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In this third-generation dual-source CT (DSCT) study, we retrospectively investigated radiation dose and image quality of portal-venous high-pitch emergency CT in 60 patients (28 female, mean age 56 years) with a body mass index (BMI) ≥ 30 kg/m2. Patients were dichotomized in groups A (median BMI 31.5 kg/m2; n = 33) and B (36.8 kg/m2; n = 27). Volumetric CT dose index (CTDIvol), size-specific dose estimate (SSDE), dose length product (DLP) and effective dose (ED) were assessed. Contrast-to-noise ratio (CNR) and dose-independent figure-of-merit (FOM) CNR were calculated. Subjective image quality was assessed using a five-point scale. Mean values of CTDIvol, SSDE as well as normalized DLP and ED were 7.6 ± 1.8 mGy, 8.0 ± 1.8 mGy, 304 ± 74 mGy * cm and 5.2 ± 1.3 mSv for group A, and 12.6 ± 3.7 mGy, 11.0 ± 2.6 mGy, 521 ± 157 mGy * cm and 8.9 ± 2.7 mSv for group B (p 36.8 kg/m2.

To observe the technical and clinical outcome as well as safety of CT fluoroscopy-guided drain placement in the multimodal clinical complication management of superinfected gastric leakage after sleeve gastrectomy. All consecutive patients who underwent CT fluoroscopy-guided drain placement to treat superinfected postoperative leakage after sleeve gastrectomy in our department between 2007 and 2014 were included in this retrospective study. All interventions were performed on a 16- or 128-row CT scanner under intermittent CT fluoroscopy guidance (15-25 mAs, 120 kV). The technical and clinical success rates as well as complications, additional therapies and patient radiation dose were analyzed. 14 patients (mean age: 43.8 ± 11.3 years, mean BMI: 52.9 ± 13.5, 7 women) who underwent a total of 31 CT fluoroscopy-guided drain placement procedures were included. 30 of 31 interventions (96.8 %) were technically successful. 7 patients underwent more than one intervention due to drain obstruction or secondary dislocation or as further treatment. During and after the intervention no procedure-associated complications occurred. In all patients, inflammation parameters decreased within days after the CT-guided intervention. The total interventional dose length product (DLP) was 1561 ± 1035 mGy*cm. CT fluoroscopy-guided drain placement has been shown to be a safe minimally invasive procedure that rarely leads to complications for treating superinfected gastric leakage occurring after sleeve gastrectomy. We assume that operative revisions in a high-risk patient group can be avoided using this procedure. · CT fluoroscopy-guided drain placement in obese - often medically highly complex - patients is a technically feasible procedure.. · Multimodal treatment (CT intervention, endoscopy and surgery) is required to successfully treat gastric leakage after bariatric surgery.. · High-risk surgery might be avoided by the CT-guided drain placement..· Schwarz J, Strobl FF, Paprottka PM et al. CT Fluoroscopy-Guided Drain Placement to Treat Infected Gastric Leakage after Sleeve Gastrectomy: Technical and Clinical Outcome of 31 Procedures. Fortschr Röntgenstr 2020; 192: 163 - 170.ZIEL: In dieser Studie wurden die technischen und klinischen Ergebnisse sowie die Sicherheit von CT-fluoroskopisch gesteuerten Drainageneinlagen in entzündete Verhalte bei Nahtinsuffizienz nach Sleeve-Gastrektomien als Teil eines multimodalen Komplikationsmanagements evaluiert. In diese retrospektive Studie wurden alle Patienten eingeschlossen, die zwischen 2007 und 2014 in unserer Abteilung eine CT-fluoroskopisch gesteuerte Drainageneinlage in entzündete Verhalte nach Sleeve-Gastrektomien erhalten haben. Alle Interventionen wurden auf einem 16- oder 128-Zeilen-CT unter intermittierender Fluoroskopie (15–25 mAs, 120 kV) durchgeführt. Technischer und klinischer Erfolg, die Patientenstrahlendosis (DLP), die Komplikationsrate und ergänzende Therapien wurden analysiert. 14 Patienten (Altersdurchschnitt 43,8 ± 11,3 Jahre, BMI 52,9 ± 13,5, 7 Frauen) wurden eingeschlossen, die insgesamt 31 CT-fluoroskopisch gesteuerte Drainagen erhalten haben. 30 der 31 Interventionen (96,8 %) waren technisch erfolgreich. Sieben Patienten erhielten mehr als eine Intervention aufgrund einer Drainageobstruktion, sekundärer Dislokationen oder als Verlaufstherapie. Peri- und postinterventionell traten keine interventionsbedingten Komplikationen auf. Bei allen Patienten fielen die laborchemischen Entzündungsparameter innerhalb von Tagen nach der Intervention. Das durchschnittliche gesamte Dosislängenprodukt einer Intervention lag bei 1561 ± 1035 mGy*cm. CT-fluoroskopisch gesteuerte Drainageneinlagen sind sichere, minimalinvasive und komplikationsarme Interventionen, um infizierte Verhalte nach Nahtinsuffizienzen bei Sleeve-Gastrektomien zu therapieren. Wir gehen davon aus, dass durch diese Interventionen komplexe Revisionsoperationen bei Hochrisikopatienten vermieden werden können. · CT-fluoroskopisch gesteuerte Drainageneinlagen bei adipösen, oft multimorbiden Patienten sind eine technisch gut durchführbare Intervention.. · Eine multidisziplinäre Behandlung (CT-Intervention, Endoskopie und Chirurgie) ist notwendig, um Nahtinsuffizienzen nach bariatrischer Chirurgie erfolgreich zu therapieren.. · Hochrisiko-Revisionsoperationen könnten in vielen Fällen durch CT-gesteuerte Drainageneinlagen verhindert werden..

