1
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Frantzi N, Nguyen XP, Herr C, Alter P, Söhler S, Soriano D, Watz H, Waschki B, Trinkmann F, Eichenlaub M, Trudzinski FC, Michels-Zetsche JD, Omlor A, Seiler F, Moneke I, Biertz F, Rohde G, Stolz D, Welte T, Kauczor HU, Kahnert K, Jörres RA, Vogelmeier CF, Bals R, Fähndrich S. Statins did not reduce the frequency of exacerbations in individuals with COPD and cardiovascular comorbidities in the COSYCONET cohort. Respir Res 2024; 25:207. [PMID: 38750572 PMCID: PMC11097413 DOI: 10.1186/s12931-024-02822-1] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 04/25/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND The evidence regarding effects of statins on exacerbation risk in COPD remains controversial. Previous studies often excluded patients with cardiovascular comorbidities despite their high prevalence in COPD and role for exacerbations. Based on the cardioprotective properties of statins, we hypothesised that statins may reduce the risk of exacerbations especially in patients with cardiovascular comorbidities. METHODS One thousand eight hundred eighty seven patients of the German COPD cohort COSYCONET (COPD and Systemic Consequences Comorbidities Network) of GOLD grades 1-4 (37.8% female, mean age 64.78 ± 8.3) were examined at baseline and over a period of 4.5 years for the occurrence of at least one exacerbation or severe exacerbation per year in cross-sectional and longitudinal analyses adjusted for age, gender, BMI, GOLD grade and pack-years. Due to their collinearity, various cardiovascular diseases were tested in separate analyses, whereby the potential effect of statins in the presence of a specific comorbidity was tested as interaction between statins and comorbidity. We also identified patients who never took statins, always took statins, or initiated statin intake during the follow-up. RESULTS One thousand three hundred six patients never took statins, 31.6% were statin user, and 12.9% initiated statins during the follow-up. Most cardiovascular diseases were significantly (p < 0.05)may associated with an increased risk of COPD exacerbations, but in none of them the intake of statins was a significant attenuating factor, neither overall nor in modulating the increased risk linked to the specific comorbidities. The results of the cross-sectional and longitudinal analyses were consistent with each other, also those regarding at least 1 exacerbation or at least 1 severe exacerbation per year. CONCLUSION These findings complement the existing literature and may suggest that even in patients with COPD, cardiovascular comorbidities and a statin therapy that targets these comorbidities, the effects of statins on exacerbation risk are either negligible or more subtle than a reduction in exacerbation frequency. TRIAL REGISTRATION Trial registration ClinicalTrials.gov, Identifier: NCT01245933. Other Study ID (BMBF grant): 01GI0881, registered 18 November 2010, study start 2010-11, primary completion 2013-12, study completion 2023-09. https://clinicaltrials.gov/study/NCT01245933?cond=COPD&term=COSYCONET&rank=3.
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Affiliation(s)
- N Frantzi
- Department of Pneumology, Faculty of Medicine, Medical Center, University of Freiburg, Freiburg, Germany
| | - X P Nguyen
- Department of Pneumology, Faculty of Medicine, Medical Center, University of Freiburg, Freiburg, Germany
| | - C Herr
- Department of Internal Medicine V - Pulmonology, Allergology, Critical Care Care Medicine, Saarland University Hospital, Homburg, Germany
| | - P Alter
- Department of Medicine, Pulmonary, Critical Care and Sleep Medicine, German Center for Lung Research (DZL), Philipps University of Marburg (UMR), Marburg, Germany
| | - S Söhler
- Department of Medicine, Pulmonary, Critical Care and Sleep Medicine, German Center for Lung Research (DZL), Philipps University of Marburg (UMR), Marburg, Germany
| | - D Soriano
- Department of Pneumology, Faculty of Medicine, Medical Center, University of Freiburg, Freiburg, Germany
| | - H Watz
- Airway Research Center North (ARCN), Pulmonary Research Institute at LungenClinic Grosshansdorf, Grosshansdorf, DZ, Germany
- LungenClinic Grosshansdorf, Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Grosshansdorf, Germany
| | - B Waschki
- Airway Research Center North (ARCN), Pulmonary Research Institute at LungenClinic Grosshansdorf, Grosshansdorf, DZ, Germany
- Hospital Itzehoe, Pneumology, Itzehoe, Germany
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - F Trinkmann
- Department of Pneumology and Critical Care, Member of the German Center for Lung Research (DZL), Translational Lung Research Center Heidelberg (TLRC-H), Thoraxklinik Heidelberg gGmbH, Heidelberg, Germany
| | - M Eichenlaub
- Department of Cardiology and Angiology, Medical Center, University of Freiburg, Freiburg, Germany
| | - F C Trudzinski
- Department of Pneumology and Critical Care, Member of the German Center for Lung Research (DZL), Translational Lung Research Center Heidelberg (TLRC-H), Thoraxklinik Heidelberg gGmbH, Heidelberg, Germany
| | - J D Michels-Zetsche
- Department of Pneumology and Critical Care, Member of the German Center for Lung Research (DZL), Translational Lung Research Center Heidelberg (TLRC-H), Thoraxklinik Heidelberg gGmbH, Heidelberg, Germany
| | - A Omlor
- Department of Internal Medicine V - Pulmonology, Allergology, Critical Care Care Medicine, Saarland University Hospital, Homburg, Germany
| | - F Seiler
- Department of Internal Medicine V - Pulmonology, Allergology, Critical Care Care Medicine, Saarland University Hospital, Homburg, Germany
| | - I Moneke
- Department of Thoracic Surgery, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - F Biertz
- Hannover Medical School, CAPNETZ STIFTUNG, Hannover, Germany
| | - G Rohde
- Department of Respiratory Medicine, Goethe University Frankfurt, University Hospital, Medical Clinic I, Frankfurt/Main, Germany
| | - D Stolz
- Department of Pneumology, Faculty of Medicine, Medical Center, University of Freiburg, Freiburg, Germany
| | - T Welte
- Department of Respiratory Medicine, (BREATH), Member of the German Center for Lung Research (DZL), Research in Endstage and Obstructive Lung Disease Hannover, Hannover, Germany
| | - H U Kauczor
- Diagnostic and Interventional Radiology, Member of the German Center of Lung Research, University Hospital Heidelberg, Heidelberg, Germany
| | - K Kahnert
- Department of Internal Medicine V, LMU University Hospital, LMU Munich, Comprehensive Pneumology Center, Member of the German Center for Lung Research (DZL), Ludwig-Maximilians-University Munich (LMU), Munich, Germany
| | - R A Jörres
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Comprehensive Pneumology Center, Member of the German Center for Lung Research (DZL), LMU University Hospital, Ludwig-Maximilians-University Munich (LMU), Munich, Germany
| | - C F Vogelmeier
- Department of Medicine, Pulmonary, Critical Care and Sleep Medicine, German Center for Lung Research (DZL), Philipps University of Marburg (UMR), Marburg, Germany
| | - R Bals
- Department of Internal Medicine V - Pulmonology, Allergology, Critical Care Care Medicine, Saarland University Hospital, Homburg, Germany
- Helmholtz Centre for Infection Research (HZI), Helmholtz Institute for Pharmaceutical Research Saarland (HIPS), Saarland University Campus, Saarbrücken, Germany
| | - S Fähndrich
- Department of Pneumology, Faculty of Medicine, Medical Center, University of Freiburg, Freiburg, Germany.
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Röhrich M, Rosales JJ, Hoppner J, Kvacskay P, Blank N, Loi L, Paech D, Schreckenberger M, Giesel F, Kauczor HU, Lorenz HM, Haberkorn U, Merkt W. Fibroblast Activation Protein Inhibitor-Positron Emission Tomography in Aortitis: Fibroblast pathology in active inflammation and remission. Rheumatology (Oxford) 2024:keae225. [PMID: 38648749 DOI: 10.1093/rheumatology/keae225] [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: 11/08/2023] [Revised: 03/29/2024] [Accepted: 04/07/2024] [Indexed: 04/25/2024] Open
Abstract
OBJECTIVES Epigenetically modified fibroblasts contribute to chronicity in inflammatory diseases. Reasons for the relapsing character of large vessel vasculitis (LVV) remain obscure, including the role of fibroblasts, in part due to limited access to biopsies of involved tissue.68Ga FAPI-46 (FAPI)-PET/CT detects activated fibroblasts in vivo. In this exploratory pilot study, we tested the detection of fibroblast activation in vessel walls using FAPI-PET/CT in LVV with aortitis. METHODS 8 LVV patients with aortitis and 8 age- and gender-matched controls were included. Distribution of FAPI uptake was evaluated in the aorta and large vessels. FAPI-uptake was compared with MRI inflammatory activity scores. Imaging results were compared with clinical parameters such as serum inflammatory markers, time of remission and medication. RESULTS Three aortitis patients were clinically active, five in remission. Irrespective of activity, FAPI uptake was significantly enhanced in aortitis compared with controls. Patients in remission had a mean duration of remission of 2.8 years (range 1-4 years), yet significant FAPI uptake in the vessel wall was found.In remitted aortitis, MRI inflammatory scores were close to be negative, while in 4/5 patients visually identifiable FAPI uptake was observed. CONCLUSIONS This pilot feasibility study shows significant tracer uptake in the aortic walls in LVV. FAPI positivity indicates ongoing fibroblast pathology in clinically remitted LVV.
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Affiliation(s)
- M Röhrich
- Department of Nuclear Medicine, Heidelberg University Hospital, Heidelberg, Germany
- Department of Nuclear Medicine, Mainz University Hospital, Mainz, Germany
| | - J J Rosales
- Department of Nuclear Medicine, Heidelberg University Hospital, Heidelberg, Germany
- Department of Nuclear Medicine, University Clinic Of Navarra, Pamplona, Spain
| | - J Hoppner
- Department of Nuclear Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - P Kvacskay
- Department of Hematology, Oncology and Rheumatology, Internal Medicine V, University Hospital Heidelberg, Heidelberg, Germany
| | - N Blank
- Department of Hematology, Oncology and Rheumatology, Internal Medicine V, University Hospital Heidelberg, Heidelberg, Germany
| | - L Loi
- Division of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - D Paech
- Division of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Neuroradiology, Bonn University Hospital, Bonn, Germany
| | - M Schreckenberger
- Department of Nuclear Medicine, Mainz University Hospital, Mainz, Germany
| | - F Giesel
- Department of Nuclear Medicine, Heidelberg University Hospital, Heidelberg, Germany
- Department of Nuclear Medicine, Medical Faculty, Heinrich-Heine-University, University Hospital Düsseldorf, Düsseldorf, Germany
- Institute for Radiation Sciences, Osaka University, Osaka, Japan
| | - H U Kauczor
- Department of Diagnostic & Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany
| | - H M Lorenz
- Department of Hematology, Oncology and Rheumatology, Internal Medicine V, University Hospital Heidelberg, Heidelberg, Germany
| | - U Haberkorn
- Department of Nuclear Medicine, Heidelberg University Hospital, Heidelberg, Germany
- Translational Lung Research Center Heidelberg, Member of the German Center for Lung Research DZL, Heidelberg, Germany
| | - W Merkt
- Department of Hematology, Oncology and Rheumatology, Internal Medicine V, University Hospital Heidelberg, Heidelberg, Germany
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Röhrich M, Daum J, Gutjahr E, Spektor AM, Glatting FM, Sahin YA, Buchholz HG, Hoppner J, Schroeter C, Mavriopoulou E, Schlamp K, Grott M, Eichhorn F, Heußel CP, Kauczor HU, Kreuter M, Giesel F, Schreckenberger M, Winter H, Haberkorn U. Diagnostic Potential of Supplemental Static and Dynamic 68Ga-FAPI-46 PET for Primary 18F-FDG-Negative Pulmonary Lesions. J Nucl Med 2024:jnumed.123.267103. [PMID: 38604763 DOI: 10.2967/jnumed.123.267103] [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: 11/24/2023] [Revised: 02/20/2024] [Indexed: 04/13/2024] Open
Abstract
PET using 68Ga-labeled fibroblast activation protein (FAP) inhibitors (FAPIs) holds high potential for diagnostic imaging of various malignancies, including lung cancer (LC). However, 18F-FDG PET is still the clinical gold standard for LC imaging. Several subtypes of LC, especially lepidic LC, are frequently 18F-FDG PET-negative, which markedly hampers the assessment of single pulmonary lesions suggestive of LC. Here, we evaluated the diagnostic potential of static and dynamic 68Ga-FAPI-46 PET in the 18F-FDG-negative pulmonary lesions of 19 patients who underwent surgery or biopsy for histologic diagnosis after PET imaging. For target validation, FAP expression in lepidic LC was confirmed by FAP immunohistochemistry. Methods: Hematoxylin and eosin staining and FAP immunohistochemistry of 24 tissue sections of lepidic LC from the local tissue bank were performed and analyzed visually. Clinically, 19 patients underwent static and dynamic 68Ga-FAPI-46 PET in addition to 18F-FDG PET based on individual clinical indications. Static PET data of both examinations were analyzed by determining SUVmax, SUVmean, and tumor-to-background ratio (TBR) against the blood pool, as well as relative parameters (68Ga-FAPI-46 in relation to18F-FDG), of histologically confirmed LC and benign lesions. Time-activity curves and dynamic parameters (time to peak, slope, k 1, k 2, k 3, and k 4) were extracted from dynamic 68Ga-FAPI-46 PET data. The sensitivity and specificity of all parameters were analyzed by calculating receiver-operating-characteristic curves. Results: FAP immunohistochemistry confirmed the presence of strongly FAP-positive cancer-associated fibroblasts in lepidic LC. LC showed markedly elevated 68Ga-FAPI-46 uptake, higher TBRs, and higher 68Ga-FAPI-46-to-18F-FDG ratios for all parameters than did benign pulmonary lesions. Dynamic imaging analysis revealed differential time-activity curves for LC and benign pulmonary lesions: initially increasing time-activity curves with a decent slope were typical of LC, and steadily decreasing time-activity curve indicated benign pulmonary lesions, as was reflected by a significantly increased time to peak and significantly smaller absolute values of the slope for LC. Relative 68Ga-FAPI-46-to-18F-FDG ratios regarding SUVmax and TBR showed the highest sensitivity and specificity for the discrimination of LC from benign pulmonary lesions. Conclusion: 68Ga-FAPI-46 PET is a powerful new tool for the assessment of single 18F-FDG-negative pulmonary lesions and may optimize patient stratification in this clinical setting.
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Affiliation(s)
- Manuel Röhrich
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany;
- Department of Nuclear Medicine, University Hospital Mainz, Mainz, Germany
- German Center of Lung Research, Heidelberg, Germany
| | - Johanna Daum
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany
- German Center of Lung Research, Heidelberg, Germany
| | - Ewgenija Gutjahr
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Anna-Maria Spektor
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany
- German Center of Lung Research, Heidelberg, Germany
| | - Frederik M Glatting
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany
- Clinical Cooperation Unit Molecular and Radiation Oncology, German Cancer Research Center, Heidelberg, Germany
- Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany
| | | | | | - Jorge Hoppner
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany
- German Center of Lung Research, Heidelberg, Germany
| | - Cathrin Schroeter
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany
- German Center of Lung Research, Heidelberg, Germany
| | - Eleni Mavriopoulou
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany
- German Center of Lung Research, Heidelberg, Germany
| | - Kai Schlamp
- German Center of Lung Research, Heidelberg, Germany
- Department of Radiology, Thoraxklinik, University Hospital Heidelberg, Heidelberg, Germany
| | - Matthias Grott
- German Center of Lung Research, Heidelberg, Germany
- Department of Thoracic Surgery, Thoraxklinik, University Hospital Heidelberg, Heidelberg, Germany
| | - Florian Eichhorn
- German Center of Lung Research, Heidelberg, Germany
- Department of Thoracic Surgery, Thoraxklinik, University Hospital Heidelberg, Heidelberg, Germany
| | - Claus Peter Heußel
- German Center of Lung Research, Heidelberg, Germany
- Department of Radiology, Thoraxklinik, University Hospital Heidelberg, Heidelberg, Germany
| | - Hans Ulrich Kauczor
- German Center of Lung Research, Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
- Center for Interstitial and Rare Lung Diseases, Pneumology, and Respiratory Critical Care Medicine, Thoraxklinik, University of Heidelberg, Heidelberg, Germany
| | - Michael Kreuter
- Department of Pneumology, Mainz Center for Pulmonary Medicine, Mainz University, Mainz, Germany
- Medical Center and Department of Pulmonary, Critical Care, and Sleep Medicine, Marienhaus Clinic Mainz, Mainz, Germany
| | - Frederik Giesel
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany
- German Center of Lung Research, Heidelberg, Germany
- Department of Nuclear Medicine, Medical Faculty, University Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany
- Institute for Radiation Sciences, Osaka University, Osaka, Japan
- German Cancer Consortium, Heidelberg, Germany; and
| | | | - Hauke Winter
- German Center of Lung Research, Heidelberg, Germany
- Department of Radiology, Thoraxklinik, University Hospital Heidelberg, Heidelberg, Germany
| | - Uwe Haberkorn
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany
- German Center of Lung Research, Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
- Clinical Cooperation Unit Nuclear Medicine, German Cancer Research Center, Heidelberg, Germany
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Liu LP, Shapira N, Halliburton SS, Meyer S, Perkins A, Litt HI, Kauczor HU, Leiner T, Stiller W, Noël PB. Spectral performance evaluation of a second-generation spectral detector CT. J Appl Clin Med Phys 2024; 25:e14300. [PMID: 38386967 PMCID: PMC11005977 DOI: 10.1002/acm2.14300] [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: 08/08/2023] [Revised: 01/10/2024] [Accepted: 01/23/2024] [Indexed: 02/24/2024] Open
Abstract
PURPOSE The aim of this study was to characterize a second-generation wide-detector dual-layer spectral computed tomography (CT) system for material quantification accuracy, acquisition parameter and patient size dependencies, and tissue characterization capabilities. METHODS A phantom with multiple tissue-mimicking and material-specific inserts was scanned with a dual-layer spectral detector CT using different tube voltages, collimation widths, radiation dose levels, and size configurations. Accuracy of iodine density maps and virtual monoenergetic images (MonoE) were investigated. Additionally, differences between conventional and MonoE 70 keV images were calculated to evaluate acquisition parameter and patient size dependencies. To demonstrate material quantification and differentiation, liver-mimicking inserts with adipose and iron were analyzed with a two-base decomposition utilizing MonoE 50 and 150 keV, and root mean square error (RMSE) for adipose and iron content was reported. RESULTS Measured inserts exhibited quantitative accuracy across a wide range of MonoE levels. MonoE 70 keV images demonstrated reduced dependence compared to conventional images for phantom size (1 vs. 27 HU) and acquisition parameters, particularly tube voltage (4 vs. 37 HU). Iodine density quantification was successful with errors ranging from -0.58 to 0.44 mg/mL. Similarly, inserts with different amounts of adipose and iron were differentiated, and the small deviation in values within inserts corresponded to a RMSE of 3.49 ± 1.76% and 1.67 ± 0.84 mg/mL for adipose and iron content, respectively. CONCLUSION The second-generation dual-layer CT enables acquisition of quantitatively accurate spectral data without compromises from differences in patient size and acquisition parameters.
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Affiliation(s)
- Leening P. Liu
- Department of RadiologyPerelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Department of BioengineeringUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Nadav Shapira
- Department of RadiologyPerelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | | | - Sebastian Meyer
- Department of RadiologyPerelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | | | - Harold I. Litt
- Department of RadiologyPerelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Hans Ulrich Kauczor
- Diagnostic and Interventional Radiology (DIR)Heidelberg University HospitalHeidelbergGermany
| | - Tim Leiner
- Department of RadiologyMayo ClinicRochesterMinnesotaUSA
| | - Wolfram Stiller
- Diagnostic and Interventional Radiology (DIR)Heidelberg University HospitalHeidelbergGermany
| | - Peter B. Noël
- Department of RadiologyPerelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
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Fähndrich S, Herr C, Teuteberg S, Alter P, Söhler S, Soriano D, Classen J, Adams J, Weinhold V, Watz H, Waschki B, Zeller T, Eichenlaub M, Trudzinski FC, Michels JD, Omlor A, Seiler F, Moneke I, Biertz F, Stolz D, Welte T, Kauczor HU, Kahnert K, Jörres RA, Vogelmeier CF, Bals R. Midregional proatrial naturetic peptide (MRproANP) and copeptin (COPAVP) as predictors of all-cause mortality in recently diagnosed mild to moderate COPD-results from COSYCONET. Respir Res 2024; 25:56. [PMID: 38267944 PMCID: PMC10809634 DOI: 10.1186/s12931-024-02690-9] [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: 09/22/2023] [Accepted: 01/12/2024] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND MRproANP and COPAVP are prognostic markers for mortality in chronic obstructive pulmonary disease (COPD). Furthermore, these biomarkers predict mortality due to cardiovascular diseases, which are important prognostically determining comorbidities in patients with COPD. However, less is known about these biomarkers in recently diagnosed mild to moderate COPD. Therefore, we analyzed these biomarkers as potential predictors of mortality in recently diagnosed mild to moderate COPD. METHODS The blood biomarkers considered were copeptin (COPAVP), midregional adrenomedullin (MRproADM), midregional proatrial naturetic peptide (MRproANP), and fibrinogen. Analyses were performed in patients with stable "recently diagnosed mild to moderate COPD" defined by GOLD grades 0-2 and diagnosis of COPD ≤ 5 years prior to inclusion into the COSYCONET cohort (COPD and Systemic Consequences-Comorbidities Network), using Cox regression analysis with stepwise adjustment for multiple COPD characteristics, comorbidities, troponin and NT-proBNP. RESULTS 655 patients with recently diagnosed mild to moderate COPD were included. In the initial regression model, 43 of 655 patients died during the 6-year follow-up, in the final model 27 of 487. Regression analyses with adjustment for confounders identified COPAVP and MRproANP as statistically robust biomarkers (p < 0.05 each) of all-cause mortality, while MRproADM and fibrinogen were not. The fourth quartile of MRproANP (97 pmol/L) was associated with a hazard ratio of 4.5 (95%CI: 1.6; 12.8), and the fourth quartile of COPAVP (9.2 pmol/L) with 3.0 (1.1; 8.0). The results for MRproANP were confirmed in the total cohort of grade 0-4 (n = 1470 finally). CONCLUSION In patients with recently diagnosed mild to moderate COPD, elevated values of COPVP and in particular MRproANP were robust, independent biomarkers for all-cause mortality risk after adjustment for multiple other factors. This suggests that these markers might be considered in the risk assessment of early COPD.
