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Dirrichs T, Tietz E, Rüffer A, Hanten J, Nguyen TD, Dethlefsen E, Kuhl CK. Photon-counting versus Dual-Source CT of Congenital Heart Defects in Neonates and Infants: Initial Experience. Radiology 2023; 307:e223088. [PMID: 37219443 DOI: 10.1148/radiol.223088] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Background Photon-counting CT (PCCT) has been shown to improve cardiovascular CT imaging in adults. Data in neonates, infants, and young children under the age of 3 years are missing. Purpose To compare image quality and radiation dose of ultrahigh-pitch PCCT with that of ultrahigh-pitch dual-source CT (DSCT) in children suspected of having congenital heart defects. Materials and Methods This is a prospective analysis of existing clinical CT studies in children suspected of having congenital heart defects who underwent contrast-enhanced PCCT or DSCT in the heart and thoracic aorta between January 2019 and October 2022. CT dose index and dose-length product were used to calculate effective radiation dose. Signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were calculated by standardized region-of-interest analysis. SNR and CNR dose ratios were calculated. Visual image quality was assessed by four independent readers on a five-point scale: 5, excellent or absent; 4, good or minimal; 3, moderate; 2, limited or substantial; and 1, poor or massive. Results Contrast-enhanced PCCT (n = 30) or DSCT (n = 84) was performed in 113 children (55 female and 58 male participants; median age, 66 days [IQR, 15-270]; median height, 56 cm [IQR, 52-67]; and median weight, 4.5 kg [IQR, 3.4-7.1]). A diagnostic image quality score of at least 3 was obtained in 29 of 30 (97%) with PCCT versus 65 of 84 (77%) with DSCT. Mean overall image quality ratings were higher for PCCT versus DSCT (4.17 vs 3.16, respectively; P < .001). SNR and CNR were higher for PCCT versus DSCT with SNR (46.3 ± 16.3 vs 29.9 ± 15.3, respectively; P = .007) and CNR (62.0 ± 50.3 vs 37.2 ± 20.8, respectively; P = .001). Mean effective radiation doses were similar for PCCT and DSCT (0.50 mSv vs 0.52 mSv; P = .47). Conclusion At a similar radiation dose, PCCT offers a higher SNR and CNR and thus better cardiovascular imaging quality than DSCT in children suspected of having cardiac heart defects. © RSNA, 2023.
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Affiliation(s)
- Timm Dirrichs
- From the Department of Diagnostic and Interventional Radiology (T.D., E.T., E.D., C.K.K.), Department of Pediatric Heart Surgery (A.R., T.D.N.), and Department of Pediatric Cardiology (J.H.), RWTH Aachen University Hospital, Pauwelsstr 30, 52074 Aachen, Germany
| | - Eric Tietz
- From the Department of Diagnostic and Interventional Radiology (T.D., E.T., E.D., C.K.K.), Department of Pediatric Heart Surgery (A.R., T.D.N.), and Department of Pediatric Cardiology (J.H.), RWTH Aachen University Hospital, Pauwelsstr 30, 52074 Aachen, Germany
| | - André Rüffer
- From the Department of Diagnostic and Interventional Radiology (T.D., E.T., E.D., C.K.K.), Department of Pediatric Heart Surgery (A.R., T.D.N.), and Department of Pediatric Cardiology (J.H.), RWTH Aachen University Hospital, Pauwelsstr 30, 52074 Aachen, Germany
| | - Jens Hanten
- From the Department of Diagnostic and Interventional Radiology (T.D., E.T., E.D., C.K.K.), Department of Pediatric Heart Surgery (A.R., T.D.N.), and Department of Pediatric Cardiology (J.H.), RWTH Aachen University Hospital, Pauwelsstr 30, 52074 Aachen, Germany
| | - Thai Duy Nguyen
- From the Department of Diagnostic and Interventional Radiology (T.D., E.T., E.D., C.K.K.), Department of Pediatric Heart Surgery (A.R., T.D.N.), and Department of Pediatric Cardiology (J.H.), RWTH Aachen University Hospital, Pauwelsstr 30, 52074 Aachen, Germany
| | - Ebba Dethlefsen
- From the Department of Diagnostic and Interventional Radiology (T.D., E.T., E.D., C.K.K.), Department of Pediatric Heart Surgery (A.R., T.D.N.), and Department of Pediatric Cardiology (J.H.), RWTH Aachen University Hospital, Pauwelsstr 30, 52074 Aachen, Germany
| | - Christiane K Kuhl
- From the Department of Diagnostic and Interventional Radiology (T.D., E.T., E.D., C.K.K.), Department of Pediatric Heart Surgery (A.R., T.D.N.), and Department of Pediatric Cardiology (J.H.), RWTH Aachen University Hospital, Pauwelsstr 30, 52074 Aachen, Germany
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Stöhr R, Dirrichs T, Kneizeh K, Reinartz S, Frank D, Brachmann J, Schroeder J, Schurgers L, Göttsch C, Keszei A, Floege J, Marx N, Brandenburg V, Schuh A. Influence of rivaroxaban compared to vitamin K antagonist treatment upon development of cardiovascular calcification in patients with atrial fibrillation and/or pulmonary embolism. Clin Cardiol 2022; 45:352-358. [PMID: 35332571 PMCID: PMC9019879 DOI: 10.1002/clc.23819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 03/03/2022] [Accepted: 03/11/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Vitamin K antagonists (VKA) such as warfarin or phenprocoumon have been the mainstay of therapy for long-term oral anticoagulant therapy (OAT) in patients with atrial fibrillation or with pulmonary embolism. Due to interferences with matrix Gla-protein, an important vitamin K-dependent local calcification inhibitor in cardiovascular structures, VKA antagonists stimulate cardiovascular calcification (CVC). In contrast, rivaroxaban, a nonvitamin K-dependent oral anticoagulant (NOAC), should be neutral in terms of CVC. We seek to investigate these potential differences in CVC development between VKA versus NOACs in a randomized controlled trial (RCT). METHODS The influence of rivaroxaban compared to vitamin K antagonist treatment upon development of cardiovascular calcification in patients with atrial fibrillation and/or pulmonary embolism trial (NCT02066662) is a multicenter, prospective RCT with a two-arm, open-label study design. The primary endpoint is the progression of coronary and aortic valve calcification (quantified as calcification volume score) as assessed by cardiac computed tomography (CT) at 24 months in patients either treated by rivaroxaban or VKA. A total of 192 patients were randomized in a 1:1 fashion. The main inclusion criteria were the presence of atrial fibrillation and/or pulmonary embolism with the indication for OAT and pre-existent coronary calcification. The development of CVC will be assessed by follow-up CT at 12 and 24 months. RESULTS In total 192 patients (median age 70, 72% male) were enrolled over a period of 5 years and followed up for 2 years.
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Affiliation(s)
- Robert Stöhr
- Department of Cardiology, RWTH University Hospital Aachen, Aachen, Germany
| | | | - Kinan Kneizeh
- Department of Cardiology, RWTH University Hospital Aachen, Aachen, Germany
| | - Sebastian Reinartz
- Department of Radiology, RWTH University Hospital Aachen, Aachen, Germany
| | - Dario Frank
- Department of Internal Medicine, St. Antonius Hospital, Eschweiler, Germany
| | | | - Joerg Schroeder
- Department of Cardiology, RWTH University Hospital Aachen, Aachen, Germany
| | - Leon Schurgers
- Department of Biochemistry, Maastricht University Hospital, Maastricht, The Netherlands.,Institute of Experimental Medicine and Systems Biology, RWTH Aachen University, Aachen, Germany
| | - Claudia Göttsch
- Department of Cardiology, RWTH University Hospital Aachen, Aachen, Germany
| | - Andras Keszei
- Center for Translational and Clinical Research, RWTH Aachen University, Aachen, Germany
| | - Jürgen Floege
- Department of Nephrology, RWTH University Hospital Aachen, Aachen, Germany
| | - Nikolaus Marx
- Department of Cardiology, RWTH University Hospital Aachen, Aachen, Germany
| | - Vincent Brandenburg
- Department of Cardiology and Nephrology, Rhein-Maas Klinikum, Würselen, Germany
| | - Alexander Schuh
- Department of Cardiology, RWTH University Hospital Aachen, Aachen, Germany.,Department of Cardiology, St.-Katharinen-Hospital, Frechen, Germany
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Gatz M, Bode D, Betsch M, Quack V, Tingart M, Kuhl C, Schrading S, Dirrichs T. Multimodal Ultrasound Versus MRI for the Diagnosis and Monitoring of Achilles Tendinopathy: A Prospective Longitudinal Study. Orthop J Sports Med 2021; 9:23259671211006826. [PMID: 33912619 PMCID: PMC8047827 DOI: 10.1177/23259671211006826] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 02/08/2021] [Indexed: 02/03/2023] Open
Abstract
Background: The diagnosis and monitoring of Achilles tendinopathy with imaging are challenging. There is a lack of studies comparing the diagnostic accuracy of magnetic resonance imaging (MRI), brightness mode ultrasound (B-mode), and power Doppler ultrasound with recent technologies such as ultrasound tissue characterization (UTC) and shear wave elastography (SWE). Purpose: To assess whether SWE and UTC, which offer quantitative values, show a superior diagnostic accuracy and capacity to detect structural improvement in Achilles tendinopathy compared with MRI, B-mode, or power Doppler. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: Patients with insertional (n = 28) and midportion (n = 38) Achilles tendinopathy were evaluated at baseline and 6-month follow-up using MRI, B-mode, power Doppler, SWE, and UTC. Asymptomatic controls (n = 37) were evaluated at T0. Diagnostic accuracy was analyzed based on a quantitative receiver operating characteristic (ROC) analysis with quantitative cutoff values (anteroposterior diameter, Öhberg score, UTC echo type, Young modulus) and by semiquantitative Likert scale–based assessment of experienced physicians. Results: For diagnosing insertional Achilles tendinopathy, semiquantitative MRI and power Doppler were most favorable (diagnostic accuracy, 95%), while the cross-sectional area of MRI revealed 89% accuracy in the ROC analyses (area under the curve [AUC], 0.911; P < .001). For diagnosing midportion Achilles tendinopathy, semiquantitative MRI and B-mode were most favorable (diagnostic accuracy, 87%), while UTC echo types 3 and 4 revealed 86% and 87% accuracy, respectively, in the ROC analyses (AUC, 0.911 and 0.941, respectively; P < .001). However, for quantitative and semiquantitative evaluation of diagnostic accuracy in both insertional and midportion Achilles tendinopathy, there was no significant difference in favor of one imaging modality over the others. Compared with baseline, only SWE showed a significant change at the 6-month follow-up (P = .003-.035), but there were only fair to poor monitoring accuracies of 71% (insertion) and 60% (midportion). However, compared with the other modalities, the monitoring accuracy of SWE was significantly higher (P = .002-.039). Conclusion: There was no statistically significant difference in favor of one imaging modality over the others, but MRI revealed the highest overall diagnostic accuracy for the diagnosis of both insertional and midportion Achilles tendinopathy.
