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  • 1
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    Treatment of Acute Mesenteric Ischemia: Individual Challenges for Interventional Radiologists and Abdominal Surgeons
    MDPI AG ; 2022
    In:  Journal of Personalized Medicine Vol. 13, No. 1 ( 2022-12-27), p. 55-
    Details
    In: Journal of Personalized Medicine, MDPI AG, Vol. 13, No. 1 ( 2022-12-27), p. 55-
    Abstract: Background: Acute mesenteric ischemia (AMI) is a life-threatening condition resulting from occlusion of the mesenteric arterial vessels. AMI requires immediate treatment with revascularization of the occluded vessels. Purpose: to evaluate the technical success, clinical outcomes and survival of patients receiving endovascular treatment for AMI followed by surgery. Material and Methods: A search of our institution’s database for AMI revealed 149 potential patients between 08/2016 and 08/2021, of which 91 were excluded due to incomplete clinical data, insufficient imaging or missing follow-up laparoscopy. The final cohort included 58 consecutive patients [(median age 73.5 years [range: 43–96 years], 55% female), median BMI 26.2 kg/m2 (range:16.0–39.2 kg/m2)] . Periinterventional imaging regarding the cause of AMI (acute-embolic or acute-on-chronic) was evaluated by two radiologists in consensus. The extent of AMI and the degree of technical success was graded according to a modified TICI (Thrombolysis in Cerebral Infarction scale) score (TICI-AMI) classification (0: no perfusion; 1: minimal; 2a 〈 50% filling; 2b 〉 50%; 2c: near complete or slow; 3: complete). Lab data and clinical data were collected, including the results of follow-up laparoscopy. Non-parametric statistics were used. Results: All interventions were considered technically successful. The most common causes of AMI were emboli (51.7%) and acute-on-chronic thrombotic occlusions (37.9%). Initial imaging showed a TICI-AMI score of 0, 1 or 2a in 87.9% (n = 51) of patients. Post-therapeutic TICI-AMI scores improved significantly with 87.9% of patients grade 2b and better. Median lactate levels reduced from 2.7 (IQR 2.0–3.7) mg/dL (1–18) to 1.45 (IQR 0.99–1.90). Intestinal ischemia was documented in 79.1% of cases with resection of the infarcted intestinal loops. In total, 22/58 (37.9%) patients died during the first 30 days after intervention and surgery. According to CIRSE criteria, we did not observe any SAE scores of grade 2 or higher. Conclusions: AMI is a serious disease with high lethality within the first 30 days despite optimal treatment. However, interventional revascularization before surgery with resection of the infarcted bowel can save two out of three of critically ill patients.
    Type of Medium: Online Resource
    ISSN: 2075-4426
    URL: Article
    DOI: 10.3390/jpm13010055
    Language: English
    Publisher: MDPI AG
    Publication Date: 2022
    detail.hit.zdb_id: 2662248-8
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  • 2
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    Deep learning‐accelerated image reconstruction in MRI of the orbit to shorten acquisition time and enhance image quality
    Wiley ; 2024
    In:  Journal of Neuroimaging Vol. 34, No. 2 ( 2024-03), p. 232-240
    Details
    In: Journal of Neuroimaging, Wiley, Vol. 34, No. 2 ( 2024-03), p. 232-240
    Abstract: This study explores the use of deep learning (DL) techniques in MRI of the orbit to enhance imaging. Standard protocols, although detailed, have lengthy acquisition times. We investigate DL‐based methods for T2‐weighted and T1‐weighted, fat‐saturated, contrast‐enhanced turbo spin echo (TSE) sequences, aiming to improve image quality, reduce acquisition time, minimize artifacts, and enhance diagnostic confidence in orbital imaging. Methods In a 3‐Tesla MRI study of 50 patients evaluating orbital diseases from March to July 2023, conventional (TSE S ) and DL TSE sequences (TSE DL ) were used. Two neuroradiologists independently assessed the image datasets for image quality, diagnostic confidence, noise levels, artifacts, and image sharpness using a randomized and blinded 4‐point Likert scale. Results TSE DL significantly reduced image noise and artifacts, enhanced image sharpness, and decreased scan time, outperforming TSE S ( p   〈  .05). TSE DL showed superior overall image quality and diagnostic confidence, with relevant findings effectively detected in both DL‐based and conventional images. In 94% of cases, readers preferred accelerated imaging. Conclusion The study proved that using DL for MRI image reconstruction in orbital scans significantly cut acquisition time by 69%. This approach also enhanced image quality, reduced image noise, sharpened images, and boosted diagnostic confidence.
