlin, Germany
| | - Benjamin Czichy
- Center for Musculoskeletal Surgery and Department of Sports Medicine, Charité - Universitaetsmedizin Berlin, Augustenburger Platz 1, Berlin, Germany
| | - Konrad Neumann
- Institute for Biometry and Clinical Epidemiology, Charité - Universitaetsmedizin Berlin, Berlin, Germany
| | - Timm Denecke
- Clinic for Radiology, Charité - Universitaetsmedizin Berlin, Berlin, Germany.,Clinic for Diagnostic and Interventional Radiology, University Hospital Leipzig, Leipzig, Germany
| | - Bernd Wolfarth
- Center for Musculoskeletal Surgery and Department of Sports Medicine, Charité - Universitaetsmedizin Berlin, Augustenburger Platz 1, Berlin, Germany
| | - Scott A Rodeo
- Sports Medicine & Shoulder Service, Hospital for Special Surgery, New York, NY, USA
| | - Markus Scheibel
- Center for Musculoskeletal Surgery and Department of Sports Medicine, Charité - Universitaetsmedizin Berlin, Augustenburger Platz 1, Berlin, Germany. .,Department of Shoulder and Elbow Surgery, Schulthess Clinic Zurich, Zurich, Switzerland.
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Elkilany A, Alwarraky M, Denecke T, Geisel D. Percutaneous transluminal angioplasty for symptomatic hepatic vein-type Budd-Chiari syndrome: feasibility and long-term outcomes. Sci Rep 2022; 12:14095. [PMID: 35982064 PMCID: PMC9388522 DOI: 10.1038/s41598-022-16818-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 07/15/2022] [Indexed: 11/09/2022] Open
Abstract
For management of Budd-Chiari syndrome (BCS), a step-wise therapeutic approach starting with medical treatment, followed by endovascular recanalization, transjugular intrahepatic portosystemic shunt, and finally liver transplantation has been adopted. We retrospectively analyzed 51 patients with symptomatic short segment (≤ 30 mm) hepatic vein (HV)-type BCS who underwent percutaneous transluminal balloon angioplasty (PTBA) with/without stenting to determine the feasibility, clinical effectiveness, and long-term outcomes. The intervention was technically successful in 94.1% of cases (48/51)—32 patients underwent PTBA and 16 patients underwent HV stenting. Procedure-related complications occurred in 14 patients (29.1%). The clinical success rate at 4 weeks was 91.7% (44/48). Nine patients underwent reintervention, six patients due to restenosis/occlusion and three patients with clinical failure. The mean primary patency duration was 64.6 ± 19.9 months (CI, 58.5–70.8; range, 1.2–81.7 months). The cumulative 1-, 2-, and 5-year primary patency rates were 85.4, 74.5, and 58.3%, respectively. The cumulative 1-, 2-, and 5-year secondary patency rates were 93.8, 87.2, and 75%, respectively. The cumulative 1-, 2-, and 5-year survival rates were 97.9, 91.5, and 50%, respectively. Percutaneous transluminal angioplasty with and without stenting is effective and achieves excellent long-term patency and survival rates in patients with symptomatic HV-type BCS. With its lower incidence of re-occlusion and higher clinical success rate, HV angioplasty combined with stenting should be the preferred option especially in patients with segmental HV-type BCS.
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Affiliation(s)
- Aboelyazid Elkilany
- Department of Diagnostic and Interventional Radiology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany. .,Department of Diagnostic Medical Imaging and Interventional Radiology, National Liver Institute, Menoufia University, Menoufia, Egypt.
| | - Mohamed Alwarraky
- Department of Diagnostic Medical Imaging and Interventional Radiology, National Liver Institute, Menoufia University, Menoufia, Egypt
| | - Timm Denecke
- Department of Diagnostic and Interventional Radiology, Leipzig University Hospital, Leipzig, Germany
| | - Dominik Geisel
- Department of Diagnostic and Interventional Radiology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
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Leonhardi J, Bailis N, Lerche M, Denecke T, Surov A, Meyer HJ. Computed Tomography Embolus Texture Analysis as a Prognostic Marker of Acute Pulmonary Embolism. Angiology 2022; 74:461-471. [PMID: 35973807 PMCID: PMC10070556 DOI: 10.1177/00033197221111862] [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: 11/16/2022]
Abstract
Texture analysis is a quantitative imaging analysis that provides novel biomarkers beyond conventional image reading. Our aim was to use texture analysis of pulmonary emboli derived from thoracic computed tomography for prediction of mortality and prognosis of acute pulmonary embolism (PE). Overall, 216 patients (116 female, 53.7%) were included in the analysis. Texture analysis was calculated on axial slices of the contrast enhanced pulmonary angiography of the proximal embolus. Clinical scores, serological parameters, need for intubation, intensive care unit (ICU) admission and mortality was assessed and correlated with the texture features. In the correlation analysis, there were several associations with mortality in days, the highest for the parameter S(0,5)SumVarnc (r = -0.43, P < 0.001). Another parameter, S(3,-3)AngScMom correlated with sepsis-related organ failure assessment score (SOFA)-score (r = 0.31, P < 0.001). Several texture features correlated with venous lactate and glucose levels. In discrimination analysis, there were significant differences in regard to texture features between survivors and non-survivors and between patients with and without the need for ICU admission (P = 0.02, respectively). These results highlight the potential clinical benefit of texture features in patients with acute PE as novel imaging biomarkers. Further studies are needed to validate these results.
