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  • 11
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    Impact of quantitative pulmonary emphysema score on the rate of pneumothorax and chest tube insertion in CT-guided lung biopsies
    Springer Science and Business Media LLC ; 2020
    In:  Scientific Reports Vol. 10, No. 1 ( 2020-07-03)
    Details
    In: Scientific Reports, Springer Science and Business Media LLC, Vol. 10, No. 1 ( 2020-07-03)
    Abstract: The aim of this study was to evaluate the risk of pneumothorax and need for chest tube insertion in CT-guided lung biopsies and identify predictors focusing on pulmonary emphysema determined with quantitative computed tomography. To that end, we retrospectively analysed the incidence of pneumothorax and chest tube insertion in 371 CT-guided lung biopsies with respect to the quantitative emphysema score determined with the density mask technique. Other possible impact factors considered were lesion diameter, length of biopsy pathway within the lung parenchyma, lung lobe, needle size, puncture technique, patient positioning and interventionalist’s level of experience. Quantitative emphysema scores of the lung were significantly higher in patients who developed instant pneumothorax (27%, p   〈  0.0001), overall pneumothorax (38%, p  = 0.001) and had chest tube insertion (9%, p  = 0.006) compared to those who did not when analysed with the Mann–Whitney U-test. In logistic regression analysis with inclusion of the other possible impact factors, the quantitative emphysema score remained a statistically significant predictor for all three output parameters. This was confirmed with least absolute shrinkage and selection operator (Lasso) regression analysis. In conclusion, quantitatively determined pulmonary emphysema is a positive predictor of the pneumothorax rate in CT-guided lung biopsy and likelihood of chest tube insertion.
    Type of Medium: Online Resource
    ISSN: 2045-2322
    URL: Article
    DOI: 10.1038/s41598-020-67348-0
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2020
    detail.hit.zdb_id: 2615211-3
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  • 12
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    Effects of Artificial Intelligence-Derived Body Composition on Kidney Graft and Patient Survival in the Eurotransplant Senior Program
    MDPI AG ; 2022
    In:  Biomedicines Vol. 10, No. 3 ( 2022-02-26), p. 554-
    Details
    In: Biomedicines, MDPI AG, Vol. 10, No. 3 ( 2022-02-26), p. 554-
    Abstract: The Eurotransplant Senior Program allocates kidneys to elderly transplant patients. The aim of this retrospective study is to investigate the use of computed tomography (CT) body composition using artificial intelligence (AI)-based tissue segmentation to predict patient and kidney transplant survival. Body composition at the third lumbar vertebra level was analyzed in 42 kidney transplant recipients. Cox regression analysis of 1-year, 3-year and 5-year patient survival, 1-year, 3-year and 5-year censored kidney transplant survival, and 1-year, 3-year and 5-year uncensored kidney transplant survival was performed. First, the body mass index (BMI), psoas muscle index (PMI), skeletal muscle index (SMI), visceral adipose tissue (VAT), and subcutaneous adipose tissue (SAT) served as independent variates. Second, the cut-off values for sarcopenia and obesity served as independent variates. The 1-year uncensored and censored kidney transplant survival was influenced by reduced PMI (p = 0.02 and p = 0.03, respectively) and reduced SMI (p = 0.01 and p = 0.03, respectively); 3-year uncensored kidney transplant survival was influenced by increased VAT (p = 0.04); and 3-year censored kidney transplant survival was influenced by reduced SMI (p = 0.05). Additionally, sarcopenia influenced 1-year uncensored kidney transplant survival (p = 0.05), whereas obesity influenced 3-year and 5-year uncensored kidney transplant survival. In summary, AI-based body composition analysis may aid in predicting short- and long-term kidney transplant survival.