    Type of Medium: Online Resource
    ISSN: 1051-2284 , 1552-6569
    URL: Issue
    URL: Article
    DOI: 10.1111/jon.v34.2
    DOI: 10.1111/jon.13187
    Language: English
    Publisher: Wiley
    Publication Date: 2024
    detail.hit.zdb_id: 2035400-9
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  • 3
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    Quantification of Facial Fat Compartment Variations: A Three-Dimensional Morphometric Analysis of the Cheek
    Ovid Technologies (Wolters Kluwer Health) ; 2023
    In:  Plastic & Reconstructive Surgery Vol. 152, No. 4 ( 2023-10), p. 617e-627e
    Details
    In: Plastic & Reconstructive Surgery, Ovid Technologies (Wolters Kluwer Health), Vol. 152, No. 4 ( 2023-10), p. 617e-627e
    Abstract: Cheek contour is a main determinant of facial attractiveness. The aim of this study was to evaluate the relationship between age, sex, and body mass index (BMI) and cheek fat volume in a large cohort to better understand and treat facial aging. Methods: The authors performed a retrospective review of the archives of the Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen. Epidemiologic data and medical history were assessed. Cheek superficial and deep fat compartment volumes were measured on magnetic resonance images. Statistical analyses were performed using SPSS and SAS statistical software. Results: A total of 87 patients with a mean age of 46 years (range, 18 to 81 years) were included. The superficial and deep fat compartment volumes of the cheek increased with BMI ( P 〈 0.001 and P = 0.005), but there was no significant relationship between age and volume. The ratio of superficial versus deep fat did not change with age. No significant difference of the superficial or deep fat compartments was found between men and women in a regression analysis ( P = 0.931 and P = 0.057). Conclusions: Cheek fat volume measurements on magnetic resonance imaging scans using reconstruction software suggest that the fat volume of the cheek increases with BMI but does not change significantly with age. Further studies are needed to elucidate the role of age-related changes of bone structures or sagging of the fat compartments.
    Type of Medium: Online Resource
    ISSN: 0032-1052
    URL: Article
    DOI: 10.1097/PRS.0000000000010357
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2023
    detail.hit.zdb_id: 2037030-1
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  • 4
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    Enhanced Recovery After Surgery (ERAS) Pathways for Aesthetic Breast Surgery: A Prospective Cohort Study on Patient-Reported Outcomes
    Springer Science and Business Media LLC ; 2023
    In:  Aesthetic Plastic Surgery
    Details
    In: Aesthetic Plastic Surgery, Springer Science and Business Media LLC
    Abstract: Patients’ expectations of an anticipated timeline of recovery and fear of anesthesia in aesthetic breast surgery have not been studied. Objective This study aims to assess patient anxiety, expectations, and satisfaction after Enhanced Recovery after Surgery (ERAS) pathways for aesthetic breast surgery and the progress of postoperative recovery. Materials and methods All consecutive patients who underwent aesthetic breast surgery between April 2021 and August 2022 were included in this single-center prospective cohort study. The ERAS protocol consists of more than 20 individual measures in the pre-, intra-, and postoperative period. Epidemiological data, expectations, and recovery were systematically assessed with standardized self-assessment questionnaires, including the International Pain Outcome Questionnaire (IPO), the BREAST-Q or BODY-Q, and data collection forms. Results In total, 48 patients with a median of 30 years of age were included. Patients returned to most daily activities within 5 days. Eighty-eight percent of patients were able to accomplish daily activities sooner than expected. The time of return to normal daily activities was similar across all procedure types. There was no statistically significant difference regarding postoperative satisfaction between patients who recovered slower (12%) and patients who recovered as fast or faster (88%) than anticipated ( p =0.180). Patients reporting fear of anesthesia in the form of conscious sedation significantly diminished from 17 to 4% postoperatively ( p 〈 0.001). Conclusion Enhanced Recovery after Surgery (ERAS) pathways for aesthetic breast surgery are associated with rapid recovery and high patient satisfaction. This survey study provides valuable insight into patients’ concerns and perspectives that may be implemented in patient education and consultations to improve patient satisfaction following aesthetic treatments. Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