Various imaging methods have been evaluated regarding non-invasive differentiation of renal cell carcinoma (RCC) subtypes. Dual-energy computed tomography (DECT) allows iodine concentration (IC) analysis as a correlate of tissue perfusion. Microvascular density (MVD) in histopathology specimens is evaluated to determine intratumoral vascularization. The objective of this study was to assess the potential of IC and MVD regarding the differentiation between papillary and clear cell RCC and between well- and dedifferentiated tumors. Further, we aimed to investigate a possible correlation between these parameters. DECT imaging series of 53 patients with clear cell RCC (ccRCC) and 15 with papillary RCC (pRCC) were analyzed regarding IC. Histology samples were stained using CD31/CD34 monoclonal antibodies; MVD was evaluated digitally. Statistical analysis included performance of Mann-Whitney U test, ROC analysis, and Spearman rank correlation. Analysis of IC demonstrated significant differences between ccRCC and pRCC (p

To evaluate the rate and types of complications after minimally invasive radiological central vein port implantation without ultrasound guidance. We retrospectively evaluated 8654 patients who underwent port implantations in the subclavian vein without ultrasound guidance in our institution from 1998 to 2014 with regard to types and rates of peri-, early and late post-interventional complications according to the common classification for complications published by the Society of Interventional Radiology (SIR). Additionally, the impact of the training level of the operators on the rate of complications was analyzed. Successful port implantations were performed in 99.8% (8636/8654 procedures). From 1998 to 2014, a total of 565 (6.52%) complications were recorded. The overall percentage of the peri-, early and late post-interventional complications according to the SIR criteria was 1.69, 0.15 and 4.68, respectively. Significant differences due to the training level of the performing physician could be seen for the rates of pneumothorax, arterial puncture and hematoma. Minimally invasive radiological interventional port implantation is a safe treatment option with a low rate of complications even without ultrasound guidance.

Background Patients with Down syndrome carry a third copy of the amyloid precursor protein gene, which is localized on chromosome 21. Consequently, these patients are prone to develop early-onset Alzheimer disease and cerebral amyloid angiopathy. Post-mortem studies suggest increased amyloid deposition to be already detectable in children with Down syndrome. The aim of our study was to evaluate if amyloid-related changes in pediatric Down syndrome patients can be detected in vivo using MRI biomarkers of cerebral microbleeds and cortical superficial siderosis. Materials and methods This retrospective study included 12 patients with Down syndrome (mean age = 5.0 years) and 12 age-matched control subjects (mean age = 4.8 years). Frequency and location of microbleeds and siderosis were assessed on blood-sensitive MRI sequences in a consensus reading by two radiologists applying a modified Microbleed Anatomical Rating Scale. Results Down syndrome patients showed a significantly higher mean microbleeds count and likelihood of siderosis than age-matched controls. Across groups, the highest microbleeds count was found in lobar regions (gray and white matter of frontal, parietal, temporal, and occipital lobes, and the insula), while fewer microbleeds were located in subcortical and infratentorial regions. The number of microbleeds increased over time in all three Down syndrome patients with a follow-up exam. Conclusion In vivo MRI biomarkers can support the diagnosis of early-onset cerebral amyloid angiopathy, which might already be present in pediatric Down syndrome patients. This might contribute to clinical decision-making and potentially to the development of therapeutic and prophylactic approaches, as cerebral amyloid angiopathy increases the risk for intracranial hemorrhage and may be associated with increased risk of developing Alzheimer disease.

In this study we aim to evaluate the assessment of bronchial pathologies in a murine model of lung transplantation with grating-based X-ray interferometry in vivo. Imaging was performed using a dedicated grating-based small-animal X-ray dark-field and phase-contrast scanner. While the contrast modality of the dark-field signal already showed several promising applications for diagnosing various types of pulmonary diseases, the phase-shifting contrast mechanism of the phase contrast has not yet been evaluated in vivo. For this purpose, qualitative analysis of phase-contrast images was performed and revealed pathologies due to previous lung transplantation, such as unilateral bronchial stenosis or bronchial truncation. Dependent lung parenchyma showed a strong loss in dark-field and absorption signal intensity, possibly caused by several post transplantational pathologies such as atelectasis, pleural effusion, or pulmonary infiltrates. With this study, we are able to show that bronchial pathologies can be visualized in vivo using conventional X-ray imaging when phase-contrast information is analysed. Absorption and dark-field images can be used to quantify the severity of lack of ventilation in the affected lung.

Purpose: Myocardial strain analysis is a promising tool for the detection of subtle but relevant alterations of left ventricular function, also in asymptomatic subjects. Thus, we determined the feasibility of cardiac magnetic resonance-based 2D global strain analysis using feature tracking and its association with cardiovascular risk factors in a sample from the general population. Materials and Methods: Subjects without a history of cardiocerebrovascular disease were enrolled in a substudy of the population-based KORA (Cooperative Health Research in the Region of Augsburg) cohort. In all participants with the absence of late gadolinium enhancement, longitudinal and circumferential global strains were measured on Cine SSFP imaging (TR: 29.97 ms, TE: 1.46 ms, ST: 8 mm), using a semiautomatic segmentation algorithm (CVI42, Circle, Canada). Differences in strain values according to age, sex, body mass index, hypertension, diabetes mellitus, and hyperlipidemia were derived using linear regression analysis. Results: Among 360 subjects (mean age, 56.2 +/- 9.2 y, 57% male), the average global systolic radial strain was 40.1 +/- 8.2%, circumferential 19.9 +/- 2.7%, and longitudinal 19.8 +/- 3.2%. Male sex was associated with decreased global strain values, independent of the strain direction (all P