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Affiliation(s)
- Jakob Leonhardi
- Department of Diagnostic and Interventional Radiology, 70622University of Leipzig, Leipzig, Germany
| | - Nikolaos Bailis
- Department of Diagnostic and Interventional Radiology, 70622University of Leipzig, Leipzig, Germany
| | - Marianne Lerche
- Department of Respiratory Medicine, University Hospital Leipzig, 70622University of Leipzig, Leipzig, Germany
| | - Timm Denecke
- Department of Diagnostic and Interventional Radiology, 70622University of Leipzig, Leipzig, Germany
| | - Alexey Surov
- Department of Radiology and Nuclear Medicine, 9376Otto von Guericke University, Magdeburg, Germany
| | - Hans-Jonas Meyer
- Department of Diagnostic and Interventional Radiology, 70622University of Leipzig, Leipzig, Germany
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Leonhardi J, Höhn KA, Denecke T, Wirtz H, Pappisch J, Frille A, Meyer JH. CT Textur-Analyse von pulmonalen neuroendokrinen Tumoren – Assoziation mit Tumor-Grading und Ki-67-Proliferationsindex. ROFO-FORTSCHR RONTG 2022. [DOI: 10.1055/s-0042-1749917] [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)
- J Leonhardi
- Universitätsklinikum Leipzig AöR, Klinik und Poliklinik für Diagnostische und Interventionelle, Leipzig
| | - K A Höhn
- Institut für Pathologie, Universitätsklinikum Leipzig, Leipzig
| | - T Denecke
- Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie, Universitätsklinkum Leipzig, Leipzig
| | - H Wirtz
- Klinik und Poliklinik für Onkologie, Gastroenterologie, Hepatologie, Pneumologie, Infektiologie, Universitätsklinikum Leipzig, Leipzig
| | - J Pappisch
- Klinik und Poliklinik für Onkologie, Gastroenterologie, Hepatologie, Pneumologie, Infektiologie, Universitätsklinikum Leipzig, Leipzig
| | - A Frille
- Klinik und Poliklinik für Onkologie, Gastroenterologie, Hepatologie, Pneumologie und Infektiologie, Universitätsklinikum Leipzig, Leipzig
| | - J H Meyer
- Klinik und Poliklinik für diagnostische und interventionelle Radiologie, Universitätsklinikum Leipzig, Leipzig
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Engelmann C, Aehling NF, Schob S, Nonnenmacher I, Handmann L, Macnaughtan J, Herber A, Surov A, Kaiser T, Denecke T, Jalan R, Seehofer D, Moche M, Berg T. Body fat composition determines outcomes before and after liver transplantation in patients with cirrhosis. Hepatol Commun 2022; 6:2198-2209. [PMID: 35420246 PMCID: PMC9315113 DOI: 10.1002/hep4.1946] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 01/24/2022] [Accepted: 02/17/2022] [Indexed: 11/25/2022] Open
Abstract
Cachexia occurs in late stages of liver cirrhosis, and a low-fat mass is potentially associated with poor outcome. This study compared different computed tomography (CT)-derived fat parameters with respect to its prognostic impact on the development of complications and death before and after liver transplantation. Between 2001 and 2014, 612 patients with liver cirrhosis without hepatocellular carcinoma listed for liver transplantation met the inclusion criteria, including abdominal CT scan (±200 days to listing). A total of 109 patients without cirrhosis served as controls. The subcutaneous fat index (SCFI), the paraspinal muscle fat index, and the visceral fat index were assessed at L3/L4 level and normalized to the height (cm2 /m2 ). Data were collected and analyzed retrospectively. Low SCFI was associated with a higher rate of ascites and increased C-reactive protein levels (p < 0.001). In addition, multivariate Cox regression analysis adjusting for sex, age, body mass index (BMI), and Model for End-Stage Liver Disease showed that decreasing SCFI was also associated with an increased risk of cirrhosis-related complications (p = 0.003) and death on the transplant wait list (p = 0.013). Increased paraspinal and visceral fat were not only positively correlated with creatinine levels (p < 0.001), BMI, and metabolic comorbidities (all p < 0.001) before transplantation, but also predictive for 1-year mortality after transplantation. Conclusion: The distribution of body fat is a major determinant for complications and outcome in cirrhosis before and after liver transplantation.
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Affiliation(s)
- Cornelius Engelmann
- Division of HepatologyDepartment of Medicine IILeipzig University Medical CenterLeipzigGermany.,Liver Failure GroupInstitute for Liver and Digestive HealthUniversity College LondonRoyal Free CampusLondonUK.,Department of Hepatology and GastroenterologyCampus Virchow-KlinikumCharité-Universitaetsmedizin BerlinBerlinGermany.,522475Berlin Institute of HealthBerlinGermany
| | - Niklas F Aehling
- Division of HepatologyDepartment of Medicine IILeipzig University Medical CenterLeipzigGermany
| | - Stefan Schob
- Department for NeuroradiologyUniversity Hospital LeipzigLeipzigGermany
| | - Ines Nonnenmacher
- Division of HepatologyDepartment of Medicine IILeipzig University Medical CenterLeipzigGermany
| | - Luise Handmann
- Division of HepatologyDepartment of Medicine IILeipzig University Medical CenterLeipzigGermany
| | - Jane Macnaughtan
- Liver Failure GroupInstitute for Liver and Digestive HealthUniversity College LondonRoyal Free CampusLondonUK
| | - Adam Herber
- Division of HepatologyDepartment of Medicine IILeipzig University Medical CenterLeipzigGermany
| | - Alexey Surov
- Department of Diagnostic and Interventional RadiologyUniversity Hospital LeipzigLeipzigGermany
| | - Thorsten Kaiser
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular DiagnosticsUniversity Hospital LeipzigLeipzigGermany
| | - Timm Denecke
- Department of Diagnostic and Interventional RadiologyUniversity Hospital LeipzigLeipzigGermany
| | - Rajiv Jalan
- Liver Failure GroupInstitute for Liver and Digestive HealthUniversity College LondonRoyal Free CampusLondonUK
| | - Daniel Seehofer
- Department of VisceralVascularThoracic and Transplant SurgeryUniversity Hospital LeipzigLeipzigGermany
| | - Michael Moche