    Type of Medium: Online Resource
    ISSN: 0364-216X , 1432-5241
    URL: Article
    DOI: 10.1007/s00266-023-03392-1
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2023
    detail.hit.zdb_id: 1462126-5
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  • 5
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    Viabahn stent graft for arterial injury management: safety, technical success, and long-term outcome
    Springer Science and Business Media LLC ; 2024
    In:  CVIR Endovascular Vol. 7, No. 1 ( 2024-02-28)
    Details
    In: CVIR Endovascular, Springer Science and Business Media LLC, Vol. 7, No. 1 ( 2024-02-28)
    Abstract: The Viabahn stent graft has emerged as an integral tool for managing vascular diseases, but there is limited long-term data on its performance in emergency endovascular treatment. This study aimed to assess safety, technical success, and long-term efficacy of the Viabahn stent graft in emergency treatment of arterial injury. Methods We conducted a retrospective single tertiary centre analysis of patients who underwent Viabahn emergency arterial injury treatment between 2015 and 2020. Indication, intraoperative complications, technical and clinical success, and major adverse events at 30 days were evaluated. Secondary efficacy endpoints were the primary and secondary patency rates assessed by Kaplan–Meier analysis. Results Forty patients (71 ± 13 years, 19 women) were analyzed. Indications for Viabahn emergency treatment were extravasation (65.0%), arterio-venous fistula (22.5%), pseudoaneurysm (10.0%), and arterio-ureteral fistula (2.5%). No intraoperative adverse events occurred, technical and clinical success rates were 100%. One acute stent graft occlusion occurred in the popliteal artery on day 9, resulting in a 30-day device-related major-adverse-event rate of 2.5%. Median follow-up was 402 days [IQR, 43–1093]. Primary patency rate was 97% (95% CI: 94–100) in year 1, and 92% (95% CI: 86–98) from years 2 to 6. One stent graft occlusion occurred in the external iliac artery at 18 months; successful revascularization resulted in secondary patency rates of 97% (95% CI: 94–100) from years 1 to 6. Conclusion Using Viabahn stent graft in emergency arterial injury treatment had 100% technical and clinical success rates, a low 30-day major-adverse-event rate of 2.5%, and excellent long-term patency rates.
    Type of Medium: Online Resource
    ISSN: 2520-8934
    URL: Article
    DOI: 10.1186/s42155-024-00435-9
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2024
    detail.hit.zdb_id: 2934084-6
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  • 6
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    AI Denoising Significantly Improves Image Quality in Whole-Body Low-Dose Computed Tomography Staging
    MDPI AG ; 2022
    In:  Diagnostics Vol. 12, No. 1 ( 2022-01-17), p. 225-
    Details
    In: Diagnostics, MDPI AG, Vol. 12, No. 1 ( 2022-01-17), p. 225-
    Abstract: (1) Background: To evaluate the effects of an AI-based denoising post-processing software solution in low-dose whole-body computer tomography (WBCT) stagings; (2) Methods: From 1 January 2019 to 1 January 2021, we retrospectively included biometrically matching melanoma patients with clinically indicated WBCT staging from two scanners. The scans were reconstructed using weighted filtered back-projection (wFBP) and Advanced Modeled Iterative Reconstruction strength 2 (ADMIRE 2) at 100% and simulated 50%, 40%, and 30% radiation doses. Each dataset was post-processed using a novel denoising software solution. Five blinded radiologists independently scored subjective image quality twice with 6 weeks between readings. Inter-rater agreement and intra-rater reliability were determined with an intraclass correlation coefficient (ICC). An adequately corrected mixed-effects analysis was used to compare objective and subjective image quality. Multiple linear regression measured the contribution of “Radiation Dose”, “Scanner”, “Mode”, “Rater”, and “Timepoint” to