Search

Background: Conventional totally implantable venous access ports (TIVAPs) are not approved for power contrast injections but often remain the only venous access site in oncologic patients. Therefore, these devices can play an important role if patients with a TIVAP are scheduled for a contrast-enhanced computed tomography (ceCT) as vascular access may become more difficult during the course of chemotherapy. Purpose: To evaluate the feasibility and safety of power injections in conventional TIVAPs in the forearm and to analyze the feasibility of bolus triggering during CT scans. Material and Methods: In this retrospective study we analyzed 177 power injections in 141 patients with TIVAPs in the forearm. Between October 2008 and March 2010 all patients underwent power injections (1.5 mL/s, 150 psi) via the TIVAP for ceCT because conventional vascular access via a peripheral vein had failed. Adequate functioning and catheter's tip location after injection were evaluated. Peak injection pressure and attenuation levels of aorta, liver and spleen were analyzed and compared with results of 50 patients who were injected via classical peripheral cannulas (3 mL/s, 300 psi). Feasibility of automatic scan initiation was evaluated. In vitro the port was stressed with 5 mL/s (300 psi). Results: One TIVAP showed tip dislocation with catheter rupture. Three (2.1%) devices were explanted owing to assumed infection within 4 weeks after the injection. Mean injection pressure was 121.9 +/-24.1 psi. Triggering with automatic scan initiation succeeded in 13/44 (29.6%) scans. Injection via classical cannulas resulted in significantly higher enhancement (p < 0.05). In vitro the port system tolerated flow rates of up to 5 mL/s, injection pressures of up to 338 psi. Conclusion: Power injection is a safe alternative for patients with TIVAPs in the forearm if classic vascular access ultimately fails. Triggering was successful in one-third of the attempts. Image quality in the arterial phase scan may be hampered. In vitro results suggest that the device tolerates even higher flow rates. [ABSTRACT FROM AUTHOR]

This study evaluates the accuracy and reproducibility of an experimental flat-panel-detector-based CT scanner (fp-CT) in comparison with those of a 64-slice multidetector row CT (MDCT) in automated pulmonary nodule volumetry. An anthropomorphic chest phantom with 31 spherical nodules (nodule diameters of 2.94-10.01 mm; volumes of 13.24-524.97 mm³) was scanned both with an amorphous siliconbased fp-CT scanner, using various tube current and kilovoltage settings, and with a conventional MDCT scanner. Automated nodule volumetry was performed using dedicated software. CT image data were evaluated twice by two independent radiologists. Intra- and inter-observer variations of volumetric measurements were determined and tested using the Kruskal-Wallis test and analysis of variance (fn-ANOVA). The percentage measurement errors (PME) were calculated and differences tested using Wilcoxon signed ranks and Friedman tests. Intraobserver variation was significantly higher for MDCT than for fp-CT (range: p50.043-0.045). The measured nodule volumes were significantly greater on fp-CT than on MDCT scans (p,0.001). The PME was significantly greater in fp-CT than in MDCT scans (PME range, 12.35-13.35% for fp-CT scan protocols and 16.87-19.02% for MDCT scan protocols; p,0.0001). The PME increased significantly with reduction of nodule size, and this increase was significantly higher on MDCT than on fp-CT scans (p50.0001). The absolute PME was significantly different for nodules of less than 5 mm in diameter (p50.0001-0.0033) than for larger nodules. Flat-panel-detector-based CT has advantages over MDCT in accurately determining the volume of pulmonary nodules below 5 mm in diameter. [ABSTRACT FROM AUTHOR]

A review of the article "Non-invasive determination of myocardial lipid content in Fabry disease by H-MR spectroscopy," by B. Petritsch and colleagues, which appeared in the periodical "Rofo" in 2012, is presented.

The present study evaluated the evolution of cardiac morphology, function, and late enhancement as a noninvasive marker of myocardial fibrosis, and their inter-relation during enzyme replacement therapy in patients with Fabry's disease using magnetic resonance imaging and color Doppler myocardial imaging. Late enhancement, which was present in up to 50% of patients, was associated with increased left ventricular mass, the failure of a significant regression of hypertrophy during enzyme replacement therapy, and worse segmental myocardial function. Late enhancement may predict the effect of enzyme replacement therapy on left ventricular mass and cardiac function. [ABSTRACT FROM AUTHOR]