- Department of Diagnostic and Interventional RadiologyUniversity Hospital LeipzigLeipzigGermany.,Diagnostic and Interventional RadiologyPark Hospital LeipzigLeipzigGermany
| | - Thomas Berg
- Division of HepatologyDepartment of Medicine IILeipzig University Medical CenterLeipzigGermany
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Linder A, Ullrich S, Linder N, Gößmann H, Denecke T, Ebel S. Interventionelle Bergung eines abgerissenen und durch ein
persistierendes Foramen ovale in beide Vorhöfe migrierten
Portkatheters. ROFO-FORTSCHR RONTG 2022. [DOI: 10.1055/s-0042-1756576] [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: 11/05/2022]
Affiliation(s)
- A Linder
- Universitätsklinikum Leipzig, Klinik u. Poliklinik für
Diagnostische u. Interv. Radiologie, Leipzig
| | - S Ullrich
- Klinik und Poliklinik für Diagnostische und Interventionelle
Radiologie, Universitätsklinikum Leipzig, Leipzig
| | - N Linder
- Klinik und Poliklinik für Diagnostische und Interventionelle
Radiologie, Universitätsklinikum Leipzig, Leipzig
| | - H Gößmann
- Klinik und Poliklinik für Diagnostische und Interventionelle
Radiologie, Universitätsklinikum Leipzig, Leipzig
| | - T Denecke
- Klinik und Poliklinik für Diagnostische und Interventionelle
Radiologie, Universitätsklinikum Leipzig, Leipzig
| | - S Ebel
- Klinik und Poliklinik für Diagnostische und Interventionelle
Radiologie, Universitätsklinikum Leipzig, Leipzig
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Grozinsky‐Glasberg S, Davar J, Hofland J, Dobson R, Prasad V, Pascher A, Denecke T, Tesselaar MET, Panzuto F, Albåge A, Connolly HM, Obadia J, Riechelmann R, Toumpanakis C. European Neuroendocrine Tumor Society (ENETS) 2022 Guidance Paper for Carcinoid Syndrome and Carcinoid Heart Disease. J Neuroendocrinol 2022; 34:e13146. [PMID: 35613326 PMCID: PMC9539661 DOI: 10.1111/jne.13146] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/17/2022] [Accepted: 04/18/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Simona Grozinsky‐Glasberg
- Neuroendocrine Tumor Unit, ENETS Center of Excellence, Department of Endocrinology and Metabolism, Hadassah Medical Organization and Faculty of MedicineHebrew University of JerusalemJerusalemIsrael
| | - Joseph Davar
- Carcinoid Heart Disease Clinic, Department of CardiologyRoyal Free Hospital & University College LondonLondonUK
| | - Johannes Hofland
- Department of Internal Medicine, Section of Endocrinology, ENETS Center of ExcellenceErasmus MC and Erasmus Cancer InstituteRotterdamThe Netherlands
| | - Rebecca Dobson
- Department of CardiologyLiverpool Heart and Chest HospitalLiverpoolUK
| | - Vikas Prasad
- Department of Nuclear MedicineUniversity UlmUlmGermany
| | - Andreas Pascher
- Department of General, Visceral and Transplantation SurgeryUniversity Hospital MuensterMuensterGermany
| | - Timm Denecke
- Department of Diagnostic and Interventional RadiologyLeipzig University Medical CenterLeipzigGermany
| | | | - Francesco Panzuto
- Digestive Disease Unit, Department of Medical‐Surgical Sciences and Translational MedicineSapienza University of Rome, ENETS Center of ExcellenceRomeItaly
| | - Anders Albåge
- Department of Cardiothoracic Surgery and Anesthesiology, University Hospital, and Department of Surgical SciencesUppsala UniversityUppsalaSweden
| | - Heidi M. Connolly
- Department of Cardiovascular DiseasesMayo ClinicRochesterMinnesotaUSA
| | | | | | - Christos Toumpanakis
- Centre for Gastroenterology, Neuroendocrine Tumour Unit, ENETS Centre of ExcellenceRoyal Free HospitalLondonUK
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Rademacher S, Denecke T, Berg T, Seehofer D. [Cholangiocarcinoma-Intrahepatic to hilar bile duct cancer]. Chirurgie (Heidelb) 2022; 93:644-651. [PMID: 35771272 DOI: 10.1007/s00104-022-01660-5] [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] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/09/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND In addition to conditioning measures in liver surgery, perioperative anti-tumor therapy is becoming increasingly more important in cholangiocarcinoma (CCA). OBJECTIVE Systematic literature review on the status of multimodal and in particular neoadjuvant therapy for CCA. MATERIAL AND METHODS Literature overview of the current scientific original and review articles. RESULTS Resection and rarely also liver transplantation are still the only curative treatment approaches for CCA in the non-distant metastatic stage; however, long-term results, e.g. in node positive tumors, are still unsatisfactory. Adjuvant chemotherapy is now standard but cannot be used in many patients. Neoadjuvant concepts include chemotherapy and local and locoregional procedures, such as radioembolization. Both are increasingly used in intrahepatic CCA (iCCA) but rarely in perihilar CCA. Initial data show that this is very effective in iCCA to achieve secondary operability in primarily inoperable cases. In addition, based on the current literature, neoadjuvant therapy also seems justified in operable intrahepatic CCA with a high risk of recurrence (e.g. lymph node metastases). CONCLUSION There is a high potential for the use of multimodal therapy in CCA, which could further increase in the near future as a result of new therapeutic agents. Due to the lack of evidence clear recommendations cannot be given; however, it is becoming apparent that neoadjuvant therapy is gaining importance in iCCA and is already increasingly used as part of individual concepts in patients with a high risk of recurrence.
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Affiliation(s)
- Sebastian Rademacher
- Klinik für Viszeral‑, Transplantations- Thorax- und Gefäßchirurgie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Deutschland
| | - Timm Denecke
- Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Leipzig, Leipzig, Deutschland
| | - Thomas Berg
- Medizinische Klinik, Universitätsklinikum Leipzig, Leipzig, Deutschland
| | - Daniel Seehofer
- Klinik für Viszeral‑, Transplantations- Thorax- und Gefäßchirurgie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Deutschland.