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Affiliation(s)
- Matthias Gatz
- Department of Orthopedics, University Hospital RWTH Aachen, Aachen, Germany
| | - Daniela Bode
- Department of Orthopedics, University Hospital RWTH Aachen, Aachen, Germany.,Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Marcel Betsch
- University of Toronto Orthopaedic Sports Medicine Program (UTOSM), Women's College Hospital, Toronto, Ontario, Canada
| | - Valentin Quack
- Department for Trauma and Reconstructive Surgery, University Hospital Aachen, Aachen, Germany
| | - Markus Tingart
- Department of Orthopedics, University Hospital RWTH Aachen, Aachen, Germany
| | - Christiane Kuhl
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Simone Schrading
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany.,Department of Radiology and Nuclear Medicine, Kantonsspital Luzern, Luzern, Switzerland
| | - Timm Dirrichs
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany
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Laubach M, Hellmann JT, Dirrichs T, Gatz M, Quack V, Tingart M, Betsch M. Anterior knee pain after total knee arthroplasty: A multifactorial analysis. J Orthop Surg (Hong Kong) 2021; 28:2309499020918947. [PMID: 32338135 DOI: 10.1177/2309499020918947] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE Dissatisfaction and an impaired quality of life after total knee arthroplasty (TKA) is often associated with postsurgical anterior knee pain (AKP). The underlying pathological mechanisms are not yet fully understood. Therefore, a multifactorial approach encompassing clinical and radiological parameters seemed reasonable and promising to investigate postsurgical AKP. METHODS In this cross-sectional study, 25 patients without and 25 patients with postsurgical AKP after unilateral TKA were randomly recruited from a larger cohort of patients. Multiple clinical and radiological parameters-including real-time shear wave elastography (SWE) to measure the patellar and quadriceps tendon elasticity-were acquired and subsequently associated with AKP. For statistical analysis, SPSS (IBM, version 25) was used. RESULTS In total 50 participants (58.0% men, mean age 63.42 years, mean body mass index 29.75 kg/m2), having different prosthetic designs implanted, were included. Independently of key covariates, the strength of the quadriceps muscle (p = 0.021), a thinner inlay (p = 0.041), and a lower position of the patella (p = 0.041) were associated with AKP. Although no correlation with AKP was found (p = 0.346, resp. p = 0.154), we observed significantly decreased Young's modulus of the patellar and quadriceps tendons for the involved knee compared to the uninvolved knee (p < 0.001). CONCLUSION In conclusion, quadriceps muscle strength, inlay thickness, and the patella position might be of particular relevance in avoiding postsurgical AKP. Future studies with larger sample sizes are needed to clarify the impact of quadriceps muscle strength and the postoperative patella position as well as the role of SWE as a personalized modifiable prediction marker.
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Affiliation(s)
- Markus Laubach
- Department of Orthopaedics, RWTH Aachen University Hospital, Aachen, Germany
| | - Julian Tr Hellmann
- Department of Orthopaedics, RWTH Aachen University Hospital, Aachen, Germany
| | - Timm Dirrichs
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Aachen, Germany
| | - Matthias Gatz
- Department of Orthopaedics, RWTH Aachen University Hospital, Aachen, Germany
| | - Valentin Quack
- Department of Orthopaedics, RWTH Aachen University Hospital, Aachen, Germany
| | - Markus Tingart
- Department of Orthopaedics, RWTH Aachen University Hospital, Aachen, Germany
| | - Marcel Betsch
- Department of Orthopaedics, RWTH Aachen University Hospital, Aachen, Germany
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Gatz M, Schweda S, Betsch M, Dirrichs T, de la Fuente M, Reinhardt N, Quack V. Line- and Point-Focused Extracorporeal Shock Wave Therapy for Achilles Tendinopathy: A Placebo-Controlled RCT Study. Sports Health 2021; 13:511-518. [PMID: 33586526 PMCID: PMC8404720 DOI: 10.1177/1941738121991791] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Background: Extracorporeal shock wave therapy (ESWT) is a widely considered treatment option for Achilles tendinopathy. Line-focused ESWT is a novel technique treating a larger tendon area than point-focused ESWT. Monitoring capacities of clinical symptoms with ultrasound under ESWT treatment are unknown. Hypothesis: Point- and line-focused ESWT have a superior outcome than placebo ESWT. ESWT leads to morphological tendon changes detectable with ultrasound. Study Design: Single-blinded placebo-controlled randomized contolled trial. Level of Evidence: Level 1. Methods: The study was conducted in 3 cohorts, namely ESWT point (n = 21), ESWT line (n = 24), and ESWT placebo (n = 21). Victorian Institute of Sports Assessment–Achilles (VISA-A) score was measured before the intervention (T0), after 6 weeks (T1), and after 24 weeks (T2). All cohorts performed daily physiotherapy for 24 weeks and received 4 sessions of point-focused, line-focused, or placebo ESWT in the first 6 weeks. Ultrasound was performed with B-mode, power Doppler, shear wave elastography (SWE) at T0 and T2 and with ultrasound tissue characterization (UTC) at T0, T1, and T2. Data were analyzed with a mixed analysis of variance and t test. Results: There was a significant VISA-A improvement over time for all groups (P < 0.001). ESWT point had the strongest VISA-A score improvement +23 (ESWT line: +18; ESWT placebo: +15), but there was no significant interaction between time and any of the groups: F(4, 116) = 1.393; P = 0.24. UTC, power Doppler, and B-mode could not show significant alterations over time. SWE revealed a significant increase of elastic properties for ESWT point in the insertion (t = −3.113, P = 0.03) and midportion (t = −2.627, P = 0.02) over time. Conclusion: There is a significant VISA-A score improvement for all study groups without a statistically significant benefit for ESWT point or ESWT line compared with ESWT placebo. Tendon adaptation could only be detected with SWE for ESWT point. Clinical Relevance: The present study could not detect any statistically relevant effect of ESWT compared to placebo. SWE is able to demonstrate tendon adaptation.
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Affiliation(s)
- Matthias Gatz
- Department of Orthopaedic Surgery, RWTH Aachen University Clinic, Aachen, Germany
| | - Sebastian Schweda
- Department of Orthopaedic Surgery, RWTH Aachen University Clinic, Aachen, Germany
| | - Marcel Betsch
- Department of Orthopaedic Surgery, RWTH Aachen University Clinic, Aachen, Germany
| | - Timm Dirrichs
- Department of Radiology, RWTH Aachen University Clinic, Aachen, Germany
| | | | - Nina Reinhardt
- Chair of Medical Engineering, RWTH Aachen University, Aachen, Germany
| | - Valentin Quack
- Department of Orthopaedic Surgery, RWTH Aachen University Clinic, Aachen, Germany
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Gatz M, Betsch M, Quack V, Bejder L, Schrading S, Tingart M, Dirrichs T. Shear wave elastography for treatment monitoring of plantar fasciitis. J Sports Med Phys Fitness 2020; 60:1137-1147. [PMID: 32955840 DOI: 10.23736/s0022-4707.20.10702-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Plantar fasciitis is a common cause of heel pain. Monitoring therapy effects is challenging with conventional B-mode ultrasound. Shear wave elastography (SWE) provides important diagnostic information beyond B-mode, with typically lower tissue stiffness in symptomatic plantar fascia. Up to now little is known about SWE features for therapy monitoring in plantar fasciitis. We evaluated the clinical effects of a 3-month physical therapy based treatment and its influence on B-mode and SWE ultrasound findings in patients suffering from plantar fasciitis, correlating ultrasound findings to score-based symptom development. METHODS Prospective, IRB-approved clinical study in plantar fasciitis patients undergoing a 3-month physical therapy based treatment. Measurement time points were before (T0), after 1 (T1) and 3 (T2) months of treatment, consisting of clinical orthopedic (FFI, AOFAS-Score) and multimodal radiologic sonographic examinations (B-mode/SWE) using a high-resolution linear 18-MHz probe. RESULTS A total of 33 patients with 43 symptomatic plantar fascia were included. We found a significant (P<0.001) clinical score improvement (AOFAS +14, FFI-Pain -21, FFI-Function -18) between T0 and T2. Mean initial thickness (T0) of symptomatic plantar fascia was 4.2 (±1.2) mm, compared to 3.2 (±0.7) mm at the asymptomatic contralateral side (P<0.001). No significant thickness changes were seen at T1 (4.2±1.1 mm) and T2 (4.5±1.3 mm), even though clinical scores improved significantly. Mean initial stiffness (T0) of symptomatic plantar fascia was 59.57 (±43.3) kPa, compared to 83.23 (±47.3) kPa at the asymptomatic contralateral side (P<0.001). In contrast to B-mode ultrasound, SWE values increased significantly between T0 (59.6±43.3 kPa), T1 (82.6±47.3 kPa) and T2 (102.5±47.2 kPa) (P<0.001-0.009), with positive correlations for AOFAS/FFI-Pain/Function scores (r=0.285-0.473, P<0.001-0.002). CONCLUSIONS A physical therapy based treatment relieves plantar fasciitis symptoms during a 3-month period. In line with symptom reduction, stiffness (Young's-moduli) of plantar fascia increased significantly, while B-mode ultrasound revealed no measurable changes during the healing process. Shear wave elastography was able to quantify plantar fascia pathologies and their recovery under therapy.