    Type of Medium: Online Resource
    ISSN: 2227-9059
    URL: Article
    DOI: 10.3390/biomedicines10030554
    Language: English
    Publisher: MDPI AG
    Publication Date: 2022
    detail.hit.zdb_id: 2720867-9
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  • 13
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    HBP-enhancing hepatocellular adenomas and how to discriminate them from FNH in Gd-EOB MRI
    Springer Science and Business Media LLC ; 2021
    In:  BMC Medical Imaging Vol. 21, No. 1 ( 2021-12)
    Details
    In: BMC Medical Imaging, Springer Science and Business Media LLC, Vol. 21, No. 1 ( 2021-12)
    Abstract: Recent studies provide evidence that hepatocellular  adenomas  (HCAs) frequently take up gadoxetic acid (Gd-EOB) during the hepatobiliary phase (HBP). The purpose of our study was to investigate how to differentiate between Gd-EOB-enhancing HCAs and focal nodular hyperplasias (FNHs). We therefore retrospectively included 40 HCAs classified as HBP Gd-EOB-enhancing lesions from a sample of 100 histopathologically proven HCAs in 65 patients. These enhancing HCAs were matched retrospectively with 28 FNH lesions (standard of reference: surgical resection). Two readers (experienced abdominal radiologists blinded to clinical data) reviewed the images evaluating morphologic features and subjectively scoring Gd-EOB uptake (25–50%, 50–75% and 75–100%) for each lesion. Quantitative lesion-to-liver enhancement was measured in arterial, portal venous (PV), transitional and HBP. Additionally, multivariate regression analyses were performed. Results Subjective scoring of intralesional Gd-EOB uptake showed the highest discriminatory accuracies (AUC: 0.848 (R#1); 0.920 (R#2)— p   〈  0.001) with significantly higher uptake scores assigned to FNHs (Cut-off: 75%-100%). Typical lobulation and presence of a central scar in FNH achieved an accuracy of 0.750 or higher in at least one reader (lobulation—AUC: 0.809 (R#1); 0.736 (R#2); central scar—AUC: 0.595 (R#1); 0.784 (R#2)). The multivariate regression emphasized the discriminatory power of the Gd-EOB scoring ( p  = 0.001/OR:22.15 (R#1) and p   〈  0.001/OR:99.12 (R#2). The lesion-to-liver ratio differed significantly between FNH and HCA in the PV phase and HBP (PV: 132.9 (FNH) and 110.2 (HCA), p  = 0.048 and HBP: 110.3 (FNH) and 39.2 (HCA), p   〈  0.001)), while the difference was not significant in arterial and transitional contrast phases ( p   〉  0.05). Conclusion Even in HBP-enhancing HCA, characterization of Gd-EOB uptake was found to provide the strongest discriminatory power in differentiating HCA from FNH. Furthermore, a lobulated appearance and a central scar are more frequently seen in FNH than in HCA.
    Type of Medium: Online Resource
    ISSN: 1471-2342
    URL: Article
    DOI: 10.1186/s12880-021-00552-0
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2021
    detail.hit.zdb_id: 2061975-3
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  • 14
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    Acute left ventricular insufficiency in a Burkitt Lymphoma patient with myocardial involvement and extensive local tumor cell lysis: a case report
    Springer Science and Business Media LLC ; 2022
    In:  BMC Cardiovascular Disorders Vol. 22, No. 1 ( 2022-12)
    Details
    In: BMC Cardiovascular Disorders, Springer Science and Business Media LLC, Vol. 22, No. 1 ( 2022-12)
    Abstract: Burkitt lymphoma (BL) is a rare disease with the sporadic variant accounting for less than 1% of adult non-Hodgkin lymphomas. BL usually presents with an abdominal bulk, but extranodal disease affecting the bone marrow and central nervous system is common. Cardiac manifestations, however, are exceedingly rare, with less than 30 cases reported in the literature. Case presentation We report on a 54-year-old male patient with a six week-long history of paranasal sinus swelling, fatigue and dyspnea on exertion. Stage IV sporadic BL with extensive lymphonodal and cardiovascular involvement was diagnosed. Manifestations included supra- and infradiaphragmatic lymphadenopathy as well as infiltration of the aortic root, the pericardium, the right atrium and the right ventricle. EBV-reactivation was detected, which is uncommon in the sporadic subtype. After initial full-dose chemotherapy with very good BL control, the patient developed acute, but fully reversible cardiac insufficiency. Myocardial lymphoma involvement receded completely during the following two therapy cycles, while cardiac function periodically deteriorated shortly after chemotherapy administration and quickly recovered thereafter. Interestingly, the decline in cardiac function lessened with decreasing myocardial lymphoma manifestation. Once the cardiovascular BL infiltration was resolved, cardiac function remained stable throughout further treatment. Following seven cycles of chemotherapy and mediastinal radiation, the patient is now in continued complete remission. Conclusions Although rare, cardiac involvement in BL can quickly become life-threatening due to rapid lymphoma doubling time and should therefore be considered at initial diagnosis. This case suggests an association between myocardial infiltration, chemotherapy associated tumor cell lysis and transient deterioration of cardiac function until the damage caused by the underlying lymphoma could be restored. While additional studies are needed to further elucidate the mechanisms of acute cardiac insufficiency due to lymphoma lysis in the infiltrated structures, prompt BL control and full recovery of the patient supports courageous treatment start despite extensive cardiovascular involvement.