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Affiliation(s)
- S Fähndrich
- Department of Pneumology, Faculty of Medicine, Medical Center, University of Freiburg, Killianstrasse 5, 79106, Freiburg, Germany.
| | - C Herr
- Department of Internal Medicine V - Pulmonology, Allergology, Critical Care Care Medicine, Saarland University Hospital, Homburg, Germany
| | - S Teuteberg
- Department of Pneumology, Faculty of Medicine, Medical Center, University of Freiburg, Killianstrasse 5, 79106, Freiburg, Germany
| | - P Alter
- Department of Medicine, Pulmonary, Critical Care and Sleep Medicine, Philipps University of Marburg (UMR), German Center for Lung Research (DZL), Marburg, Germany
| | - S Söhler
- Department of Medicine, Pulmonary, Critical Care and Sleep Medicine, Philipps University of Marburg (UMR), German Center for Lung Research (DZL), Marburg, Germany
| | - D Soriano
- Department of Pneumology, Faculty of Medicine, Medical Center, University of Freiburg, Killianstrasse 5, 79106, Freiburg, Germany
| | - J Classen
- Department of Internal Medicine V - Pulmonology, Allergology, Critical Care Care Medicine, Saarland University Hospital, Homburg, Germany
| | - J Adams
- Department of Internal Medicine V - Pulmonology, Allergology, Critical Care Care Medicine, Saarland University Hospital, Homburg, Germany
| | - V Weinhold
- Department of Internal Medicine V - Pulmonology, Allergology, Critical Care Care Medicine, Saarland University Hospital, Homburg, Germany
| | - H Watz
- Airway Research Center North (ARCN), Pulmonary Research Institute at LungenClinic Grosshansdorf, Grosshansdorf, DZ, Germany
| | - B Waschki
- LungenClinic Grosshansdorf, Member of the German Center for Lung Research (DZL), Airway Research Center North (ARCN), Grosshansdorf, Germany
- Pneumology, Hospital Itzehoe, Itzehoe, Germany
- University Heart & Vascular Center Hamburg, Department of Cardiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - T Zeller
- University Heart & Vascular Center Hamburg, Department of Cardiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - M Eichenlaub
- Department of Cardiology and Angiology, Medical Center, University of Freiburg, Freiburg, Germany
| | - F C Trudzinski
- Department of Pneumology and Critical Care, Heidelberg, Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL), Thoraxklinik Heidelberg gGmbH, Heidelberg, Germany
| | - J D Michels
- Department of Pneumology and Critical Care, Heidelberg, Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL), Thoraxklinik Heidelberg gGmbH, Heidelberg, Germany
| | - A Omlor
- Department of Internal Medicine V - Pulmonology, Allergology, Critical Care Care Medicine, Saarland University Hospital, Homburg, Germany
| | - F Seiler
- Department of Internal Medicine V - Pulmonology, Allergology, Critical Care Care Medicine, Saarland University Hospital, Homburg, Germany
| | - I Moneke
- Department of Thoracic Surgery, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg, Germany
| | - F Biertz
- Institute for Biostatistics, Hannover Medical School, Hannover, Germany
| | - D Stolz
- Department of Pneumology, Faculty of Medicine, Medical Center, University of Freiburg, Killianstrasse 5, 79106, Freiburg, Germany
| | - T Welte
- Department of Respiratory Medicine, Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Member of the German Center for Lung Research (DZL), Hannover Medical School, Hannover, Germany
| | - H U Kauczor
- Diagnostic and Interventional Radiology, Member of the German Center of Lung Research, University Hospital Heidelberg, Heidelberg, Germany
| | - K Kahnert
- Department of Internal Medicine V, Comprehensive Pneumology Center, Member of the German Center for Lung Research (DZL), LMU University Hospital, LMU Munich, Ludwig-Maximilians-University Munich (LMU), Munich, Germany
| | - R A Jörres
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Munich, Germany
| | - C F Vogelmeier
- Department of Medicine, Pulmonary, Critical Care and Sleep Medicine, Philipps University of Marburg (UMR), German Center for Lung Research (DZL), Marburg, Germany
- Airway Research Center North (ARCN), Pulmonary Research Institute at LungenClinic Grosshansdorf, Grosshansdorf, DZ, Germany
| | - R Bals
- Department of Internal Medicine V - Pulmonology, Allergology, Critical Care Care Medicine, Saarland University Hospital, Homburg, Germany
- Helmholtz Institute for Pharmaceutical Research Saarland (HIPS), Helmholtz Centre for Infection Research (HZI), Saarland University Campus, Saarbrücken, Germany
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Do TD, Haas A, Vollherbst DF, Pan F, Melzig C, Jesser J, Pereira PL, Kauczor HU, Skornitzke S, Sommer CM. Semi-automatic artifact quantification in thermal ablation probe and algorithms for the evaluation of metal artifact reduction. Int J Hyperthermia 2023; 40:2205071. [PMID: 37127281 DOI: 10.1080/02656736.2023.2205071] [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: 10/13/2022] [Revised: 03/29/2023] [Accepted: 04/15/2023] [Indexed: 05/03/2023] Open
Abstract
OBJECTIVES To compare metal artifacts and evaluation of metal artifact reduction algorithms during probe positioning in computed tomography (CT)-guided microwave ablation (MWA), cryoablation (CRYO), and radiofrequency ablation (RFA). MATERIALS AND METHODS Using CT guidance, individual MWA, CRYO, and RFA ablation probes were placed into the livers of 15 pigs. CT imaging was then performed to determine the probe's position within the test subject's liver. Filtered back projection (B30f) and iterative reconstructions (I30-1) were both used with and without dedicated iterative metal artifact reduction (iMAR) to generate images from the initial data sets. Semi-automatic segmentation-based quantitative evaluation was conducted to estimate artifact percentage within the liver, while qualitative evaluation of metal artifact extent and overall image quality was performed by two observers using a 5-point Likert scale: 1-none, 2-mild, 3-moderate, 4-severe, 5-non-diagnostic. RESULTS Among MWA, RFA, and CRYO, compared with non-iMAR in B30f reconstruction, the largest extent of artifact volume percentages were observed for CRYO (11.5-17.9%), followed by MWA (4.7-6.6%) and lastly in RFA (5.5-6.2%). iMAR significantly reduces metal artifacts for CRYO and MWA quantitatively (p = 0.0020; p = 0.0036, respectively) and qualitatively (p = 0.0001, p = 0.0005), but not for RFA. No significant reduction in metal artifact percentage was seen after applying iterative reconstructions (p > 0.05). Noise, contrast-to-noise-ratio, or overall image quality did not differ between probe types, irrespective of the application of iterative reconstruction and iMAR. CONCLUSION A dedicated metal artifact algorithm may decrease metal artifacts and improves image quality significantly for MWA and CRYO probes. Their application alongside with dedicated metal artifact algorithm should be considered during CT-guided positioning.
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Affiliation(s)
- T D Do
- Clinic for Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - A Haas
- Clinic for Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - D F Vollherbst
- Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany
| | - F Pan
- Clinic for Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology
| | - C Melzig
- Clinic for Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - J Jesser
- Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany
| | - P L Pereira
- Center for Radiology, Minimally-invasive Therapies and Nuclear Medicine, SLK Kliniken Heilbronn GmbH, Heilbronn, Germany
| | - H U Kauczor
- Clinic for Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - S Skornitzke
- Clinic for Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - C M Sommer
- Clinic for Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
- Department of Nuclear Medicine, University Hospital Heidelberg, Germany
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7
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Stein P, Lückerath C, Melzig C, Bülhoff M, Tanner M, Kauczor HU, Rehnitz C. [Postoperative imaging of the shoulder]. Radiologie (Heidelb) 2022; 62:835-843. [PMID: 35771235 DOI: 10.1007/s00117-022-01026-2] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/25/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Imaging of the postoperative shoulder joint includes complex, diagnostically challenging changes regarding the anatomical structures. OBJECTIVES Case-based presentation of common surgical procedures, expected postoperative findings, and typical complications. MATERIALS AND METHODS Interdisciplinary evaluation of (didactically instructive) cases and discussion of pertinent literature and expert opinions. RESULTS Presentation of normal postoperative findings and complications after subacromial decompression, surgical treatment of rotator cuff lesions, SLAP (superior labral anterior to posterior) lesions/lesions of the long biceps tendon, Bankart lesions as well as instability-related procedures and after shoulder arthroplasty. Discussion of the appropriate use of imaging methods with a focus on magnetic resonance imaging (MRI), which are supplemented by computed tomography (CT), and conventional x‑ray images. CONCLUSION The broad spectrum of complex findings as well as the evermore developing and thereby changing surgical procedures result in significant challenges in the radiological evaluation of the postoperative shoulder joint. To differentiate physiological reactions from pathological changes it is necessary to have general knowledge of the common surgical procedures, expected postoperative findings and possible complications. A variety imaging modalities can be used to further advance diagnostic precision.
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Affiliation(s)
- P Stein
- Diagnostische und Interventionelle Radiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Deutschland
| | - C Lückerath
- Diagnostische und Interventionelle Radiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Deutschland
| | - C Melzig
- Diagnostische und Interventionelle Radiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Deutschland
| | - M Bülhoff
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - M Tanner
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - H U Kauczor
- Diagnostische und Interventionelle Radiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Deutschland
| | - C Rehnitz
- Diagnostische und Interventionelle Radiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Deutschland.
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8
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Röhrich M, Leitz D, Glatting FM, Wefers AK, Weinheimer O, Flechsig P, Kahn N, Mall MA, Giesel FL, Kratochwil C, Huber PE, Deimling AV, Heußel CP, Kauczor HU, Kreuter M, Haberkorn U. Fibroblast Activation Protein-Specific PET/CT Imaging in Fibrotic Interstitial Lung Diseases and Lung Cancer: A Translational Exploratory Study. J Nucl Med 2022; 63:127-133. [PMID: 34272325 PMCID: PMC8717194 DOI: 10.2967/jnumed.121.261925] [Citation(s) in RCA: 58] [Impact Index Per Article: 29.0] [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: 01/11/2021] [Revised: 05/27/2021] [Indexed: 11/16/2022] Open
Abstract
Interstitial lung diseases (ILDs) comprise over 200 parenchymal lung disorders. Among them, fibrosing ILDs, especially idiopathic pulmonary fibrosis, are associated with a poor prognosis, whereas some other ILDs, such as sarcoidosis, have a much better prognosis. A high proportion manifests as fibrotic ILD (fILD). Lung cancer (LC) is a frequent complication of fILD. Activated fibroblasts are crucial for fibrotic processes in fILD. The aim of this exploratory study was to evaluate the imaging properties of static and dynamic fibroblast activation protein (FAP) inhibitor (FAPI) PET/CT in various types of fILD and to confirm FAP expression in fILD lesions by FAP immunohistochemistry of human fILD biopsy samples and of lung sections of genetically engineered (Nedd4-2-/- ) mice with an idiopathic pulmonary fibrosislike lung disease. Methods: PET scans of 15 patients with fILD and suspected LC were acquired 10, 60, and 180 min after the administration of 150-250 MBq of a 68Ga-labeled FAPI tracer (FAPI-46). In 3 patients, dynamic scans over 40 min were performed instead of imaging after 10 min. The SUVmax and SUVmean of fibrotic lesions and LC were measured and CT-density-corrected. Target-to-background ratios (TBRs) were calculated. PET imaging was correlated with CT-based fibrosis scores. Time-activity curves derived from dynamic imaging were analyzed. FAP immunohistochemistry of 4 human fILD biopsy samples and of fibrotic lungs of Nedd4-2-/- mice was performed. Results: fILD lesions as well as LC showed markedly elevated 68Ga-FAPI uptake (density-corrected SUVmax and SUVmean 60 min after injection: 11.12 ± 6.71 and 4.29 ± 1.61, respectively, for fILD lesions and 16.69 ± 9.35 and 6.44 ± 3.29, respectively, for LC) and high TBR (TBR of density-corrected SUVmax and SUVmean 60 min after injection: 2.30 ± 1.47 and 1.67 ± 0.79, respectively, for fILD and 3.90 ± 2.36 and 2.37 ± 1.14, respectively, for LC). SUVmax and SUVmean decreased over time, with a stable TBR for fILD and a trend toward an increasing TBR in LC. Dynamic imaging showed differing time-activity curves for fILD and LC. 68Ga-FAPI uptake showed a positive correlation with the CT-based fibrosis index. Immunohistochemistry of human biopsy samples and the lungs of Nedd4-2-/- mice showed a patchy expression of FAP in fibrotic lesions, preferentially in the transition zone to healthy lung parenchyma. Conclusion:68Ga-FAPI PET/CT imaging is a promising new imaging modality for fILD and LC. Its potential clinical value for monitoring and therapy evaluation of fILD should be investigated in future studies.
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Affiliation(s)
- Manuel Röhrich
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany;
| | - Dominik Leitz
- Translational Lung Research Center Heidelberg, Member of the German Center for Lung Research DZL, Heidelberg, Germany
| | - Frederik M Glatting
- Clinical Cooperation Unit Molecular and Radiation Oncology, German Cancer Research Center, Heidelberg, Germany
| | - Annika K Wefers
- Department of Neuropathology, Institute of Pathology, University of Heidelberg, Heidelberg, Germany
| | - Oliver Weinheimer
- Translational Lung Research Center Heidelberg, Member of the German Center for Lung Research DZL, Heidelberg, Germany
| | - Paul Flechsig
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Nicolas Kahn
- Centre for Interstitial and Rare Lung Diseases, Pneumology and Respiratory Critical Care Medicine, Thorax Clinic, University of Heidelberg, Heidelberg, Germany; and
| | - Marcus A Mall
- Translational Lung Research Center Heidelberg, Member of the German Center for Lung Research DZL, Heidelberg, Germany
| | - Frederik L Giesel
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Clemens Kratochwil
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Peter E Huber
- Clinical Cooperation Unit Molecular and Radiation Oncology, German Cancer Research Center, Heidelberg, Germany
| | - Andreas von Deimling
- Department of Neuropathology, Institute of Pathology, University of Heidelberg, Heidelberg, Germany
| | - Claus Peter Heußel
- Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik, University of Heidelberg, Heidelberg, Germany
| | - Hans Ulrich Kauczor
- Translational Lung Research Center Heidelberg, Member of the German Center for Lung Research DZL, Heidelberg, Germany
| | - Michael Kreuter
- Translational Lung Research Center Heidelberg, Member of the German Center for Lung Research DZL, Heidelberg, Germany
| | - Uwe Haberkorn
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany
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9
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Sommer CM, Pieper CC, Offensperger F, Pan F, Killguss HJ, Köninger J, Loos M, Hackert T, Wortmann M, Do TD, Maleux G, Richter GM, Kauczor HU, Kim J, Hur S. Radiological management of postoperative lymphorrhea. Langenbecks Arch Surg 2021; 406:945-969. [PMID: 33844077 DOI: 10.1007/s00423-021-02094-z] [Citation(s) in RCA: 6] [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: 01/05/2021] [Accepted: 01/17/2021] [Indexed: 12/21/2022]
Abstract
PURPOSE Postoperative lymphorrhea can occur after different surgical procedures and may prolong the hospital stay due to the need for specific treatment. In this work, the therapeutic significance of the radiological management of postoperative lymphorrhea was assessed and illustrated. METHOD A standardized search of the literature was performed in PubMed applying the Medical Subject Headings (MeSH) term "lymphangiography." For the review, the inclusion criterion was "studies with original data on Lipiodol-based Conventional Lymphangiography (CL) with subsequent Percutaneous Lymphatic Intervention (PLI)." Different exclusion criteria were defined (e.g., studies with <15 patients). The collected data comprised of clinical background and indications, procedural aspects and types of PLI, and outcomes. In the form of a pictorial essay, each author illustrated a clinical case with CL and/or PLI. RESULTS Seven studies (corresponding to evidence level 4 [Oxford Centre for Evidence-Based Medicine]) accounting for 196 patients were included in the synthesis and analysis of data. Preceding surgery resulting in postoperative lymphorrhea included different surgical procedures such as extended oncologic surgery or vascular surgery. Central (e.g., chylothorax) and peripheral (e.g., lymphocele) types of postoperative lymphorrhea with a drainage volume of 100-4000 ml/day underwent CL with subsequent PLI. The intervals between "preceding surgery and CL" and between "CL and PLI" were 2-330 days and 0-5 days, respectively. CL was performed before PLI to visualize the lymphatic pathology (e.g., leakage point or inflow lymph ducts), applying fluoroscopy, radiography, and/or computed tomography (CT). In total, seven different types of PLI were identified: (1) thoracic duct (or thoracic inflow lymph duct) embolization, (2) thoracic duct (or thoracic inflow lymph duct) maceration, (3) leakage point direct embolization, (4) inflow lymph node interstitial embolization, (5) inflow lymph duct (other than thoracic) embolization, (6) inflow lymph duct (other than thoracic) maceration, and (7) transvenous retrograde lymph duct embolization. CL-associated and PLI-associated technical success rates were 97-100% and 89-100%, respectively. The clinical success rate of CL and PLI was 73-95%. CL-associated and PLI-associated major complication rates were 0-3% and 0-5%, respectively. The combined CL- and PLI-associated 30-day mortality rate was 0%, and the overall mortality rate was 3% (corresponding to six patients). In the pictorial essay, the spectrum of CL and/or PLI was illustrated. CONCLUSION The radiological management of postoperative lymphorrhea is feasible, safe, and effective. Standardized radiological treatments embedded in an interdisciplinary concept are a step towards improving outcomes.
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Affiliation(s)
- C M Sommer
- Clinic of Diagnostic and Interventional Radiology, Stuttgart Clinics, Kriegsbergstrasse 60, 70174, Stuttgart, Germany.
- Clinic of Diagnostic and Interventional Radiology, Heidelberg University Hospital, INF 420, 69120, Heidelberg, Germany.
- Clinic of Radiology and Neuroradiology, Sana Kliniken Duisburg, Zu den Rehwiesen 9-11, 47055, Duisburg, Germany.