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Affiliation(s)
- Matthias Gatz
- Department of Orthopedics, University Hospital RWTH Aachen, Aachen, Germany
| | - Marcel Betsch
- Department of Orthopedics, University Hospital RWTH Aachen, Aachen, Germany
| | - Valentin Quack
- Department of Orthopedics, University Hospital RWTH Aachen, Aachen, Germany
| | - Ljudmila Bejder
- Department of Orthopedics, University Hospital RWTH Aachen, Aachen, Germany
| | - Simone Schrading
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Markus Tingart
- Department of Orthopedics, University Hospital RWTH Aachen, Aachen, Germany
| | - Timm Dirrichs
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany -
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Schmoee J, Dirrichs T, Fehrenbacher K, Tietz E, Hardt F, Schmid M, Gohmann RF, Reinartz SD. Virtual Monoenergetic Images (VMI+) in Dual-Source Dual-Energy CT Venography (DSDE-CTV) of the Lower Extremity Prior to Coronary Artery Bypass Graft (CABG): A Feasibility Study. Acad Radiol 2020; 27:1249-1254. [PMID: 31843393 DOI: 10.1016/j.acra.2019.11.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 10/24/2019] [Accepted: 11/02/2019] [Indexed: 12/29/2022]
Abstract
RATIONALE AND OBJECTIVES To evaluate the image quality and suitability of Dual-Source Dual-Energy CT venography (DSDE-CTV) with asynchronous virtual monoenergetic images (VMI+) of the entire lower extremity in the context of pre-surgical assessment of complex cases prior to coronary bypass graft as a feasibility study. MATERIALS AND METHODS Fifteen consecutive patients, consisting of 5 females and 10 males with an average age of 52 ± 17 years underwent DSDE-CTV from the pubic symphysis to the ankles after intravenous injection of an iodinated contrast medium. DSDE-CTV was acquired with tube voltages of 80 kVp and sn140 kVp. Single spectrum images (A - 80 kVp; B - 140 kVp) as well as a linearly blended mixed data set (M_0.6) were reconstructed. By postprocessing, an VMI+ dataset at 40 keV was generated. Objective image quality parameters of the deep and superficial veins of thigh, knee, and calves were measured separately for each location. Signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were calculated. Additionally, subjective image quality was assessed independently by two radiologists. RESULTS Mean vascular attenuation was 73.9 ± 17.8 HU at B, 113.7 ± 42.2 HU at M_0.6, 119.4 ± 45.5 HU at A, and 201.0 ± 89.7 HU at VMI+. Mean CNR was 6.7 ± 2.0 at 140 keV, 9.25 ± 2.3 in the M_0.6 datasets, 8.7 ± 3.0 at 80 keV, and 12.9 ± 4.3 at 40 keV. Attenuation values were approximately doubled when compared to the reference standard (M_0.6) with significantly improved SNR and CNR (p < 0.05). Subjective image quality scores were highest for VMI+ datasets (4.1 ± 0.5) and lowest for B datasets (2.3 ± 0.37), however differences between VMI+ datasets and M_0.6 datasets did not reach statistical significance. CONCLUSION Postprocessing of dual-energy CTV with VMI+ significantly increases attenuation of veins and markedly improves SNR and CNR values, thereby improving the diagnostic quality of CTV for the evaluation of deep and superficial veins of the entire lower limb prior to coronary bypass graft.
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Schneider CV, Hamesch K, Gross A, Mandorfer M, Moeller LS, Pereira V, Pons M, Kuca P, Reichert MC, Benini F, Burbaum B, Voss J, Gutberlet M, Woditsch V, Lindhauer C, Fromme M, Kümpers J, Bewersdorf L, Schaefer B, Eslam M, Bals R, Janciauskiene S, Carvão J, Neureiter D, Zhou B, Wöran K, Bantel H, Geier A, Dirrichs T, Stickel F, Teumer A, Verbeek J, Nevens F, Govaere O, Krawczyk M, Roskams T, Haybaeck J, Lurje G, Chorostowska-Wynimko J, Genesca J, Reiberger T, Lammert F, Krag A, George J, Anstee QM, Trauner M, Datz C, Gaisa NT, Denk H, Trautwein C, Aigner E, Strnad P. Liver Phenotypes of European Adults Heterozygous or Homozygous for Pi∗Z Variant of AAT (Pi∗MZ vs Pi∗ZZ genotype) and Noncarriers. Gastroenterology 2020; 159:534-548.e11. [PMID: 32376409 DOI: 10.1053/j.gastro.2020.04.058] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 03/26/2020] [Accepted: 04/20/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND & AIMS Homozygosity for the Pi∗Z variant of the gene that encodes the alpha-1 antitrypsin peptide (AAT), called the Pi∗ZZ genotype, causes a liver and lung disease called alpha-1 antitrypsin deficiency. Heterozygosity (the Pi∗MZ genotype) is a risk factor for cirrhosis in individuals with liver disease. Up to 4% of Europeans have the Pi∗MZ genotype; we compared features of adults with and without Pi∗MZ genotype among persons without preexisting liver disease. METHODS We analyzed data from the European Alpha-1 Liver Cohort, from 419 adults with the Pi∗MZ genotype, 309 adults with the Pi∗ZZ genotype, and 284 individuals without the variant (noncarriers). All underwent a comprehensive evaluation; liver stiffness measurements (LSMs) were made by transient elastography. Liver biopsies were analyzed to define histologic and biochemical features associated with the Pi∗Z variant. Levels of serum transaminases were retrieved from 444,642 participants, available in the United Kingdom biobank. RESULTS In the UK biobank database, levels of serum transaminases were increased in subjects with the Pi∗MZ genotype compared with noncarriers. In the Alpha-1 Liver Cohort, adults with Pi∗MZ had lower levels of gamma-glutamyl transferase in serum and lower LSMs than adults with the Pi∗ZZ variant, but these were higher than in noncarriers. Ten percent of subjects with the Pi∗MZ genotype vs 4% of noncarriers had LSMs of 7.1 kPa or more (adjusted odds ratio, 4.8; 95% confidence interval, 2.0-11.8). Obesity and diabetes were the most important factors associated with LSMs ≥7.1 kPa in subjects with the Pi∗MZ genotype. AAT inclusions were detected in liver biopsies of 63% of subjects with the Pi∗MZ genotype, vs 97% of subjects with the Pi∗ZZ genotype, and increased with liver fibrosis stages. Subjects with the Pi∗MZ genotype did not have increased hepatic levels of AAT, whereas levels of insoluble AAT varied among individuals. CONCLUSIONS Adults with the Pi∗MZ genotype have lower levels of serum transaminases, fewer AAT inclusions in liver, and lower liver stiffness than adults with the Pi∗ZZ genotype, but higher than adults without the Pi∗Z variant. These findings should help determine risk of subjects with the Pi∗MZ genotype and aid in counseling.
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Affiliation(s)
- Carolin V Schneider
- Medical Clinic III, Gastroenterology, Metabolic diseases and Intensive Care, University Hospital RWTH Aachen, Aachen, Germany
| | - Karim Hamesch
- Medical Clinic III, Gastroenterology, Metabolic diseases and Intensive Care, University Hospital RWTH Aachen, Aachen, Germany; Coordinating Center for alpha-1 antitrypsin deficiency-related liver disease of the European Reference Network (ERN) "Rare Liver" and the European Association for the Study of the Liver (EASL) registry group "Alpha-1 Liver," University Hospital Aachen, Aachen, Germany
| | - Annika Gross
- Medical Clinic III, Gastroenterology, Metabolic diseases and Intensive Care, University Hospital RWTH Aachen, Aachen, Germany
| | - Mattias Mandorfer
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University Vienna, Vienna, Austria; Rare Liver Disease (RALID) Center of the European Reference Network (ERN) RARE-LIVER, Medical University Vienna, Vienna, Austria
| | - Linda S Moeller
- Department of Gastroenterology and Hepatology, Odense University Hospital, Odense, Denmark
| | - Vitor Pereira
- Department of Gastroenterology, Centro Hospitalar do Funchal, Madeira, Portugal
| | - Monica Pons
- Liver Unit, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute (VHIR), Universitat Autonoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid
| | - Pawel Kuca
- Department of Genetics and Clinical Immunology, National Institute of Tuberculosis and Lung Diseases, Warsaw, Poland
| | - Matthias C Reichert
- Department of Medicine II, Saarland University Medical Center, Saarland University, Homburg, Germany
| | - Federica Benini
- Gastroenterology Unit, Department of Medicine, Spedali Civili and University, Brescia, Italy
| | - Barbara Burbaum
- Medical Clinic III, Gastroenterology, Metabolic diseases and Intensive Care, University Hospital RWTH Aachen, Aachen, Germany
| | - Jessica Voss
- Medical Clinic III, Gastroenterology, Metabolic diseases and Intensive Care, University Hospital RWTH Aachen, Aachen, Germany
| | - Marla Gutberlet
- Medical Clinic III, Gastroenterology, Metabolic diseases and Intensive Care, University Hospital RWTH Aachen, Aachen, Germany
| | - Vivien Woditsch
- Medical Clinic III, Gastroenterology, Metabolic diseases and Intensive Care, University Hospital RWTH Aachen, Aachen, Germany
| | - Cecilia Lindhauer
- Medical Clinic III, Gastroenterology, Metabolic diseases and Intensive Care, University Hospital RWTH Aachen, Aachen, Germany
| | - Malin Fromme
- Medical Clinic III, Gastroenterology, Metabolic diseases and Intensive Care, University Hospital RWTH Aachen, Aachen, Germany
| | - Julia Kümpers
- Medical Clinic III, Gastroenterology, Metabolic diseases and Intensive Care, University Hospital RWTH Aachen, Aachen, Germany
| | - Lisa Bewersdorf
- Medical Clinic III, Gastroenterology, Metabolic diseases and Intensive Care, University Hospital RWTH Aachen, Aachen, Germany
| | - Benedikt Schaefer
- Department of Internal Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Mohammed Eslam
- Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital and University of Sydney, NSW, Australia
| | - Robert Bals
- Department of Internal Medicine V, Saarland University Medical Center, Homburg, Germany
| | | | - Joana Carvão
- Department of Gastroenterology, Centro Hospitalar do Funchal, Madeira, Portugal
| | - Daniel Neureiter