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Ablefoni M, Leonhardi J, Ehrengut C, Mehdorn M, Sucher R, Gockel I, Denecke T, Meyer HJ. Magnetic Resonance Imaging of Peritoneal Carcinomatosis: Evaluation of High b-Value Computed Diffusion-Weighted Imaging. Curr Oncol 2022; 29:4593-4603. [PMID: 35877224 PMCID: PMC9324469 DOI: 10.3390/curroncol29070364] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 06/21/2022] [Accepted: 06/27/2022] [Indexed: 11/16/2022] Open
Abstract
Over the last few years, diffusion-weighted imaging (DWI) has become increasingly relevant in the diagnostic assessment of peritoneal carcinomatosis. The aim of this study was to investigate the benefits of high-b DWI (c-DWI) compared to standard DWI in patients with peritoneal carcinomatosis. A cohort of 40 patients with peritoneal carcinomatosis were included in this retrospective study. DWI was performed with b-values of 50, 400, and 800 or 1000 s/mm² on a 1.5-T magnetic resonance imaging (MRI) scanner. C-DWI was calculated using a mono-exponential model with high b-values of 1000, 2000, 3000, 4000, and 5000 s/mm². All c-DWI images with high b-values were compared in terms of volume, detectability of peritoneal lesions, and image quality with the DWI sequence acquired with a b-value of 800 or 1000 s/mm² by two readers. In the group with a b-value of 800 s/mm², there was no statistically significant difference in terms of lesion volume. In the second group with a b-value of 1000 s/mm², peritoneal carcinomatosis lesions were statistically significantly larger than in the c-DWI with a- high b-value of 2000 s/mm² (median 7 cm³, range 1−26 cm³vs. median 6 cm³, range 1−83 cm³, p < 0.05). In both groups, there was a marked decrease in the detectability of peritoneal lesions starting at b = 2000 s/mm². In addition, image quality decreased noticeably from c-DWI at b = 3000 s/mm². In both groups, all images with high b-values at b = 4000 s/mm² and 5000 s/mm² were not diagnostically valuable due to poor image quality. The c-DWI technique offers good diagnostic performance without additional scanning time. High c-DWI b-values up to b = 1000 s/mm² provide comparable detectability of peritoneal carcinomatosis compared to standard DWI. Higher b-values over 1500 s/mm² result in lower image quality, which might lead to misdiagnosis.
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Affiliation(s)
- Maxime Ablefoni
- Department of Paediatric Radiology, University of Leipzig, Liebigstraße 20a, 04103 Leipzig, Germany;
- Department of Diagnostic and Interventional Radiology, University of Leipzig, Liebigstraße 20, 04103 Leipzig, Germany; (J.L.); (C.E.); (T.D.)
| | - Jakob Leonhardi
- Department of Diagnostic and Interventional Radiology, University of Leipzig, Liebigstraße 20, 04103 Leipzig, Germany; (J.L.); (C.E.); (T.D.)
| | - Constantin Ehrengut
- Department of Diagnostic and Interventional Radiology, University of Leipzig, Liebigstraße 20, 04103 Leipzig, Germany; (J.L.); (C.E.); (T.D.)
| | - Matthias Mehdorn
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, 04103 Leipzig, Germany; (M.M.); (R.S.); (I.G.)
| | - Robert Sucher
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, 04103 Leipzig, Germany; (M.M.); (R.S.); (I.G.)
| | - Ines Gockel
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, 04103 Leipzig, Germany; (M.M.); (R.S.); (I.G.)
| | - Timm Denecke
- Department of Diagnostic and Interventional Radiology, University of Leipzig, Liebigstraße 20, 04103 Leipzig, Germany; (J.L.); (C.E.); (T.D.)
| | - Hans-Jonas Meyer
- Department of Diagnostic and Interventional Radiology, University of Leipzig, Liebigstraße 20, 04103 Leipzig, Germany; (J.L.); (C.E.); (T.D.)
- Correspondence:
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38
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Henkelmann J, Henkelmann R, Denecke T, Zajonz D, Roth A, Sabri O, Purz S. Simultaneous 18F-FDG-PET/MRI for the detection of periprosthetic joint infections after knee or hip arthroplasty: a prospective feasibility study. International Orthopaedics (SICOT) 2022; 46:1921-1928. [PMID: 35635553 PMCID: PMC9372014 DOI: 10.1007/s00264-022-05445-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 05/14/2022] [Indexed: 10/26/2022]
Abstract
Abstract
Purpose
This study investigated the diagnostic value of simultaneous 18F-fluordeoxyglucose positron emission tomography/magnetic resonance imaging (PET/MRI) in suspected periprosthetic joint infection (PJI) of the hip and knee.
Methods
Sixteen prostheses from 13 patients with suspected PJI were prospectively examined using PET/MRI. Image datasets were evaluated in consensus by a radiologist and a nuclear physician for the overall diagnosis of ‘PJI’ (yes/no) and its anatomical involvement, such as the periprosthetic bone margin, bone marrow, and soft tissue. The imaging results were compared with the reference standard obtained from surgical or biopsy specimens and subjected to statistical analysis.
Results
Using the reference standard, ten out of the 13 prostheses (ten hips, threes knees) were diagnosed with PJI. Using PET/MRI, every patient with PJI was correctly diagnosed (sensitivity, 100%; specificity, 100%). Considering the anatomical regions, the sensitivity and specificity were 57% and 50% in the periprosthetic bone margin, 75% and 33% in the bone marrow, and 100% and 100% in the soft tissue.
Conclusion
PET/MRI can be reliably used for the diagnosis of PJI. However, assessment of the periprosthetic bone remains difficult due to the presence of artefacts. Thus, currently, this modality is unlikely to be recommended in clinical practice.
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Ebel S, Kühn A, Aggarwal A, Köhler B, Behrendt B, Gohmann R, Riekena B, Lücke C, Ziegert J, Vogtmann C, Preim B, Kropf S, Jung B, Denecke T, Grothoff M, Gutberlet M. Quantitative normal values of helical flow, flow jets and wall shear stress of healthy volunteers in the ascending aorta. Eur Radiol 2022; 32:8597-8607. [PMID: 35612663 DOI: 10.1007/s00330-022-08866-5] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 04/08/2022] [Accepted: 05/08/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVES 4D flow MRI enables quantitative assessment of helical flow. We sought to generate normal values and elucidate changes of helical flow (duration, volume, length, velocities and rotational direction) and flow jet (displacement, flow angle) as well as wall shear stress (WSS). METHODS We assessed the temporal helical existence (THEX), maximum helical volume (HVmax), accumulated helical volume (HVacc), accumulated helical volume length (HVLacc), maximum forward velocity (maxVfor), maximum circumferential velocity (maxVcirc), rotational direction (RD) and maximum wall shear stress (WSS) as reported elsewhere using the software tool Bloodline in 86 healthy volunteers (46 females, mean age 41 ± 13 years). RESULTS WSS decreased by 42.1% and maxVfor by 55.7% across age. There was no link between age and gender regarding the other parameters. CONCLUSION This study provides age-dependent normal values regarding WSS and maxVfor and age- and gender-independent normal values regarding THEX, HVmax, HVacc, HVLacc, RD and maxVcirc. KEY POINTS • 4D flow provides numerous new parameters; therefore, normal values are mandatory. • Wall shear stress decreases over age. • Maximum helical forward velocity decreases over age.