- Department of Nuclear Medicine, Heidelberg University Hospital, INF 400, 69120, Heidelberg, Germany.
| | - C C Pieper
- Clinic of Diagnostic and Interventional Radiology, Bonn University Hospital, Venusberg-Campus 1, 53105, Bonn, Germany
| | - F Offensperger
- Clinic of Diagnostic and Interventional Radiology, Stuttgart Clinics, Kriegsbergstrasse 60, 70174, Stuttgart, Germany
| | - F Pan
- Clinic of Diagnostic and Interventional Radiology, Heidelberg University Hospital, INF 420, 69120, Heidelberg, Germany
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - H J Killguss
- Clinic of General, Visceral, Thoracic and Transplantation Surgery, Stuttgart Clinics, Kriegsbergstrasse 60, 70174, Stuttgart, Germany
| | - J Köninger
- Clinic of General, Visceral, Thoracic and Transplantation Surgery, Stuttgart Clinics, Kriegsbergstrasse 60, 70174, Stuttgart, Germany
| | - M Loos
- Clinic of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, INF 420, 69120, Heidelberg, Germany
| | - T Hackert
- Clinic of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, INF 420, 69120, Heidelberg, Germany
| | - M Wortmann
- Clinic of Vascular and Endovascular Surgery, Heidelberg University Hospital, INF 420, 69120, Heidelberg, Germany
| | - T D Do
- Clinic of Diagnostic and Interventional Radiology, Heidelberg University Hospital, INF 420, 69120, Heidelberg, Germany
| | - G Maleux
- Department of Radiology, Leuven University Hospitals, Herestraat 49, 3000, Leuven, UZ, Belgium
| | - G M Richter
- Clinic of Diagnostic and Interventional Radiology, Stuttgart Clinics, Kriegsbergstrasse 60, 70174, Stuttgart, Germany
| | - H U Kauczor
- Clinic of Diagnostic and Interventional Radiology, Heidelberg University Hospital, INF 420, 69120, Heidelberg, Germany
| | - J Kim
- Department of Radiology, School of Medicine, Ajou University Hospital, Ajou University, 164 World Cup-ro, Yeongtong-gu, Suwon, 16499, Republic of Korea
| | - S Hur
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Ihwa-dong, Jongno-gu, Seoul, Republic of Korea
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10
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Brandelik SC, Skornitzke S, Mokry T, Sauer S, Stiller W, Nattenmüller J, Kauczor HU, Weber TF, Do TD. Quantitative and qualitative assessment of plasma cell dyscrasias in dual-layer spectral CT. Eur Radiol 2021; 31:7664-7673. [PMID: 33783572 PMCID: PMC8452563 DOI: 10.1007/s00330-021-07821-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 12/23/2020] [Accepted: 02/19/2021] [Indexed: 01/01/2023]
Abstract
Objectives Virtual non-calcium (VNCa) images could improve assessment of plasma cell dyscrasias by enhancing visibility of bone marrow. Thus, VNCa images from dual-layer spectral CT (DLCT) were evaluated at different calcium suppression (CaSupp) indices, correlating results with apparent diffusion coefficient (ADC) values from MRI. Methods Thirty-two patients with initial clinical diagnosis of a plasma cell dyscrasia before any chemotherapeutic treatment, who had undergone whole-body low-dose DLCT and MRI within 2 months, were retrospectively enrolled. VNCa images with CaSupp indices ranging from 25 to 95 in steps of 10, conventional CT images, and ADC maps were quantitatively analyzed using region-of-interests in the vertebral bodies C7, T12, L1-L5, and the iliac bone. Independent two-sample t-test, Wilcoxon-signed-rank test, Pearson’s correlation, and ROC analysis were performed. Results Eighteen patients had a non-diffuse, 14 a diffuse infiltration in conventional MRI. A significant difference between diffuse and non-diffuse infiltration was shown for VNCa-CT with CaSupp indices from 55 to 95, for conventional CT, and for ADC (each p < 0.0001). Significant quantitative correlation between VNCa-CT and MRI could be found with strongest correlation at CaSupp index 65 for L3 (r = 0.68, p < 0.0001) and averaged L1-L5 (r = 0.66, p < 0.0001). The optimum CT number cut-off point for differentiation between diffuse and non-diffuse infiltration at CaSupp index 65 for averaged L1-L5 was −1.6 HU (sensitivity 78.6%, specificity 75.0%). Conclusion Measurements in VNCa-CT showed the highest correlation with ADC at CaSupp index 65. VNCa technique may prove useful for evaluation of bone marrow infiltration if MRI is not feasible. Key Points • VNCa-CT images can support the evaluation of bone marrow infiltration in plasma cell dyscrasias. • VNCa measurements of vertebral bodies show significant correlation with ADC in MRI. • Averaging L1-L5 at CaSupp index 65 allowed quantitative detection of infiltration comparable to MRI ADC.
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Affiliation(s)
- S C Brandelik
- Clinic of Diagnostic and Interventional Radiology (DIR), Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - S Skornitzke
- Clinic of Diagnostic and Interventional Radiology (DIR), Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - T Mokry
- Clinic of Diagnostic and Interventional Radiology (DIR), Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - S Sauer
- Medical Department V, Hematology/Oncology/Rheumatology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - W Stiller
- Clinic of Diagnostic and Interventional Radiology (DIR), Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - J Nattenmüller
- Clinic of Diagnostic and Interventional Radiology (DIR), Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - H U Kauczor
- Clinic of Diagnostic and Interventional Radiology (DIR), Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - T F Weber
- Clinic of Diagnostic and Interventional Radiology (DIR), Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - T D Do
- Clinic of Diagnostic and Interventional Radiology (DIR), Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany.
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11
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Mayer P, Giannakis A, Klauß M, Gaida MM, Bergmann F, Kauczor HU, Feisst M, Hackert T, Loos M. Radiological evaluation of pancreatic cancer: What is the significance of arterial encasement >180° after neoadjuvant treatment? Eur J Radiol 2021; 137:109603. [PMID: 33618209 DOI: 10.1016/j.ejrad.2021.109603] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/16/2021] [Accepted: 02/08/2021] [Indexed: 12/27/2022]
Abstract
PURPOSE This study aimed to evaluate contrast-enhanced computed tomography (CE-CT) features for prediction of arterial tumor invasion in pancreatic cancer (PDAC) patients in the event of arterial encasement >180° after neoadjuvant (radio-)chemotherapy (NAT). METHODS Seventy PDAC patients with seventy-five arteries showing encasement >180° after completion of NAT were analyzed. All patients underwent surgical exploration with either tumor resection including arterial resection, periadventitial dissection (arterial divestment) or confirmation of locally irresectable disease. CE-CT scans were assessed regarding tumor extent and artery-specific imaging features. The results were analyzed on a per-artery basis. Based on the intraoperative and histopathological findings, encased arteries were classified as either invaded or non-invaded. RESULTS Eighteen radiologically encased arteries were resected; of these, nine had pathologic evidence for tumor invasion. In 42 encased arteries, the tumor could be removed by arterial divestment. In 13 patients with 15 encased arteries, the tumor was deemed technically irresectable. Median tumor size, length of solid soft tissue contact, and degree of circumferential contiguity by solid soft tissue along the artery in CE-CT were significantly lower in the non-invaded than in the invaded artery group (p ≤ 0.017). Imaging features showed moderate accuracies for prediction of arterial invasion (≤72.0 %). The thresholds ≤26 mm for post-NAT solid soft tissue contact and ≤270° for circumferential contiguity by solid soft tissue had high negative predictive values (≥87.5 %). CONCLUSION Although post-NAT prediction of arterial invasion remains difficult, arteries with ≤270° contiguity by soft tissue and arteries with ≤26 mm length of solid soft tissue contact are unlikely to be invaded, with possible implications for surgical planning.
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Affiliation(s)
- P Mayer
- Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany.
| | - A Giannakis
- Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany
| | - M Klauß
- Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany
| | - M M Gaida
- Institute of Pathology, University Medical Center Mainz, Mainz, Germany
| | - F Bergmann
- Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
| | - H U Kauczor
- Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany
| | - M Feisst
- Institute of Medical Biometry and Informatics, Heidelberg University, Heidelberg, Germany
| | - T Hackert
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - M Loos
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
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12
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Akl EA, Blazic I, Yaacoub S, Frija G, Chou R, Appiah JA, Fatehi M, Flor N, Hitti E, Jafri H, Jin ZY, Kauczor HU, Kawooya M, Kazerooni EA, Ko JP, Mahfouz R, Muglia V, Nyabanda R, Sanchez M, Shete PB, Ulla M, Zheng C, van Deventer E, Perez MDR. Use of Chest Imaging in the Diagnosis and Management of COVID-19: A WHO Rapid Advice Guide. Radiology 2021; 298:E63-E69. [PMID: 32729811 PMCID: PMC7393953 DOI: 10.1148/radiol.2020203173] [Citation(s) in RCA: 105] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The World Health Organization (WHO) undertook the development of a rapid guide on the use of chest imaging in the diagnosis and management of coronavirus disease 2019 (COVID-19). The rapid guide was developed over 2 months by using standard WHO processes, except for the use of "rapid reviews" and online meetings of the panel. The evidence review was supplemented by a survey of stakeholders regarding their views on the acceptability, feasibility, impact on equity, and resource use of the relevant chest imaging modalities (chest radiography, chest CT, and lung US). The guideline development group had broad expertise and country representation. The rapid guide includes three diagnosis recommendations and four management recommendations. The recommendations cover patients with confirmed or who are suspected of having COVID-19 with different levels of disease severity, throughout the care pathway from outpatient facility or hospital entry to home discharge. All recommendations are conditional and are based on low certainty evidence (n = 2), very low certainty evidence (n = 2), or expert opinion (n = 3). The remarks accompanying the recommendations suggest which patients are likely to benefit from chest imaging and what factors should be considered when choosing the specific imaging modality. The guidance offers considerations about implementation, monitoring, and evaluation, and also identifies research needs. Published under a CC BY 4.0 license. Online supplemental material is available for this article.
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Affiliation(s)
- Elie A. Akl
- From the Department of Internal Medicine, American University of Beirut Beirut, Lebanon (E.A.K.), Clinical Hospital Centre, Zemun, Belgrade, Serbia (I.B.), Clinical Research Institute (CRI), American University of Beirut Beirut, Lebanon (S.Y.), Paris Descartes University Paris, France (G.F.), Oregon Health & Science University Portland, OR (R.C.), Komfo Anokye Teaching Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana (J.A.A.), Department of Imaging Informatics, Virtual University of Medical Sciences, Tehran, Iran (M.F.), L. Sacco, University Hospital Milan, Italy (N.F.), Department of Emergency Medicine, American University of Beirut Beirut, Lebanon (E.H.), WHO Patients for Patient Safety Program Advisory Group; Fatima Jinnah Medical University Lahore, Pakistan (H.J.), Department of Radiology PUMC Hospital Beijing Beijing, China (Z.Y.J.), Department of Diagnostic and Interventional Radiology; Translational Pneumology, Heidelberg University Hospital, Translational lung Research Center Heidelberg member of the German Center of Lung Research, Heidelberg, Germany (H.U.K.), Ernest Cook Ultrasound Research and Education Institute Kampala, Uganda (M.K.), Departments of Radiology & Internal Medicine, University of Michigan / Michigan Medicine Ann Arbor, Michigan, USA (E.A.K.), Department of Radiology, NYU Langone Health New York, NY 10016 (J.P.K.), Department of Pathology and Laboratory Medicine, American University of Beirut Beirut, Lebanon (R.M.), Imaging, Radiation Therapy and Oncohematology Department Ribeirao Preto, Sao Paulo, Brazil (V.M.), Radiology Department. Kenyatta National Hospital Nairobi, Kenya (R.N.), Radiology Department.CDI.Hospital Clinic. University of Barcelona Barcelona, Spain (M.S.), Division of Pulmonary and Critical Care Medicine, University of California San Francisco San Francisco, CA, USA (P.B.S.), Imaging Department, Hospital Italiano de Buenos Aires. Buenos Aires, Argentina. (M.U.), Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology Wuhan, China (C.Z.), World Health Organization, Department of Environment, Climate Change and Health (ECH), Radiation and Health Unit Geneva, Switzerland (E.V.D.), World Health Organization, Department of Environment, Climate Change and Health (ECH), Radiation and Health Unit Geneva, Switzerland (M.D.R.P.)
| | - Ivana Blazic
- From the Department of Internal Medicine, American University of Beirut Beirut, Lebanon (E.A.K.), Clinical Hospital Centre, Zemun, Belgrade, Serbia (I.B.), Clinical Research Institute (CRI), American University of Beirut Beirut, Lebanon (S.Y.), Paris Descartes University Paris, France (G.F.), Oregon Health & Science University Portland, OR (R.C.), Komfo Anokye Teaching Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana (J.A.A.), Department of Imaging Informatics, Virtual University of Medical Sciences, Tehran, Iran (M.F.), L. Sacco, University Hospital Milan, Italy (N.F.), Department of Emergency Medicine, American University of Beirut Beirut, Lebanon (E.H.), WHO Patients for Patient Safety Program Advisory Group; Fatima Jinnah Medical University Lahore, Pakistan (H.J.), Department of Radiology PUMC Hospital Beijing Beijing, China (Z.Y.J.), Department of Diagnostic and Interventional Radiology; Translational Pneumology, Heidelberg University Hospital, Translational lung Research Center Heidelberg member of the German Center of Lung Research, Heidelberg, Germany (H.U.K.), Ernest Cook Ultrasound Research and Education Institute Kampala, Uganda (M.K.), Departments of Radiology & Internal Medicine, University of Michigan / Michigan Medicine Ann Arbor, Michigan, USA (E.A.K.), Department of Radiology, NYU Langone Health New York, NY 10016 (J.P.K.), Department of Pathology and Laboratory Medicine, American University of Beirut Beirut, Lebanon (R.M.), Imaging, Radiation Therapy and Oncohematology Department Ribeirao Preto, Sao Paulo, Brazil (V.M.), Radiology Department. Kenyatta National Hospital Nairobi, Kenya (R.N.), Radiology Department.CDI.Hospital Clinic. University of Barcelona Barcelona, Spain (M.S.), Division of Pulmonary and Critical Care Medicine, University of California San Francisco San Francisco, CA, USA (P.B.S.), Imaging Department, Hospital Italiano de Buenos Aires. Buenos Aires, Argentina. (M.U.), Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology Wuhan, China (C.Z.), World Health Organization, Department of Environment, Climate Change and Health (ECH), Radiation and Health Unit Geneva, Switzerland (E.V.D.), World Health Organization, Department of Environment, Climate Change and Health (ECH), Radiation and Health Unit Geneva, Switzerland (M.D.R.P.)
| | - Sally Yaacoub
- From the Department of Internal Medicine, American University of Beirut Beirut, Lebanon (E.A.K.), Clinical Hospital Centre, Zemun, Belgrade, Serbia (I.B.), Clinical Research Institute (CRI), American University of Beirut Beirut, Lebanon (S.Y.), Paris Descartes University Paris, France (G.F.), Oregon Health & Science University Portland, OR (R.C.), Komfo Anokye Teaching Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana (J.A.A.), Department of Imaging Informatics, Virtual University of Medical Sciences, Tehran, Iran (M.F.), L. Sacco, University Hospital Milan, Italy (N.F.), Department of Emergency Medicine, American University of Beirut Beirut, Lebanon (E.H.), WHO Patients for Patient Safety Program Advisory Group; Fatima Jinnah Medical University Lahore, Pakistan (H.J.), Department of Radiology PUMC Hospital Beijing Beijing, China (Z.Y.J.), Department of Diagnostic and Interventional Radiology; Translational Pneumology, Heidelberg University Hospital, Translational lung Research Center Heidelberg member of the German Center of Lung Research, Heidelberg, Germany (H.U.K.), Ernest Cook Ultrasound Research and Education Institute Kampala, Uganda (M.K.), Departments of Radiology & Internal Medicine, University of Michigan / Michigan Medicine Ann Arbor, Michigan, USA (E.A.K.), Department of Radiology, NYU Langone Health New York, NY 10016 (J.P.K.), Department of Pathology and Laboratory Medicine, American University of Beirut Beirut, Lebanon (R.M.), Imaging, Radiation Therapy and Oncohematology Department Ribeirao Preto, Sao Paulo, Brazil (V.M.), Radiology Department. Kenyatta National Hospital Nairobi, Kenya (R.N.), Radiology Department.CDI.Hospital Clinic. University of Barcelona Barcelona, Spain (M.S.), Division of Pulmonary and Critical Care Medicine, University of California San Francisco San Francisco, CA, USA (P.B.S.), Imaging Department, Hospital Italiano de Buenos Aires. Buenos Aires, Argentina. (M.U.), Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology Wuhan, China (C.Z.), World Health Organization, Department of Environment, Climate Change and Health (ECH), Radiation and Health Unit Geneva, Switzerland (E.V.D.), World Health Organization, Department of Environment, Climate Change and Health (ECH), Radiation and Health Unit Geneva, Switzerland (M.D.R.P.)
| | - Guy Frija
- From the Department of Internal Medicine, American University of Beirut Beirut, Lebanon (E.A.K.), Clinical Hospital Centre, Zemun, Belgrade, Serbia (I.B.), Clinical Research Institute (CRI), American University of Beirut Beirut, Lebanon (S.Y.), Paris Descartes University Paris, France (G.F.), Oregon Health & Science University Portland, OR (R.C.), Komfo Anokye Teaching Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana (J.A.A.), Department of Imaging Informatics, Virtual University of Medical Sciences, Tehran, Iran (M.F.), L. Sacco, University Hospital Milan, Italy (N.F.), Department of Emergency Medicine, American University of Beirut Beirut, Lebanon (E.H.), WHO Patients for Patient Safety Program Advisory Group; Fatima Jinnah Medical University Lahore, Pakistan (H.J.), Department of Radiology PUMC Hospital Beijing Beijing, China (Z.Y.J.), Department of Diagnostic and Interventional Radiology; Translational Pneumology, Heidelberg University Hospital, Translational lung Research Center Heidelberg member of the German Center of Lung Research, Heidelberg, Germany (H.U.K.), Ernest Cook Ultrasound Research and Education Institute Kampala, Uganda (M.K.), Departments of Radiology & Internal Medicine, University of Michigan / Michigan Medicine Ann Arbor, Michigan, USA (E.A.K.), Department of Radiology, NYU Langone Health New York, NY 10016 (J.P.K.), Department of Pathology and Laboratory Medicine, American University of Beirut Beirut, Lebanon (R.M.), Imaging, Radiation Therapy and Oncohematology Department Ribeirao Preto, Sao Paulo, Brazil (V.M.), Radiology Department. Kenyatta National Hospital Nairobi, Kenya (R.N.), Radiology Department.CDI.Hospital Clinic. University of Barcelona Barcelona, Spain (M.S.), Division of Pulmonary and Critical Care Medicine, University of California San Francisco San Francisco, CA, USA (P.B.S.), Imaging Department, Hospital Italiano de Buenos Aires. Buenos Aires, Argentina. (M.U.), Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology Wuhan, China (C.Z.), World Health Organization, Department of Environment, Climate Change and Health (ECH), Radiation and Health Unit Geneva, Switzerland (E.V.D.), World Health Organization, Department of Environment, Climate Change and Health (ECH), Radiation and Health Unit Geneva, Switzerland (M.D.R.P.)
| | - Roger Chou
- From the Department of Internal Medicine, American University of Beirut Beirut, Lebanon (E.A.K.), Clinical Hospital Centre, Zemun, Belgrade, Serbia (I.B.), Clinical Research Institute (CRI), American University of Beirut Beirut, Lebanon (S.Y.), Paris Descartes University Paris, France (G.F.), Oregon Health & Science University Portland, OR (R.C.), Komfo Anokye Teaching Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana (J.A.A.), Department of Imaging Informatics, Virtual University of Medical Sciences, Tehran, Iran (M.F.), L. Sacco, University Hospital Milan, Italy (N.F.), Department of Emergency Medicine, American University of Beirut Beirut, Lebanon (E.H.), WHO Patients for Patient Safety Program Advisory Group; Fatima Jinnah Medical University Lahore, Pakistan (H.J.), Department of Radiology PUMC Hospital Beijing Beijing, China (Z.Y.J.), Department of Diagnostic and Interventional Radiology; Translational Pneumology, Heidelberg University Hospital, Translational lung Research Center Heidelberg member of the German Center of Lung Research, Heidelberg, Germany (H.U.K.), Ernest Cook Ultrasound Research and Education Institute Kampala, Uganda (M.K.), Departments of Radiology & Internal Medicine, University of Michigan / Michigan Medicine Ann Arbor, Michigan, USA (E.A.K.), Department of Radiology, NYU Langone Health New York, NY 10016 (J.P.K.), Department of Pathology and Laboratory Medicine, American University of Beirut Beirut, Lebanon (R.M.), Imaging, Radiation Therapy and Oncohematology Department Ribeirao Preto, Sao Paulo, Brazil (V.M.), Radiology Department. Kenyatta National Hospital Nairobi, Kenya (R.N.), Radiology Department.CDI.Hospital Clinic. University of Barcelona Barcelona, Spain (M.S.), Division of Pulmonary and Critical Care Medicine, University of California San Francisco San Francisco, CA, USA (P.B.S.), Imaging Department, Hospital Italiano de Buenos Aires. Buenos Aires, Argentina. (M.U.), Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology Wuhan, China (C.Z.), World Health Organization, Department of Environment, Climate Change and Health (ECH), Radiation and Health Unit Geneva, Switzerland (E.V.D.), World Health Organization, Department of Environment, Climate Change and Health (ECH), Radiation and Health Unit Geneva, Switzerland (M.D.R.P.)