- Institute of Pathology, Paracelsus Medical University/Salzburger Landeskliniken (SALK), Salzburg, Austria
| | - Biaohuan Zhou
- Medical Clinic III, Gastroenterology, Metabolic diseases and Intensive Care, University Hospital RWTH Aachen, Aachen, Germany
| | - Katharina Wöran
- Department of Pathology, Medical University Vienna, Vienna, Austria
| | - Heike Bantel
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Andreas Geier
- Department of Hepatology, University of Wuerzburg, Wuerzburg, Germany
| | - Timm Dirrichs
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Aachen, Germany
| | - Felix Stickel
- Department of Gastroenterology and Hepatology, University Hospital of Zurich, Zürich, Switzerland
| | - Alexander Teumer
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany; DZHK (German Center for Cardiovascular Research), partner site Greifswald, Greifswald, Germany
| | - Jef Verbeek
- Department of Gastroenterology & Hepatology, University Hospitals KU Leuven, Leuven, Belgium
| | - Frederik Nevens
- Department of Gastroenterology & Hepatology, University Hospitals KU Leuven, Leuven, Belgium
| | - Olivier Govaere
- Translational & Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK; Newcastle NIHR Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Marcin Krawczyk
- Department of Medicine II, Saarland University Medical Center, Saarland University, Homburg, Germany; Department of Medicine II Saarland University Medical Center Saarland University Homburg Germany Laboratory of Metabolic Liver Diseases, Centre for Preclinical Research, Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Tania Roskams
- Department of Pathology, University Hospitals KU Leuven, Leuven, Belgium
| | - Johannes Haybaeck
- Department of Pathology, Neuropathology, and Molecular Pathology, Medical University of Innsbruck, Innsbruck, Austria; Diagnostic & Research Center for Molecular Biomedicine, Institute of Pathology, Medical University of Graz, Austria
| | - Georg Lurje
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Aachen, Germany; Department of Surgery, Campus Charité Mitte I Campus Virchow Klinikum Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Joanna Chorostowska-Wynimko
- Department of Genetics and Clinical Immunology, National Institute of Tuberculosis and Lung Diseases, Warsaw, Poland
| | - Joan Genesca
- Liver Unit, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute (VHIR), Universitat Autonoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid
| | - Thomas Reiberger
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University Vienna, Vienna, Austria; Rare Liver Disease (RALID) Center of the European Reference Network (ERN) RARE-LIVER, Medical University Vienna, Vienna, Austria
| | - Frank Lammert
- Department of Medicine II, Saarland University Medical Center, Saarland University, Homburg, Germany
| | - Aleksander Krag
- Department of Gastroenterology and Hepatology, Odense University Hospital, Odense, Denmark
| | - Jacob George
- Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital and University of Sydney, NSW, Australia
| | - Quentin M Anstee
- Translational & Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK; Newcastle NIHR Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Michael Trauner
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University Vienna, Vienna, Austria; Rare Liver Disease (RALID) Center of the European Reference Network (ERN) RARE-LIVER, Medical University Vienna, Vienna, Austria
| | - Christian Datz
- Department of Internal Medicine, Hospital Oberndorf, Teaching Hospital of the Paracelsus Private University of Salzburg, Oberndorf, Austria
| | - Nadine T Gaisa
- Institute of Pathology, University Hospital RWTH Aachen, Aachen, Germany
| | - Helmut Denk
- Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Christian Trautwein
- Medical Clinic III, Gastroenterology, Metabolic diseases and Intensive Care, University Hospital RWTH Aachen, Aachen, Germany; Coordinating Center for alpha-1 antitrypsin deficiency-related liver disease of the European Reference Network (ERN) "Rare Liver" and the European Association for the Study of the Liver (EASL) registry group "Alpha-1 Liver," University Hospital Aachen, Aachen, Germany
| | - Elmar Aigner
- First Department of Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Pavel Strnad
- Medical Clinic III, Gastroenterology, Metabolic diseases and Intensive Care, University Hospital RWTH Aachen, Aachen, Germany; Coordinating Center for alpha-1 antitrypsin deficiency-related liver disease of the European Reference Network (ERN) "Rare Liver" and the European Association for the Study of the Liver (EASL) registry group "Alpha-1 Liver," University Hospital Aachen, Aachen, Germany.
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Michalik R, Knod M, Siebers H, Gatz M, Dirrichs T, Eschweiler J, Quack V, Betsch M. Introduction and evaluation of a novel multi-camera surface topography system. Gait Posture 2020; 80:367-373. [PMID: 32619923 DOI: 10.1016/j.gaitpost.2020.06.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 06/10/2020] [Accepted: 06/11/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Surface topography can be used for the evaluation of spinal deformities without any radiation. However, so far this technique is limited to posterior trunk measurements due to the use of a single posterior camera. RESEARCH QUESTION Purpose of this study was to introduce a new multi camera surface topography system and to test its reliability and validity. METHODS The surface topograph uses a two-camera system for imaging and evaluating the subjects front and back simultaneously. Inter- and intra-rater reliability was tested on 40 human subjects by two observers. For validation human, subjects were scanned by MRI and surface-topography. For additional validation we used a phantom with an anthropomorphic body which was scanned by CT and surface topography. RESULTS Inter- (0.97-0.99) and intra-rater reliability (0.81-0.98) testing revealed good and excellent results in the detection of the body surface structures and measurement of areas and volumes. CT based validation revealed good correspondence between systems in the imaging and evaluation of the phantom model (0.61-10.52 %). Results on validation of human subjects revealed good to moderate results in the detection and measurements of almost all body surface structures (1.36-13.34 %). Only measurements using jugular notch as a reference showed moderate results in validity (0.62-27.5%) testing. SIGNIFICANCE We have introduced a novel and innovative surface topography system that allows for simultaneous anterior and posterior trunk measurements. The results of our reliability and validity tests are satisfactory. However, in particular around the jugular notch region further improvements in the surface topography reconstruction are needed.
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Affiliation(s)
- R Michalik
- Department for Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Aachen, Germany..
| | - M Knod
- Department of Orthopaedic Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - H Siebers
- Department of Orthopaedic Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - M Gatz
- Department of Orthopaedic Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - T Dirrichs
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany
| | - J Eschweiler
- Department of Orthopaedic Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - V Quack
- Department of Orthopaedic Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - M Betsch
- Department of Orthopaedic Surgery, University Hospital RWTH Aachen, Aachen, Germany
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10
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Gatz M, Betsch M, Bode D, Schweda S, Dirrichs T, Migliorini F, Tingart M, Quack V. Intra individual comparison of unilateral Achilles tendinopathy using B-mode, power Doppler, ultrasound tissue characterization and shear wave elastography. J Sports Med Phys Fitness 2020; 60:1462-1469. [PMID: 32586084 DOI: 10.23736/s0022-4707.20.11031-4] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The asymptomatic side of unilateral Achilles tendinopathy (AT) is used as a reference in ultrasound. However, this procedure has not been evaluated in a comparative analysis using B-mode (B-US), power Doppler (PD-US), ultrasound tissue characterization (UTC) and shear wave elastography (SWE). METHODS Retrospective cross-sectional study. Tendons were assigned to 3 groups: 1) asymptomatic side of unilateral AT N.=55; 2) symptomatic side of unilateral AT N.=55; and 3) young reference group N.=29. The following parameters were analyzed separately for the insertion and midportion: UTC (echo type I, II, III, IV), B-US (diameter, cross sectional area), PD-US (Öhberg Score) and SWE (SWE 3 mm, SWE area) using a Wilcoxon Test (group 1 vs. 2) and a Kruskal-Wallis Test (group 1 vs. 2 vs. 3). RESULTS The Wilcoxon Test making an isolated comparison between group 1 vs. 2 revealed a significant difference for all parameters of B-US, PD-US, UTC and SWE (P<0.001, P=0.042), except for the insertion in UTC. However, in the overall analysis including the reference group, the Kruskal-Wallis Test could only detect a significant difference between group 1 vs. 2 for PD-US (P<0.001). Thus, group 1 and 2 had significantly more pathological parameters in B-US (P<0.001, P=0.027), SWE (P<0.001, P=0.008) and UTC (type I, III, IV P<0.001) in both, insertion and midportion, compared to the reference group. CONCLUSIONS The asymptomatic side of unilateral AT seems to show subclinical tendons alterations in B-US, SWE and UTC in comparison to a young and healthy control group. The asymptomatic side of unilateral AT especially with detectable neovascularization might be at risk for future symptoms. Further studies must examine whether the asymptomatic side can still serve as a reference for intra individual comparison in clinical evaluation.