Background Magnetic field therapy is a popular approach to pain therapy, but scientific evidence on treatment effects or even effects on sensory and pain perception in healthy controls is scarce. Methods In the present randomized, placebo-controlled study, we investigated the influence of static magnetic field exposure on sensory (touch) and pain (pinprick, pressure and heat) perception. Eighteen healthy volunteers (age: 23 ± 2 years, nine women) underwent three 10-min static magnetic field exposures using field strengths of 0 T (placebo), 1.5 T and 3 T within clinical MR scanners in randomized order on three separate days. Participants were blinded to magnetic field strength. Experimental sensory and pain testing was performed immediately before and after each magnetic field exposure. Results There was no significant effect of field strength on the assessed experimental sensory and pain testing parameters (mechanical detection threshold, pinprick threshold, pressure pain threshold, heat pain threshold and suprathreshold heat pain rating). Conclusion We found no evidence that a 10-min 1.5 T or 3 T static magnetic field exposure affects experimental sensory or pain perception in young healthy volunteers. Significance We used clinical MR scanners to investigate the effect of magnetic fields on pain perception. Using a rigorous, straightforward, placebo-controlled design, no effect of static magnetic fields on human experimental pain perception was detected. This provides a base for a more systematic investigation of magnetic field effects on pain.

To assess the prognostic value of pre-therapeutic computed tomography (CT) attenuation of liver metastases for overall survival (OS) in metastatic colorectal cancer (mCRC). In the open-label, randomised, prospective phase-III FIRE-3 trial, patients with histologically confirmed mCRC received fluorouracil (5-FU), leucovorin and irinotecan (FOLFIRI) with either cetuximab or bevacizumab. Participating patients gave written informed consent prior to study entry. In CT at baseline (portal venous phase, slice thickness ≤5 mm), mean attenuation [Hounsfield units (HU)] of liver metastases was retrospectively assessed by semi-automated volumetry. Its prognostic influence on OS was analysed in Kaplan-Meier-analysis and Cox proportional hazard regression and an optimal threshold was determined. In FIRE-3, 592 patients were enrolled between 2007 and 2012. Among the 347 patients eligible for liver volumetry, median baseline CT attenuation of liver metastases was 59.67 HU [interquartile range (IQR), 49.13, 68.85]. Increased attenuation was associated with longer OS {per 10 HU: hazard ratio (HR), 0.85 [95% confidence interval (CI), 0.78, 0.93], p < 0.001}. The optimised threshold (≥61.62 HU) was a strong predictor for increased OS [median, 21.3 vs 30.6 months; HR, 0.61 (95% CI, 0.47, 0.80), p < 0.001]. Multivariate regression controlling for correlated and further prognostic factors confirmed this [HR, 0.60 (95% CI, 0.45, 0.81), p = 0.001]. Furthermore, mean attenuation ≥61.62 HU was significantly associated with increased early tumour shrinkage (p = 0.002) and increased depth of response (p = 0.012). Increased mean baseline CT attenuation of liver metastases may identify mCRC patients with prolonged OS and better tumour response. • In colorectal cancer, increased attenuation of liver metastases in baseline computed tomography is a prognostic factor for prolonged OS (p < 0.001). • A threshold of ≥61.62 HU was determined as optimal cut-off to identify patients with prolonged OS (p < 0.001), early tumour shrinkage (p = 0.002) and increased depth of response (p = 0.012).

Introduction Detailed mechanisms in the pathophysiology of diabetes disease are poorly understood, but structural alterations in various organ systems incur an elevated risk for cardiovascular events and adverse outcome. The aim of this study was to compare multiorgan subclinical disease phenotypes by magnetic resonance (MR) imaging to study differences between subjects with prediabetes, diabetes, and normal controls. Materials and Methods Subjects without prior cardiovascular disease were enrolled in a prospective case-control study and underwent multiorgan MR for the assessment of metabolic and arteriosclerotic alterations, including age-related white matter changes, hepatic proton density fat fraction, visceral adipose tissue volume, left ventricular remodeling index, carotid plaque, and late gadolinium enhancement. Magnetic resonance features were summarized in a phenotypic-based score (range, 0-6). Univariate, multivariate correlation, and unsupervised clustering were performed. Results Among 243 subjects with complete multiorgan MR data sets included in the analysis (55.6 ± 8.9 years, 62% males), 48 were classified as subjects with prediabetes and 38 as subjects with diabetes. The MR phenotypic score was significantly higher in subjects with prediabetes and diabetes as compared with controls (mean score, 3.00 ± 1.04 and 2.69 ± 0.98 vs 1.22 ± 0.98, P < 0.001 respectively), also after adjustment for potential confounders. We identified 2 clusters of MR phenotype patterns associated with glycemic status (P < 0.001), independent of the MR score (cluster II-metabolic specific: odds ratio, 2.49; 95% CI, 1.00-6.17; P = 0.049). Discussion Subjects with prediabetes and diabetes have a significantly higher phenotypic-based score with a distinctive multiorgan phenotypic pattern, which may enable improved disease characterization.