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Affiliation(s)
- Sebastian Ebel
- Department of Diagnostic and Interventional Radiology, University of Leipzig - Heart Centre, Leipzig, Germany.
- Department of Diagnostic and Interventional Radiology, University of Leipzig, Liebigstr. 20, 04103, Leipzig, Germany.
| | - Alexander Kühn
- Department of Diagnostic and Interventional Radiology, University of Leipzig - Heart Centre, Leipzig, Germany
| | - Abhinav Aggarwal
- Department of Diagnostic and Interventional Radiology, University of Leipzig - Heart Centre, Leipzig, Germany
- Department of Radiology, Mata Chanan Devi Hospital of New Delhi, New Delhi, India
| | - Benjamin Köhler
- Department of Simulation and Graphics, University of Magdeburg, Magdeburg, Germany
| | - Benjamin Behrendt
- Department of Simulation and Graphics, University of Magdeburg, Magdeburg, Germany
| | - Robin Gohmann
- Department of Diagnostic and Interventional Radiology, University of Leipzig - Heart Centre, Leipzig, Germany
| | - Boris Riekena
- Department of Diagnostic and Interventional Radiology, University of Leipzig - Heart Centre, Leipzig, Germany
| | - Christian Lücke
- Department of Diagnostic and Interventional Radiology, University of Leipzig - Heart Centre, Leipzig, Germany
| | - Juliane Ziegert
- Department of Diagnostic and Interventional Radiology, University of Leipzig - Heart Centre, Leipzig, Germany
| | - Charlotte Vogtmann
- Department of Diagnostic and Interventional Radiology, University of Leipzig - Heart Centre, Leipzig, Germany
| | - Bernhard Preim
- Department of Simulation and Graphics, University of Magdeburg, Magdeburg, Germany
| | - Siegfried Kropf
- Department for Biometry and Medical Informatics, University of Magdeburg, Magdeburg, Germany
| | - Bernd Jung
- Department of Diagnostic, Interventional and Paediatric Radiology, University of Bern, Bern, Switzerland
| | - Timm Denecke
- Department of Diagnostic and Interventional Radiology, University of Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
| | - Matthias Grothoff
- Department of Diagnostic and Interventional Radiology, University of Leipzig - Heart Centre, Leipzig, Germany
| | - Matthias Gutberlet
- Department of Diagnostic and Interventional Radiology, University of Leipzig - Heart Centre, Leipzig, Germany
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Meyer HJ, Martin M, Denecke T. DWI of the Breast - Possibilities and Limitations. ROFO-FORTSCHR RONTG 2022; 194:966-974. [PMID: 35439830 DOI: 10.1055/a-1775-8572] [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: 10/18/2022]
Abstract
BACKGROUND The MRI of the breast is of great importance in the diagnosis of disorders of the breast. This can be stated for the primary diagnosis as well as the follow up. Of special interest is diffusion weighted imaging (DWI), which has an increasingly important role. The present review provides results regarding the diagnostic and prognostic relevance of DWI for disorders of the breast. METHODS Under consideration of the recently published literature, the clinical value of DWI of the breast is discussed. Several diagnostic applications are shown, especially for the primary diagnosis of unclear tumors of the breast, the prediction of the axillary lymph node status and the possibility of a native screening. Moreover, correlations between DWI and histopathology features and treatment prediction with DWI are provided. RESULTS Many studies have shown the diagnostic value of DWI for the primary diagnosis of intramammary lesions. Benign lesions of the breast have significantly higher apparent diffusion coefficients (ADC values) compared to malignant tumors. This can be clinically used to reduce unnecessary biopsies in clinical routine. However, there are inconclusive results for the prediction of the histological subtype of the breast cancer. DWI can aid in the prediction of treatment to neoadjuvant chemotherapy. CONCLUSION DWI is a very promising imaging modality, which should be included in the standard protocol of the MRI of the breast. DWI can provide clinically value in the diagnosis as well as for prognosis in breast cancer. KEY POINTS · DWI can aid in the discrimination between benign and malignant tumors of the breast and therefore avoiding unnecessary biopsies.. · The ADC value cannot discriminate between immunhistochemical subtypes of the breast cancer. · The ADC value of breast cancer increases under neoadjuvant chemotherapy and can by this aid in treatment prediction.. · There is definite need of standardisation for clinical translation. CITATION FORMAT · Meyer HJ, Martin M, Denecke T. DWI of the Breast - Possibilities and Limitations. Fortschr Röntgenstr 2022; DOI: 10.1055/a-1775-8572.