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Affiliation(s)
- Matthias Gatz
- Department of Orthopedics, University Hospital RWTH Aachen, Aachen, Germany -
| | - Marcel Betsch
- Department of Orthopedics, University Hospital RWTH Aachen, Aachen, Germany
| | - Daniela Bode
- Department of Orthopedics, University Hospital RWTH Aachen, Aachen, Germany.,Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Sebastian Schweda
- Department of Orthopedics, University Hospital RWTH Aachen, Aachen, Germany
| | - Timm Dirrichs
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Filippo Migliorini
- Department of Orthopedics, University Hospital RWTH Aachen, Aachen, Germany
| | - Markus Tingart
- Department of Orthopedics, University Hospital RWTH Aachen, Aachen, Germany
| | - Valentin Quack
- Department of Orthopedics, University Hospital RWTH Aachen, Aachen, Germany
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11
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Quack V, Betsch M, Hellmann J, Eschweiler J, Schrading S, Gatz M, Rath B, Tingart M, Laubach M, Kuhl CK, Dirrichs T. Evaluation of Postoperative Changes in Patellar and Quadriceps Tendons after Total Knee Arthroplasty-A Comprehensive Analysis by Shear Wave Elastography, Power Doppler and B-mode Ultrasound. Acad Radiol 2020; 27:e148-e157. [PMID: 31526688 DOI: 10.1016/j.acra.2019.08.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 08/12/2019] [Accepted: 08/13/2019] [Indexed: 02/04/2023]
Abstract
RATIONALE AND OBJECTIVES Up to now, the diagnosis of tendinopathies is based on conventional B-mode-ultrasound (B-US), Power Doppler-ultrasound (PD-US), and magnetic resonance imaging. In the past decade, Shear Wave Elastography (SWE) has been introduced in tendon imaging, for example in athletes or patients suffering from tendinopathy. SWE allows real-time quantification of tissue stiffness, and, by this, the assessment of the mechanical properties of a tendon and its changes during acute disease and tendon healing. So far there are no ultrasound-based studies that have evaluated postoperative tendon changes, anatomical and mechanical properties and tendon healing of the patellar, and quadriceps tendon following Total Knee Arthroplasty (TKA). The purpose of this prospective study was two-fold: first to analyze morphologic, vascular, and mechanical properties of patellar and quadriceps tendons in patients following TKA; and, second to evaluate possible changes thereof and their visibility in the course of time. MATERIALS AND METHODS Observational cross-sectional, IRB-approved study in 63 postoperative patients with a total of 76 total knee arthroplasties (50 unilateral, 13 bilateral) and 50 nonoperated knees for comparison, resulting in 152 postoperative patellar- and quadriceps and 100 nonoperated patellar- and quadriceps-tendons for comparative analysis. For further examination, we divided the 63 patients into two groups according to the duration since surgery (group A < 24 months; group B > 24 months). All patients completed a standardized questionnaire, furthermore the Knee Society score and the Knee Society function score. The amount of experienced pain was assessed using the ordinal numeric rating scale and the presence of anterior knee pain was examined. Subsequently every participant underwent a standardized multimodal ultrasound protocol consisting of B-US, PD-US, and SWE of the left and right patellar and quadriceps tendons. RESULTS Using the different US-modalities, operated patellar, and quadriceps tendons (n = 152) were significantly more frequent classified as pathological (B-US) (p < 0.001), the mean Ohberg score was significantly higher (PD-US) (p < 0.001), and the tendons were significantly softer (SWE) than their nonoperated counterparts (n = 100). Mean SWE-value of postoperative patellar tendons was 45.66 ± 14.84 kPa versus 60.08 ± 19.13 kPa in nonoperated knees (p < 0.001). Mean SWE-value of postoperative quadriceps tendons was 35.73 ± 15.66 kPa versus 52.69 ± 16.20 kPa in nonoperated knees (p < 0.001). Comparing the two postoperative groups (group A and B), we recognized a significant decrease of pathologically classified patellar and quadriceps tendons (B-US and PD-US) in group B. The early postoperatively reduced SWE values slightly increased during the course of time. CONCLUSION After TKA, patellar, and quadriceps tendons show significant measurable alterations in B-US, PD-US, and SWE. Especially a significant decrease of tendon stiffness in operated knees, as assessed by SWE, might be a surrogate marker for changed mechanical properties. These alterations improve, the longer ago the surgery was. The quantitative information obtained by SWE could be of particular interest in follow-up and therapy monitoring after TKA. Knowledge about tendon stiffness and it's varieties in different population groups (e.g. athletes, elderly, postoperative patients) is crucial to sonographically rate a tendon as "healthy" or "diseased."
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Affiliation(s)
- Valentin Quack
- Department of Orthopedics, University Hospital RWTH Aachen, Aachen, Germany
| | - Marcel Betsch
- Department of Orthopedics, University Hospital RWTH Aachen, Aachen, Germany
| | - Julian Hellmann
- Department of Orthopedics, University Hospital RWTH Aachen, Aachen, Germany
| | - Jörg Eschweiler
- Department of Orthopedics, University Hospital RWTH Aachen, Aachen, Germany
| | - Simone Schrading
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstraße 30, Aachen 52074, Germany
| | - Matthias Gatz
- Department of Orthopedics, University Hospital RWTH Aachen, Aachen, Germany
| | - Björn Rath
- Department of Orthopedics, University Hospital RWTH Aachen, Aachen, Germany
| | - Markus Tingart
- Department of Orthopedics, University Hospital RWTH Aachen, Aachen, Germany
| | - Markus Laubach
- Department of Orthopedics, University Hospital RWTH Aachen, Aachen, Germany
| | - Christiane K Kuhl
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstraße 30, Aachen 52074, Germany
| | - Timm Dirrichs
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstraße 30, Aachen 52074, Germany.
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Hardt F, Becker M, Brandenburg V, Grebe J, Dirrichs T, Gohmann RF, Fehrenbacher K, Schmoee J, Reinartz SD. Impact of epicardial adipose tissue volume upon left ventricular dysfunction in patients with mild-to-moderate aortic stenosis: A post-hoc analysis. PLoS One 2020; 15:e0229636. [PMID: 32119694 PMCID: PMC7051069 DOI: 10.1371/journal.pone.0229636] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 02/10/2020] [Indexed: 12/14/2022] Open
Abstract
Background Aortic stenosis (AS) may lead to diastolic dysfunction and later on heart failure (HF) with preserved left ventricular ejection fraction (HFpEF) via increased afterload and left-ventricular (LV) hypertrophy. Since epicardial adipose tissue (EAT) is a metabolically active fat depot that is adjacent to the myocardium and can influence cardiomyocytes and LV function via secretion of proinflammatory cytokines, we hypothesized that high amounts of EAT, as assessed by computed tomography (CT), may aggravate the development and severity of LV hypertrophy and diastolic dysfunction in the context of AS. Methods We studied 50 patients (mean age 71 ± 9 years; 9 women) in this preliminary study with mild or moderate AS and mild to severe LV diastolic dysfunction (LVDD), diagnosed by echocardiography, who underwent non-contrast cardiac CT and echocardiography. EAT parameters were measured on 2nd generation dual source CT. Conventional two-dimensional echocardiography and Tissue Doppler Imaging (TDI) was performed to assess LV function and to derive myocardial straining parameter. All patients had a preserved LV ejection fraction > 50%. Data was analysed using Pearson’s correlation. Results Only weak correlation was found between EAT volume or density and E/é ratio as LVDD marker (r = -.113 p = .433 and r = .260, p = .068 respectively). Also, EAT volume or density were independent from Global Strain Parameters (r = 0.058 p = .688 and r = -0.207 p = .239). E/é ratio was strongly associated with LVDD (r = .761 p≤0.0001) and Strain Parameters were moderately associated with LV Ejection Fraction (r = -.669 p≤0.001 and r = -.454 P≤0.005). Conclusions In this preliminary study in patients with AS, the EAT volume and density as assessed by CT correlated only weakly with LVDD, as expressed by the commonly used E/é ratio, and with LV strain function. Hence, measuring EAT volume and density may neither contribute to the prediction nor upon the severity of LVDD, respectively.
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Affiliation(s)
- F. Hardt
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany
- * E-mail:
| | - M. Becker
- Department of Cardiology, Angiology and Intensive Care, University Hospital RWTH Aachen, Aachen, Germany
| | - V. Brandenburg
- Department of Cardiology, Angiology and Intensive Care, University Hospital RWTH Aachen, Aachen, Germany
| | - J. Grebe
- Department of Cardiology, Angiology and Intensive Care, University Hospital RWTH Aachen, Aachen, Germany
| | - T. Dirrichs
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany
| | - R. F. Gohmann
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany
| | - K. Fehrenbacher
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany
| | - J. Schmoee
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany
| | - S. D. Reinartz
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany
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Gatz M, Betsch M, Tingart M, Michalik R, Migliorini F, Dirrichs T, Kuhl C, Quack V. Effect of a 12-week Eccentric and Isometric Training in Achilles Tendinopathy on the Gastrocnemius Muscle: an Ultrasound Shear Wave Elastography Study. Muscles Ligaments Tendons J 2020. [DOI: 10.32098/mltj.01.2020.12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- M. Gatz
- Department of Orthopedics, University Hospital RWTH Aachen, Aachen, Germany
| | - M. Betsch
- Department of Orthopedics, University Hospital RWTH Aachen, Aachen, Germany
| | - M. Tingart
- Department of Orthopedics, University Hospital RWTH Aachen, Aachen, Germany
| | - R. Michalik
- Department of Orthopedics, University Hospital RWTH Aachen, Aachen, Germany
| | - F. Migliorini
- Department of Orthopedics, University Hospital RWTH Aachen, Aachen, Germany
| | - T. Dirrichs
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany
| | - C. Kuhl
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany
| | - V. Quack
- Department of Orthopedics, University Hospital RWTH Aachen, Aachen, Germany
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14
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Gatz M, Bejder L, Quack V, Schrading S, Dirrichs T, Tingart M, Kuhl C, Betsch M. Shear Wave Elastography (SWE) for the Evaluation of Patients with Plantar Fasciitis. Acad Radiol 2020; 27:363-370. [PMID: 31153782 DOI: 10.1016/j.acra.2019.04.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 04/08/2019] [Accepted: 04/30/2019] [Indexed: 10/26/2022]
Abstract
RATIONALE AND OBJECTIVES The current imaging standard for diagnosing plantar fasciitis is B-Mode ultrasound (B-US). The aim of this study was to determine the diagnostic potential of Shear Wave Elastography (SWE) and the correlation of clinical scores to elastographic parameters. MATERIALS AND METHODS Diagnostic case-control study with n = 82 plantar fascia (PF). PF were divided into three subgroups: (1) symptomatic PF (n = 39); (2) control group of unilateral asymptomatic PF (n = 23); (3) bilateral asymptomatic PF (n = 20). Reference standard for positive findings in B-US was a PF thickness greater than 4 mm. For SWE tissue elasticity (Young's modulus kPa; shear wave speed m/s) was measured at Location 1: directly at the calcaneus; Location 2: +1 cm distal of the calcaneus and Location 3: central part of the calcaneus. Sensitivity, specificity, and diagnostic accuracy as well as correlation to American Orthopaedic Foot and Ankle Score (AOFAS) and Food Functional Index (FFI) were determined. RESULTS Symptomatic PF are thicker (4.2 mm, n = 39) than asymptomatic (3.0 mm, n = 43) (p < 0.001). Thickness of the PF (n = 82) correlated poorly to clinical scores (p = 0.001): FFI-pain (r = 0.349); FFI-function (r = 0.381); AOFAS (r = -0.387). Cut-off point for positive SWE finding was 51.5 kPa (4.14 m/s). Symptomatic PF (31.9 kPa, 3.26 m/s, n = 39) differ significantly from asymptomatic PF (93.3 kPa, 5.58 m/s, n = 43) with significant differences at L1 between all groups (p < 0.001). Correlation between Young's modulus (n = 82) and clinical scores was strong (p < 0.001): FFI-pain (r = -0.595); FFI-function (r = -0.567); AOFAS (r = 0.623,). B-US: sensitivity (61%), specificity (95%); SWE sensitivity (85%), specificity (83%). The combination of SWE and B-US increases the sensitivity (100%) with a diagnostic accuracy of 90%. CONCLUSION Based on our results, we could show that SWE can improve the diagnostic accuracy in patients with plantar fasciitis compared to B-US. LEVEL OF EVIDENCE II.