ObjectiveAmong ischemic stroke patients with negative CT angiography (CTA), we aimed to determine the predictive value of enhanced distal vessel occlusion detection using CT perfusion postprocessing (waveletCTA) for the treatment effect of IV thrombolysis (IVT).MethodsPatients were selected from 1,851 consecutive patients who had undergone CT perfusion. Inclusion criteria were (1) significant cerebral blood flow (CBF) deficit, (2) no occlusion on CTA, and (3) infarction confirmed on follow-up. Favorable morphologic response was defined as smaller values of final infarction volume divided by initial CBF deficit volume (FIV/CBF). Favorable functional outcome was defined as modified Rankin Scale score of ≤2 after 90 days and decrease in NIH Stroke Scale score of ≥3 from admission to 24 hours (∆NIHSS).ResultsAmong patients with negative CTA (n = 107), 58 (54%) showed a distal occlusion on waveletCTA. There was no difference between patients receiving IVT (n = 57) vs supportive care (n = 50) regarding symptom onset, early ischemic changes, perfusion mismatch, or admission NIHSS score (all p > 0.05). In IVT-treated patients, the presence of an occlusion was an independent predictor of a favorable morphologic response (FIV/CBF: β −1.43; 95% confidence interval [CI] −1.96, −0.83; p = 0.001) and functional outcome (90-day modified Rankin Scale: odds ratio 7.68; 95% CI 4.33–11.51; p = 0.039; ∆NIHSS: odds ratio 5.76; 95% CI 3.98–8.27; p = 0.013), while it did not predict outcome in patients receiving supportive care (all p > 0.05).ConclusionIn stroke patients with negative CTA, distal vessel occlusions as detected by waveletCTA are an independent predictor of a favorable response to IVT.

Importance Social and occupational impairments contribute to the burden of psychosis and depression. There is a need for risk stratification tools to inform personalized functional-disability preventive strategies for individuals in at-risk and early phases of these illnesses. Objective To determine whether predictors associated with social and role functioning can be identified in patients in clinical high-risk (CHR) states for psychosis or with recent-onset depression (ROD) using clinical, imaging-based, and combined machine learning; assess the geographic, transdiagnostic, and prognostic generalizability of machine learning and compare it with human prognostication; and explore sequential prognosis encompassing clinical and combined machine learning. Design, Setting, and Participants This multisite naturalistic study followed up patients in CHR states, with ROD, and with recent-onset psychosis, and healthy control participants for 18 months in 7 academic early-recognition services in 5 European countries. Participants were recruited between February 2014 and May 2016, and data were analyzed from April 2017 to January 2018. Main Outcomes and Measures Performance and generalizability of prognostic models. Results A total of 116 individuals in CHR states (mean [SD] age, 24.0 [5.1] years; 58 [50.0%] female) and 120 patients with ROD (mean [SD] age, 26.1 [6.1] years; 65 [54.2%] female) were followed up for a mean (SD) of 329 (142) days. Machine learning predicted the 1-year social-functioning outcomes with a balanced accuracy of 76.9% of patients in CHR states and 66.2% of patients with ROD using clinical baseline data. Balanced accuracy in models using structural neuroimaging was 76.2% in patients in CHR states and 65.0% in patients with ROD, and in combined models, it was 82.7% for CHR states and 70.3% for ROD. Lower functioning before study entry was a transdiagnostic predictor. Medial prefrontal and temporo-parieto-occipital gray matter volume (GMV) reductions and cerebellar and dorsolateral prefrontal GMV increments had predictive value in the CHR group; reduced mediotemporal and increased prefrontal-perisylvian GMV had predictive value in patients with ROD. Poor prognoses were associated with increased risk of psychotic, depressive, and anxiety disorders at follow-up in patients in the CHR state but not ones with ROD. Machine learning outperformed expert prognostication. Adding neuroimaging machine learning to clinical machine learning provided a 1.9-fold increase of prognostic certainty in uncertain cases of patients in CHR states, and a 10.5-fold increase of prognostic certainty for patients with ROD. Conclusions and Relevance Precision medicine tools could augment effective therapeutic strategies aiming at the prevention of social functioning impairments in patients with CHR states or with ROD.

The aim of this study was to assess the diagnostic accuracy of a modified high-resolution whole-brain three-dimensional T1-weighted black-blood sequence (T1-weighted modified volumetric isotropic turbo spin echo acquisition [T1-mVISTA]) in comparison to a standard three-dimensional T1-weighted magnetization-prepared rapid gradient echo (MP-RAGE) sequence for detection of contrast-enhancing cerebral lesions in patients with relapsing-remitting multiple sclerosis (MS).After institutional review board approval and informed consent, 22 patients (8 men; aged 31.0 ± 9.2 years) with relapsing-remitting MS were included in this monocentric prospective cohort study.Contrast-enhanced T1-mVISTA and MP-RAGE, both with 0.8 mm resolution, were performed in all patients. In a substudy of 12 patients, T1-mVISTA was compared with a T1-mVISTA with 1.0 mm resolution (T1-mVISTA_1.0). Reference lesions were defined by an experienced neuroradiologist using all available sequences and served as the criterion standard. T1-mVISTA, T1-mVISTA_1.0, and MP-RAGE sequences were read in random order 4 weeks apart. Image quality, visual contrast enhancement, contrast-to-noise-ratio (CNR), diagnostic confidence, and lesion size were assessed and compared by Wilcoxon and Mann-Whitney U tests.Eleven of 22 patients displayed contrast-enhancing lesions. Visual contrast enhancement, CNR, and diagnostic confidence of contrast-enhancing MS lesions were significantly increased in T1-mVISTA compared with MP-RAGE (P0.001). Significantly more contrast-enhancing lesions were detected with T1-mVISTA than with MP-RAGE (71 vs 39, respectively; P0.001). With MP-RAGE, 25.6% of lesions were missed in the initial reading, whereas only 4.2% of lesions were missed with T1-mVISTA. Increase of the voxel volume from 0.8 mm to 1.0 mm isotropic in T1-mVISTA_1.0 did not affect the detectability of lesions, whereas scan time was decreased from 4:43 to 1:55 minutes.Three-dimensional T1-mVISTA improves the detection rates of contrast-enhancing cerebral MS lesions compared with conventional 3D MP-RAGE sequences by increasing CNR of lesions and might, therefore, be useful in patient management.