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Affiliation(s)
- Hans Jonas Meyer
- Diagnostic and Interventional Radiology, University of Leipzig Faculty of Medicine, Leipzig, Germany
| | - Mireille Martin
- Diagnostic and Interventional Radiology, University of Leipzig Faculty of Medicine, Leipzig, Germany
| | - Timm Denecke
- Diagnostic and Interventional Radiology, University of Leipzig Faculty of Medicine, Leipzig, Germany
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41
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Henkelmann J, Wiersbicki D, Steinke H, Denecke T, Heyde CE, Voelker A. In vivo detection of the lumbar intraforaminal ligaments by MRI. Eur Spine J 2022; 31:882-888. [PMID: 35275254 DOI: 10.1007/s00586-022-07153-7] [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] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 01/09/2022] [Accepted: 02/13/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Intraforaminal ligaments (IFL) are of great interest to anatomists and clinicians to fully understand the detailed anatomy of the neuroforamina and to diagnose unclear radicular symptoms. Studies published until now have described radiological imaging of the IFLs using magnetic resonance imaging (MRI) on donor bodies. In the present study, we investigated the detectability of lumbar IFLs in vivo in adults using the high spatial resolution of the constructive interference in steady state (CISS) sequence. METHODS A total of 14 patients were studied using a 1.5 T MRI scanner. The lumbar spine was imaged using the parasagittal CISS sequence, and the detectability of the IFLs was assessed for each lumbar level. All image datasets were analyzed by a radiologist, an orthopedic surgeon, and an anatomist. Interrater reliability was expressed as Fleiss' Kappa. Using a single data set, a three-dimensional (3D) model was created to map the location of the IFLs within the intervertebral foramen (IF) and the immediate surrounding vessels. RESULTS Overall, the radiologist was able to detect IFLs in 60% of all imaged IFs, the orthopedic surgeon in 62%, and the anatomist in 66%. Fleiss' Kappa for the various segments varies from 0.71 for L4/5 up to 0.90 for L3/4. CONCLUSION Lumbar IFLs were successfully detected in vivo in every patient. The detection frequency varied from 42-86% per IF. We demonstrated reproducible imaging of the IFLs on MRI, with good interrater reliability. The present study was a launching point for further clinical studies investigating the potential impact of altered IFLs on radicular pain.
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Affiliation(s)
- Jeanette Henkelmann
- Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | - Dina Wiersbicki
- Institute of Anatomy, Leipzig University, Liebigstraße. 13, 04103, Leipzig, Germany
| | - Hanno Steinke
- Institute of Anatomy, Leipzig University, Liebigstraße. 13, 04103, Leipzig, Germany
| | - Timm Denecke
- Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | - Christoph-Eckhard Heyde
- Department of Orthopedics, Trauma and Plastic Surgery, University Hospital Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | - Anna Voelker
- Department of Orthopedics, Trauma and Plastic Surgery, University Hospital Leipzig, Liebigstraße 20, 04103, Leipzig, Germany.
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42
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Steinhoff KG, Petersen TO, Purz S, Veelken R, Van Boemmel F, Denecke T, Berg T, Sabri O. Yttrium-90 radioembolization-induced abscopal effect on hepatocellular carcinoma. J Dig Dis 2022; 23:237-239. [PMID: 35319823 DOI: 10.1111/1751-2980.13092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 03/17/2022] [Accepted: 03/22/2022] [Indexed: 12/11/2022]
Affiliation(s)
- Karen Geva Steinhoff
- Department of Nuclear Medicine, University of Leipzig Medical Center, Leipzig, Germany
| | - Tim-Ole Petersen
- Department of Diagnostic and Interventional Radiology, Hospital St. Elisabeth and St. Barbara, Halle (Saale), Germany
| | - Sandra Purz
- Department of Nuclear Medicine, University of Leipzig Medical Center, Leipzig, Germany
| | - Rhea Veelken
- Medical Department II - Gastroenterology, Hepatology, Infectious Diseases, Pneumology, University of Leipzig Medical Center, Leipzig, Germany
| | - Florian Van Boemmel
- Medical Department II - Gastroenterology, Hepatology, Infectious Diseases, Pneumology, University of Leipzig Medical Center, Leipzig, Germany
| | - Timm Denecke
- Department of Diagnostic and Interventional Radiology, University of Leipzig Medical Center, Leipzig, Germany
| | - Thomas Berg
- Medical Department II - Gastroenterology, Hepatology, Infectious Diseases, Pneumology, University of Leipzig Medical Center, Leipzig, Germany
| | - Osama Sabri
- Department of Nuclear Medicine, University of Leipzig Medical Center, Leipzig, Germany
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Kroese TE, van Hillegersberg R, Schoppmann S, Deseyne PR, Nafteux P, Obermannova R, Nordsmark M, Pfeiffer P, Hawkings MA, Smyth E, Markar S, Hanna GB, Cheong E, Chaudry A, Elme A, Adenis A, Piessen G, Gani C, Bruns CJ, Moehler M, Liakakos T, Reynolds J, Morganti A, Rosati R, Castoro C, D'Ugo D, Roviello F, Bencivenga M, de Manzoni G, Jeene P, van Sandick JW, Muijs C, Slingerland M, Nieuwenhuijzen G, Wijnhoven B, Beerepoot LV, Kolodziejczyk P, Polkowski WP, Alsina M, Pera M, Kanonnikoff TF, Nilsson M, Guckenberger M, Monig S, Wagner D, Wyrwicz L, Berbee M, Gockel I, Lordick F, Griffiths EA, Verheij M, van Rossum PS, van Laarhoven HW, Rosman C, Rütten H, Gootjes EC, Vonken FE, van Dieren JM, Vollebergh MA, van der Sangen M, Creemers GJ, Zander T, Schlößer H, Cascinu S, Mazza E, Nicoletti R, Damascelli A, Slim N, Passoni P, Cossu A, Puccetti F, Barbieri L, Fanti L, Azzolini F, Ventoruzzo F, Szczepanik A, Visa L, Reig A, Roques T, Harrison M, Ciseł B, Pikuła A, Skórzewska M, Vanommeslaeghe H, Van Daele E, Pattyn P, Geboes K, Callebout E, Ribeiro S, van Duijvendijk P, Tromp C, Sosef M, Warmerdam F, Heisterkamp J, Heisterkamp J, Vera A, Jordá E, López-Mozos F, Fernandez-Moreno MC, Barrios-Carvajal M, Huerta M, de Steur W, Lips I, Diez M, Castro S, O'Neill R, Holyoake D, Hacker U, Denecke T, Kuhnt T, Hoffmeister A, Kluge R, Bostel T, Grimminger P, Jedlička V, Křístek J, Pospíšil P, Mourregot A, Maurin C, Starling N, Chong I. Definitions and treatment of oligometastatic oesophagogastric cancer according to multidisciplinary tumour boards in Europe. Eur J Cancer 2022; 164:18-29. [DOI: 10.1016/j.ejca.2021.11.032] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 11/28/2021] [Indexed: 12/17/2022]
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Hofland J, Lamarca A, Steeds R, Toumpanakis C, Srirajaskanthan R, Riechelmann R, Panzuto F, Frilling A, Denecke T, Christ E, Grozinsky‐Glasberg S, Davar J. Synoptic reporting of echocardiography in carcinoid heart disease (ENETS Carcinoid Heart Disease Task Force). J Neuroendocrinol 2022; 34:e13060. [PMID: 34825753 PMCID: PMC9286034 DOI: 10.1111/jne.13060] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 10/30/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND This European Neuroendocrine Tumor Society (ENETS) Expert Consensus document aims to provide practical guidance and standardization for echocardiography in the screening and follow-up of carcinoid heart disease (CHD) in patients with a neuroendocrine tumour (NET) and carcinoid syndrome. METHODS NET experts within the ENETS Carcinoid Heart Disease Task Force reviewed both general reporting guidelines and specialized scoring systems for transthoracic echocardiography (TTE) in CHD. Based on this review, a dedicated template report was designed by the multidisciplinary working group of cardiologists, oncologists, endocrinologists, gastroenterologists, surgeons and radiologists. RESULTS We propose a Synoptic Reporting of Echocardiography in Carcinoid Heart Disease which represents an agreed peer reviewed proforma to capture information at the time of referral and enable a detailed outcome of CHD assessment. This includes a systematic and detailed list of structures to evaluate data to capture at the time of reporting of TTE. CONCLUSIONS Adherence to these reporting guidelines aims to promote homogeneous and detailed evaluation of CHD to secure accurate assessment and allow comparison of studies performed intra- and inter-individually. These guidelines could also facilitate CHD assessment as part of prospective clinical trials to enable standardization of the findings seen in response to therapy.