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Gatz M, Betsch M, Dirrichs T, Schrading S, Tingart M, Michalik R, Quack V. Eccentric and Isometric Exercises in Achilles Tendinopathy Evaluated by the VISA-A Score and Shear Wave Elastography. Sports Health 2020; 12:373-381. [PMID: 32003647 DOI: 10.1177/1941738119893996] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Apart from eccentric exercises (EE), isometric exercises (ISO) might be a treatment option for Achilles tendinopathy. Shear wave elastography (SWE) provides information for diagnosis and for monitoring tissue elasticity, which is altered in symptomatic tendons. HYPOTHESIS Isometric exercises will have a beneficial effect on patients' outcome scores. Based on SWE, insertional and midportion tendon parts will differ in their elastic properties according to current symptoms. STUDY DESIGN Randomized clinical trial. LEVEL OF EVIDENCE Level 2. METHODS Group 1 (EE; n = 20; 12 males, 8 females; mean age, 52 ± 8.98 years) and group 2 (EE + ISO; n = 22; 15 males, 7 females; mean age, 47 ± 15.11 years) performed exercises for 3 months. Measurement points were before exercises were initiated as well as after 1 and 3 months using the Victorian Institute of Sports Assessment-Achilles (VISA-A) score, American Orthopaedic Foot & Ankle Society score, and SWE (insertion and midportion). RESULTS Both groups improved significantly, but there were no significant interindividual differences (VISA-A; P = 0.362) between group 1 (n = 15; +15 VISA-A) and group 2 (n = 15; +15 VISA-A). The symptomatic insertion (symptomatic, 136.89 kPa; asymptomatic, 174.68 kPa; P = 0.045) and the symptomatic midportion of the Achilles tendon (symptomatic, 184.40 kPa; asymptomatic, 215.41 kPa; P = 0.039) had significantly lower Young modulus compared with the asymptomatic tendons. The midportion location had significantly higher Young modulus than the insertional part of the tendon (P = 0.005). CONCLUSION Isometric exercises do not have additional benefit when combined with eccentric exercises, as assessed over a 3-month intervention period. SWE is able to distinguish between insertional and midportion tendon parts in a symptomatic and asymptomatic state. CLINICAL RELEVANCE The present study shows no additional effect of ISO when added to baseline EE in treating Achilles tendinopathy. Different elastic properties of the insertional and midportion tendon have to be taken into consideration when rating a tendon as pathologic.
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Affiliation(s)
- Matthias Gatz
- Department of Orthopedics, University Hospital RWTH Aachen, Aachen, Germany
| | - Marcel Betsch
- Department of Orthopedics, University Hospital RWTH Aachen, Aachen, Germany
| | - Timm Dirrichs
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Simone Schrading
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Markus Tingart
- Department of Orthopedics, University Hospital RWTH Aachen, Aachen, Germany
| | - Roman Michalik
- Department of Orthopedics, University Hospital RWTH Aachen, Aachen, Germany
| | - Valentin Quack
- Department of Orthopedics, University Hospital RWTH Aachen, Aachen, Germany
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Michalik R, Siebers H, Eschweiler J, Quack V, Gatz M, Dirrichs T, Betsch M. Development of a new 360-degree surface topography application. Gait Posture 2019; 73:39-44. [PMID: 31299502 DOI: 10.1016/j.gaitpost.2019.06.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 06/06/2019] [Accepted: 06/28/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Surface-topography has been used for almost two decades in the radiation-free clinical evaluation of spinal posture. So far, it was limited to the analysis of back surface and spine. In order to better understand, diagnose and treat complex spinal pathologies, it is important to measure the whole torso. RESEARCH QUESTION Purpose of this study was to introduce and test an application that allows 360° reconstruction and analysis of the patient's torso. METHODS The application uses the information gathered from eight distinct scans and angles. For validation we used an Alderson phantom as an anthropomorphic body. Defined areas and volumes were measured by CT and surface-topography. Inter- and intra-rater reliability was tested in 35 healthy subjects by two observers. RESULTS The results revealed good correspondence between systems in the imaging and evaluation of the Alderson model (5.3-0.5%). Inter- (0.9-0.98) and intra-rater reliability (0.8-0.95) testing revealed good and excellent results in the detection of almost all body surface structures and measurement of areas and volumes. Only area and volume measurements using jugular notch as a reference showed partly moderate results in reliability (0.62-0.93) testing. SIGNIFICANCE We were able to introduce a novel 360° torso scan application using surface topography to reconstruct torso measurements. The results of our study showed its high validity and reliability. In the future, this application needs to be tested in patients with spinal pathologies. In summary, this new application may help to better understand, diagnose and treat patients with pathologies of torso and spine.
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Affiliation(s)
- R Michalik
- Department of Orthopaedics, University Hospital RWTH Aachen, Aachen, Germany.
| | - H Siebers
- Department of Orthopaedics, University Hospital RWTH Aachen, Aachen, Germany
| | - J Eschweiler
- Department of Orthopaedics, University Hospital RWTH Aachen, Aachen, Germany
| | - V Quack
- Department of Orthopaedics, University Hospital RWTH Aachen, Aachen, Germany
| | - M Gatz
- Department of Orthopaedics, University Hospital RWTH Aachen, Aachen, Germany
| | - T Dirrichs
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany
| | - M Betsch
- Department of Orthopaedics, University Hospital RWTH Aachen, Aachen, Germany
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Gatz M, Schrading S, Dirrichs T, Betsch M, Tingart M, Rath B, Kuhl C, Quack V. Topical polidocanol application in combination with static stretching in tendinopathies: a prospective pilot study. Muscles Ligaments Tendons J 2019. [DOI: 10.32098/mltj.01.2017.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- M. Gatz
- Department of Orthopaedics, RWTH Aachen, Germany
| | - S. Schrading
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Germany
| | - T. Dirrichs
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Germany
| | - M. Betsch
- Department of Orthopaedics, RWTH Aachen, Germany
| | - M. Tingart
- Department of Orthopaedics, RWTH Aachen, Germany
| | - B. Rath
- Department of Orthopaedics, RWTH Aachen, Germany
| | - C. Kuhl
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Germany
| | - V. Quack
- Department of Orthopaedics, RWTH Aachen, Germany
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Dirrichs T, Quack V, Gatz M, Tingart M, Rath B, Betsch M, Kuhl CK, Schrading S. Shear Wave Elastography (SWE) for Monitoring of Treatment of Tendinopathies: A Double-blinded, Longitudinal Clinical Study. Acad Radiol 2018; 25:265-272. [PMID: 29153963 DOI: 10.1016/j.acra.2017.09.011] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 08/16/2017] [Accepted: 09/08/2017] [Indexed: 10/18/2022]
Abstract
RATIONALE AND OBJECTIVES We aimed to investigate the diagnostic accuracy with which shear wave elastography (SWE) can be used to monitor response to treatment of tendinopathies, and to compare it to conventional ultrasound (US)-imaging methods (B-mode US (B-US) and power Doppler US (PD-US)). MATERIALS AND METHODS A prospective Institutional Review Board-approved longitudinal study on 35 patients with 47 symptomatic tendons (17 Achilles-, 15 patellar-, and 15 humeral-epicondylar) who underwent standardized multimodal US and standardized clinical assessment before and after 6 months of treatment (tailored stretching exercise, sport break, and local Polidocanol) was carried out. All US studies were performed by radiologists blinded to the clinical symptoms on both tendon sides to avoid biased interpretations, by B-US, PD-US, and SWE, conducted in the same order, using a high-resolution linear 15 MHz probe (Aixplorer). Orthopedic surgeons who were in turn blinded to US imaging results used established orthopedic scores (Victorian Institute of Sports Assessment questionnaire for Achilles, Victorian Institute of Sports Assessment questionnaire for patellar tendons, and Disability Arm Shoulder Hand scoring system) to rate presence, degree, and possible resolution of symptoms. We analyzed the diagnostic accuracy with which the different US imaging methods were able to detect symptomatic tendons at baseline as well as treatment effects, with orthopedic scores serving as reference standard. RESULTS B-US, PD-US, and SWE detected symptomatic tendons with a sensitivity of 66% (31 of 47), 72% (34 of 47), and 87.5% (41 of 47), respectively. Positive predictive value was 0.67 for B-US, 0.87 for PD-US, and 1 for SWE. After treatment, clinical scores improved in 68% (32 of 47) of tendons. Treatment effects were observable by B-US, PD-US, and SWE with a sensitivity of 3.1% (1 of 32), 28.1% (9 of 32), and 81.3% (26 of 32), respectively. B-US was false-positive in 68.8% (20 of 32), PD-US in 46.9% (15 of 32), and SWE in 12.5% (4 of 32) (SWE). Clinical scores and B-US, PD-US, and SWE findings correlated poorly (r = 0.24), moderately (r = 0.59), and strongly (r = 0.80). CONCLUSION Unlike B-US or PD-US, SWE is able to depict processes associated with tendon healing and may be a useful tool to monitor treatment effects.