    Type of Medium: Online Resource
    ISSN: 1471-2261
    URL: Article
    DOI: 10.1186/s12872-022-02480-5
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2022
    detail.hit.zdb_id: 2059859-2
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  • 15
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    Portosystemic shunt surgery in the era of TIPS: imaging-based planning of the surgical approach
    Springer Science and Business Media LLC ; 2020
    In:  Abdominal Radiology Vol. 45, No. 9 ( 2020-09), p. 2726-2735
    Details
    In: Abdominal Radiology, Springer Science and Business Media LLC, Vol. 45, No. 9 ( 2020-09), p. 2726-2735
    Abstract: With the spread of transjugular intrahepatic portosystemic shunts (TIPS), portosystemic shunt surgery (PSSS) has decreased and leaves more complex patients with great demands for accurate preoperative planning. The aim was to evaluate the role of imaging for predicting the most suitable PSSS approach. Material and methods Forty-four patients who underwent PSSS (2002 to 2013) were examined by contrast-enhanced CT ( n = 33) and/or MRI ( n = 15) prior to surgery. Imaging was analyzed independently by two observers (O1 and O2) with different levels of experience (O1 〉 O2). They recommended two shunting techniques (vessels and anastomotic variant) for each patient and ranked them according to their appropriateness and complexity. Findings were compared with the actually performed shunt procedure and its outcome. Results The first two choices taken together covered the performed PSSS regarding vessels in 88%/100% (CT/MRI, O1) and 76%/73% (O2); and vessels + anastomosis in 79%/73% (O1) and 67%/60% (O2). The prediction of complex surgical procedures (resection of interposing structures, additional thrombectomy, use of a collateral vessel, and use of a graft interposition) was confirmed in 87%, resulting in 80% sensitivity and 96% specificity. Larger shunt vessel distances were associated with therapy failure ( p = 0.030) and a vessel distance of ≥ 20 mm was identified as optimal cutoff, in which a graft interposition was used. There was no significant difference between MRI and CT in predicting the intraoperative decisions ( p = 0.294 to 1.000). Conclusion Preoperative imaging and an experienced radiologist can guide surgeons in PSSS. CT and MRI provide the information necessary to identify technically feasible variants and complicating factors.
    Type of Medium: Online Resource
    ISSN: 2366-004X , 2366-0058
    URL: Article
    DOI: 10.1007/s00261-020-02599-z
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2020
    detail.hit.zdb_id: 2845742-0
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  • 16
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    First PACS‐integrated artificial intelligence‐based software tool for rapid and fully automatic analysis of body composition from CT in clinical routine
    Wiley ; 2022
    In:  JCSM Clinical Reports Vol. 7, No. 1 ( 2022-01), p. 3-11
    Details
    In: JCSM Clinical Reports, Wiley, Vol. 7, No. 1 ( 2022-01), p. 3-11
    Abstract: To externally evaluate the first picture archiving communications system (PACS)‐integrated artificial intelligence (AI)‐based workflow, trained to automatically detect a predefined computed tomography (CT) slice at the third lumbar vertebra (L3) and automatically perform complete image segmentation for analysis of CT body composition and to compare its performance with that of an established semi‐automatic segmentation tool regarding speed and accuracy of tissue area calculation. Methods For fully automatic analysis of body composition with L3 recognition, U‐Nets were trained (Visage) and compared with a conventional image segmentation software (TomoVision). Tissue was differentiated into psoas muscle, skeletal muscle, visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT). Mid‐L3 level images from randomly selected DICOM slice files of 20 CT scans acquired with various imaging protocols were segmented with both methods. Results Success rate of AI‐based L3 recognition was 100%. Compared with semi‐automatic, fully automatic AI‐based image segmentation yielded relative differences of 0.22% and 0.16% for skeletal muscle, 0.47% and 0.49% for psoas muscle, 0.42% and 0.42% for VAT and 0.18% and 0.18% for SAT. AI‐based fully automatic segmentation was significantly faster than semi‐automatic segmentation (3 ± 0 s vs. 170 ± 40 s, P   〈  0.001, for User 1 and 152 ± 40 s, P   〈  0.001, for User 2). Conclusion Rapid fully automatic AI‐based, PACS‐integrated assessment of body composition yields identical results without transfer of critical patient data. Additional metabolic information can be inserted into the patient's image report and offered to the referring clinicians.