image quality. Consistent regions of interest (ROI) measured noise for objective image quality; (3) Results: With good–excellent inter-rater agreement and intra-rater reliability (Timepoint 1: ICC ≥ 0.82, 95% CI 0.74–0.88; Timepoint 2: ICC ≥ 0.86, 95% CI 0.80–0.91; Timepoint 1 vs. 2: ICC ≥ 0.84, 95% CI 0.78–0.90; all p ≤ 0.001), subjective image quality deteriorated significantly below 100% for wFBP and ADMIRE 2 but remained good–excellent for the post-processed images, regardless of input (p ≤ 0.002). In regression analysis, significant increases in subjective image quality were only observed for higher radiation doses (≥0.78, 95%CI 0.63–0.93; p 〈 0.001), as well as for the post-processed images (≥2.88, 95%CI 2.72–3.03, p 〈 0.001). All post-processed images had significantly lower image noise than their standard counterparts (p 〈 0.001), with no differences between the post-processed images themselves. (4) Conclusions: The investigated AI post-processing software solution produces diagnostic images as low as 30% of the initial radiation dose (3.13 ± 0.75 mSv), regardless of scanner type or reconstruction method. Therefore, it might help limit patient radiation exposure, especially in the setting of repeated whole-body staging examinations.
    Type of Medium: Online Resource
    ISSN: 2075-4418
    URL: Article
    DOI: 10.3390/diagnostics12010225
    Language: English
    Publisher: MDPI AG
    Publication Date: 2022
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  • 7
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    Use of Cone-Beam Computed Tomography (CBCT) for Targeting the Portal Vein in Transjugular Intrahepatic Portosystemic Shunt (TIPS) Procedures: Comparison of Low-Dose with Standard-Dose CBCT
    Briefland ; 2021
    In:  Iranian Journal of Radiology Vol. 18, No. 3 ( 2021-09-06)
    Details
    In: Iranian Journal of Radiology, Briefland, Vol. 18, No. 3 ( 2021-09-06)
    Abstract: Background: A transjugular intrahepatic portosystemic shunt (TIPS) is a common treatment for patients with portal hypertension. In these patients, the portal vein can be punctured under the guidance of cone-beam computed tomography (CBCT). Objectives: To compare standard-dose (SD) CBCT with low-dose (LD) CBCT, as three-dimensional (3D) intraprocedural guidance for transhepatic puncture in TIPS placement, in terms of image quality, radiation dose, technical success, and complications. Patients and Methods: A total of 44 patients were retrospectively enrolled in this study. Eighteen patients underwent LD-CBCT, while 26 patients underwent SD-CBCT for guiding the portal vein puncture. A quantitative assessment of image quality was performed by calculating the contrast-to-noise ratio (CNR) of the hepatic portal vein. This analysis was based on a five-point vascular visualization scale (VVS), ranging from optimal (score = 1) to non-diagnostic (score = 5), while a three-point Likert scale was used for motion artifacts (1 = no motion artifacts, 3 = blurred). Image streak artifacts were also rated from one to three, based on the image quality results. Technical success was also investigated, including the number of puncture attempts, time to successful portal vein access, and radiation dose of the TIPS procedure. Results: Based on the results, TIPS could be placed successfully in all cases. Neither VVS (LD-CBCT VVS: 2.78, SD-CBCT VVS: 2.54; P = 0.467), nor the procedure time showed any significant differences between the groups (LD-CBCT: 48.3 min, SD-CBCT: 40.2 min; P = 0.45). Moreover, the objective evaluation of image quality indicated the lower quality of LD-CBCT images; however, the difference was not statistically significant (LD-CBCT CNR: 1.1 ± 0.76, SD-CBCT CNR: 1.3 ± 1.1; P = 0.5). The median number of puncture attempts was the same for SD-CBCT and LD-CBCT (n = 3; range: 1 - 6). Also, the mean dose area product (DAP) was significantly lower in LD-CBCT as compared to SD-CBCT (LD-CBCT: 2733 ± 848 µGm2, SD-CBCT: 6119 ± 1677 µGm2; P 〈 0.0001). The total DAP was significantly lower using LD-CBCT (LD-CBCT: 14831 ± 9299 µGm2, SD-CBCT: 20985 ± 10127 µGm2; P = 0.047). Conclusion: Both SD-CBCT and LD-CBCT provided successful 3D guidance for portal vein puncture during TIPS creation. Although these methods did not differ significantly in terms of image quality, complications, or number of puncture attempts, LD-CBCT significantly reduced the radiation dose.