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Gatz M, Schrading S, Dirrichs T, Betsch M, Tingart M, Rath B, Kuhl C, Quack V. Topical polidocanol application in combination with static stretching in tendinopathies: a prospective pilot study. Muscles Ligaments Tendons J 2017; 7:88-97. [PMID: 28717616 DOI: 10.11138/mltj/2017.7.1.088] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Highly operator-based injection therapy with vasosclerosing and anesthetic polidocanol is used for tendinopathies. This pilot-study evaluates the topical application of polidocanol gel. METHODS Prospective case series. 39 patients with tendinopathies (14 Achilles, 14 patella, 11 wrist extensors) with a symptom duration > 6 months were included. Polidocanol and static stretching were the therapy in the first 2 weeks, while static stretching was continuously performed for 6 months. Clinical outcome was evaluated with VISA-A, VISA-P and DASH Scores and sonographically with B-Mode (B-Mode), Power Doppler (PD) and Shearwave Elastography (SWE). RESULTS 22 patients clinically improved (>+10 score points), 11 patients were without improvement (<+ 10) and 1 patient worsened during 6 months. The VISA-A Score increased in average 19 points from 56 to 75 (p< 0.01), VISA-P Score increased 13 points from 59 to 72 (p< 0,01) and the DASH-Score decreased 20 points from 40 to 20 (p< 0,01). SWE correlates better than B-Mode or PD with symptom improvement. CONCLUSION The combination of static training and topical polidocanol application seems to be successful in the treatment of tendinopathies. Further RCT studies need to evaluate the efficiency of topical polidocanol application. SWE is a more sensitive tool to describe symptom development than PD or B-Mode. LEVEL OF EVIDENCE IV.
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Affiliation(s)
| | - Simone Schrading
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Germany
| | - Timm Dirrichs
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Germany
| | | | | | - Björn Rath
- Department of Orthopaedics, RWTH Aachen, Germany
| | - Christiane Kuhl
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Germany
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Schrading S, Dirrichs T, Schneider H, Kuhl C. Upgrade-Raten nach MR-geführter Vakuum-Biopsie (MR-g VAB). ROFO-FORTSCHR RONTG 2017. [DOI: 10.1055/s-0037-1600340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- S Schrading
- Klinik für Diagnostische und Interventionelle Radiologie der RWTH Aaachen, Aachen
| | - T Dirrichs
- Klinik für Diagnostische und Interventionelle Radiologie der RWTH Aaachen, Aachen
| | - H Schneider
- Klinik für Diagnostische und Interventionelle Radiologie der RWTH Aaachen, Aachen
| | - C Kuhl
- Klinik für Diagnostische und Interventionelle Radiologie der RWTH Aaachen, Aachen
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Schrading S, Keulers A, Dirrichs T, Strobel K, Kuhl C. Früherkennung des Mammakarzinoms: Welchen Einfluss hat die mammografische Drüsengewebs-Dichte tatsächlich bei mammografisch okkulten Karzinomen? ROFO-FORTSCHR RONTG 2017. [DOI: 10.1055/s-0037-1600338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- S Schrading
- Klinik für Diagnostische und Interventionelle Radiologie der RWTH Aaachen, Aachen
| | - A Keulers
- Klinik für Diagnostische und Interventionelle Radiologie der RWTH Aaachen, Aachen
| | - T Dirrichs
- Klinik für Diagnostische und Interventionelle Radiologie der RWTH Aaachen, Aachen
| | - K Strobel
- Klinik für Diagnostische und Interventionelle Radiologie der RWTH Aaachen, Aachen
| | - C Kuhl
- Klinik für Diagnostische und Interventionelle Radiologie der RWTH Aaachen, Aachen
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Dirrichs T, Kuhl C, Quack V, Hamm N, Schrading S. Auf der Suche nach Referenzwerten: Scherwellenelastografie (SWE) asymptomatischer Achilles-Sehnen: Ein Vergleich zwischen professionellen Athleten und der Normalbevölkerung. ROFO-FORTSCHR RONTG 2017. [DOI: 10.1055/s-0037-1600360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- T Dirrichs
- Uniklinik RWTH Aachen, Klinik für Diagnostische und Interventionelle Radiologie, Aachen
| | - C Kuhl
- Klinik für Diagnostische und Interventionelle Radiologie, Uniklinik RWTH Aachen, Aachen
| | - V Quack
- Klinik für Orthopädie, Uniklinik RWTH Aachen, Aachen
| | - N Hamm
- Klinik für Diagnostische und Interventionelle Radiologie, Uniklinik RWTH Aachen, Aachen
| | - S Schrading
- Klinik für Diagnostische und Interventionelle Radiologie, Uniklinik RWTH Aachen, Aachen
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Schrading S, Keulers A, Dirrichs T, Arnemann J, Kuhl C. Suche nach einem bildgebenden Biomarker für eine Tamoxifen-Resistenz: Korrelation des Hintergrund-Anreicherns (BPE) in der Mamma-MRT mit dem CYP2D6 Genotyp bei Patientinnen unter Tamoxifen-Therapie. ROFO-FORTSCHR RONTG 2017. [DOI: 10.1055/s-0037-1600339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- S Schrading
- Klinik für Diagnostische und Interventionelle Radiologie der RWTH Aaachen, Aachen
| | - A Keulers
- Klinik für Diagnostische und Interventionelle Radiologie der RWTH Aaachen, Aachen
| | - T Dirrichs
- Klinik für Diagnostische und Interventionelle Radiologie der RWTH Aaachen, Aachen
| | | | - C Kuhl
- Klinik für Diagnostische und Interventionelle Radiologie der RWTH Aaachen, Aachen
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Michalik R, Schrading S, Dirrichs T, Prescher A, Kuhl CK, Tingart M, Rath B. New approach for predictive measurement of knee cartilage defects with three-dimensional printing based on CT-arthrography: A feasibility study. J Orthop 2016; 14:95-103. [PMID: 27829733 DOI: 10.1016/j.jor.2016.10.013] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Accepted: 10/13/2016] [Indexed: 11/26/2022] Open
Abstract
PURPOSE The aim was to prove the possibility of creating an exact module of knee cartilage defects using 3D printing. METHODS Defects were created in cadaver knees. CT-arthrography and 3-Tesla MRI were performed. Based on CTA images a model of the cartilage was created using 3D printing. Defect-sizes in the imaging modalities were compared. RESULTS Estimated lesion area in 3D model differed approximately 5% comparing to the defect sizes in knees. MRI underestimated the defect on average of 12%, whereas the CTA overestimated the defect about 3%. CONCLUSIONS We proved the feasibility of creating an accurate module of knee cartilage.
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Affiliation(s)
- R Michalik
- Department of Orthopaedic Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - S Schrading
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany
| | - T Dirrichs
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany
| | - A Prescher
- Institute of Molecular and Cellular Anatomy, University RWTH Aachen, Aachen, Germany
| | - C K Kuhl
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany
| | - M Tingart
- Department of Orthopaedic Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - B Rath
- Department of Orthopaedic Surgery, University Hospital RWTH Aachen, Aachen, Germany
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Dirrichs T, Quack V, Gatz M, Tingart M, Kuhl CK, Schrading S. Shear Wave Elastography (SWE) for the Evaluation of Patients with Tendinopathies. Acad Radiol 2016; 23:1204-13. [PMID: 27318786 DOI: 10.1016/j.acra.2016.05.012] [Citation(s) in RCA: 99] [Impact Index Per Article: 12.4] [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] [Received: 03/24/2016] [Revised: 05/11/2016] [Accepted: 05/12/2016] [Indexed: 11/28/2022]
Abstract
RATIONALE AND OBJECTIVES Shear wave elastography (SWE) has been shown to be a powerful tool to estimate tissue stiffness. The aim of this study was to compare the diagnostic accuracy of SWE to that of standard ultrasound (US) (combined use of B-mode US and power Doppler [PD] US) for diagnosing tendinopathies. MATERIALS AND METHODS This is a prospective institutional review board-approved study on 112 participants (mean age 42 ± 13.4 years) with chronic (>6 months) tendon pain in Achilles, patellar, or epicondylar tendons. Participants were systematically examined with US, PD, and SWE using a high-resolution linear 15 MHz probe (SuperSonic Imagine). A semiquantitative analysis of SWE color charts and a quantitative region of interest-based analysis of tendon elasticity were performed. SWE values of symptomatic and healthy tendons were compared by using Student t test. Clinical symptom scores served as the standard of reference. US findings were compared to clinical symptom scores by using Spearman correlation. RESULTS At semiquantitative analysis of SWE color charts, symptomatic tendons were rated as "soft" in 80/140 (57.1%), as "intermediate" in 54/140 (38.6%), and as "rigid" in 6/140 (4.3%). Healthy tendons were rated as "soft" in 8/84 (10%), as "intermediate" in 31/84 (37%), and as "rigid" in 45/84 (53%). At quantitative analysis, symptomatic tendons exhibited significantly lower mean SWE values (60.3 kPa/4.48 m/s; range 15.3-201.4 kPa/2.26-14.18 m/s) than healthy tendons (185 kPa/7.85 m/s; range 56-265 kPa/4.32-9.23 m/s) (P = 0.0004). SWE values correlated closely with patients' clinical symptoms obtained by clinical scores (r = 0.81). Overall sensitivity of conventional US and PD in detecting tendinopathies could be enhanced from 67.1% (94/140) to 94.3% (132/140) when combined with SWE. CONCLUSIONS SWE is a simple way to estimate tissue stiffness and, by reduced tissue rigidity, to identify tendon pathology. SWE significantly increases the diagnostic accuracy of tendon sonography and may prove to be a sensitive tool to early detect or monitor tendinopathy.