| | - John Adabie Appiah
- From the Department of Internal Medicine, American University of Beirut Beirut, Lebanon (E.A.K.), Clinical Hospital Centre, Zemun, Belgrade, Serbia (I.B.), Clinical Research Institute (CRI), American University of Beirut Beirut, Lebanon (S.Y.), Paris Descartes University Paris, France (G.F.), Oregon Health & Science University Portland, OR (R.C.), Komfo Anokye Teaching Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana (J.A.A.), Department of Imaging Informatics, Virtual University of Medical Sciences, Tehran, Iran (M.F.), L. Sacco, University Hospital Milan, Italy (N.F.), Department of Emergency Medicine, American University of Beirut Beirut, Lebanon (E.H.), WHO Patients for Patient Safety Program Advisory Group; Fatima Jinnah Medical University Lahore, Pakistan (H.J.), Department of Radiology PUMC Hospital Beijing Beijing, China (Z.Y.J.), Department of Diagnostic and Interventional Radiology; Translational Pneumology, Heidelberg University Hospital, Translational lung Research Center Heidelberg member of the German Center of Lung Research, Heidelberg, Germany (H.U.K.), Ernest Cook Ultrasound Research and Education Institute Kampala, Uganda (M.K.), Departments of Radiology & Internal Medicine, University of Michigan / Michigan Medicine Ann Arbor, Michigan, USA (E.A.K.), Department of Radiology, NYU Langone Health New York, NY 10016 (J.P.K.), Department of Pathology and Laboratory Medicine, American University of Beirut Beirut, Lebanon (R.M.), Imaging, Radiation Therapy and Oncohematology Department Ribeirao Preto, Sao Paulo, Brazil (V.M.), Radiology Department. Kenyatta National Hospital Nairobi, Kenya (R.N.), Radiology Department.CDI.Hospital Clinic. University of Barcelona Barcelona, Spain (M.S.), Division of Pulmonary and Critical Care Medicine, University of California San Francisco San Francisco, CA, USA (P.B.S.), Imaging Department, Hospital Italiano de Buenos Aires. Buenos Aires, Argentina. (M.U.), Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology Wuhan, China (C.Z.), World Health Organization, Department of Environment, Climate Change and Health (ECH), Radiation and Health Unit Geneva, Switzerland (E.V.D.), World Health Organization, Department of Environment, Climate Change and Health (ECH), Radiation and Health Unit Geneva, Switzerland (M.D.R.P.)
| | - Mansoor Fatehi
- From the Department of Internal Medicine, American University of Beirut Beirut, Lebanon (E.A.K.), Clinical Hospital Centre, Zemun, Belgrade, Serbia (I.B.), Clinical Research Institute (CRI), American University of Beirut Beirut, Lebanon (S.Y.), Paris Descartes University Paris, France (G.F.), Oregon Health & Science University Portland, OR (R.C.), Komfo Anokye Teaching Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana (J.A.A.), Department of Imaging Informatics, Virtual University of Medical Sciences, Tehran, Iran (M.F.), L. Sacco, University Hospital Milan, Italy (N.F.), Department of Emergency Medicine, American University of Beirut Beirut, Lebanon (E.H.), WHO Patients for Patient Safety Program Advisory Group; Fatima Jinnah Medical University Lahore, Pakistan (H.J.), Department of Radiology PUMC Hospital Beijing Beijing, China (Z.Y.J.), Department of Diagnostic and Interventional Radiology; Translational Pneumology, Heidelberg University Hospital, Translational lung Research Center Heidelberg member of the German Center of Lung Research, Heidelberg, Germany (H.U.K.), Ernest Cook Ultrasound Research and Education Institute Kampala, Uganda (M.K.), Departments of Radiology & Internal Medicine, University of Michigan / Michigan Medicine Ann Arbor, Michigan, USA (E.A.K.), Department of Radiology, NYU Langone Health New York, NY 10016 (J.P.K.), Department of Pathology and Laboratory Medicine, American University of Beirut Beirut, Lebanon (R.M.), Imaging, Radiation Therapy and Oncohematology Department Ribeirao Preto, Sao Paulo, Brazil (V.M.), Radiology Department. Kenyatta National Hospital Nairobi, Kenya (R.N.), Radiology Department.CDI.Hospital Clinic. University of Barcelona Barcelona, Spain (M.S.), Division of Pulmonary and Critical Care Medicine, University of California San Francisco San Francisco, CA, USA (P.B.S.), Imaging Department, Hospital Italiano de Buenos Aires. Buenos Aires, Argentina. (M.U.), Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology Wuhan, China (C.Z.), World Health Organization, Department of Environment, Climate Change and Health (ECH), Radiation and Health Unit Geneva, Switzerland (E.V.D.), World Health Organization, Department of Environment, Climate Change and Health (ECH), Radiation and Health Unit Geneva, Switzerland (M.D.R.P.)
| | - Nicola Flor
- From the Department of Internal Medicine, American University of Beirut Beirut, Lebanon (E.A.K.), Clinical Hospital Centre, Zemun, Belgrade, Serbia (I.B.), Clinical Research Institute (CRI), American University of Beirut Beirut, Lebanon (S.Y.), Paris Descartes University Paris, France (G.F.), Oregon Health & Science University Portland, OR (R.C.), Komfo Anokye Teaching Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana (J.A.A.), Department of Imaging Informatics, Virtual University of Medical Sciences, Tehran, Iran (M.F.), L. Sacco, University Hospital Milan, Italy (N.F.), Department of Emergency Medicine, American University of Beirut Beirut, Lebanon (E.H.), WHO Patients for Patient Safety Program Advisory Group; Fatima Jinnah Medical University Lahore, Pakistan (H.J.), Department of Radiology PUMC Hospital Beijing Beijing, China (Z.Y.J.), Department of Diagnostic and Interventional Radiology; Translational Pneumology, Heidelberg University Hospital, Translational lung Research Center Heidelberg member of the German Center of Lung Research, Heidelberg, Germany (H.U.K.), Ernest Cook Ultrasound Research and Education Institute Kampala, Uganda (M.K.), Departments of Radiology & Internal Medicine, University of Michigan / Michigan Medicine Ann Arbor, Michigan, USA (E.A.K.), Department of Radiology, NYU Langone Health New York, NY 10016 (J.P.K.), Department of Pathology and Laboratory Medicine, American University of Beirut Beirut, Lebanon (R.M.), Imaging, Radiation Therapy and Oncohematology Department Ribeirao Preto, Sao Paulo, Brazil (V.M.), Radiology Department. Kenyatta National Hospital Nairobi, Kenya (R.N.), Radiology Department.CDI.Hospital Clinic. University of Barcelona Barcelona, Spain (M.S.), Division of Pulmonary and Critical Care Medicine, University of California San Francisco San Francisco, CA, USA (P.B.S.), Imaging Department, Hospital Italiano de Buenos Aires. Buenos Aires, Argentina. (M.U.), Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology Wuhan, China (C.Z.), World Health Organization, Department of Environment, Climate Change and Health (ECH), Radiation and Health Unit Geneva, Switzerland (E.V.D.), World Health Organization, Department of Environment, Climate Change and Health (ECH), Radiation and Health Unit Geneva, Switzerland (M.D.R.P.)
| | - Eveline Hitti
- From the Department of Internal Medicine, American University of Beirut Beirut, Lebanon (E.A.K.), Clinical Hospital Centre, Zemun, Belgrade, Serbia (I.B.), Clinical Research Institute (CRI), American University of Beirut Beirut, Lebanon (S.Y.), Paris Descartes University Paris, France (G.F.), Oregon Health & Science University Portland, OR (R.C.), Komfo Anokye Teaching Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana (J.A.A.), Department of Imaging Informatics, Virtual University of Medical Sciences, Tehran, Iran (M.F.), L. Sacco, University Hospital Milan, Italy (N.F.), Department of Emergency Medicine, American University of Beirut Beirut, Lebanon (E.H.), WHO Patients for Patient Safety Program Advisory Group; Fatima Jinnah Medical University Lahore, Pakistan (H.J.), Department of Radiology PUMC Hospital Beijing Beijing, China (Z.Y.J.), Department of Diagnostic and Interventional Radiology; Translational Pneumology, Heidelberg University Hospital, Translational lung Research Center Heidelberg member of the German Center of Lung Research, Heidelberg, Germany (H.U.K.), Ernest Cook Ultrasound Research and Education Institute Kampala, Uganda (M.K.), Departments of Radiology & Internal Medicine, University of Michigan / Michigan Medicine Ann Arbor, Michigan, USA (E.A.K.), Department of Radiology, NYU Langone Health New York, NY 10016 (J.P.K.), Department of Pathology and Laboratory Medicine, American University of Beirut Beirut, Lebanon (R.M.), Imaging, Radiation Therapy and Oncohematology Department Ribeirao Preto, Sao Paulo, Brazil (V.M.), Radiology Department. Kenyatta National Hospital Nairobi, Kenya (R.N.), Radiology Department.CDI.Hospital Clinic. University of Barcelona Barcelona, Spain (M.S.), Division of Pulmonary and Critical Care Medicine, University of California San Francisco San Francisco, CA, USA (P.B.S.), Imaging Department, Hospital Italiano de Buenos Aires. Buenos Aires, Argentina. (M.U.), Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology Wuhan, China (C.Z.), World Health Organization, Department of Environment, Climate Change and Health (ECH), Radiation and Health Unit Geneva, Switzerland (E.V.D.), World Health Organization, Department of Environment, Climate Change and Health (ECH), Radiation and Health Unit Geneva, Switzerland (M.D.R.P.)
| | - Hussain Jafri
- From the Department of Internal Medicine, American University of Beirut Beirut, Lebanon (E.A.K.), Clinical Hospital Centre, Zemun, Belgrade, Serbia (I.B.), Clinical Research Institute (CRI), American University of Beirut Beirut, Lebanon (S.Y.), Paris Descartes University Paris, France (G.F.), Oregon Health & Science University Portland, OR (R.C.), Komfo Anokye Teaching Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana (J.A.A.), Department of Imaging Informatics, Virtual University of Medical Sciences, Tehran, Iran (M.F.), L. Sacco, University Hospital Milan, Italy (N.F.), Department of Emergency Medicine, American University of Beirut Beirut, Lebanon (E.H.), WHO Patients for Patient Safety Program Advisory Group; Fatima Jinnah Medical University Lahore, Pakistan (H.J.), Department of Radiology PUMC Hospital Beijing Beijing, China (Z.Y.J.), Department of Diagnostic and Interventional Radiology; Translational Pneumology, Heidelberg University Hospital, Translational lung Research Center Heidelberg member of the German Center of Lung Research, Heidelberg, Germany (H.U.K.), Ernest Cook Ultrasound Research and Education Institute Kampala, Uganda (M.K.), Departments of Radiology & Internal Medicine, University of Michigan / Michigan Medicine Ann Arbor, Michigan, USA (E.A.K.), Department of Radiology, NYU Langone Health New York, NY 10016 (J.P.K.), Department of Pathology and Laboratory Medicine, American University of Beirut Beirut, Lebanon (R.M.), Imaging, Radiation Therapy and Oncohematology Department Ribeirao Preto, Sao Paulo, Brazil (V.M.), Radiology Department. Kenyatta National Hospital Nairobi, Kenya (R.N.), Radiology Department.CDI.Hospital Clinic. University of Barcelona Barcelona, Spain (M.S.), Division of Pulmonary and Critical Care Medicine, University of California San Francisco San Francisco, CA, USA (P.B.S.), Imaging Department, Hospital Italiano de Buenos Aires. Buenos Aires, Argentina. (M.U.), Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology Wuhan, China (C.Z.), World Health Organization, Department of Environment, Climate Change and Health (ECH), Radiation and Health Unit Geneva, Switzerland (E.V.D.), World Health Organization, Department of Environment, Climate Change and Health (ECH), Radiation and Health Unit Geneva, Switzerland (M.D.R.P.)
| | - Zheng-Yu Jin
- From the Department of Internal Medicine, American University of Beirut Beirut, Lebanon (E.A.K.), Clinical Hospital Centre, Zemun, Belgrade, Serbia (I.B.), Clinical Research Institute (CRI), American University of Beirut Beirut, Lebanon (S.Y.), Paris Descartes University Paris, France (G.F.), Oregon Health & Science University Portland, OR (R.C.), Komfo Anokye Teaching Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana (J.A.A.), Department of Imaging Informatics, Virtual University of Medical Sciences, Tehran, Iran (M.F.), L. Sacco, University Hospital Milan, Italy (N.F.), Department of Emergency Medicine, American University of Beirut Beirut, Lebanon (E.H.), WHO Patients for Patient Safety Program Advisory Group; Fatima Jinnah Medical University Lahore, Pakistan (H.J.), Department of Radiology PUMC Hospital Beijing Beijing, China (Z.Y.J.), Department of Diagnostic and Interventional Radiology; Translational Pneumology, Heidelberg University Hospital, Translational lung Research Center Heidelberg member of the German Center of Lung Research, Heidelberg, Germany (H.U.K.), Ernest Cook Ultrasound Research and Education Institute Kampala, Uganda (M.K.), Departments of Radiology & Internal Medicine, University of Michigan / Michigan Medicine Ann Arbor, Michigan, USA (E.A.K.), Department of Radiology, NYU Langone Health New York, NY 10016 (J.P.K.), Department of Pathology and Laboratory Medicine, American University of Beirut Beirut, Lebanon (R.M.), Imaging, Radiation Therapy and Oncohematology Department Ribeirao Preto, Sao Paulo, Brazil (V.M.), Radiology Department. Kenyatta National Hospital Nairobi, Kenya (R.N.), Radiology Department.CDI.Hospital Clinic. University of Barcelona Barcelona, Spain (M.S.), Division of Pulmonary and Critical Care Medicine, University of California San Francisco San Francisco, CA, USA (P.B.S.), Imaging Department, Hospital Italiano de Buenos Aires. Buenos Aires, Argentina. (M.U.), Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology Wuhan, China (C.Z.), World Health Organization, Department of Environment, Climate Change and Health (ECH), Radiation and Health Unit Geneva, Switzerland (E.V.D.), World Health Organization, Department of Environment, Climate Change and Health (ECH), Radiation and Health Unit Geneva, Switzerland (M.D.R.P.)
| | - Hans Ulrich Kauczor
- From the Department of Internal Medicine, American University of Beirut Beirut, Lebanon (E.A.K.), Clinical Hospital Centre, Zemun, Belgrade, Serbia (I.B.), Clinical Research Institute (CRI), American University of Beirut Beirut, Lebanon (S.Y.), Paris Descartes University Paris, France (G.F.), Oregon Health & Science University Portland, OR (R.C.), Komfo Anokye Teaching Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana (J.A.A.), Department of Imaging Informatics, Virtual University of Medical Sciences, Tehran, Iran (M.F.), L. Sacco, University Hospital Milan, Italy (N.F.), Department of Emergency Medicine, American University of Beirut Beirut, Lebanon (E.H.), WHO Patients for Patient Safety Program Advisory Group; Fatima Jinnah Medical University Lahore, Pakistan (H.J.), Department of Radiology PUMC Hospital Beijing Beijing, China (Z.Y.J.), Department of Diagnostic and Interventional Radiology; Translational Pneumology, Heidelberg University Hospital, Translational lung Research Center Heidelberg member of the German Center of Lung Research, Heidelberg, Germany (H.U.K.), Ernest Cook Ultrasound Research and Education Institute Kampala, Uganda (M.K.), Departments of Radiology & Internal Medicine, University of Michigan / Michigan Medicine Ann Arbor, Michigan, USA (E.A.K.), Department of Radiology, NYU Langone Health New York, NY 10016 (J.P.K.), Department of Pathology and Laboratory Medicine, American University of Beirut Beirut, Lebanon (R.M.), Imaging, Radiation Therapy and Oncohematology Department Ribeirao Preto, Sao Paulo, Brazil (V.M.), Radiology Department. Kenyatta National Hospital Nairobi, Kenya (R.N.), Radiology Department.CDI.Hospital Clinic. University of Barcelona Barcelona, Spain (M.S.), Division of Pulmonary and Critical Care Medicine, University of California San Francisco San Francisco, CA, USA (P.B.S.), Imaging Department, Hospital Italiano de Buenos Aires. Buenos Aires, Argentina. (M.U.), Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology Wuhan, China (C.Z.), World Health Organization, Department of Environment, Climate Change and Health (ECH), Radiation and Health Unit Geneva, Switzerland (E.V.D.), World Health Organization, Department of Environment, Climate Change and Health (ECH), Radiation and Health Unit Geneva, Switzerland (M.D.R.P.)
| | - Michael Kawooya
- From the Department of Internal Medicine, American University of Beirut Beirut, Lebanon (E.A.K.), Clinical Hospital Centre, Zemun, Belgrade, Serbia (I.B.), Clinical Research Institute (CRI), American University of Beirut Beirut, Lebanon (S.Y.), Paris Descartes University Paris, France (G.F.), Oregon Health & Science University Portland, OR (R.C.), Komfo Anokye Teaching Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana (J.A.A.), Department of Imaging Informatics, Virtual University of Medical Sciences, Tehran, Iran (M.F.), L. Sacco, University Hospital Milan, Italy (N.F.), Department of Emergency Medicine, American University of Beirut Beirut, Lebanon (E.H.), WHO Patients for Patient Safety Program Advisory Group; Fatima Jinnah Medical University Lahore, Pakistan (H.J.), Department of Radiology PUMC Hospital Beijing Beijing, China (Z.Y.J.), Department of Diagnostic and Interventional Radiology; Translational Pneumology, Heidelberg University Hospital, Translational lung Research Center Heidelberg member of the German Center of Lung Research, Heidelberg, Germany (H.U.K.), Ernest Cook Ultrasound Research and Education Institute Kampala, Uganda (M.K.), Departments of Radiology & Internal Medicine, University of Michigan / Michigan Medicine Ann Arbor, Michigan, USA (E.A.K.), Department of Radiology, NYU Langone Health New York, NY 10016 (J.P.K.), Department of Pathology and Laboratory Medicine, American University of Beirut Beirut, Lebanon (R.M.), Imaging, Radiation Therapy and Oncohematology Department Ribeirao Preto, Sao Paulo, Brazil (V.M.), Radiology Department. Kenyatta National Hospital Nairobi, Kenya (R.N.), Radiology Department.CDI.Hospital Clinic. University of Barcelona Barcelona, Spain (M.S.), Division of Pulmonary and Critical Care Medicine, University of California San Francisco San Francisco, CA, USA (P.B.S.), Imaging Department, Hospital Italiano de Buenos Aires. Buenos Aires, Argentina. (M.U.), Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology Wuhan, China (C.Z.), World Health Organization, Department of Environment, Climate Change and Health (ECH), Radiation and Health Unit Geneva, Switzerland (E.V.D.), World Health Organization, Department of Environment, Climate Change and Health (ECH), Radiation and Health Unit Geneva, Switzerland (M.D.R.P.)
| | - Ella Annabelle Kazerooni
- From the Department of Internal Medicine, American University of Beirut Beirut, Lebanon (E.A.K.), Clinical Hospital Centre, Zemun, Belgrade, Serbia (I.B.), Clinical Research Institute (CRI), American University of Beirut Beirut, Lebanon (S.Y.), Paris Descartes University Paris, France (G.F.), Oregon Health & Science University Portland, OR (R.C.), Komfo Anokye Teaching Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana (J.A.A.), Department of Imaging Informatics, Virtual University of Medical Sciences, Tehran, Iran (M.F.), L. Sacco, University Hospital Milan, Italy (N.F.), Department of Emergency Medicine, American University of Beirut Beirut, Lebanon (E.H.), WHO Patients for Patient Safety Program Advisory Group; Fatima Jinnah Medical University Lahore, Pakistan (H.J.), Department of Radiology PUMC Hospital Beijing Beijing, China (Z.Y.J.), Department of Diagnostic and Interventional Radiology; Translational Pneumology, Heidelberg University Hospital, Translational lung Research Center Heidelberg member of the German Center of Lung Research, Heidelberg, Germany (H.U.K.), Ernest Cook Ultrasound Research and Education Institute Kampala, Uganda (M.K.), Departments of Radiology & Internal Medicine, University of Michigan / Michigan Medicine Ann Arbor, Michigan, USA (E.A.K.), Department of Radiology, NYU Langone Health New York, NY 10016 (J.P.K.), Department of Pathology and Laboratory Medicine, American University of Beirut Beirut, Lebanon (R.M.), Imaging, Radiation Therapy and Oncohematology Department Ribeirao Preto, Sao Paulo, Brazil (V.M.), Radiology Department. Kenyatta National Hospital Nairobi, Kenya (R.N.), Radiology Department.CDI.Hospital Clinic. University of Barcelona Barcelona, Spain (M.S.), Division of Pulmonary and Critical Care Medicine, University of California San Francisco San Francisco, CA, USA (P.B.S.), Imaging Department, Hospital Italiano de Buenos Aires. Buenos Aires, Argentina. (M.U.), Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology Wuhan, China (C.Z.), World Health Organization, Department of Environment, Climate Change and Health (ECH), Radiation and Health Unit Geneva, Switzerland (E.V.D.), World Health Organization, Department of Environment, Climate Change and Health (ECH), Radiation and Health Unit Geneva, Switzerland (M.D.R.P.)