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Affiliation(s)
- Johannes Hofland
- Department of Internal MedicineSection of EndocrinologyENETS Center of ExcellenceErasmus MC and Erasmus Cancer InstituteRotterdamThe Netherlands
| | - Angela Lamarca
- Department of Medical OncologyThe Christie NHS FoundationManchesterUK
- Division of Cancer SciencesUniversity of ManchesterManchesterUK
| | - Richard Steeds
- Department of CardiologyUniversity Hospitals Birmingham NHS Foundation Trust and Institute of Cardiovascular SciencesUniversity of BirminghamBirminghamUK
| | - Christos Toumpanakis
- Centre for GastroenterologyNeuroendocrine Tumour UnitENETS Centre of ExcellenceRoyal Free HospitalLondonUK
| | | | | | - Francesco Panzuto
- Digestive Disease UnitSant' Andrea University HospitalENETS Center of ExcellenceRomeItaly
| | - Andrea Frilling
- Department of Surgery and CancerImperial College LondonLondonUK
| | - Timm Denecke
- Department of Diagnostic and Interventional RadiologyLeipzig University Medical CenterLeipzigGermany
| | - Emanuel Christ
- Division of Endocrinology, Diabetology and MetabolismENETS Centre of ExcellenceUniversity Hospital BaselBaselSwitzerland
| | - Simona Grozinsky‐Glasberg
- Neuroendocrine Tumor UnitENETS Center of ExcellenceDepartment of Endocrinology and MetabolismHadassah Medical Center and Faculty of MedicineHebrew University of JerusalemJerusalemIsrael
| | - Joseph Davar
- Royal Free Hospital & University College LondonLondonUK
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Meyer HJ, Benkert F, Bailis N, Lerche M, Denecke T, Surov A. Low skeletal muscle mass defined by thoracic CT as a prognostic marker in acute pulmonary embolism. Nutrition 2022; 98:111622. [DOI: 10.1016/j.nut.2022.111622] [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] [Received: 08/14/2021] [Revised: 01/04/2022] [Accepted: 01/26/2022] [Indexed: 11/26/2022]
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Seehofer D, Sucher R, Denecke T. Resektion und Transplantation bei hepatozellulärem Karzinom und intrahepatischem Cholangiokarzinom. Radiologe 2022; 62:210-218. [DOI: 10.1007/s00117-021-00962-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2021] [Indexed: 10/19/2022]
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Wienicke V, Denecke T, Henkelmann J, Jacob R, von Dercks N. [Cross-sectional diagnostic imaging in the InEK benchmark : An opportunity for radiology]. Radiologe 2022; 62:343-349. [PMID: 35029721 PMCID: PMC8983549 DOI: 10.1007/s00117-021-00963-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2021] [Indexed: 11/25/2022]
Abstract
Hintergrund Anhand der vom Institut für das Entgeltsystem im Krankenhaus (InEK) kalkulierten Fallpauschalen ist ein Vergleich der eigenen Leistungsdaten gegenüber allen nach der DRG („diagnosis-related groups“, diagnosebezogene Gruppen) abrechnenden Kliniken in Deutschland möglich. Ziel der vorliegenden Arbeit ist es, Über- oder Unterschreitungen von CT- oder MRT-Untersuchungen im Vergleich mit den InEK-Daten zu ermitteln und mögliche Verbesserungspotenziale zu erschließen. Methodik Die InEK-Kalkulationsdaten für 2021 wurden zur Bildung von Vergleichskennzahlen der CT- und MRT-Diagnostik auf DRG-Ebene herangezogen. Auf Fallebene wurden Daten eines universitären Maximalversorgers auf Gesamthaus‑, Klinik‑, DRG- und Hauptdiagnosen-Ebene gegenübergestellt. Ergebnis Auf Gesamthausebene zeigt sich eine Überschreitung der MRTs um 1025 und der CTs um 371 gegenüber InEK. Die Analyse nach Fachabteilungen ergab am Beispiel der Neurologie eine Überschreibung der MRTs gegenüber InEK um 489 sowie eine Unterschreitung der CTs um \documentclass[12pt]{minimal}
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\begin{document}$$-$$\end{document}-620. Der Benchmark der DRGs zeigte in beiden Untersuchungsmodalitäten insbesondere die DRG B70B als Treiber der Abweichungen (MRT + 42,7; CT − 273). Die identifizierten Abweichungen lassen sich auf Hauptdiagnosen-Ebene weiter herunterbrechen. Diskussion Das Bewusstsein über eine überdurchschnittliche Schnittbilddiagnostik kann einen wichtigen Anstoß zur Weiterentwicklung der Behandlungspfade einer Klinik bilden. Die Methodik des InEK-Benchmarks ist für jedes Krankenhaus anwendbar und identifiziert valide bereits erbrachte Leistungen und Prozesse mit einem Verbesserungspotenzial. Die Prüfung beeinflussender Faktoren sowie die Bewertung durch Mediziner und Kaufleute bildet die Voraussetzung für Akzeptanz und Erfolg der daraus generierten Maßnahmen.