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Affiliation(s)
- Timm Dirrichs
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074 Aachen, Germany.
| | - Valentin Quack
- Department of Orthopedics, RWTH Aachen University Hospital, Aachen, Germany
| | - Matthias Gatz
- Department of Orthopedics, RWTH Aachen University Hospital, Aachen, Germany
| | - Markus Tingart
- Department of Orthopedics, RWTH Aachen University Hospital, Aachen, Germany
| | - Christiane K Kuhl
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074 Aachen, Germany
| | - Simone Schrading
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074 Aachen, Germany
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Dirrichs T, Quack V, Gatz M, Kuhl C, Schrading S. Einsatz der Scherwellenelastografie (SWE) zum Therapie-Monitoring bei Patienten mit Tendinopathien. ROFO-FORTSCHR RONTG 2016. [DOI: 10.1055/s-0036-1581702] [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: 10/22/2022]
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Detering S, Schrading S, Dirrichs T, Kuhl C. Integriertes axilläres LK-Staging im Rahmen der Mamma-MRT. ROFO-FORTSCHR RONTG 2016. [DOI: 10.1055/s-0036-1581631] [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: 10/22/2022]
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Dirrichs T, Quack V, Gatz M, Kuhl C, Schrading S. Additiver Nutzen der Scherwellen-Elastografie (SWE) in der Evaluation von symptomatischen Achilles-, Patellar- und Epicondylus humeri radialis und ulnaris-Tendinopathien. ROFO-FORTSCHR RONTG 2016. [DOI: 10.1055/s-0036-1581703] [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: 10/22/2022]
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Barros X, Dirrichs T, Koos R, Reinartz S, Kaesler N, Kramann R, Gladziwa U, Ketteler M, Floege J, Marx N, Torregrosa JV, Keszei A, Brandenburg VM. Epicardial adipose tissue in long-term hemodialysis patients: its association with vascular calcification and long-term development. J Nephrol 2015; 29:241-250. [PMID: 26253562 DOI: 10.1007/s40620-015-0221-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [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: 02/24/2015] [Accepted: 07/11/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND Epicardial adipose tissue (EAT) is associated with coronary artery disease (CAD) in the general population. EAT is suggested to promote CAD by paracrine mechanisms and local inflammation. We evaluated whether in chronic hemodialysis (HD) patients EAT associates with CAD, how the amount of EAT develops over time, and if EAT independently predicts the mortality risk. METHODS Post-hoc analysis of a prospective study in 59 chronic HD patients who underwent non-enhanced multi-slice computed tomography (MSCT) at baseline. Thirty-seven patients underwent another MSCT after 24 ± 5 months. We measured EAT volume (cm³) and Agatston calcification scores of coronary arteries (CAC) and aortic valves (AVC). All-cause mortality was assessed after a follow-up of 88 months (IQR 52-105). RESULTS Baseline EAT was 128.2 ± 60.8 cm³ and significantly higher than in a control group of non-renal patients (94 ± 46 cm³; p < 0.05). Median Agatston score for CAC was 329 (IQR 23-1181) and for AVC was 0 (IQR 0-25.3) in HD patients. We observed significant positive correlations between baseline EAT and age (r = 0.386; p = 0.003), BMI (r = 0.314; p = 0.016), CAC (r = 0.278; p = 0.03), and AVC (r = 0.282; p = 0.03). In multivariate analysis, age, BMI and AVC remained as significant predictors of EAT (p < 0.01). Calcification scores significantly increased over 2 years; in contrast EAT change was not significant (+11 %, IQR -10 to 24 %; p = 0.066). The limited patient number in the present study precludes analysis of the EAT impact upon survival. CONCLUSION EAT correlated significantly with cardiovascular calcification in long-term HD patients. Mean EAT did not significantly change over 2 years.
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Affiliation(s)
- Xoana Barros
- Department of Nephrology, University Hospital of the RWTH Aachen, Aachen, Germany. .,Department of Nephrology, Hospital Clinic, Carrer Villarroel 170, 08036, Barcelona, Spain.
| | - Timm Dirrichs
- Department of Radiology, University Hospital of the RWTH Aachen, Aachen, Germany
| | - Ralf Koos
- Department of Cardiology, Städtische Kliniken Mönchengladbach GmbH, Elisabeth-Krankenhaus Rheydt, Rheydt, Germany
| | - Sebastian Reinartz
- Department of Radiology, University Hospital of the RWTH Aachen, Aachen, Germany
| | - Nadine Kaesler
- Department of Nephrology, University Hospital of the RWTH Aachen, Aachen, Germany
| | - Rafael Kramann
- Department of Nephrology, University Hospital of the RWTH Aachen, Aachen, Germany
| | - Ulrich Gladziwa
- Dialysis Center, Kuratorium für Heimdialyse (KfH), Würselen, Germany
| | | | - Jürgen Floege
- Department of Nephrology, University Hospital of the RWTH Aachen, Aachen, Germany
| | - Nikolaus Marx
- Department of Cardiology, University Hospital of the RWTH Aachen, Aachen, Germany
| | - José V Torregrosa
- Department of Nephrology, Hospital Clinic, Carrer Villarroel 170, 08036, Barcelona, Spain
| | - András Keszei
- Department of Medical Informatics, University Hospital of the RWTH Aachen, Aachen, Germany
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Dirrichs T, Penzkofer T, Reinartz SD, Kraus T, Mahnken AH, Kuhl CK. Extracoronary Thoracic and Coronary Artery Calcifications on Chest CT for Lung Cancer Screening: Association with Established Cardiovascular Risk Factors - The "CT-Risk" Trial. Acad Radiol 2015; 22:880-9. [PMID: 25957500 DOI: 10.1016/j.acra.2015.03.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Revised: 02/28/2015] [Accepted: 03/02/2015] [Indexed: 02/06/2023]
Abstract
RATIONALE AND OBJECTIVES To investigate the correlation between prevalence and degree of coronary artery calcification (CAC) and extracoronary calcifications (ECCs), scored quantitatively according to Agatston and semiquantitatively by visual analysis, in chest computed tomography (CT) studies obtained for lung cancer screening in asymptomatic subjects and in patients with known coronary heart disease (CHD), and to compare the association of ECC and CAC to established cardiovascular risk factors. MATERIALS AND METHODS Prospective study on 501 males (67 ± 8 years) with a history of working dust exposure who underwent nongated low-dose chest CT for lung cancer screening. Of these, 63 (12.6%) had a history of CHD, the remaining 438 subjects (87.4%) were clinically asymptomatic and without a history of CHD. On the day of the CT study, subjects underwent a thorough clinical examination including blood tests and completed a standardized questionnaire to establish a complete medical history. ECC and CAC scores were quantified according to Agatston and, in addition, by visual rating of calcium load of individual vessel territories on a five-point scale from "absent" to "extensive." Results were correlated with the respective subjects' cardiovascular risk factors and with the presence or absence of CHD. RESULTS ECC scores correlated significantly with CAC scores (two-sided Spearman 0.515; P < .001). ECC scores were associated significantly (P < .001) with cardiovascular risk factors (smoking history, hypertension, diabetes, and hypercholesterolemia) and with subjects' Framingham/prospective cardiovascular münster study scores, whereas CAC scores were associated only with the presence of hypercholesterolemia. CAC scores were strongly associated with CHD than ECC scores (area under the curve, 0.88 vs. 0.66 at receiver operating characteristic analysis). Visual scoring of ECC/CAC load correlated closely with the respective Agatston values (P < .001) and revealed the same association (or lack thereof) with cardiovascular risk factors/CHD. CONCLUSIONS In nongated low-dose CT for lung cancer screening, CAC and ECC load can be accurately established by visual analysis. ECC and CAC scores correlate closely, but not perfectly. There is a strong association between established cardiovascular risk factors and ECC load, but not CAC load, providing further evidence that ECC scoring may complement CAC scoring for broader risk assessment, for example, regarding prediction of extracoronary vascular events.
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Dirrichs T, Quack V, Kuhl C, Schrading S. Charakterisierung gesunder und symptomatischer Patellar- und Achilles-Sehnen mittels Scherwellenelastografie (SWE). ROFO-FORTSCHR RONTG 2015. [DOI: 10.1055/s-0035-1551253] [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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Schrading S, Distelmaier M, Dirrichs T, Detering S, Brolund L, Strobel K, Kuhl CK. Digital breast tomosynthesis-guided vacuum-assisted breast biopsy: initial experiences and comparison with prone stereotactic vacuum-assisted biopsy. Radiology 2014; 274:654-62. [PMID: 25386875 DOI: 10.1148/radiol.14141397] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To use digital breast tomosynthesis (DBT)-guided vacuum-assisted biopsy (VAB) to sample target lesions identified at full-field digital screening mammography and compare clinical performance with that of prone stereotactic (PS) VAB. MATERIALS AND METHODS In this institutional review board-approved study, 205 patients with 216 mammographic findings suspicious for cancer were scheduled to undergo mammography-guided VAB. Written informed consent was obtained. PS VAB was performed in 159 patients with 165 target lesions. DBT VAB was performed in 46 consecutive patients with 51 target lesions. Tissue-sampling methods and materials (9-gauge needles) were the same with both systems. For calcifications, specimen radiographs were obtained, and for masses or architectural distortions, control mammography or DBT was performed to confirm adequate target lesion sampling. χ(2) and Student t tests were used to compare biopsy time, and the Fisher exact test was used to compare lesion type distribution for DBT versus PS VAB. RESULTS Technical success was achieved in 51 of 51 lesions (100%) with DBT VAB versus 154 of 165 lesions (93%) with PS VAB. In one of 11 lesions in which PS VAB failed, DBT VAB was performed successfully. Mean time to complete VAB was 13 minutes ± 3.7 for DBT VAB versus 29 minutes ± 10.1 for PS VAB (P < .0001). Reidentifying and targeting lesions during PS VAB took longer than it did during DBT VAB (P < .0001). Tissue sampling took about the same time for PS VAB and DBT VAB (P = .067). Significantly more "low-contrast" (ie, uncalcified) target lesions were biopsied with DBT VAB (13 of 51 lesions) versus PS VAB (nine of 165 lesions) (P < .0002). No major complications were observed with either system. One patient who underwent DBT VAB in the sitting position and one patient who underwent PS VAB developed self-limiting vasovagal reactions. CONCLUSION Clinical performance of DBT VAB was significantly superior to PS VAB. Because DBT VAB allows use of the full detector size for imaging and provides immediate lesion depth information without requiring triangulation, it facilitates target lesion reidentification and sampling of even low-contrast targets, such as uncalcified masses.
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Affiliation(s)
- Simone Schrading
- From the Department of Diagnostic and Interventional Radiology, University of Aachen, RWTH, Pauwelsstr 30, 52074 Aachen, Germany
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Strobel K, Schrading S, Hansen NL, Barabasch A, Dirrichs T, Gaspar CA, Kuhl CK. Mamma-MRT zur Abklärung unklarer mammografischer und sonografischer Befunde. ROFO-FORTSCHR RONTG 2014. [DOI: 10.1055/s-0034-1373171] [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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