| | - Jane P. Ko
- From the Department of Internal Medicine, American University of Beirut Beirut, Lebanon (E.A.K.), Clinical Hospital Centre, Zemun, Belgrade, Serbia (I.B.), Clinical Research Institute (CRI), American University of Beirut Beirut, Lebanon (S.Y.), Paris Descartes University Paris, France (G.F.), Oregon Health & Science University Portland, OR (R.C.), Komfo Anokye Teaching Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana (J.A.A.), Department of Imaging Informatics, Virtual University of Medical Sciences, Tehran, Iran (M.F.), L. Sacco, University Hospital Milan, Italy (N.F.), Department of Emergency Medicine, American University of Beirut Beirut, Lebanon (E.H.), WHO Patients for Patient Safety Program Advisory Group; Fatima Jinnah Medical University Lahore, Pakistan (H.J.), Department of Radiology PUMC Hospital Beijing Beijing, China (Z.Y.J.), Department of Diagnostic and Interventional Radiology; Translational Pneumology, Heidelberg University Hospital, Translational lung Research Center Heidelberg member of the German Center of Lung Research, Heidelberg, Germany (H.U.K.), Ernest Cook Ultrasound Research and Education Institute Kampala, Uganda (M.K.), Departments of Radiology & Internal Medicine, University of Michigan / Michigan Medicine Ann Arbor, Michigan, USA (E.A.K.), Department of Radiology, NYU Langone Health New York, NY 10016 (J.P.K.), Department of Pathology and Laboratory Medicine, American University of Beirut Beirut, Lebanon (R.M.), Imaging, Radiation Therapy and Oncohematology Department Ribeirao Preto, Sao Paulo, Brazil (V.M.), Radiology Department. Kenyatta National Hospital Nairobi, Kenya (R.N.), Radiology Department.CDI.Hospital Clinic. University of Barcelona Barcelona, Spain (M.S.), Division of Pulmonary and Critical Care Medicine, University of California San Francisco San Francisco, CA, USA (P.B.S.), Imaging Department, Hospital Italiano de Buenos Aires. Buenos Aires, Argentina. (M.U.), Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology Wuhan, China (C.Z.), World Health Organization, Department of Environment, Climate Change and Health (ECH), Radiation and Health Unit Geneva, Switzerland (E.V.D.), World Health Organization, Department of Environment, Climate Change and Health (ECH), Radiation and Health Unit Geneva, Switzerland (M.D.R.P.)
| | - Rami Mahfouz
- From the Department of Internal Medicine, American University of Beirut Beirut, Lebanon (E.A.K.), Clinical Hospital Centre, Zemun, Belgrade, Serbia (I.B.), Clinical Research Institute (CRI), American University of Beirut Beirut, Lebanon (S.Y.), Paris Descartes University Paris, France (G.F.), Oregon Health & Science University Portland, OR (R.C.), Komfo Anokye Teaching Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana (J.A.A.), Department of Imaging Informatics, Virtual University of Medical Sciences, Tehran, Iran (M.F.), L. Sacco, University Hospital Milan, Italy (N.F.), Department of Emergency Medicine, American University of Beirut Beirut, Lebanon (E.H.), WHO Patients for Patient Safety Program Advisory Group; Fatima Jinnah Medical University Lahore, Pakistan (H.J.), Department of Radiology PUMC Hospital Beijing Beijing, China (Z.Y.J.), Department of Diagnostic and Interventional Radiology; Translational Pneumology, Heidelberg University Hospital, Translational lung Research Center Heidelberg member of the German Center of Lung Research, Heidelberg, Germany (H.U.K.), Ernest Cook Ultrasound Research and Education Institute Kampala, Uganda (M.K.), Departments of Radiology & Internal Medicine, University of Michigan / Michigan Medicine Ann Arbor, Michigan, USA (E.A.K.), Department of Radiology, NYU Langone Health New York, NY 10016 (J.P.K.), Department of Pathology and Laboratory Medicine, American University of Beirut Beirut, Lebanon (R.M.), Imaging, Radiation Therapy and Oncohematology Department Ribeirao Preto, Sao Paulo, Brazil (V.M.), Radiology Department. Kenyatta National Hospital Nairobi, Kenya (R.N.), Radiology Department.CDI.Hospital Clinic. University of Barcelona Barcelona, Spain (M.S.), Division of Pulmonary and Critical Care Medicine, University of California San Francisco San Francisco, CA, USA (P.B.S.), Imaging Department, Hospital Italiano de Buenos Aires. Buenos Aires, Argentina. (M.U.), Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology Wuhan, China (C.Z.), World Health Organization, Department of Environment, Climate Change and Health (ECH), Radiation and Health Unit Geneva, Switzerland (E.V.D.), World Health Organization, Department of Environment, Climate Change and Health (ECH), Radiation and Health Unit Geneva, Switzerland (M.D.R.P.)
| | - Valdair Muglia
- From the Department of Internal Medicine, American University of Beirut Beirut, Lebanon (E.A.K.), Clinical Hospital Centre, Zemun, Belgrade, Serbia (I.B.), Clinical Research Institute (CRI), American University of Beirut Beirut, Lebanon (S.Y.), Paris Descartes University Paris, France (G.F.), Oregon Health & Science University Portland, OR (R.C.), Komfo Anokye Teaching Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana (J.A.A.), Department of Imaging Informatics, Virtual University of Medical Sciences, Tehran, Iran (M.F.), L. Sacco, University Hospital Milan, Italy (N.F.), Department of Emergency Medicine, American University of Beirut Beirut, Lebanon (E.H.), WHO Patients for Patient Safety Program Advisory Group; Fatima Jinnah Medical University Lahore, Pakistan (H.J.), Department of Radiology PUMC Hospital Beijing Beijing, China (Z.Y.J.), Department of Diagnostic and Interventional Radiology; Translational Pneumology, Heidelberg University Hospital, Translational lung Research Center Heidelberg member of the German Center of Lung Research, Heidelberg, Germany (H.U.K.), Ernest Cook Ultrasound Research and Education Institute Kampala, Uganda (M.K.), Departments of Radiology & Internal Medicine, University of Michigan / Michigan Medicine Ann Arbor, Michigan, USA (E.A.K.), Department of Radiology, NYU Langone Health New York, NY 10016 (J.P.K.), Department of Pathology and Laboratory Medicine, American University of Beirut Beirut, Lebanon (R.M.), Imaging, Radiation Therapy and Oncohematology Department Ribeirao Preto, Sao Paulo, Brazil (V.M.), Radiology Department. Kenyatta National Hospital Nairobi, Kenya (R.N.), Radiology Department.CDI.Hospital Clinic. University of Barcelona Barcelona, Spain (M.S.), Division of Pulmonary and Critical Care Medicine, University of California San Francisco San Francisco, CA, USA (P.B.S.), Imaging Department, Hospital Italiano de Buenos Aires. Buenos Aires, Argentina. (M.U.), Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology Wuhan, China (C.Z.), World Health Organization, Department of Environment, Climate Change and Health (ECH), Radiation and Health Unit Geneva, Switzerland (E.V.D.), World Health Organization, Department of Environment, Climate Change and Health (ECH), Radiation and Health Unit Geneva, Switzerland (M.D.R.P.)
| | - Rose Nyabanda
- From the Department of Internal Medicine, American University of Beirut Beirut, Lebanon (E.A.K.), Clinical Hospital Centre, Zemun, Belgrade, Serbia (I.B.), Clinical Research Institute (CRI), American University of Beirut Beirut, Lebanon (S.Y.), Paris Descartes University Paris, France (G.F.), Oregon Health & Science University Portland, OR (R.C.), Komfo Anokye Teaching Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana (J.A.A.), Department of Imaging Informatics, Virtual University of Medical Sciences, Tehran, Iran (M.F.), L. Sacco, University Hospital Milan, Italy (N.F.), Department of Emergency Medicine, American University of Beirut Beirut, Lebanon (E.H.), WHO Patients for Patient Safety Program Advisory Group; Fatima Jinnah Medical University Lahore, Pakistan (H.J.), Department of Radiology PUMC Hospital Beijing Beijing, China (Z.Y.J.), Department of Diagnostic and Interventional Radiology; Translational Pneumology, Heidelberg University Hospital, Translational lung Research Center Heidelberg member of the German Center of Lung Research, Heidelberg, Germany (H.U.K.), Ernest Cook Ultrasound Research and Education Institute Kampala, Uganda (M.K.), Departments of Radiology & Internal Medicine, University of Michigan / Michigan Medicine Ann Arbor, Michigan, USA (E.A.K.), Department of Radiology, NYU Langone Health New York, NY 10016 (J.P.K.), Department of Pathology and Laboratory Medicine, American University of Beirut Beirut, Lebanon (R.M.), Imaging, Radiation Therapy and Oncohematology Department Ribeirao Preto, Sao Paulo, Brazil (V.M.), Radiology Department. Kenyatta National Hospital Nairobi, Kenya (R.N.), Radiology Department.CDI.Hospital Clinic. University of Barcelona Barcelona, Spain (M.S.), Division of Pulmonary and Critical Care Medicine, University of California San Francisco San Francisco, CA, USA (P.B.S.), Imaging Department, Hospital Italiano de Buenos Aires. Buenos Aires, Argentina. (M.U.), Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology Wuhan, China (C.Z.), World Health Organization, Department of Environment, Climate Change and Health (ECH), Radiation and Health Unit Geneva, Switzerland (E.V.D.), World Health Organization, Department of Environment, Climate Change and Health (ECH), Radiation and Health Unit Geneva, Switzerland (M.D.R.P.)
| | - Marcelo Sanchez
- From the Department of Internal Medicine, American University of Beirut Beirut, Lebanon (E.A.K.), Clinical Hospital Centre, Zemun, Belgrade, Serbia (I.B.), Clinical Research Institute (CRI), American University of Beirut Beirut, Lebanon (S.Y.), Paris Descartes University Paris, France (G.F.), Oregon Health & Science University Portland, OR (R.C.), Komfo Anokye Teaching Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana (J.A.A.), Department of Imaging Informatics, Virtual University of Medical Sciences, Tehran, Iran (M.F.), L. Sacco, University Hospital Milan, Italy (N.F.), Department of Emergency Medicine, American University of Beirut Beirut, Lebanon (E.H.), WHO Patients for Patient Safety Program Advisory Group; Fatima Jinnah Medical University Lahore, Pakistan (H.J.), Department of Radiology PUMC Hospital Beijing Beijing, China (Z.Y.J.), Department of Diagnostic and Interventional Radiology; Translational Pneumology, Heidelberg University Hospital, Translational lung Research Center Heidelberg member of the German Center of Lung Research, Heidelberg, Germany (H.U.K.), Ernest Cook Ultrasound Research and Education Institute Kampala, Uganda (M.K.), Departments of Radiology & Internal Medicine, University of Michigan / Michigan Medicine Ann Arbor, Michigan, USA (E.A.K.), Department of Radiology, NYU Langone Health New York, NY 10016 (J.P.K.), Department of Pathology and Laboratory Medicine, American University of Beirut Beirut, Lebanon (R.M.), Imaging, Radiation Therapy and Oncohematology Department Ribeirao Preto, Sao Paulo, Brazil (V.M.), Radiology Department. Kenyatta National Hospital Nairobi, Kenya (R.N.), Radiology Department.CDI.Hospital Clinic. University of Barcelona Barcelona, Spain (M.S.), Division of Pulmonary and Critical Care Medicine, University of California San Francisco San Francisco, CA, USA (P.B.S.), Imaging Department, Hospital Italiano de Buenos Aires. Buenos Aires, Argentina. (M.U.), Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology Wuhan, China (C.Z.), World Health Organization, Department of Environment, Climate Change and Health (ECH), Radiation and Health Unit Geneva, Switzerland (E.V.D.), World Health Organization, Department of Environment, Climate Change and Health (ECH), Radiation and Health Unit Geneva, Switzerland (M.D.R.P.)
| | - Priya B. Shete
- From the Department of Internal Medicine, American University of Beirut Beirut, Lebanon (E.A.K.), Clinical Hospital Centre, Zemun, Belgrade, Serbia (I.B.), Clinical Research Institute (CRI), American University of Beirut Beirut, Lebanon (S.Y.), Paris Descartes University Paris, France (G.F.), Oregon Health & Science University Portland, OR (R.C.), Komfo Anokye Teaching Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana (J.A.A.), Department of Imaging Informatics, Virtual University of Medical Sciences, Tehran, Iran (M.F.), L. Sacco, University Hospital Milan, Italy (N.F.), Department of Emergency Medicine, American University of Beirut Beirut, Lebanon (E.H.), WHO Patients for Patient Safety Program Advisory Group; Fatima Jinnah Medical University Lahore, Pakistan (H.J.), Department of Radiology PUMC Hospital Beijing Beijing, China (Z.Y.J.), Department of Diagnostic and Interventional Radiology; Translational Pneumology, Heidelberg University Hospital, Translational lung Research Center Heidelberg member of the German Center of Lung Research, Heidelberg, Germany (H.U.K.), Ernest Cook Ultrasound Research and Education Institute Kampala, Uganda (M.K.), Departments of Radiology & Internal Medicine, University of Michigan / Michigan Medicine Ann Arbor, Michigan, USA (E.A.K.), Department of Radiology, NYU Langone Health New York, NY 10016 (J.P.K.), Department of Pathology and Laboratory Medicine, American University of Beirut Beirut, Lebanon (R.M.), Imaging, Radiation Therapy and Oncohematology Department Ribeirao Preto, Sao Paulo, Brazil (V.M.), Radiology Department. Kenyatta National Hospital Nairobi, Kenya (R.N.), Radiology Department.CDI.Hospital Clinic. University of Barcelona Barcelona, Spain (M.S.), Division of Pulmonary and Critical Care Medicine, University of California San Francisco San Francisco, CA, USA (P.B.S.), Imaging Department, Hospital Italiano de Buenos Aires. Buenos Aires, Argentina. (M.U.), Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology Wuhan, China (C.Z.), World Health Organization, Department of Environment, Climate Change and Health (ECH), Radiation and Health Unit Geneva, Switzerland (E.V.D.), World Health Organization, Department of Environment, Climate Change and Health (ECH), Radiation and Health Unit Geneva, Switzerland (M.D.R.P.)
| | - Marina Ulla
- From the Department of Internal Medicine, American University of Beirut Beirut, Lebanon (E.A.K.), Clinical Hospital Centre, Zemun, Belgrade, Serbia (I.B.), Clinical Research Institute (CRI), American University of Beirut Beirut, Lebanon (S.Y.), Paris Descartes University Paris, France (G.F.), Oregon Health & Science University Portland, OR (R.C.), Komfo Anokye Teaching Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana (J.A.A.), Department of Imaging Informatics, Virtual University of Medical Sciences, Tehran, Iran (M.F.), L. Sacco, University Hospital Milan, Italy (N.F.), Department of Emergency Medicine, American University of Beirut Beirut, Lebanon (E.H.), WHO Patients for Patient Safety Program Advisory Group; Fatima Jinnah Medical University Lahore, Pakistan (H.J.), Department of Radiology PUMC Hospital Beijing Beijing, China (Z.Y.J.), Department of Diagnostic and Interventional Radiology; Translational Pneumology, Heidelberg University Hospital, Translational lung Research Center Heidelberg member of the German Center of Lung Research, Heidelberg, Germany (H.U.K.), Ernest Cook Ultrasound Research and Education Institute Kampala, Uganda (M.K.), Departments of Radiology & Internal Medicine, University of Michigan / Michigan Medicine Ann Arbor, Michigan, USA (E.A.K.), Department of Radiology, NYU Langone Health New York, NY 10016 (J.P.K.), Department of Pathology and Laboratory Medicine, American University of Beirut Beirut, Lebanon (R.M.), Imaging, Radiation Therapy and Oncohematology Department Ribeirao Preto, Sao Paulo, Brazil (V.M.), Radiology Department. Kenyatta National Hospital Nairobi, Kenya (R.N.), Radiology Department.CDI.Hospital Clinic. University of Barcelona Barcelona, Spain (M.S.), Division of Pulmonary and Critical Care Medicine, University of California San Francisco San Francisco, CA, USA (P.B.S.), Imaging Department, Hospital Italiano de Buenos Aires. Buenos Aires, Argentina. (M.U.), Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology Wuhan, China (C.Z.), World Health Organization, Department of Environment, Climate Change and Health (ECH), Radiation and Health Unit Geneva, Switzerland (E.V.D.), World Health Organization, Department of Environment, Climate Change and Health (ECH), Radiation and Health Unit Geneva, Switzerland (M.D.R.P.)
| | - Chuansheng Zheng
- From the Department of Internal Medicine, American University of Beirut Beirut, Lebanon (E.A.K.), Clinical Hospital Centre, Zemun, Belgrade, Serbia (I.B.), Clinical Research Institute (CRI), American University of Beirut Beirut, Lebanon (S.Y.), Paris Descartes University Paris, France (G.F.), Oregon Health & Science University Portland, OR (R.C.), Komfo Anokye Teaching Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana (J.A.A.), Department of Imaging Informatics, Virtual University of Medical Sciences, Tehran, Iran (M.F.), L. Sacco, University Hospital Milan, Italy (N.F.), Department of Emergency Medicine, American University of Beirut Beirut, Lebanon (E.H.), WHO Patients for Patient Safety Program Advisory Group; Fatima Jinnah Medical University Lahore, Pakistan (H.J.), Department of Radiology PUMC Hospital Beijing Beijing, China (Z.Y.J.), Department of Diagnostic and Interventional Radiology; Translational Pneumology, Heidelberg University Hospital, Translational lung Research Center Heidelberg member of the German Center of Lung Research, Heidelberg, Germany (H.U.K.), Ernest Cook Ultrasound Research and Education Institute Kampala, Uganda (M.K.), Departments of Radiology & Internal Medicine, University of Michigan / Michigan Medicine Ann Arbor, Michigan, USA (E.A.K.), Department of Radiology, NYU Langone Health New York, NY 10016 (J.P.K.), Department of Pathology and Laboratory Medicine, American University of Beirut Beirut, Lebanon (R.M.), Imaging, Radiation Therapy and Oncohematology Department Ribeirao Preto, Sao Paulo, Brazil (V.M.), Radiology Department. Kenyatta National Hospital Nairobi, Kenya (R.N.), Radiology Department.CDI.Hospital Clinic. University of Barcelona Barcelona, Spain (M.S.), Division of Pulmonary and Critical Care Medicine, University of California San Francisco San Francisco, CA, USA (P.B.S.), Imaging Department, Hospital Italiano de Buenos Aires. Buenos Aires, Argentina. (M.U.), Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology Wuhan, China (C.Z.), World Health Organization, Department of Environment, Climate Change and Health (ECH), Radiation and Health Unit Geneva, Switzerland (E.V.D.), World Health Organization, Department of Environment, Climate Change and Health (ECH), Radiation and Health Unit Geneva, Switzerland (M.D.R.P.)
| | - Emilie van Deventer
- From the Department of Internal Medicine, American University of Beirut Beirut, Lebanon (E.A.K.), Clinical Hospital Centre, Zemun, Belgrade, Serbia (I.B.), Clinical Research Institute (CRI), American University of Beirut Beirut, Lebanon (S.Y.), Paris Descartes University Paris, France (G.F.), Oregon Health & Science University Portland, OR (R.C.), Komfo Anokye Teaching Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana (J.A.A.), Department of Imaging Informatics, Virtual University of Medical Sciences, Tehran, Iran (M.F.), L. Sacco, University Hospital Milan, Italy (N.F.), Department of Emergency Medicine, American University of Beirut Beirut, Lebanon (E.H.), WHO Patients for Patient Safety Program Advisory Group; Fatima Jinnah Medical University Lahore, Pakistan (H.J.), Department of Radiology PUMC Hospital Beijing Beijing, China (Z.Y.J.), Department of Diagnostic and Interventional Radiology; Translational Pneumology, Heidelberg University Hospital, Translational lung Research Center Heidelberg member of the German Center of Lung Research, Heidelberg, Germany (H.U.K.), Ernest Cook Ultrasound Research and Education Institute Kampala, Uganda (M.K.), Departments of Radiology & Internal Medicine, University of Michigan / Michigan Medicine Ann Arbor, Michigan, USA (E.A.K.), Department of Radiology, NYU Langone Health New York, NY 10016 (J.P.K.), Department of Pathology and Laboratory Medicine, American University of Beirut Beirut, Lebanon (R.M.), Imaging, Radiation Therapy and Oncohematology Department Ribeirao Preto, Sao Paulo, Brazil (V.M.), Radiology Department. Kenyatta National Hospital Nairobi, Kenya (R.N.), Radiology Department.CDI.Hospital Clinic. University of Barcelona Barcelona, Spain (M.S.), Division of Pulmonary and Critical Care Medicine, University of California San Francisco San Francisco, CA, USA (P.B.S.), Imaging Department, Hospital Italiano de Buenos Aires. Buenos Aires, Argentina. (M.U.), Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology Wuhan, China (C.Z.), World Health Organization, Department of Environment, Climate Change and Health (ECH), Radiation and Health Unit Geneva, Switzerland (E.V.D.), World Health Organization, Department of Environment, Climate Change and Health (ECH), Radiation and Health Unit Geneva, Switzerland (M.D.R.P.)
| | - Maria del Rosario Perez
- From the Department of Internal Medicine, American University of Beirut Beirut, Lebanon (E.A.K.), Clinical Hospital Centre, Zemun, Belgrade, Serbia (I.B.), Clinical Research Institute (CRI), American University of Beirut Beirut, Lebanon (S.Y.), Paris Descartes University Paris, France (G.F.), Oregon Health & Science University Portland, OR (R.C.), Komfo Anokye Teaching Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana (J.A.A.), Department of Imaging Informatics, Virtual University of Medical Sciences, Tehran, Iran (M.F.), L. Sacco, University Hospital Milan, Italy (N.F.), Department of Emergency Medicine, American University of Beirut Beirut, Lebanon (E.H.), WHO Patients for Patient Safety Program Advisory Group; Fatima Jinnah Medical University Lahore, Pakistan (H.J.), Department of Radiology PUMC Hospital Beijing Beijing, China (Z.Y.J.), Department of Diagnostic and Interventional Radiology; Translational Pneumology, Heidelberg University Hospital, Translational lung Research Center Heidelberg member of the German Center of Lung Research, Heidelberg, Germany (H.U.K.), Ernest Cook Ultrasound Research and Education Institute Kampala, Uganda (M.K.), Departments of Radiology & Internal Medicine, University of Michigan / Michigan Medicine Ann Arbor, Michigan, USA (E.A.K.), Department of Radiology, NYU Langone Health New York, NY 10016 (J.P.K.), Department of Pathology and Laboratory Medicine, American University of Beirut Beirut, Lebanon (R.M.), Imaging, Radiation Therapy and Oncohematology Department Ribeirao Preto, Sao Paulo, Brazil (V.M.), Radiology Department. Kenyatta National Hospital Nairobi, Kenya (R.N.), Radiology Department.CDI.Hospital Clinic. University of Barcelona Barcelona, Spain (M.S.), Division of Pulmonary and Critical Care Medicine, University of California San Francisco San Francisco, CA, USA (P.B.S.), Imaging Department, Hospital Italiano de Buenos Aires. Buenos Aires, Argentina. (M.U.), Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology Wuhan, China (C.Z.), World Health Organization, Department of Environment, Climate Change and Health (ECH), Radiation and Health Unit Geneva, Switzerland (E.V.D.), World Health Organization, Department of Environment, Climate Change and Health (ECH), Radiation and Health Unit Geneva, Switzerland (M.D.R.P.)