Loss of neural structures (such as hair cells or neurones within the spiral ganglion) has been proposed to be involved in Meniere’s disease (MD) (Spoendlin et al. Acta oto-laryngologica Supplementum 499:1–21, 1; Merchant et al. Eur Arch Oto-Rhino-Laryngol Off J Eur Feder Oto-Rhino-Laryngol Soc (EUFOS) Affil German Soc Oto-Rhino-Laryngol Head Neck Surg 252(2):63–75, 2; Tsuji et al. Ann Otol Rhinol Laryngol Suppl 81:26–31, 3; Kariya, Otol Neurotol Off Publ Am Otol Soc Am Neurotol Soc Eur Acad Otol Neurotol 28(8):1063–1068, 4; Megerian Laryngoscope 115(9):1525–1535, 5) but this has yet to be confirmed. Therefore, the aim of this study was to investigate morphometric changes of VIIth and VIIIth cranial nerve in MD. MD is characterized by episodic vertigo, tinnitus, fluctuating hearing loss, and aural fullness. The exact pathophysiological mechanisms involved such as viral infections, autoimmune processes, genetic predisposition, cellular apoptosis, and oxidative stress are still not clear. Using a T2-weighted 3D-GE “constructive interference in steady state” (CISS) 3T magnetic resonance imaging (MRI) sequence, we evaluated the properties of the VIIth and VIIIth cranial nerves as they passed from the cerebellopontine angle to the inner ear modiolus. 21 patients with MD were examined along with 39 normal controls. Bidirectional nerve diameters and cross-sectional areas (CSA) were measured in a transverse plane. The comparison of study and control group showed statistically significant (P

Objectives The aim of this study was to investigate whether radiomic analysis with random survival forests (RSFs) can predict overall survival from T1-weighted contrast-enhanced baseline magnetic resonance imaging (MRI) scans in a cohort of glioblastoma multiforme (GBM) patients with uniform treatment. Materials and Methods This retrospective study was approved by the institutional review board and informed consent was waived. The MRI scans from 66 patients with newly diagnosed GBM from a previous prospective study were analyzed. Tumors were segmented manually on contrast-enhanced 3-dimensional T1-weighted images. Using these segmentations, P = 208 quantitative image features characterizing tumor shape, signal intensity, and texture were calculated in an automated fashion. On this data set, an RSF was trained using 10-fold cross validation to establish a link between image features and overall survival, and the individual risk for each patient was predicted. The mean concordance index was assessed as a measure of prediction accuracy. Association of individual risk with overall survival was assessed using Kaplan-Meier analysis and a univariate proportional hazards model. Results Mean overall survival was 14 months (range, 0.8-85 months). Mean concordance index of the 10-fold cross-validated RSF was 0.67. Kaplan-Meier analysis clearly distinguished 2 patient groups with high and low predicted individual risk (P = 5.5 x 10(-5)). Low predicted individual mortality was found to be a favorable prognostic factor for overall survival in a univariate Cox proportional hazards model (hazards ratio, 1.038;95% confidence interval, 1.015-1.062;P = 0.0059). Conclusions This study demonstrates that baseline MRI in GBM patients contains prognostic information, which can be accessed by radiomic analysis using RSFs.

Objective: The aim of this study was to test the diagnostic value of wavelet-based angiographic reconstruction of CT perfusion data (waveletCTA) to detect cerebral venous sinus thrombosis (CVST) in patients who underwent whole-brain CT perfusion imaging (WB-CTP). Materials and Methods: Datasets were retrospectively selected from an initial cohort of 2863 consecutive patients who had undergone multiparametric CT including WB-CTP. WaveletCTA was reconstructed from WB-CTP: the angiographic signal was generated by voxel-based wavelet transform of time attenuation curves (TACs) from WB-CTP raw data. In a preliminary clinical evaluation, waveletCTA was analyzed by 2 readers with respect to presence and location of CVST. Venous CT and MR angiography (venCTA/venMRA) served as reference standard. Diagnostic confidence for CVST detection and the quality of depiction for venous sections were evaluated on 5-point Likert scales. Thrombus extent was assessed by length measurements. The mean CT attenuation and waveletCTA signal of the thrombus and of flowing blood were quantified. Results: Sixteen patients were included: 10 patients with venCTA-/venMRAconfirmed CVST and 6 patients with arterial single-phase CT angiography (artCTA)-suspected but follow-up-excluded CVST. The reconstruction of waveletCTA was successful in all patients. Among the patients with confirmed CVST, waveletCTA correctly demonstrated presence, location, and extent of the thrombosis in 10/10 cases. In 6 patients with artCTA-suspected but follow-up-excluded CVST, waveletCTA correctly ruled out CVST in 5 patients. Reading waveletCTA in addition to artCTA significantly increased the diagnostic confidence concerning CVST compared with reading artCTA alone (4.4 vs 3.6, P = 0.044). The mean flowing blood-to-thrombus ratio was highest in waveletCTA, followed by venCTA and artCTA (146.2 vs 5.9 vs 2.6, each with P < 0.001). In waveletCTA, the venous sections were depicted better compared with artCTA (4.2 vs 2.6, P < 0.001), and equally well compared with venCTA/venMRA (4.2 vs 4.1, P = 0.374). Conclusions: WaveletCTA was technically feasible in CVST patients and reliably identified CVST in a preliminary clinical evaluation. WaveletCTA might serve as an additional reconstruction to rule out or incidentally detect CVST in patients who undergo WB-CTP.