    Type of Medium: Online Resource
    ISSN: 1735-1065 , 2008-2711
    URL: Journal
    URL: Article
    DOI: 10.5812/iranjradiol
    DOI: 10.5812/iranjradiol.111704
    Language: Unknown
    Publisher: Briefland
    Publication Date: 2021
    detail.hit.zdb_id: 2388783-7
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  • 8
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    AI Denoising Significantly Enhances Image Quality and Diagnostic Confidence in Interventional Cone-Beam Computed Tomography
    MDPI AG ; 2022
    In:  Tomography Vol. 8, No. 2 ( 2022-04-01), p. 933-947
    Details
    In: Tomography, MDPI AG, Vol. 8, No. 2 ( 2022-04-01), p. 933-947
    Abstract: (1) To investigate whether interventional cone-beam computed tomography (cbCT) could benefit from AI denoising, particularly with respect to patient body mass index (BMI); (2) From 1 January 2016 to 1 January 2022, 100 patients with liver-directed interventions and peri-procedural cbCT were included. The unenhanced mask run and the contrast-enhanced fill run of the cbCT were reconstructed using weighted filtered back projection. Additionally, each dataset was post-processed using a novel denoising software solution. Place-consistent regions of interest measured signal-to-noise ratio (SNR) per dataset. Corrected mixed-effects analysis with BMI subgroup analyses compared objective image quality. Multiple linear regression measured the contribution of “Radiation Dose”, “Body-Mass-Index”, and “Mode” to SNR. Two radiologists independently rated diagnostic confidence. Inter-rater agreement was measured using Spearman correlation (r); (3) SNR was significantly higher in the denoised datasets than in the regular datasets (p 〈 0.001). Furthermore, BMI subgroup analysis showed significant SNR deteriorations in the regular datasets for higher patient BMI (p 〈 0.001), but stable results for denoising (p 〉 0.999). In regression, only denoising contributed positively towards SNR (0.6191; 95%CI 0.6096 to 0.6286; p 〈 0.001). The denoised datasets received overall significantly higher diagnostic confidence grades (p = 0.010), with good inter-rater agreement (r ≥ 0.795, p 〈 0.001). In a subgroup analysis, diagnostic confidence deteriorated significantly for higher patient BMI (p 〈 0.001) in the regular datasets but was stable in the denoised datasets (p ≥ 0.103).; (4) AI denoising can significantly enhance image quality in interventional cone-beam CT and effectively mitigate diagnostic confidence deterioration for rising patient BMI.
    Type of Medium: Online Resource
    ISSN: 2379-139X
    URL: Article
    DOI: 10.3390/tomography8020075
    Language: English
    Publisher: MDPI AG
    Publication Date: 2022
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  • 9
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    AI Denoising Improves Image Quality and Radiological Workflows in Pediatric Ultra-Low-Dose Thorax Computed Tomography Scans
    MDPI AG ; 2022
    In:  Tomography Vol. 8, No. 4 ( 2022-06-24), p. 1678-1689
    Details
    In: Tomography, MDPI AG, Vol. 8, No. 4 ( 2022-06-24), p. 1678-1689
    Abstract: (1) This study evaluates the impact of an AI denoising algorithm on image quality, diagnostic accuracy, and radiological workflows in pediatric chest ultra-low-dose CT (ULDCT). (2) Methods: 100 consecutive pediatric thorax ULDCT were included and reconstructed using weighted filtered back projection (wFBP), iterative reconstruction (ADMIRE 2), and AI denoising (PixelShine). Place-consistent noise measurements were used to compare objective image quality. Eight blinded readers independently rated the subjective image quality on a Likert scale (1 = worst to 5 = best). Each reader wrote a semiquantitative report to evaluate disease severity using a severity score with six common pathologies. The time to diagnosis was measured for each reader to compare the possible workflow benefits. Properly corrected mixed-effects analysis with post-hoc subgroup tests were used. Spearman’s correlation