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Pan F, Loos M, Do TD, Richter GM, Kauczor HU, Hackert T, Sommer CM. Percutaneous afferent lymphatic vessel sclerotherapy for postoperative lymphatic leakage after previous ineffective therapeutic transpedal lymphangiography. Eur Radiol Exp 2020; 4:60. [PMID: 33135104 PMCID: PMC7604276 DOI: 10.1186/s41747-020-00188-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 10/01/2020] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND To demonstrate the efficacy of percutaneous computed tomography (CT)-guided afferent lymphatic vessel sclerotherapy (ALVS) in the treatment of postoperative lymphatic leakage (LL) after ineffective therapeutic transpedal lymphangiography (TL). METHODS A retrospective review in this institute involving 201 patients was conducted from May 2011 to September 2018. Patients diagnosed with postoperative LL undergoing ineffective therapeutical TL before the performance of percutaneous CT-guided ALVS were involved. Technical success and clinical success of TL and ALVS were established. The technical success and efficacy of ALVS in the treatment of postoperative LL after ineffective therapeutic TL were assessed. The clinical success rate of ALVS is also assessed, and the complications are reviewed. RESULTS In total, nine patients were involved including three patients (33.3%) presented with chylothorax, three patients (33.3%) presented with inguinal lymphatic fistula/lymphocele, and three patients (33.3%) presented with lymphatic fistula in the thigh; 27 ± 18 days (mean ± standard deviation) after surgery, therapeutic TL was successfully performed and showed definite afferent lymphatic vessel and leakage site in all the patients. Due to clinical failure after TLs, the following ALVS was performed with a mean interval of 12 ± 8 days after TL. The technical success rate was 9/9 (100.0%, 95% confidence interval [CI] 63.1-100.0%). An average of 2.7 ± 1.3 mL 95% ethanol as sclerosant agent was injected during the procedure. The clinical success was observed in 8 of the 9 patients (88.9%, 95% CI 51.8-99.7%) with a time between ALVS and the LL cure of 8 ± 6 days. No complications were reported. CONCLUSIONS Our results showed the role of percutaneous CT-guided ALVS as a safe, feasible, and effective salvage treatment for postoperative LL after ineffective TL.
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Affiliation(s)
- F Pan
- Clinic for Diagnostic and Interventional Radiology, University Hospital Heidelberg, INF 110, 69120, Heidelberg, Germany.,Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - M Loos
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - T D Do
- Clinic for Diagnostic and Interventional Radiology, University Hospital Heidelberg, INF 110, 69120, Heidelberg, Germany
| | - G M Richter
- Clinic for Diagnostic and Interventional Radiology, Stuttgart Clinics, Katharinenhospital, Kriegsbergstrasse 60, 70174, Stuttgart, Germany
| | - H U Kauczor
- Clinic for Diagnostic and Interventional Radiology, University Hospital Heidelberg, INF 110, 69120, Heidelberg, Germany
| | - T Hackert
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - C M Sommer
- Clinic for Diagnostic and Interventional Radiology, University Hospital Heidelberg, INF 110, 69120, Heidelberg, Germany. .,Clinic for Diagnostic and Interventional Radiology, Stuttgart Clinics, Katharinenhospital, Kriegsbergstrasse 60, 70174, Stuttgart, Germany.
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Pan F, Loos M, Do TD, Richter GM, Kauczor HU, Hackert T, Sommer CM. The roles of iodized oil-based lymphangiography and post-lymphangiographic computed tomography for specific lymphatic intervention planning in patients with postoperative lymphatic fistula: a literature review and case series. CVIR Endovasc 2020; 3:79. [PMID: 33085018 PMCID: PMC7578215 DOI: 10.1186/s42155-020-00146-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 08/03/2020] [Indexed: 01/30/2023] Open
Abstract
In the management of patients with postoperative lymphatic fistula (LF) in different locations, iodized oil-based lymphangiography (LAG) from trans-pedal or intranodal route is an established diagnostic approach with the potential to plan further interventional treatments. However, specific lymphatic interventions are indicated depending on different locations and morphologies of the LF. After a systematic literature review, four types of interventions can be considered, including direct leakage embolization/sclerotherapy (DLE/DLS), percutaneous afferent lymphatic vessel embolization (ALVE), percutaneous afferent lymphatic vessels disruption/sclerotherapy (ALVD/ALVS), and trans-afferent nodal embolization (TNE). In the iodized oil-based LAG, three potential lymphatic targets including confined leakage, definite afferent LVs, and definite closest afferent LNs should be comprehensively assessed. For optimal prospective treatment planning for LF, iodized oil-based post-lymphangiographic computed tomography (post-LAG CT) is a useful complement to the conventional iodized oil-based LAG, which can be performed easily after LAG. This review article summarized the current evidence of the specific lymphatic interventions in patients with postoperative LF and explored the potential benefits of post-LAG CT in the intervention planning from a case series.
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Affiliation(s)
- F Pan
- Clinic for Diagnostic and Interventional Radiology, University Hospital Heidelberg, INF 110, 69120, Heidelberg, Germany.,Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - M Loos
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - T D Do
- Clinic for Diagnostic and Interventional Radiology, University Hospital Heidelberg, INF 110, 69120, Heidelberg, Germany
| | - G M Richter
- Clinic for Diagnostic and Interventional Radiology, Stuttgart Clinics, Katharinenhospital, Kriegsbergstrasse 60, 70174, Stuttgart, Germany
| | - H U Kauczor
- Clinic for Diagnostic and Interventional Radiology, University Hospital Heidelberg, INF 110, 69120, Heidelberg, Germany
| | - T Hackert
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - C M Sommer
- Clinic for Diagnostic and Interventional Radiology, University Hospital Heidelberg, INF 110, 69120, Heidelberg, Germany. .,Clinic for Diagnostic and Interventional Radiology, Stuttgart Clinics, Katharinenhospital, Kriegsbergstrasse 60, 70174, Stuttgart, Germany.
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15
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Alt CD, Katzenberger SM, Hallscheidt P, Sohn C, Kauczor HU, Eickhoff SB, Brocker KA. Urethral length and bladder neck behavior: can dynamic magnetic resonance imaging give the same results as introital ultrasound? Arch Gynecol Obstet 2019; 299:809-816. [PMID: 30706182 DOI: 10.1007/s00404-019-05060-9] [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: 10/22/2018] [Accepted: 01/21/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE To compare dynamic magnetic resonance imaging (dMRI) and introital ultrasound results with regard to urethral length measurements and the evaluation of bladder neck changes. METHODS Retrospective analyses of urethral length measurements and detection of bladder neck changes (rotated/vertical bladder neck descent, urethral funneling) were conducted in women-scheduled for surgical treatment with alloplastic material-who had undergone introital ultrasound and dMRI presurgery and 3 months postsurgery. Measurement differences between both imaging modalities were evaluated by assessing the confidence interval for the difference in means between the datasets using bootstrap analysis. RESULTS Based on data from 40 patients (320 image series), the urethra could be clearly measured on every pre- and postsurgical dMRI dataset but not on preoperative ultrasound images in nine women during Valsalva maneuver due to a large cystocele. The estimation of the mean difference distribution based on 500,000 bootstrap resamples indicated that the urethral length was measured shorter by dMRI pre- and postsurgery at rest and postsurgery during Valsalva maneuver (median 1.6-3.1 mm) but longer by dMRI (median 0.2 mm) during Valsalva maneuver presurgery. Rotated/vertical bladder neck descent and urethral funneling diagnoses showed concordance of 67-74% in the direct comparison of patients; the estimation of the concordance indicated poorer outcomes with 50-72%. CONCLUSIONS Metric information on urethral length from dMRI is comparable to that from introital ultrasound. dMRI is more advantageous in cases with an extended organ prolapse. At present, dMRI does not give the same diagnosis on bladder neck changes as introital ultrasound does.
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Affiliation(s)
- C D Alt
- Department of Diagnostic and Interventional Radiology, University Duesseldorf, Medical Faculty, Moorenstrasse 5, 40225, Duesseldorf, Germany
| | - S M Katzenberger
- Department of Obstetrics and Gynecology, Medical School, University of Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany.,Hannover Medical School, Clinic of Orthodontics, OE 7730, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - P Hallscheidt
- Department of Diagnostic and Interventional Radiology, University Heidelberg, Medical Faculty, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.,Radiological Department Darmstadt, Academic Teaching Practice, University of Heidelberg Medical Center, Dieburger Str. 29-31, 64287, Darmstadt, Germany
| | - C Sohn
- Department of Obstetrics and Gynecology, Medical School, University of Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - H U Kauczor
- Department of Diagnostic and Interventional Radiology, University Heidelberg, Medical Faculty, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - S B Eickhoff
- Institute of Neuroscience and Medicine (INM-7), Juelich Research Centre, 52428, Juelich, Germany.,Institute of Systems Neuroscience, Heinrich Heine University, 40225, Dusseldorf, Germany
| | - K A Brocker
- Department of Obstetrics and Gynecology, Medical School, University of Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany.
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16
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Wagner WL, Wuennemann F, Pacilé S, Albers J, Arfelli F, Dreossi D, Biederer J, Konietzke P, Stiller W, Wielpütz MO, Accardo A, Confalonieri M, Cova M, Lotz J, Alves F, Kauczor HU, Tromba G, Dullin C. Towards synchrotron phase-contrast lung imaging in patients - a proof-of-concept study on porcine lungs in a human-scale chest phantom. J Synchrotron Radiat 2018; 25:1827-1832. [PMID: 30407195 DOI: 10.1107/s1600577518013401] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 09/20/2018] [Indexed: 05/23/2023]
Abstract
In-line free propagation phase-contrast synchrotron tomography of the lungs has been shown to provide superior image quality compared with attenuation-based computed tomography (CT) in small-animal studies. The present study was performed to prove the applicability on a human-patient scale using a chest phantom with ventilated fresh porcine lungs. Local areas of interest were imaged with a pixel size of 100 µm, yielding a high-resolution depiction of anatomical hallmarks of healthy lungs and artificial lung nodules. Details like fine spiculations into surrounding alveolar spaces were shown on a micrometre scale. Minor differences in artificial lung nodule density were detected by phase retrieval. Since we only applied a fraction of the X-ray dose used for clinical high-resolution CT scans, it is believed that this approach may become applicable to the detailed assessment of focal lung lesions in patients in the future.
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Affiliation(s)
- Willi L Wagner
- Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Felix Wuennemann
- Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Jonas Albers
- Institute for Diagnostic and Interventional Radiology, University Medical Center Goettingen, Goettingen, Germany
| | - Fulvia Arfelli
- Department of Physics, University of Trieste and INFN, Trieste, Italy
| | | | - Jürgen Biederer
- Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Philip Konietzke
- Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Wolfram Stiller
- Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Mark O Wielpütz
- Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Agostino Accardo
- Department of Engineering and Architecture, University of Trieste, Trieste, Italy
| | | | - Maria Cova
- Department of Radiology, University of Trieste, ASUITS, Trieste, Italy
| | - Joachim Lotz
- Institute for Diagnostic and Interventional Radiology, University Medical Center Goettingen, Goettingen, Germany
| | - Frauke Alves
- Institute for Diagnostic and Interventional Radiology, University Medical Center Goettingen, Goettingen, Germany
| | - Hans Ulrich Kauczor
- Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
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17
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Vollherbst DF, Otto R, Hantz M, Ulfert C, Kauczor HU, Bendszus M, Sommer CM, Möhlenbruch MA. Investigation of a New Version of the Liquid Embolic Agent PHIL with Extra-Low-Viscosity in an Endovascular Embolization Model. AJNR Am J Neuroradiol 2018; 39:1696-1702. [PMID: 30093480 DOI: 10.3174/ajnr.a5750] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 06/12/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND PURPOSE The type and composition of an embolic agent have a relevant influence on the performance of endovascular embolization. The aim of this study was to investigate a new version of the liquid embolic agent precipitating hydrophobic injectable liquid (PHIL) with extra-low-viscosity in an in vivo embolization model. MATERIALS AND METHODS Twenty-four embolization procedures were performed in the porcine rete mirabile. Eight embolizations were performed with PHIL 25% low viscosity, Squid 12, and standard PHIL 25%, respectively. Procedure time, required volume of embolic agent, visibility of the embolic agent, embolization control, embolization extent (ie, penetration of the rete mirabile), amount of reflux, and degree of embolization distal to the rete mirabile were assessed. RESULTS All embolic agents were adequately visible. The embolization extent was not significantly different among the 3 investigated agents; however, there was a tendency toward a higher embolization extent for PHIL 25% low viscosity (median embolization extent: 88% [PHIL 25% low viscosity]; 65% [Squid 12]; 60% [PHIL 25%]; P = .146). The amount of reflux was significantly lower for the extra-low-viscosity agents PHIL 25% low viscosity and Squid 12 compared with the standard PHIL 25% (median reflux distance: 8 mm [PHIL 25% low viscosity]; 6 mm [Squid 12]; 17 mm [PHIL 25%]; P = .011). All other embolization features did not differ among agents. CONCLUSIONS PHIL 25% low viscosity is a promising liquid embolic agent for endovascular embolization, featuring effective distal penetration, adequate visibility, a low amount of reflux, and good flow control.
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Affiliation(s)
- D F Vollherbst
- From the Department of Neuroradiology (D.F.V., R.O., M.H., C.U., M.B., M.A.M.)
- Clinic for Diagnostic and Interventional Radiology (D.F.V., H.U.K., C.M.S.), Heidelberg University Hospital, Heidelberg, Germany
| | - R Otto
- From the Department of Neuroradiology (D.F.V., R.O., M.H., C.U., M.B., M.A.M.)
| | - M Hantz
- From the Department of Neuroradiology (D.F.V., R.O., M.H., C.U., M.B., M.A.M.)
| | - C Ulfert
- From the Department of Neuroradiology (D.F.V., R.O., M.H., C.U., M.B., M.A.M.)
| | - H U Kauczor
- Clinic for Diagnostic and Interventional Radiology (D.F.V., H.U.K., C.M.S.), Heidelberg University Hospital, Heidelberg, Germany
| | - M Bendszus
- From the Department of Neuroradiology (D.F.V., R.O., M.H., C.U., M.B., M.A.M.)
| | - C M Sommer
- Clinic for Diagnostic and Interventional Radiology (D.F.V., H.U.K., C.M.S.), Heidelberg University Hospital, Heidelberg, Germany
- Clinic for Diagnostic and Interventional Radiology (C.M.S.), Klinikum Stuttgart, Stuttgart, Germany
| | - M A Möhlenbruch
- From the Department of Neuroradiology (D.F.V., R.O., M.H., C.U., M.B., M.A.M.)
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18
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Brandelik SC, Krzykalla J, Hielscher T, Hillengass J, Kloth JK, Kauczor HU, Weber MA. [Focal lesions in whole-body MRI in multiple myeloma : Quantification of tumor mass and correlation with disease-related parameters and prognosis]. Radiologe 2017; 58:72-78. [PMID: 28905085 DOI: 10.1007/s00117-017-0299-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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] [Indexed: 01/12/2023]
Abstract
BACKGROUND AND OBJECTIVES In this study, we evaluated methods of quantification of tumor mass in whole-body MRI (wb-MRI) in multiple myeloma and correlated these with disease-related parameters in serum and bone marrow. MATERIALS AND METHODS We retrospectively evaluated wb-MRIs of 52 patients with focal infiltration pattern and a total of 700 focal lesions (subsequently called lesions). We determined the longest diameter (LD), the segmented volume (SV), and the morphology (spherical or non-spherical). We correlated total number/volume of the lesions with clinical parameters and prognosis and furthermore LD with SV. After that we analyzed the agreement of SV and estimated volume (EV) using the volume formula of a sphere based on LD. RESULTS Results showed no significant correlations of total number/volume with prognosis or clinical parameters. The latter were situated predominantly in the normal range. Furthermore, 10% of lesions were spherical. SV and LD correlated significantly in single lesions and on patient level. SV was in lesions <6 cm3 systematically larger and in lesions ≥6 cm3 smaller than EV. In 95%, we found in small lesions a deviation of EV versus SV from +0.9 cm3 to -4.6 cm3 and in large lesions from +160 cm3 to -111 cm3 (EV-SV). CONCLUSIONS Quantification of tumor mass in the focal infiltration pattern is performed more accurately by volumetry than LD due to the predominant existence of non-spherical lesions. The patient cohort with clinical parameters predominantly in the normal range is distributed to ISS stage I and partly pretreated, a fact that makes interpretation of absent correlations more difficult. Consider also a variation in activitiy of lesions and a diffuse infiltration not detectable by MRI.
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Affiliation(s)
- S C Brandelik
- Diagnostische und Interventionelle Radiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland.
| | - J Krzykalla
- Biostatistik, Deutsches Krebsforschungszentrum (dkfz), Heidelberg, Deutschland
| | - T Hielscher
- Biostatistik, Deutsches Krebsforschungszentrum (dkfz), Heidelberg, Deutschland
| | - J Hillengass
- Hämatologie und Onkologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - J K Kloth
- Radiologie Löbau, Löbau, Deutschland
| | - H U Kauczor
- Diagnostische und Interventionelle Radiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland
| | - M A Weber
- Diagnostische und Interventionelle Radiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland
- Diagnostische und Interventionelle Radiologie, Universitätsmedizin Rostock, Rostock, Deutschland
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19
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Sommer CM, Vollherbst DF, Richter GM, Kauczor HU, Pereira PL. [What can/should be treated in kidney tumors and when]. Radiologe 2017; 57:80-89. [PMID: 28130580 DOI: 10.1007/s00117-016-0202-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
CLINICAL/METHODICAL ISSUE In the treatment of localized renal cell carcinoma, the lack of randomization in controlled trials on thermal ablation is a major limitation. The latter leads to significant study bias and it ultimately remains unclear whether the improved overall survival in favor of partial nephrectomy can actually be attributed to the treatment method. STANDARD RADIOLOGICAL METHODS For T1a (≤4 cm) renal cell carcinoma without lymph node and distant metastases, excellent technical and clinical results have been described after imaging-guided radiofrequency ablation and cryoablation. METHODICAL INNOVATIONS Low major complication rates, preservation of renal function and three-dimensional confirmation of negative ablation margins (A0 ablation) are the advantages of computed tomography (CT)-guided thermal ablation. PERFORMANCE According to the results of controlled (non-randomized) trials on T1a renal cell cancer, the cancer-specific survival rates are comparable between ablative and surgical techniques. ACHIEVEMENTS It is high time for prospective randomized controlled trials to define the actual value of percutaneous thermal ablation and partial nephrectomy in the treatment of T1a renal cell carcinoma. PRACTICAL RECOMMENDATIONS Apart from localized renal cell carcinoma, angiomyolipoma and oncocytoma can be treated by thermal ablation. Transarterial embolization extends the radiological spectrum for the treatment of renal tumors, either as complementary embolization (e. g. before thermal ablation of T1a and T1b renal cell carcinoma), prophylactic embolization (e. g. angiomyolipoma >6 cm), preoperative embolization (e. g. before laparoscopic partial nephrectomy) or palliative embolization (e. g. in patients with symptomatic macrohematuria due to renal cell carcinoma).