    Type of Medium: Online Resource
    ISSN: 2521-3555 , 2521-3555
    URL: Issue
    URL: Article
    DOI: 10.1002/crt2.v7.1
    DOI: 10.1002/crt2.44
    Language: English
    Publisher: Wiley
    Publication Date: 2022
    detail.hit.zdb_id: 3009848-8
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  • 17
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    Predictive influence of artificial intelligence‐based body composition analysis in trauma patients with pelvic injuries
    Wiley ; 2023
    In:  JCSM Clinical Reports Vol. 8, No. 3 ( 2023-07), p. 49-57
    Details
    In: JCSM Clinical Reports, Wiley, Vol. 8, No. 3 ( 2023-07), p. 49-57
    Abstract: High‐energy trauma patients represent the ultimate challenge to trauma care and are at risk of injury‐related mortality and morbidity—a common cause of loss of productivity. The aim of this study was to implement computed tomography (CT)‐derived, artificial intelligence (AI)‐based body composition analysis (BCA) to identify predictors of morbidity. Methods Retrospectively, we enrolled 104 patients (38 females and 66 males) who underwent CT imaging for assessment of injuries caused by high‐energy trauma (motor vehicle accidents, falls from significant height, or blast injury). We sought to identify risk factors for prolonged length of stay in hospital and intensive care unit (ICU) and fractures requiring pelvic surgery. Cox and logistic regression analysis were performed using BCA parameters as covariates besides conventional risk factors. Additionally, the effects of pre‐existing conditions, obesity, and sarcopenia were analysed. Results Increased subcutaneous adipose tissue (SAT), determined by BCA, at hospital admittance is a predictor of prolonged hospital stay ( P  = 0.02) independent of treatment regime and occurrence of related complications, whereas muscle mass does not influence the length of stay. Individuals with sarcopenia and a decreased psoas muscle index (PMI) sustaining high‐energy trauma are at risk of pelvic injuries requiring surgical treatment. Conclusion BCA parameters are easily available from routine CT and significantly predict outcomes in trauma patients with pelvic injuries. Patients with reduced muscle mass are at risk for injuries requiring pelvic surgery, and increased SAT is a risk factor for longer hospital stays. These findings underline the potential of BCA, which may be valuable in identifying trauma patients who require specific support to optimize their physiological reserves and clinical outcome.
    Type of Medium: Online Resource
    ISSN: 2521-3555 , 2521-3555
    URL: Issue
    URL: Article
    DOI: 10.1002/crt2.v8.3
    DOI: 10.1002/crt2.61
    Language: English
    Publisher: Wiley
    Publication Date: 2023
    detail.hit.zdb_id: 3009848-8
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  • 18
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    Hepatopulmonary shunting after surgical, interventional and systemic therapy in patients with liver malignancies scheduled for radioembolization
    SAGE Publications ; 2016
    In:  Acta Radiologica Vol. 57, No. 8 ( 2016-08), p. 908-913
    Details
    In: Acta Radiologica, SAGE Publications, Vol. 57, No. 8 ( 2016-08), p. 908-913
    Abstract: Hepatopulmonary shunts (HPS) lead to radiation exposure of the lungs in patients undergoing radioembolization (RE) of malignant liver tumors. Purpose To retrospectively analyze how HPS is affected by prior systemic or local therapy of the liver. Material and Methods The percentage HPS was calculated from SPECT/CT scans obtained after technetium-99 m macroaggregated albumin administration into hepatic arteries in 316 patients evaluated for RE. Results Patients with partial liver resection ( n = 80) did not differ in HPS from the remaining patient population ( n = 236) (HPS (median [range]) = 10.2 [2.1–48.3] resection % vs. 8.9 [2.3–32.9] no resection %; P = 0.527). In patients undergoing sequential RE, HPS was significantly higher in the liver lobe treated second ( n = 10; HPS = 6.4 [2.1–10.2] firstlobe/session % vs. 12.0 [2.0–24.6] second lobe/session %; P = 0.019). (Chemo-)embolization ( n = 19; HPS = 11.0 [2.8–48.3]%) or transcutaneous ablation ( n = 63; HPS = 8.8 [3.0–32.9] %) had no effect on HPS compared to patients without prior interventions (no (chemo-)embolization: n = 297; HPS = 9.3 [2.1–47.3]%; P = 0.489; no ablation: n = 253; HPS = 9.5 [2.1–48.3] %; P = 0.382). Pretreatment with sorafenib (HPS = 9.5 [2.3–35.9] yes % vs. 10.2 [2.8–42.0] no %; P = 0.777) orbevacizumab (HPS = 10.7 [2.1–30.6] yes % vs. 9.0 [3.9–23.3] no %; P = 0.870) had no effect on HPS. Conclusion Sequential RE results in an increase in the HPS in the contralateral liver lobe at the time of the second RE session. Other investigated therapy do not affect HPS.