coefficient measured inter-reader agreement for the subjective image quality analysis and the severity score sheets. (3) Results: The highest noise was measured for wFBP, followed by ADMIRE 2, and PixelShine (76.9 ± 9.62 vs. 43.4 ± 4.45 vs. 34.8 ± 3.27 HU; each p 〈 0.001). The highest subjective image quality was measured for PixelShine, followed by ADMIRE 2, and wFBP (4 (4–5) vs. 3 (4–5) vs. 3 (2–4), each p 〈 0.001) with good inter-rater agreement (r ≥ 0.790; p ≤ 0.001). In diagnostic accuracy analysis, there was a good inter-rater agreement between the severity scores (r ≥ 0.764; p 〈 0.001) without significant differences between severity score items per reconstruction mode (F (5.71; 566) = 0.792; p = 0.570). The shortest time to diagnosis was measured for the PixelShine datasets, followed by ADMIRE 2, and wFBP (2.28 ± 1.56 vs. 2.45 ± 1.90 vs. 2.66 ± 2.31 min; F (1.000; 99.00) = 268.1; p 〈 0.001). (4) Conclusions: AI denoising significantly improves image quality in pediatric thorax ULDCT without compromising the diagnostic confidence and reduces the time to diagnosis substantially.
    Type of Medium: Online Resource
    ISSN: 2379-139X
    URL: Article
    DOI: 10.3390/tomography8040140
    Language: English
    Publisher: MDPI AG
    Publication Date: 2022
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  • 10
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    Impact of Tracer Dose Reduction in [18 F]-Labelled Fluorodeoxyglucose-Positron Emission Tomography ([18 F]-FDG)-PET) on Texture Features and Histogram Indices: A Study in Homogeneous Tissues of Phantom and Patient
    MDPI AG ; 2023
    In:  Tomography Vol. 9, No. 5 ( 2023-09-27), p. 1799-1810
    Details
    In: Tomography, MDPI AG, Vol. 9, No. 5 ( 2023-09-27), p. 1799-1810
    Abstract: Background: Histogram indices (HIs) and texture features (TFs) are considered to play an important role in future oncologic PET-imaging and it is unknown how these indices are affected by changes of tracer doses. A randomized undersampling of PET list mode data enables a simulation of tracer dose reduction. We performed a phantom study to compare HIs/TFs of simulated and measured tracer dose reductions and evaluated changes of HIs/TFs in the liver of patients with PETs from simulated reduced tracer doses. Overall, 42 HIs/TFs were evaluated in a NEMA phantom at measured and simulated doses (stepwise reduction of [18 F] from 100% to 25% of the measured dose). [18 F] -FDG-PET datasets of 15 patients were simulated from 3.0 down to 0.5 MBq/kgBW in intervals of 0.25 MBq/kgBW. HIs/TFs were calculated from two VOIs placed in physiological tissue of the right and left liver lobe and linear correlations and coefficients of variation analysis were performed. Results: All 42 TFs did not differ significantly in measured and simulated doses (p 〉 0.05). Also, 40 TFs showed the same behaviour over dose reduction regarding differences in the same group (measured or simulated), and for 26 TFs a linear behaviour over dose reduction for measured and simulated doses could be validated. Out of these, 13 TFs could be identified, which showed a linear change in TF value in both the NEMA phantom and patient data and therefore should maintain the same informative value when transferred in a dose reduction setting. Out of this Homogeneity 2, Entropy and Zone size non-uniformity are of special interest because they have been described as preferentially considerable for tumour heterogeneity characterization. Conclusions: We could show that there was no significant difference of measured and simulated HIs/TFs in the phantom study and most TFs reveal a linear behaviour over dose reduction, when tested in homogeneous tissue. This indicates that texture analysis in PET might be robust to dose modulations.
    Type of Medium: Online Resource
    ISSN: 2379-139X
    URL: Article
    DOI: 10.3390/tomography9050143
    Language: English
    Publisher: MDPI AG
    Publication Date: 2023
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