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Affiliation(s)
- C M Sommer
- Klinik für Diagnostische und Interventionelle Radiologie, Radiologische Klinik, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland. .,Klinik für Diagnostische und Interventionelle Radiologie, Klinikum Stuttgart, Katharinenhospital, Stuttgart, Deutschland.
| | - D F Vollherbst
- Abteilung Neuroradiologie, Radiologische Klinik, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - G M Richter
- Klinik für Diagnostische und Interventionelle Radiologie, Klinikum Stuttgart, Katharinenhospital, Stuttgart, Deutschland
| | - H U Kauczor
- Klinik für Diagnostische und Interventionelle Radiologie, Radiologische Klinik, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland
| | - P L Pereira
- Klinik für Radiologie, minimal-invasive Therapien und Nuklearmedizin, SLK-Kliniken Heilbronn GmbH, Heilbronn, Deutschland
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20
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Cieciera M, Kratochwil C, Moltz J, Kauczor HU, Holland Letz T, Choyke P, Mier W, Haberkorn U, Giesel FL. Semi-automatic 3D-volumetry of liver metastases from neuroendocrine tumors to improve combination therapy with 177Lu-DOTATOC and 90Y-DOTATOC. Diagn Interv Radiol 2017; 22:201-6. [PMID: 27015320 DOI: 10.5152/dir.2015.15304] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE Patients with neuroendocrine tumors (NET) often present with disseminated liver metastases and can be treated with a number of different nuclides or nuclide combinations in peptide receptor radionuclide therapy (PRRT) depending on tumor load and lesion diameter. For quantification of disseminated liver lesions, semi-automatic lesion detection is helpful to determine tumor burden and tumor diameter in a time efficient manner. Here, we aimed to evaluate semi-automated measurement of total metastatic burden for therapy stratification. METHODS Nineteen patients with liver metastasized NET underwent contrast-enhanced 1.5 T MRI using gadolinium-ethoxybenzyl diethylenetriaminepentaacetic acid. Liver metastases (n=1537) were segmented using Fraunhofer MEVIS Software for three-dimensional (3D) segmentation. All lesions were stratified according to longest 3D diameter >20 mm or ≤20 mm and relative contribution to tumor load was used for therapy stratification. RESULTS Mean count of lesions ≤20 mm was 67.5 and mean count of lesions >20 mm was 13.4. However, mean contribution to total tumor volume of lesions ≤20 mm was 24%, while contribution of lesions >20 mm was 76%. CONCLUSION Semi-automatic lesion analysis provides useful information about lesion distribution in predominantly liver metastasized NET patients prior to PRRT. As conventional manual lesion measurements are laborious, our study shows this new approach is more efficient and less operator-dependent and may prove to be useful in the decision making process selecting the best combination PRRT in each patient.
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Affiliation(s)
- Matthaeus Cieciera
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany.
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21
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Radeleff B, Sumkauskaite M, Kortes N, Gnutzmann D, Mokry T, Kauczor HU, Stampfl U. [Subintimal recanalization. Indications, technique and results]. Radiologe 2016; 56:266-74. [PMID: 26885652 DOI: 10.1007/s00117-016-0078-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
CLINICAL/METHODICAL ISSUE This article gives an overview of the current importance of so-called subintimal recanalization in the lower extremities. STANDARD RADIOLOGICAL METHODS The primary technical goal of endovascular interventions in the lower extremities is the endoluminal restoration of blood circulation from the iliac arteries into the feet. METHODICAL INNOVATIONS If endoluminal recanalization of e.g. high-grade flow-relevant stenoses or chronic total occlusion (CTO) is technically not possible, subintimal recanalization is a promising option and the only remaining minimally invasive alternative. During subintimal recanalization a channel is intentionally generated in the vessel wall (dissection) in order to bypass e. g. a chronic vascular occlusion over as short a distance as possible. PERFORMANCE The technical success rate for subintimal recanalization of CTO of the lower extremities is 65-100 %. Technical failure occurs in approximately 25 % using the catheter and wire technique and is caused in most cases by difficulties in reaching the true lumen after the subintimal passage (the so-called re-entry). ACHIEVEMENTS Compared to conventional subintimal recanalization, in recent years so-called re-entry devices have expanded the technical possibilities and depending on the medical experience and training level of the physician, provide an improvement in the technical success rate, a lower complication rate, a reduction of fluoroscopy time and the amount of necessary contrast medium but also result in higher costs. PRACTICAL RECOMMENDATIONS Subintimal recanalization, whether carried out conventionally with a catheter and wire or using re-entry devices, of high-grade stenoses or CTO in the lower extremities provides a high technical success rate but requires an experienced and trained physician who is capable of operating the elaborate materials and mastering any possible complications.
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Affiliation(s)
- B Radeleff
- Sektion für Interventionelle Radiologie, Diagnostische und Interventionelle Radiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland.
| | - M Sumkauskaite
- Sektion für Interventionelle Radiologie, Diagnostische und Interventionelle Radiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland
| | - N Kortes
- Sektion für Interventionelle Radiologie, Diagnostische und Interventionelle Radiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland
| | - D Gnutzmann
- Sektion für Interventionelle Radiologie, Diagnostische und Interventionelle Radiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland
| | - T Mokry
- Sektion für Interventionelle Radiologie, Diagnostische und Interventionelle Radiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland
| | - H U Kauczor
- Sektion für Interventionelle Radiologie, Diagnostische und Interventionelle Radiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland
| | - U Stampfl
- Sektion für Interventionelle Radiologie, Diagnostische und Interventionelle Radiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland
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22
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Rehm J, Veith S, Akbar M, Kauczor HU, Weber MA. CT-Guided Percutaneous Spine Biopsy in Suspected Infection or Malignancy: A Study of 214 Patients. ROFO-FORTSCHR RONTG 2016; 188:1156-1162. [PMID: 27907940 DOI: 10.1055/s-0042-116233] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Purpose: To retrospectively determine the effectiveness and accuracy of CT-guided percutaneous biopsy of malignant and inflammatory bone lesions of the spine and to assess the reliability of pre-biopsy CT and MRI. Materials and Methods: 214 patients with lesions of the spine, which were suspicious either for being malignant or inflammatory, underwent CT-guided biopsy for pathological and/or microbiological detection. Biopsy samples were sent for histological examination in 128/214 patients, for microbiological analysis in 17/214 patients and for both analyses in 69/214 patients. Retrospectively, the diagnostic accuracy and sensitivity/specificity of the pre-interventional imaging (CT and MRI) were determined. In addition, the influence of the biopsy on subsequent patient management was assessed. Results: The accuracy was 94.4 % for histopathological analysis and 97.7 % for microbiological analysis. In 25 % of cases the microbiological analysis revealed an underlying pathogen that was not significantly affected by pre-biopsy antibiotic therapy. The sensitivity/specificity of the pre-biopsy cross-sectional imaging concerning suspected malignancy was 69 %/78 %. For suspected infection, the sensitivity/specificity of pre-biopsy imaging was 81 %/44 %. In 52 % of all cases, the biopsy result changed subsequent patient management. Conclusion: Percutaneous CT-guided spine biopsy is a useful and reliable diagnostic procedure to establish a definitive diagnosis but with a relatively low yield of microorganisms in the case of infection. Key Points: • CT-guided spine biopsy is an accurate and reliable procedure in case of infection and tumour.• The results of the CT-guided spine biopsy have a significant influence on the subsequent patient management.• Pathogen recovery-rate in case of infection is moderate but not significantly affected by prebiopsy antibiotic therapy. Citation Format: • Rehm J, Veith S, Akbar M et al. CT-Guided Percutaneous Spine Biopsy in Suspected Infection or Malignancy: A Study of 214 Patients. Fortschr Röntgenstr 2016; 188: 1156 - 1162.
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Affiliation(s)
- J Rehm
- Institute of Diagnostic and Interventional Radiology, Universitiy of Heidelberg, Germany
| | - S Veith
- Institute of Diagnostic and Interventional Radiology, Universitiy of Heidelberg, Germany
| | - M Akbar
- Department of Orthopaedic Surgery and Rehabilitation Medicine, University of Heidelberg, Germany
| | - H U Kauczor
- Institute of Diagnostic and Interventional Radiology, Universitiy of Heidelberg, Germany
| | - M A Weber
- Institute of Diagnostic and Interventional Radiology, Universitiy of Heidelberg, Germany
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23
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Vollherbst D, Bertheau R, Kauczor HU, Radeleff BA, Pereira PL, Sommer CM. Erratum: Treatment Failure After Image-Guided Percutaneous Radiofrequency Ablation (RFA) of Renal Tumors - A Systematic Review with Description of Type, Frequency, Risk Factors and Management. ROFO-FORTSCHR RONTG 2016; 189:e1. [PMID: 27737483 DOI: 10.1055/s-0035-1567133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- D Vollherbst
- Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany
| | - R Bertheau
- Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - H U Kauczor
- Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - B A Radeleff
- Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - P L Pereira
- Clinic for Radiology, Minimally-invasive Therapies and Nuclear Medicine, SLK-Kliniken, Heilbronn, Germany
| | - C M Sommer
- Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany.,Clinic for Diagnostic and Interventional Radiology, Klinikum Stuttgart, Stuttgart, Germany
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Leutz P, Wielpütz MO, Kauczor HU, Weinheimer O, Skornitzke S, Pahn G, Stiller W, Puderbach M. Influence of Exposure Parameters and Iterative Reconstruction on MDCT-based Lung Densitometry – An ex vivo Phantom Study. Pneumologie 2016. [DOI: 10.1055/s-0036-1584640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Jobst B, Melzig C, Biederer J, Burmester K, Triphan S, Schliebus J, Fellhauer I, Karch A, Heussel CP, Kauczor HU. MRI and CT phenotyping of 600 subjects from the German COPD trial COSYCONET: study concept and current status. Pneumologie 2016. [DOI: 10.1055/s-0036-1584643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Fritz F, Skornitzke S, Hackert T, Kauczor HU, Stiller W, Grenacher L, Klauss M. Dual-Energy Perfusion-CT in Recurrent Pancreatic Cancer - Preliminary Results. ROFO-FORTSCHR RONTG 2016; 188:559-65. [PMID: 27224576 DOI: 10.1055/s-0042-105765] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE To evaluate the diagnostic performance of dual energy (DE) perfusion-CT for the differentiation between postoperative soft-tissue formation and tumor recurrence in patients after potentially curative pancreatic cancer resection. MATERIAL AND METHODS 24 patients with postoperative soft-tissue formation in the conventional regular follow-up CT acquisition after pancreatic cancer resection with curative intent were included prospectively. They were examined with a 64-row dual-source CT using a dynamic sequence of 34 DE acquisitions every 1.5 s (80 ml of iodinated contrast material, 370 mg/ml, flow rate 5 ml/s). Weighted average (linearly blended M0.5) 120kVp-equivalent dual-energy perfusion image data sets were evaluated with a body-perfusion CT tool (see above) for estimating blood flow, permeability, and blood volume. Diagnosis was confirmed by histological study (n = 4) and by regular follow-up. RESULTS Final diagnosis was local recurrence of pancreatic cancer in 15 patients and unspecific postoperative tissue formation in 9 patients. The blood-flow values for recurrence tissue trended to be lower compared to postoperative tissue formation with 16.6 ml/100 ml/min and 24.7 ml/100 ml/min, respectively for weighted average 120kVp-equivalent image data, which was not significant (n.s.) (p = 0.06, significance level 0.05). Permeability- and blood-volume values were only slightly lower in recurrence tissue (n.s.). CONCLUSION DE perfusion-CT is feasible in patients after pancreatic cancer resection and a promising functional imaging technique. As only a trend for lower perfusion values in local recurrence compared to unspecific postoperative alterations was found, the perfusion differences are not yet sufficient to differentiate between malignancy and unspecific postoperative alterations for this new technique. Further studies and technical improvements are needed to generate reliable data for this clinically highly relevant differentiation. KEY POINTS • DE Perfusion CT is feasible in patients after pancreatic cancer resection.• While reliable differentiation of unspecific postoperative tissue formation from recurrent malignancy cannot be achieved yet, it is within reach.• DE Perfusion CT has the potential to overcome todays limitations of pure morphological diagnosis of recurrent pancreatic cancer. Citation Format: • Fritz F, Skornitzke S, Hackert T et al. Dual-Energy Perfusion-CT in Recurrent Pancreatic Cancer - Preliminary RESULTS. Fortschr Röntgenstr 2016; 188: 559 - 565.
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Affiliation(s)
- F Fritz
- Clinic of Diagnostic and Interventional Radiology, University of Heidelberg, Germany
| | - S Skornitzke
- Clinic of Diagnostic and Interventional Radiology, University of Heidelberg, Germany
| | - T Hackert
- Clinic of Surgery, University of Heidelberg, Germany
| | - H U Kauczor
- Clinic of Diagnostic and Interventional Radiology, University of Heidelberg, Germany
| | - W Stiller
- Clinic of Diagnostic and Interventional Radiology, University of Heidelberg, Germany
| | - L Grenacher
- Diagnostic Imaging Center, Diagnostik München, Germany
| | - M Klauss
- Clinic of Diagnostic and Interventional Radiology, University of Heidelberg, Germany
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Rehnitz C, Klaan B, von Stillfried F, Amarteifio E, Burkholder I, Kauczor HU, Weber MA. Comparison of Modern 3D and 2D MR Imaging Sequences of the Wrist at 3 Tesla. ROFO-FORTSCHR RONTG 2016; 188:753-62. [PMID: 27139176 DOI: 10.1055/s-0042-104512] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE To compare the image quality of modern 3 D and 2 D sequences for dedicated wrist imaging at 3 Tesla (T) MRI. MATERIALS AND METHODS At 3 T MRI, 18 patients (mean age: 36.2 years) with wrist pain and 16 healthy volunteers (mean age: 26.4 years) were examined using 2 D proton density-weighted fat-saturated (PDfs), isotropic 3 D TrueFISP, 3 D MEDIC, and 3 D PDfs SPACE sequences. Image quality was rated on a five-point scale (0 - 4) including overall image quality (OIQ), visibility of important structures (cartilage, ligaments, TFCC) and degree of artifacts. Signal-to-noise ratios (SNR) and contrast-to-noise ratios (CNR) of cartilage/bone/muscle/fluid as well as the mean overall SNR/CNR were calculated using region-of-interest analysis. ANOVA, paired t-, and Wilcoxon-signed-rank tests were applied. RESULTS The image quality of all tested sequences was superior to 3 D PDfs SPACE (p < 0.01). 3 D TrueFISP had the highest combined cartilage score (mean: 3.4) and performed better in cartilage comparisons against 3 D PDfs SPACE in both groups and 2 D PDfs in volunteers (p < 0.05). 3 D MEDIC performed better in 7 of 8 comparisons (p < 0.05) regarding ligaments and TFCC. 2 D PDfs provided constantly high scores. The mean overall SNR/CNR for 2 D PDfs, 3 D PDfs SPACE, 3 D TrueFISP, and 3 D MEDIC were 68/65, 32/27, 45/47, and 57/45, respectively. 2 D PDfs performed best in most SNR/CNR comparisons (p < 0.05) and 3 D MEDIC performed best within the 3 D sequences (p < 0.05). CONCLUSION Except 3 D PDfs SPACE, all tested 3 D and 2 D sequences provided high image quality. 3 D TrueFISP was best for cartilage imaging, 3 D MEDIC for ligaments and TFCC and 2 D PDfs for general wrist imaging. KEY POINTS • 3 D TrueFISP is recommended for cartilage imaging of the wrist at 3 T.• 3 D MEDIC is recommended for ligaments and TFCC.• Robust 2 D PDfs should be used in routine protocols. 3 D sequences may be added depending on the clinical question.• 3 D PDfs SPACE is currently inferior. Citation Format: • Rehnitz C, Klaan B, von Stillfried F et al. Comparison of Modern 3D and 2D MR Imaging Sequences of the Wrist at 3 Tesla. Fortschr Röntgenstr 2016; 188: 753 - 762.
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Affiliation(s)
- C Rehnitz
- Diagnostic and Interventional Radiology, University of Heidelberg, Germany
| | - B Klaan
- Diagnostic and Interventional Radiology, University of Heidelberg, Germany
| | - F von Stillfried
- Department for Orthopedics, Traumatology and Paraplegiology, University of Heidelberg, Germany
| | - E Amarteifio
- Diagnostic and Interventional Radiology, University of Heidelberg, Germany
| | - I Burkholder
- Department of Nursing and Health, University of Applied Sciences of the Saarland, Saarbruecken, Germany
| | - H U Kauczor
- Diagnostic and Interventional Radiology, University of Heidelberg, Germany
| | - M A Weber
- Diagnostic and Interventional Radiology, University of Heidelberg, Germany
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Wielpütz MO, Eichinger M, Biederer J, Wege S, Stahl M, Sommerburg O, Mall MA, Kauczor HU, Puderbach M. Imaging of Cystic Fibrosis Lung Disease and Clinical Interpretation. ROFO-FORTSCHR RONTG 2016; 188:834-45. [PMID: 27074425 DOI: 10.1055/s-0042-104936] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
UNLABELLED Progressive lung disease in cystic fibrosis (CF) is the life-limiting factor of this autosomal recessive genetic disorder. Increasing implementation of CF newborn screening allows for a diagnosis even in pre-symptomatic stages. Improvements in therapy have led to a significant improvement in survival, the majority now being of adult age. Imaging provides detailed information on the regional distribution of CF lung disease, hence longitudinal imaging is recommended for disease monitoring in the clinical routine. Chest X-ray (CXR), computed tomography (CT) and magnetic resonance imaging (MRI) are now available as routine modalities, each with individual strengths and drawbacks, which need to be considered when choosing the optimal modality adapted to the clinical situation of the patient. CT stands out with the highest morphological detail and has often been a substitute for CXR for regular severity monitoring at specialized centers. Multidetector CT data can be post-processed with dedicated software for a detailed measurement of airway dimensions and bronchiectasis and potentially a more objective and precise grading of disease severity. However, changing to CT was inseparably accompanied by an increase in radiation exposure of CF patients, a young population with high sensitivity to ionizing radiation and lifetime accumulation of dose. MRI as a cross-sectional imaging modality free of ionizing radiation can depict morphological hallmarks of CF lung disease at lower spatial resolution but excels with comprehensive functional lung imaging, with time-resolved perfusion imaging currently being most valuable. KEY POINTS • Hallmarks are bronchiectasis, mucus plugging, air trapping, perfusion abnormalities, and emphysema.• Imaging is more sensitive to disease progression than lung function testing.• CT provides the highest morphological detail but is associated with radiation exposure.• MRI shows comparable sensitivity for morphology but excels with additional functional information.• MRI sensitively depicts reversible abnormalities such as mucus plugging and perfusion abnormalities. Citation Format: • Wielpütz MO, Eichinger M, Biederer J et al. Imaging of Cystic Fibrosis Lung Disease and Clinical Interpretation. Fortschr Röntgenstr 2016; 188: 834 - 845.
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Affiliation(s)
- M O Wielpütz
- Department of Diagnostic and Interventional Radiology, Subdivision of Pulmonary Imaging, University Hospital of Heidelberg, Heidelberg, Germany
| | - M Eichinger
- Department of Diagnostic and Interventional Radiology, Subdivision of Pulmonary Imaging, University Hospital of Heidelberg, Heidelberg, Germany
| | - J Biederer
- Department of Diagnostic and Interventional Radiology, Subdivision of Pulmonary Imaging, University Hospital of Heidelberg, Heidelberg, Germany
| | - S Wege
- Department of Pulmonology and Respiratory Medicine, Cystic Fibrosis Center, Thoraxklinik at the University Hospital of Heidelberg, Heidelberg, Germany
| | - M Stahl
- Translational Lung Research Center Heidelberg (TLRC), Member of the German Lung Research Center (DZL), Heidelberg, Germany
| | - O Sommerburg
- Translational Lung Research Center Heidelberg (TLRC), Member of the German Lung Research Center (DZL), Heidelberg, Germany
| | - M A Mall
- Translational Lung Research Center Heidelberg (TLRC), Member of the German Lung Research Center (DZL), Heidelberg, Germany
| | - H U Kauczor
- Department of Diagnostic and Interventional Radiology, Subdivision of Pulmonary Imaging, University Hospital of Heidelberg, Heidelberg, Germany
| | - M Puderbach
- Department of Diagnostic and Interventional Radiology, Subdivision of Pulmonary Imaging, University Hospital of Heidelberg, Heidelberg, Germany
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Kubo T, Ohno Y, Takenaka D, Nishino M, Gautam S, Sugimura K, Kauczor HU, Hatabu H. Standard-dose vs. low-dose CT protocols in the evaluation of localized lung lesions: Capability for lesion characterization-iLEAD study. Eur J Radiol Open 2016; 3:67-73. [PMID: 27957516 PMCID: PMC5144111 DOI: 10.1016/j.ejro.2016.03.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 03/06/2016] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE To determine the lesion characterization capability by low dose CT for localized lung lesions in comparison with standard dose CT. SUBJECTS AND METHODS Approval for this study was granted by our Institutional Review Board. Fifty-two consecutive patients (36 males and 16 females, median age of 71 years.) who had CT examinations for evaluation of lung lesions comprise the study population. Two chest CT scans were performed with current time product of 50 and 150 mAs at 120 kVp, with the same scan length with a 16 detector-row CT scanner. Three readers evaluated 52 target lesions and assigned an overall impression score to each target lesion, using a 5 point scale from 1 (definitely benign) to 5 (definitely malignant). Six features of the lesions including lesion type, margin characteristics, calcification, lobulation, speculation, and pleural indentation were also reported with 5-point scales. The weighted kappa analyses and receiver operating characteristic analysis were used for analysis. RESULTS The mean kappa value between low-and standard-dose CT was 0.82 for overall impression of the lesions, showing almost perfect agreement. Area under the curve of low-dose CT (Az = 0.74) had no significant difference from that of standard-dose CT (Az = 0.74) (p = 0.61). The kappa values for six lesion features ranged from 0.45 to 0.83, showing moderate to almost perfect agreement. CONCLUSION Lesion characterization capability by low-dose CT images was comparable to that by standard-dose CT images and therefore sufficient for evaluation of localized lung lesions.