Objectives: The aim of this study was to determine the diagnostic accuracy of grating-based phase-contrast computed tomography (gb-PCCT) to classify and quantify coronary vessel characteristics in comparison with optical coherence tomography (OCT) and histopathology in an ex vivo setting. Materials and Methods: After excision from 5 heart specimens, 15 human coronary arteries underwent gb-PCCT examination using an experimental imaging setup consisting of a rotating molybdenum anode x-ray tube, a Talbot-Lau grating interferometer, and a single photon counting detector. Subsequently, all vessels were imaged by OCT and histopathologically processed. Optical coherence tomography, gb-PCCT, and histopathology images were manually matched using anatomical landmarks. Optical coherence tomography and gb-PCCT were reviewed by 2 independent observers blinded to histopathology. Vessel, lumen, and plaque area were measured, and plaque characteristics (lipid rich, calcified, and fibrous) were determined for each section. Measures of diagnostic accuracy were derived, applying histopathology as the standard of reference. Results: Of a total of 286 assessed cross sections, 241 corresponding sections were included in the statistical analysis. Quantitative measures derived from gb-PCCT were significantly higher than from OCT (P = 0.85 for gb-PCCT and >= 0.61 for OCT, respectively). Results of Bland-Altman analysis demonstrated smaller mean differences between OCT and histopathology than for gb-PCCT and histopathology. Limits of agreement were narrower for gb-PCCT with regard to lumen area, for OCT with regard to plaque area, and were comparable with regard to vessel area. Based on histopathology, 228/241 (94.6%) sections were classified as fibrous, calcified, or lipid rich. The diagnostic accuracy of gb-PCCT was excellent for the detection of all plaque components (sensitivity, >= 0.95;specificity, >= 0.94), whereas the results for OCT showed sensitivities of >= 0.73 and specificities of >= 0.66. Conclusions: In this ex vivo setting, gb-PCCT provides excellent results in the assessment of coronary atherosclerotic plaque characteristics and vessel dimensions in comparison to OCT and histopathology. Thus, the technique may serve as adjunct nondestructive modality for advanced plaque characterization in an experimental setting.

PURPOSE: Diagnosis of bone marrow edema syndrome (BMES) can be challenging. There is sometimes uncertainty about the correct diagnosis of BMES on morphologic magnetic resonance imaging (MRI), since subchondral findings like lines and spots can be misinterpreted as “beginning” or “possible” avascular osteonecrosis (AVN). The aim of our study was to systematically assess the temporal course of BMES from first diagnosis on MRI until the end of clinical symptoms and the full disappearance of bone marrow edema (BME) to determine whether subchondral lines and spots detected in these patients can develop into osteonecrosis. METHODS: In a combined retrospective and prospective study, we retrieved serial MRI scans of hips and knees with BME from the hospital database. According to clinical and imaging data, all patients with degenerative, infectious/inflammatory, rheumatic, neoplastic conditions and those showing typical osteonecrosis were excluded. We collected all available MRI examinations from first detection of BME until its disappearance. In case edema had not fully resolved in the last available MRI scan, we performed an MRI with an additional dynamic contrast-enhanced (DCE-MRI) sequence. For each MRI scan, we recorded the severity of edema, the presence of subchondral hypointense lines and the presence of subchondral focal hypointense zones on T1-weighted images by two independent readers. The DCE-MRI scans were used to calculate parameter maps to assess the perfusion characteristics. RESULTS: The study comprised 49 patients aged 22–71 years. In total, 171 morphologic and 5 DCE-MRI scans were evaluated. In 44 patients (89.8%), the BMES completely healed without remnants. In 18 of 49 patients (36.7%), a subchondral line was present in the first MRI exam. Nine patients (18.4%) developed a subchondral line within 1–5 months after the first MRI. In total, 27 out of 49 patients (55.1%) had subchondral lines (12 knees, 15 hips) during the timeframe of the study. All subchondral lines disappeared in the timeframe of the study. Subchondral focal hypointense zones were present in 14 out of 49 patients (28.6%): in 9 cases, subchondral focal hypointense zones disappeared after a median of 5.5 months (range, 1–85 months), while in 5 cases, subchondral focal lesions persisted until the end of the study (up to more than 85 months) without edema in the surrounding bone. All persisting subchondral focal lesions were hyperperfused. These 5 patients had associated meniscal lesions. CONCLUSION: Our study shows that subchondral lines and spots found in patients with BMES do not develop into AVN. Subchondral lines, which resemble subchondral insufficiency fractures, are associated with BMES. Subchondral focal T1-hypointense zones do not represent AVN; most probably these areas represent reparative processes within the subchondral bone, where tensile and shear force overload is present due to altered biomechanics.

The purpose of this study was to investigate the findings of diffuse periportal enhancement in the liver on hepatobiliary phase gadoxetate disodium-enhanced magnetic resonance images by comparing with the finding of periportal hyperintensity on T2-weighted images and to reveal their clinical significance. Nineteen consecutive patients with diffuse periportal enhancement on hepatobiliary phase images constituted the study population. The intrahepatic diffuse periportal enhancement finding was assessed on whether it corresponded to periportal hyperintense patterns on T2-weighted images or not in the location, and the cases were classified into 2 groups according to this characteristic. Signal intensities at the periportal areas were also assessed on T1-, T2-, diffusion-weighted and dynamic images. Furthermore, possible associations between these image findings and the final diagnoses were explored. In 7 of the 19 patients, periportal enhancement area corresponded with the periportal hyperintensity area on T2-weighted images. In the remaining 12 patients, the finding of periportal T2-hyperintensity was absent or the periportal enhancement differed from the periportal T2-hyperintensity in the location. Diseases of the former group comprised autoimmune hepatitis, acute exacerbation of chronic hepatitis and acute alcoholic steatohepatitis, and those of the latter group primary sclerosing cholangitis, autoimmune hepatitis-primary biliary cirrhosis overlap syndrome, and liver cirrhosis with miscellaneous etiology. Diffuse periportal enhancement during the hepatobiliary phase did not always correspond to periportal hyperintensity on T2-weighted images. In the classification based on whether enhancement area corresponded or not, each enhancement pattern appeared in different groups of liver diseases. Specifically, the former (corresponding) was associated with active inflammation such as hepatitis and the latter (not corresponding) was predominantly associated with a chronic change such as cirrhosis. Appropriate recognition of these periportal enhancement patterns may contribute to the improved diagnosis of diffuse liver diseases.