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Affiliation(s)
- V Wienicke
- Stabsstelle Medizincontrolling, Universitätsklinikum Leipzig, Liebigstr. 18, 04103, Leipzig, Deutschland
| | - T Denecke
- Klinik und Poliklinik für diagnostische und interventionelle Radiologie, Universitätsklinikum Leipzig, Leipzig, Deutschland
| | - J Henkelmann
- Klinik und Poliklinik für diagnostische und interventionelle Radiologie, Universitätsklinikum Leipzig, Leipzig, Deutschland
| | - R Jacob
- Vorstand, Universitätsklinikum Leipzig, Leipzig, Deutschland
| | - Nikolaus von Dercks
- Stabsstelle Medizincontrolling, Universitätsklinikum Leipzig, Liebigstr. 18, 04103, Leipzig, Deutschland.
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Meyer HJ, Schnarkowski B, Leonhardi J, Mehdorn M, Ebel S, Goessmann H, Denecke T. CT Texture analysis and CT scores for characterization of fluid collections. BMC Med Imaging 2021; 21:187. [PMID: 34872524 PMCID: PMC8647367 DOI: 10.1186/s12880-021-00718-w] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 11/17/2021] [Indexed: 02/02/2023] Open
Abstract
Background Texture analysis derived from Computed tomography (CT) might be able to better characterize fluid collections undergoing CT-guided percutaneous drainage treatment. The present study tested, whether texture analysis can reflect microbiology results in fluid collections suspicious for septic focus. Methods Overall, 320 patients with 402 fluid collections were included into this retrospective study. All fluid collections underwent CT-guided drainage treatment and were microbiologically evaluated. Clinically, serologically parameters and conventional imaging findings as well as textures features were included into the analysis. A new CT score was calculated based upon imaging features alone. Established CT scores were used as a reference standard. Results The present score achieved a sensitivity of 0.78, a specificity of 0.69, area under curve (AUC 0.82). The present score and the score by Gnannt et al. (AUC 0.81) were both statistically better than the score by Radosa et al. (AUC 0.75). Several texture features were statistically significant between infected fluid collections and sterile fluid collections, but these features were not significantly better compared with conventional imaging findings. Conclusions Texture analysis is not superior to conventional imaging findings for characterizing fluid collections. A novel score was calculated based upon imaging parameters alone with similar diagnostic accuracy compared to established scores using imaging and clinical features.
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Affiliation(s)
- Hans-Jonas Meyer
- Department of Diagnostic and Interventional Radiology, University of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany.
| | - Benedikt Schnarkowski
- Department of Diagnostic and Interventional Radiology, University of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | - Jakob Leonhardi
- Department of Diagnostic and Interventional Radiology, University of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | - Matthias Mehdorn
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University of Leipzig, Leipzig, Germany
| | - Sebastian Ebel
- Department of Diagnostic and Interventional Radiology, University of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | - Holger Goessmann
- Department of Diagnostic and Interventional Radiology, University of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | - Timm Denecke
- Department of Diagnostic and Interventional Radiology, University of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
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Auer TA, Fehrenbach U, Grieser C, Penzkofer T, Geisel D, Schmelzle M, Müller T, Bläker H, Seehofer D, Denecke T. Correction to: Hepatocellular adenomas: is there additional value in using Gd-EOB-enhanced MRI for subtype differentiation? Eur Radiol 2021; 32:3609. [PMID: 34866169 PMCID: PMC9038812 DOI: 10.1007/s00330-021-08386-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Timo Alexander Auer
- Klinik für Radiologie, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, 13353, Berlin,, Germany.
| | - Uli Fehrenbach
- Klinik für Radiologie, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, 13353, Berlin,, Germany
| | - Christian Grieser
- Klinik für Radiologie, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, 13353, Berlin,, Germany
| | - Tobias Penzkofer
- Klinik für Radiologie, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, 13353, Berlin,, Germany
| | - Dominik Geisel
- Klinik für Radiologie, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, 13353, Berlin,, Germany
| | - Moritz Schmelzle
- Klinik für Allgemein, Viszeral und Transplantationschirurgie, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Tobias Müller
- Medizinische Klinik m.S. Gastroenterologie und Hepatologie, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Hendrik Bläker
- Institut für Pathologie, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Daniel Seehofer
- Hepatobiliäre Chirurgie & Viszerale Transplantation, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Timm Denecke
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Leipzig, Leipzig, Germany
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Rayes N, Denecke T. [Gastroenteropancreatic neuroendocrine tumors]. Radiologe 2021; 61:1129-1138. [PMID: 34727206 DOI: 10.1007/s00117-021-00929-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Neuroendocrine tumors (NET), or more generally neuroendocrine neoplasms (NEN), represent a very heterogeneous group of rare tumors with varying location which are only defined by their endocrine biology and secretion of synaptophysin and chromogranin A. They originate from mesoderm-derived stem cells. In the last few years, the incidence and prevalence of NEN have been steadily increasing. Classification is based on the affected organ, the proliferation rate and presence or absence of hormone production with typical symptoms. Diagnosis and treatment of these tumors is therefore very specific and requires an interdisciplinary approach. Treatment options include endoscopic or surgical resection, drug therapy for control of symptoms and proliferation, locoregional therapy and radionuclide therapy. Guidelines with algorithms for diagnostic workup and treatment are constantly updated.
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Affiliation(s)
- Nada Rayes
- Klinik und Poliklinik für Viszeral‑, Transplantations‑, Thorax- und Gefäßchirurgie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Deutschland.
| | - Timm Denecke
- Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Leipzig, Leipzig, Deutschland
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