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Affiliation(s)
- Takeshi Kubo
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Yoshiharu Ohno
- Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan
| | - Daisuke Takenaka
- Department of Radiology, Hyogo Cancer Center, 13-70 Kitaouji-cho, Akashi, 673-8558, Japan
| | - Mizuki Nishino
- Department of Radiology, Dana Farber Cancer Institute, 44 Binney Street, Boston, MA 02115, United States
| | - Shiva Gautam
- Departments of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, United States
| | - Kazuro Sugimura
- Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan
| | - Hans Ulrich Kauczor
- Diagnostic and Interventional Radiology, University Clinic Heidelberg, Im Neuenheimer Feld 110, D-69120 Heidelberg, Germany
| | - Hiroto Hatabu
- Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, United States
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Lorenz J, Bals R, Ewert R, Heussel CP, Kauczor HU, Randerath W, Steinkamp G, Watz H, Worth H. [Expert meeting obstructive airway disease measuring and evaluating in COPD]. Pneumologie 2015; 69:521-33. [PMID: 26335896 DOI: 10.1055/s-0034-1392787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This report gives an overview on the contributions presented in an expert meeting in February, 2015. They deal with the analysis and evaluation of the multiple dimensions of COPD. This complex disease not only interferes with pulmonary mechanics and gas exchange, but also with cardiopulmonary crosstalk and the ventilator pump. A bulk of inflammatory and microbial activity develops during the progression of disease. As a consequence, systemic effects on muscles, metabolism and psyche develop.The sections consider the value of multiple endpoints in clinical research. Quantifiable parameters of lung mechanics and gas exchange, of exercise tolerance and biomarkers improve the measurability of effects in interventions. However, do we really know in a biological sense what we are measuring? What conclusions can we draw in terms of prognosis?Vice versa, we have to look into the origin and meaning of integrative endpoints e.g. quality or life, dyspnoea and spontaneous physical activity. As a new dimension, the clinical significance of morphological findings in HRCT and MRT is analyzed.
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Affiliation(s)
- J Lorenz
- Klinik für Pneumologie, Internistische Intensivmedizin, Infektiologie und Schlafmedizin, Klinikum Lüdenscheid
| | - R Bals
- Klinik für Pneumologie, Allergologie, Beatmungsmedizin, Universitätsklinikum des Saarlandes Homburg/Saar
| | - R Ewert
- Universitätsmedizin Greifswald, Klinik Innere Medizin B, Bereich Pneumologie, Internistische Intensivmedizin
| | - C P Heussel
- Diagnostische und Interventionelle Radiologie und Nuklearmedizin, Thoraxklinik am Universitätsklinikum Heidelberg
| | - H U Kauczor
- Translational Lung Research Center Heidelberg (TLRC-H), Mitglied im Deutschen Zentrum für Lungenforschung (DZL)
| | - W Randerath
- Klinik für Pneumologie und Allergologie, Krankenhaus Bethanien, Solingen
| | - G Steinkamp
- Medizinisch-wissenschaftliches Publizieren, Schwerin
| | - H Watz
- Pneumologisches Forschungsinstitut an der LungenClinic Grosshansdorf
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Hansen J, Wielpütz MO, Pahn G, Schlemmer HP, Kauczor HU, Stiller W. Quantitative dual-energy computed tomography (DECT) imaging: Evaluation of system performance regarding iodine quantification accuracy. Pneumologie 2015. [DOI: 10.1055/s-0035-1556644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Weinheimer O, Heussel CP, Kauczor HU, Wielpütz MO. Simulation study about the accuracy of advanced airway geometry determination on MDCT using a computer-generated phantom. Pneumologie 2015. [DOI: 10.1055/s-0035-1556645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Jobst B, Wielpütz MO, Triphan S, Anjorin A, Ley-Zaporozhan J, Kauczor HU, Biederer J, Ley S, Sedlaczek O. Morpho-functional Lung MRI in COPD: Short-term Test-retest Reliability. Pneumologie 2015. [DOI: 10.1055/s-0035-1556616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Flechsig P, Zabeck H, Heußel CP, Kauczor HU, Haberkorn U, Giesel F. Sequential dynamic PET and dynamic MR imaging in N-staging of lung cancer patients. Pneumologie 2015. [DOI: 10.1055/s-0035-1556660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Triphan S, Wielpütz M, Heussel CP, Biederer J, Kauczor HU, Jakob P, Jobst B. Echo-time dependence of observed lung T1 in COPD patients: preliminary results. Pneumologie 2015. [DOI: 10.1055/s-0035-1556615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Renz M, Abels B, Quispe G, Wielpütz M, Kohlmann P, Puderbach M, Dinkel J, Eichinger M, Herth F, Hoffmann H, Kauczor HU, Heußel CP. Dynamic contrast-enhanced MRI Perfusion of the Lung – Feasibility and Accuracy in Patients with COPD, lung cancer and pulmonary embolism. Pneumologie 2015. [DOI: 10.1055/s-0035-1556618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Abstract
CLINICAL/METHODICAL ISSUE Evidence-based therapeutic and diagnostic algorithm for hepatocellular carcinoma. STANDARD RADIOLOGICAL METHODS Ultrasound, computed tomography, magnetic resonance imaging, image-guided percutaneous biopsy, percutaneous thermal ablation and transarterial chemoembolization. METHODICAL INNOVATIONS Diagnostic and therapy of hepatocellular carcinoma according to the official German interdisciplinary guidelines. PERFORMANCE The formulation of the German S3 guidelines on diagnosis and therapy of hepatocellular carcinoma was performed under special consideration of quality indicators and standardized quality improvement methods. ACHIEVEMENTS In 2013 the German S3 guidelines on diagnosis and therapy of hepatocellular carcinoma were published and clinically implemented as part of the nationwide guideline program in oncology of the Deutsche Krebsgesellschaft (German Cancer Society). PRACTICAL RECOMMENDATIONS The German S3 guidelines on diagnosis and therapy of hepatocellular carcinoma have to be considered as the national gold standard with the goal of optimization of patient care.
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Affiliation(s)
- C M Sommer
- Abteilung für Diagnostische und Interventionelle Radiologie, Radiologische Klinik, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
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Jobst BJ, Triphan SMF, Sedlaczek O, Anjorin A, Kauczor HU, Biederer J, Ley-Zaporozhan J, Ley S, Wielpütz MO. Functional lung MRI in chronic obstructive pulmonary disease: comparison of T1 mapping, oxygen-enhanced T1 mapping and dynamic contrast enhanced perfusion. PLoS One 2015; 10:e0121520. [PMID: 25822195 PMCID: PMC4379151 DOI: 10.1371/journal.pone.0121520] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 02/03/2015] [Indexed: 01/23/2023] Open
Abstract
PURPOSE Monitoring of regional lung function in interventional COPD trials requires alternative endpoints beyond global parameters such as FEV1. T1 relaxation times of the lung might allow to draw conclusions on tissue composition, blood volume and oxygen fraction. The aim of this study was to evaluate the potential value of lung Magnetic resonance imaging (MRI) with native and oxygen-enhanced T1 mapping for the assessment of COPD patients in comparison with contrast enhanced perfusion MRI. MATERIALS AND METHODS 20 COPD patients (GOLD I-IV) underwent a coronal 2-dimensional inversion recovery snapshot flash sequence (8 slices/lung) at room air and during inhalation of pure oxygen, as well as dynamic contrast-enhanced first-pass perfusion imaging. Regional distribution of T1 at room air (T1), oxygen-induced T1 shortening (ΔT1) and peak enhancement were rated by 2 chest radiologists in consensus using a semi-quantitative 3-point scale in a zone-based approach. RESULTS Abnormal T1 and ΔT1 were highly prevalent in the patient cohort. T1 and ΔT1 correlated positively with perfusion abnormalities (r = 0.81 and r = 0.80; p&0.001), and with each other (r = 0.80; p<0.001). In GOLD stages I and II ΔT1 was normal in 16/29 lung zones with mildly abnormal perfusion (15/16 with abnormal T1). The extent of T1 (r = 0.45; p<0.05), ΔT1 (r = 0.52; p<0.05) and perfusion abnormalities (r = 0.52; p<0.05) showed a moderate correlation with GOLD stage. CONCLUSION Native and oxygen-enhanced T1 mapping correlated with lung perfusion deficits and severity of COPD. Under the assumption that T1 at room air correlates with the regional pulmonary blood pool and that oxygen-enhanced T1 reflects lung ventilation, both techniques in combination are principally suitable to characterize ventilation-perfusion imbalance. This appears valuable for the assessment of regional lung characteristics in COPD trials without administration of i.v. contrast.
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Affiliation(s)
- Bertram J. Jobst
- Department of Diagnostic & Interventional Radiology, University Hospital of Heidelberg, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), Member of the German Lung Research Center (DZL), Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany
- * E-mail:
| | - Simon M. F. Triphan
- Department of Diagnostic & Interventional Radiology, University Hospital of Heidelberg, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), Member of the German Lung Research Center (DZL), Heidelberg, Germany
- Research Center Magnetic Resonance Bavaria (MRB), Würzburg, Germany
| | - Oliver Sedlaczek
- Department of Diagnostic & Interventional Radiology, University Hospital of Heidelberg, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), Member of the German Lung Research Center (DZL), Heidelberg, Germany
| | - Angela Anjorin
- Department of Diagnostic & Interventional Radiology, University Hospital of Heidelberg, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), Member of the German Lung Research Center (DZL), Heidelberg, Germany
| | - Hans Ulrich Kauczor
- Department of Diagnostic & Interventional Radiology, University Hospital of Heidelberg, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), Member of the German Lung Research Center (DZL), Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany
| | - Jürgen Biederer
- Department of Diagnostic & Interventional Radiology, University Hospital of Heidelberg, Heidelberg, Germany
- Radiologie Darmstadt, Department of Radiology Hospital Gross-Gerau, Gross-Gerau, Germany
| | - Julia Ley-Zaporozhan
- Department of Diagnostic & Interventional Radiology, University Hospital of Heidelberg, Heidelberg, Germany
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany
| | - Sebastian Ley
- Department of Diagnostic & Interventional Radiology, University Hospital of Heidelberg, Heidelberg, Germany
- Department of Diagnostic & Interventional Radiology, Surgical Hospital Dr. Rinecker, Munich, Germany
| | - Mark O. Wielpütz
- Department of Diagnostic & Interventional Radiology, University Hospital of Heidelberg, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), Member of the German Lung Research Center (DZL), Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany
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Sedlaczek O, Wiedemann C, Gruellich C, Klingmüller U, Kauczor HU, Schlemmer HP. Alteration of MR-DWI/ADC before and 24h after induction of chemotherapy in patients with lung cancer. Cancer Imaging 2014. [PMCID: PMC4242758 DOI: 10.1186/1470-7330-14-s1-p34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Demirel S, Chen D, Mei Y, Partovi S, von Tengg-Kobligk H, Dadrich M, Böckler D, Kauczor HU, Müller-Eschner M. Comparison of morphological and rheological conditions between conventional and eversion carotid endarterectomy using computational fluid dynamics – a pilot study. Vascular 2014; 23:474-82. [DOI: 10.1177/1708538114552836] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: To compare postoperative morphological and rheological conditions after eversion carotid endarterectomy versus conventional carotid endarterectomy using computational fluid dynamics. Basic methods: Hemodynamic metrics (velocity, wall shear stress, time-averaged wall shear stress and temporal gradient wall shear stress) in the carotid arteries were simulated in one patient after conventional carotid endarterectomy and one patient after eversion carotid endarterectomy by computational fluid dynamics analysis based on patient specific data. Principal findings: Systolic peak of the eversion carotid endarterectomy model showed a gradually decreased pressure along the stream path, the conventional carotid endarterectomy model revealed high pressure (about 180 Pa) at the carotid bulb. Regions of low wall shear stress in the conventional carotid endarterectomy model were much larger than that in the eversion carotid endarterectomy model and with lower time-averaged wall shear stress values (conventional carotid endarterectomy: 0.03–5.46 Pa vs. eversion carotid endarterectomy: 0.12–5.22 Pa). Conclusions: Computational fluid dynamics after conventional carotid endarterectomy and eversion carotid endarterectomy disclosed differences in hemodynamic patterns. Larger studies are necessary to assess whether these differences are consistent and might explain different rates of restenosis in both techniques.
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Affiliation(s)
- S Demirel
- Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - D Chen
- Department of Biomedical Engineering, School of Life Science, Beijing Institute of Technology, Beijing, China
| | - Y Mei
- Department of Biomedical Engineering, School of Life Science, Beijing Institute of Technology, Beijing, China
| | - S Partovi
- Department of Radiology, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, USA
| | - H von Tengg-Kobligk
- Institute of Diagnostic, Interventional and Pediatric Radiology, University Hospital Bern, Inselspital, Bern, Switzerland
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - M Dadrich
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
- Department of Radiology, German Cancer Research Center (dkfz), Heidelberg, Germany
| | - D Böckler
- Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - HU Kauczor
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - M Müller-Eschner
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
- Department of Radiology, German Cancer Research Center (dkfz), Heidelberg, Germany
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Tedla M, Golatta M, Stieber A, Rauch G, Marmé F, Schulz S, Harcos A, Schott S, Domschke C, Kauczor HU, Schneeweiss A, Schuetz F, Sohn C, Sinn P, Heil J. Prädiktion einer pathologischen Komplettremission nach neoadjuvanter Chemotherapie bei Brustkrebs mithilfe bildgebender und pathologischer Befunde. Geburtshilfe Frauenheilkd 2014. [DOI: 10.1055/s-0034-1388423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Gockner TL, Zelzer S, Mokry T, Gnutzmann D, Bellemann N, Mogler C, Beierfuß A, Köllensperger E, Germann G, Radeleff BA, Stampfl U, Kauczor HU, Pereira PL, Sommer CM. Sphere-enhanced microwave ablation (sMWA) versus bland microwave ablation (bMWA): technical parameters, specific CT 3D rendering and histopathology. Cardiovasc Intervent Radiol 2014; 38:442-52. [PMID: 25167958 DOI: 10.1007/s00270-014-0964-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 06/30/2014] [Indexed: 11/29/2022]
Abstract
PURPOSE This study was designed to compare technical parameters during ablation as well as CT 3D rendering and histopathology of the ablation zone between sphere-enhanced microwave ablation (sMWA) and bland microwave ablation (bMWA). METHODS In six sheep-livers, 18 microwave ablations were performed with identical system presets (power output: 80 W, ablation time: 120 s). In three sheep, transarterial embolisation (TAE) was performed immediately before microwave ablation using spheres (diameter: 40 ± 10 μm) (sMWA). In the other three sheep, microwave ablation was performed without spheres embolisation (bMWA). Contrast-enhanced CT, sacrifice, and liver harvest followed immediately after microwave ablation. Study goals included technical parameters during ablation (resulting power output, ablation time), geometry of the ablation zone applying specific CT 3D rendering with a software prototype (short axis of the ablation zone, volume of the largest aligned ablation sphere within the ablation zone), and histopathology (hematoxylin-eosin, Masson Goldner and TUNEL). RESULTS Resulting power output/ablation times were 78.7 ± 1.0 W/120 ± 0.0 s for bMWA and 78.4 ± 1.0 W/120 ± 0.0 s for sMWA (n.s., respectively). Short axis/volume were 23.7 ± 3.7 mm/7.0 ± 2.4 cm(3) for bMWA and 29.1 ± 3.4 mm/11.5 ± 3.9 cm(3) for sMWA (P < 0.01, respectively). Histopathology confirmed the signs of coagulation necrosis as well as early and irreversible cell death for bMWA and sMWA. For sMWA, spheres were detected within, at the rim, and outside of the ablation zone without conspicuous features. CONCLUSIONS Specific CT 3D rendering identifies a larger ablation zone for sMWA compared with bMWA. The histopathological signs and the detectable amount of cell death are comparable for both groups. When comparing sMWA with bMWA, TAE has no effect on the technical parameters during ablation.
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Affiliation(s)
- T L Gockner
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, INF 110, 69120, Heidelberg, Germany,
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Kubo T, Ohno Y, Kauczor HU, Hatabu H. Radiation dose reduction in chest CT--review of available options. Eur J Radiol 2014; 83:1953-61. [PMID: 25066756 DOI: 10.1016/j.ejrad.2014.06.033] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Revised: 06/24/2014] [Accepted: 06/30/2014] [Indexed: 10/25/2022]
Abstract
Computed tomography currently accounts for the majority of radiation exposure related to medical imaging. Although technological improvement of CT scanners has reduced the radiation dose of individual examinations, the benefit was overshadowed by the rapid increase in the number of CT examinations. Radiation exposure from CT examination should be kept as low as reasonably possible for patient safety. Measures to avoid inappropriate CT examinations are needed. Principles and information on radiation dose reduction in chest CT are reviewed in this article. The reduction of tube current and tube potential are the mainstays of dose reduction methods. Study results indicate that routine protocols with reduced tube current are feasible with diagnostic results comparable to conventional standard dose protocols. Tube current adjustment is facilitated by the advent of automatic tube current modulation systems by setting the appropriate image quality level for the purpose of the examination. Tube potential reduction is an effective method for CT pulmonary angiography. Tube potential reduction often requires higher tube current for satisfactory image quality, but may still contribute to significant radiation dose reduction. Use of lower tube potential also has considerable advantage for smaller patients. Improvement in image production, especially the introduction of iterative reconstruction methods, is expected to lower radiation dose significantly. Radiation dose reduction in CT is a multifaceted issue. Understanding these aspects leads to an optimal solution for various indications of chest CT.
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Affiliation(s)
- Takeshi Kubo
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan.
| | - Yoshiharu Ohno
- Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan.
| | - Hans Ulrich Kauczor
- Diagnostic and Interventional Radiology, University Clinic Heidelberg, Im Neuenheimer Feld 110, D-69120 Heidelberg, Germany.
| | - Hiroto Hatabu
- Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, United States.
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Kauczor HU. Radiologische Diagnose und Therapiestratifizierung der COPD. ROFO-FORTSCHR RONTG 2014. [DOI: 10.1055/s-0034-1373415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Weber MA, Sprengel SD, Omlor G, Lehner B, Kauczor HU, Rehnitz C. Radiofrequenzablation zur Therapie von Osteoidosteomen und Osteoblastomen in der Wirbelsäule – langfristige klinische Erfolgsraten und Techniken zur Protektion angrenzender Nervenwurzeln. ROFO-FORTSCHR RONTG 2014. [DOI: 10.1055/s-0034-1373596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Mokry T, Pahn G, Stiller W, Schemmer P, Stampfl U, Kauczor HU, Radeleff B, Sommer C. Dosis-reduzierte CT-Angiografie bei Leberlebendspendern mittels 64-Zeilen CT mit Stellar-Detektoren: Vergleich der Bildqualität bei „Filtered Back Projektion“- und iterativer Rekonstruktion. ROFO-FORTSCHR RONTG 2014. [DOI: 10.1055/s-0034-1372831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Gnutzmann D, Mechel J, Schmitz A, Bellemann N, Sommer CM, Gockner T, Mokry T, Kortes N, Stampfl U, Kauczor HU, Radeleff BA. Vergleich der Plasma- und Gewebekonzentrationskinetik von Irinotecan zweier unterchiedlicher mit Irinotecan beladener Partikel. ROFO-FORTSCHR RONTG 2014. [DOI: 10.1055/s-0034-1373006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Hansen J, Wielpütz MO, Pahn G, Kauczor HU, Stiller W. Quantitative Dual-Energy CT Bildgebung: Systemcharakterisierung im Hinblick auf die Genauigkeit der Jodquantifizierung. ROFO-FORTSCHR RONTG 2014. [DOI: 10.1055/s-0034-1372742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Schmitz A, Gnutzmann D, Bellemann N, Mokry T, Kortes N, Sommer C, Gotthard D, Weiss KH, Stampfl U, Kauczor HU, Radeleff B. Erste Erfahrungen mit der superselektiven TANDEM® TACE in Heidelberg. ROFO-FORTSCHR RONTG 2014. [DOI: 10.1055/s-0034-1373007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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50
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Hoegen P, Müller-Eschner M, Schalck S, Unterhinninghofen R, Geisbüsch P, Kauczor HU, Tengg-Kobligk HV. Endovaskuläre Therapie (TEVAR) bei Typ-B-Aortendissektionen: In vivo Konfiguration von Stentgrafts postinterventionell und im Follow-Up im Vergleich zu Herstellerangaben. ROFO-FORTSCHR RONTG 2014. [DOI: 10.1055/s-0034-1373026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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