Diverticular disease represents an increasing pathology and healthcare burden worldwide. Our aim was to study the prevalence, extent and distribution of asymptomatic diverticular disease assessed by magnetic resonance imaging (MRI) in a sample of a Western population. Subjects from a population-based cohort study who underwent 3-T MRI were analyzed for the prevalence and extent of diverticula of the colon using an isotropic VIBE-Dixon gradient-echo sequence. The extent of diverticular disease was categorized according to the number of diverticula in each colonic segment. Univariate and adjusted analyses were performed to assess associated characteristics and risk factors. Among 393 subjects included in the analysis (56.4 ± 9.2 years, 57.5% males), 164 (42%) had diverticular disease, with the highest prevalence in the left-sided colonic segments (93% diverticular disease in the descending and sigmoid segment). Subjects with advanced diverticular disease were older (62.1 vs. 54.4 years) and had a higher body mass index (BMI), LDL cholesterol levels and systolic blood pressure (30.2 ± 5.1 vs. 27.8 ± 4.9 kg/m2, 149.8 ± 29.3 vs. 135.2 ± 32.9 mg/dl and 128.2 ± 14.1 vs. 118.4 ± 16.1 mmHg, respectively; all p > 0.003) compared with subjects without diverticular disease. In contrast, no significant correlation could be found for gender, physical activity, smoking status and alcohol consumption (all p > 0.31). Intra-rater reliability was excellent for all colonic segments (intra-class correlation [ICC] = 0.99-1.00), and inter-rater reliability was excellent for left- and right-sided colonic segments (ICC = 0.84-0.97). These findings provide insights into the disease mechanism of asymptomatic diverticular disease and may help to improve prevention of diverticulosis and its associated complications. • Overall prevalence of asymptomatic diverticular disease assessed by MRI was 42%, affecting predominantly the left-sided colon. • Asymptomatic diverticular disease was associated with age and cardiometabolic risk factors. • Magnetic resonance imaging reveals insights into the pathophysiologic mechanism of asymptomatic diverticular disease.

Although the diagnostic performance of whole-brain computed tomographic perfusion (WB-CTP) in the detection of supratentorial infarctions is well established, its value in the detection of infratentorial strokes remains less well defined. We examined its diagnostic accuracy in the detection of infratentorial infarctions and compared it to nonenhanced computed tomography (NECT), aiming to identify factors influencing its detection rate. Out of a cohort of 1380 patients who underwent WB-CTP due to suspected stroke, we retrospectively included all patients with MRI-confirmed infratentorial strokes and compared it to control patients without infratentorial strokes. Two blinded readers evaluated NECT and four different CTP maps independently for the presence and location of infratentorial ischemic perfusion deficits. The study was designed as a retrospective case-control study and included 280 patients (cases/controls = 1/3). WB-CTP revealed a greater diagnostic sensitivity than NECT (41.4 vs. 17.1 %, P = 0.003). The specificity, however, was comparable (93.3 vs. 95.0 %). Mean transit time (MTT) and time to drain (TTD) were the most sensitive (41.4 and 40.0 %) and cerebral blood volume (CBV) the most specific (99.5 %) perfusion maps. Infarctions detected using WB-CTP were significantly larger than those not detected (15.0 vs. 2.2 ml; P = 0.0007); infarct location, however, did not influence the detection rate. The detection of infratentorial infarctions can be improved by assessing WB-CTP as part of the multimodal stroke workup. However, it remains a diagnostic challenge, especially small volume infarctions in the brainstem are likely to be missed.

To date, research into the biomarker-aided early recognition of psychosis has focused on predicting the transition likelihood of clinically defined individuals with different at-risk mental states (ARMS) based on structural (and functional) brain changes. However, it is currently unknown whether neuroimaging patterns could be identified to facilitate the individualized prediction of symptomatic and functional recovery. Therefore, we investigated whether cortical surface alterations analyzed by means of multivariate pattern recognition methods could enable the single-subject identification of functional outcomes in twenty-seven ARMS individuals. Subjects were dichotomized into ‘good’ vs. ‘poor’ outcome groups on average 4 years after the baseline MRI scan using a Global Assessment of Functioning (GAF) threshold of 70. Cortical surface-based pattern classification predicted good (N = 14) vs. poor outcome status (N = 13) at follow-up with an accuracy of 82% as determined by nested leave-one-cross-validation. Neuroanatomical prediction involved cortical area reductions in superior temporal, inferior frontal and inferior parietal areas and was not confounded by functional impairment at baseline, or antipsychotic medication and transition status over the follow-up period. The prediction model's decision scores were correlated with positive and general symptom scores in the ARMS group at follow-up, whereas negative symptoms were not linked to predicted poorer functional outcome. These findings suggest that poorer functional outcomes are associated with non-resolving attenuated psychosis and could be predicted at the single-subject level using multivariate neuroanatomical risk stratification methods. However, the generalizability and specificity of the suggested prediction model should be thoroughly investigated in future large-scale and cross-diagnostic MRI studies.