    Type of Medium: Online Resource
    ISSN: 0284-1851 , 1600-0455
    URL: Article
    DOI: 10.1177/0284185115605680
    RVK:
    XA 10000
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2016
    detail.hit.zdb_id: 2024579-8
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  • 19
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    Tomoelastography for Measurement of Tumor Volume Related to Tissue Stiffness in Pancreatic Ductal Adenocarcinomas
    Ovid Technologies (Wolters Kluwer Health) ; 2020
    In:  Investigative Radiology Vol. 55, No. 12 ( 2020-12), p. 769-774
    Details
    In: Investigative Radiology, Ovid Technologies (Wolters Kluwer Health), Vol. 55, No. 12 ( 2020-12), p. 769-774
    Abstract: Estimations of tumor volume and boundary in pancreatic ductal adenocarcinoma (PDAC) are crucial for surgery planning. The aim of the study is to evaluate tomoelastography for detection of PDAC and quantification of PDAC volume based on tissue stiffness. Materials and Methods From March 2018 to December 2019, a total of 102 participants (30 healthy participants and 72 patients with histologically proven PDAC) were prospectively enrolled in a multicenter study. Multifrequency magnetic resonance elastography was combined with tomoelastography postprocessing to generate maps of shear wave speed (SWS) depicting highly resolved anatomical details of tissue stiffness. Subregional analysis of pancreatic head, body, and tail and reproducibility tests were performed in healthy participants, whereas tumorous (PDAC-T) and nontumorous (PDAC-NT) pancreatic tissue analysis was conducted in patients. In all patients, tumor volumes measured by computed tomography (CT) were compared with SWS-derived volumes. In addition, in 32 patients, tumor sizes were evaluated by macroscopy after resection. Results Tumor volumes were quantified in 99% and 87% of all cases with tomoelastography and CT, respectively. Pancreatic SWS was highly reproducible (repeatability coefficient = 0.12) and did not vary regionally or with patient age, sex, or body mass index (all P 〉 0.08). Shear wave speed was higher in PDAC-T (2.08 ± 0.38 m/s) than in healthy (1.25 ± 0.09 m/s; P 〈 0.001) and PDAC-NT (1.28 ± 0.14 m/s; P 〈 0.001) participants. A threshold of 1.47 m/s separated PDAC-T from healthy volunteers (area under the curve = 1.0, sensitivity = 100%, specificity = 100%), while 1.49 m/s separated PDAC-T from PDAC-NT with high accuracy (area under the curve = 0.99, sensitivity = 90%, specificity = 100%). Tomoelastography-derived tumor volume correlated with CT volume ( r = 0.91, P 〈 0.001) and ex vivo tumor volume ( r = 0.66, P 〈 0.001). Conclusions Tomoelastography provides a quantitative imaging marker for tissue stiffness depicting PDAC boundaries and separates PDAC from unaffected pancreatic tissue.
    Type of Medium: Online Resource
    ISSN: 1536-0210 , 0020-9996
    URL: Article
    DOI: 10.1097/RLI.0000000000000704
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
    detail.hit.zdb_id: 2041543-6
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  • 20
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    Pelvic Microcystic Lymphatic Malformation
    Radiological Society of North America (RSNA) ; 2023
    In:  Radiology Vol. 308, No. 1 ( 2023-07-01)
    Details
    In: Radiology, Radiological Society of North America (RSNA), Vol. 308, No. 1 ( 2023-07-01)
    Type of Medium: Online Resource
    ISSN: 0033-8419 , 1527-1315
    URL: Article
    DOI: 10.1148/radiol.230364
    RVK:
    XA 10000
    Language: English
    Publisher: Radiological Society of North America (RSNA)
    Publication Date: 2023
    detail.hit.zdb_id: 80324-8
    detail.hit.zdb_id: 2010588-5
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