Objective The aim of this study was to investigate the effects of partial nephrectomy (PN) in kidneys with solid renal masses on the apparent diffusion coefficient (ADC) and on intravoxel incoherent motion (IVIM)-based parameters using diffusion-weighted magnetic resonance imaging (DWI). Methods Fifteen patients with renal masses underwent DWI before and 1 week after PN on a clinical 3 T scanner using a single-shot echo planar imaging sequence with 10 diffusion weightings. Motion-corrected images were quantified using a monoexponential model fit to calculate ADCs and a segmented biexponential fit to calculate IVIM parameters f (perfusion fraction), D-slow and D-fast (slow and fast diffusion coefficients), as well as the pseudoflow (PF) D-fast x f. The median values derived from multislice (minimum of 3 slices) regions of interest encompassing the kidney cortex were used for statistical analysis. Estimated glomerular filtration rate values were calculated based on serum creatinine levels on each examination day using the Modification of Diet in Renal Disease formula. Results The follow-up measurement yielded significantly lower values in the partially nephrectomized kidneys compared with contralateral kidneys for the parameters ADC (P = 0.002), D-fast (P = 0.43), f (P = 0.001), and PF (P = 0.0008). Comparing baseline and follow-up, partially nephrectomized kidneys showed a significant decrease for ADC (P = 0.01), D-fast (P = 0.43), f (P = 0.002), and PF (P = 0.002). Nonnephrectomized kidneys expressed a significant increase for ADC (P = 0.01) and PF (P = 0.01). Follow-up Modification of Diet in Renal Disease showed positive correlations with all DWI parameters in the partially nephrectomized kidneys (ADC: r(2) = 0.63, P = 0.0004;D-fast: r(2) = 0.59, P = 0.0009;f: r(2) = 0.36, P = 0.018;PF: r(2) = 0.60, P = 0.00075) except for D-slow. Conclusions Our study suggests that quantitative parameters derived from DWI are highly indicative of renal function. Apparent diffusion coefficients showed substantial differences in the renal cortex after PN, whereas an IVIM analysis delivered additional insight into kidney physiology. Quantitative DWI, particularly perfusion-related IVIM parameters, therefore demonstrated great potential as truly noninvasive biomarker to obtain information about single kidney function.

To evaluate the role of diffusion-weighted MRI (DW-MRI) in detecting and differentiating acute from chronic bowel inflammation in patients with Crohn's disease (CD).MR-enteroclysis examinations with DW-MRI were reviewed from 24 patients with histologically proven CD. Segments of bowel were evaluated for acute and chronic inflammation in three different reviews of the MRI images: T2w alone, T2w + DWI, and T2w + CET1w. Mean ADC values of normal bowel segments, as well as bowel segments with acute and chronic inflammation were calculated and compared. Analyses of receiver-operating characteristic (ROC) curve were performed.Hundred and forty four bowel segments in total were reviewed. Inflammation was present in 45 segments. Acute inflammation was present in 31 segments, chronic inflammation in 14. 98 bowel segments showed no inflammatory activity. Sensitivity and specificity for differentiation between normal and inflamed bowel segments was 0.6, 0.67, and 0.80 on T2w, T2w + DWI, and T2w + CET1w datasets, respectively. Specificities for differentiation between normal and inflamed bowel segments were 0.96, 0.96, and 0.98. Sensitivities for differentiation between acute and chronically inflamed bowel segments were 0.85, 0.91, and 0.96, and specificities were 0.88, 0.89, and 1.0, respectively. The mean ADC value of normal bowel (2.18 ± 0.37 × 10(-3) mm(2)/s) was statistically significantly greater than the mean value of inflamed bowel segments (p 0.001). The mean ADC value of acutely inflamed bowel segments was statistically significantly lower than that of chronically inflamed bowel segments (1.09 ± 0.18 × 10(-3) vs. 1.55 ± 0.21 × 10(-3) mm(2)/s) (p 0.001). Estimated area under the ROC curve for the diagnosis of acute vs. chronic inflammation was 0.950. A threshold of ADC value of 1.41 × 10(-3) mm(2)/s was optimal for calculation of sensitivity and specificity.DW-MRI improves detection and differentiation of acute vs. chronic inflammatory changes of the bowel in patients with CD compared to T2w-images alone.

OBJECTIVE. The aim of this study was to quantitatively assess hyaline cartilage and subchondral bone conditions in a fully preserved cadaveric human knee joint using high-resolution x-ray propagation-based phase-contrast imaging (PBI) CT and to compare the performance of the new technique with conventional CT and MRI. MATERIALS AND METHODS. A cadaveric human knee was examined using an x-ray beam of 60 keV, a detector with a 90-mm 2 FOV, and a pixel size of 46 × 46 µm 2 . PBI CT images were reconstructed with both the filtered back projection algorithm and the equally sloped tomography method. Conventional 3-T MRI and CT were also performed. Measurements of cartilage thickness, cartilage lesions, International Cartilage Repair Society scoring, and detection of subchondral bone changes were evaluated. Visual inspection of the specimen akin to arthroscopy was conducted and served as a standard of reference for lesion detection. RESULTS. Loss of cartilage height was visible on PBI CT and MRI. Quantification of cartilage thickness showed a strong correlation between the two modalities. Cartilage lesions appeared darker than the adjacent cartilage on PBI CT. PBI CT showed similar agreement to MRI for depicting cartilage substance defects or lesions compared with the visual inspection. The assessment of subchondral bone cysts showed moderate to strong agreement between PBI CT and CT. CONCLUSION. In contrast to the standard clinical methods of MRI and CT, PBI CT is able to simultaneously depict cartilage and bony changes at high resolution. Though still an experimental technique, PBI CT is a promising high-resolution imaging method to evaluate comprehensive changes of osteoarthritic disease in a clinical setting.

To compare a semi-automatic software tool for the measurement of aortic annulus dimensions with manual measurements by expert readers and to analyze whether and to what extent interchangeability exists between semi-automatic and manual measurements. We retrospectively included 374 consecutive patients with high-grade aortic stenosis who had undergone CT-angiography of the heart prior to trans-catheter aortic valve replacement (TAVR). In independent analyses, two expert readers manually measured aortic annulus dimensions (long axis, short axis, circumference, area) as well as the distance of the coronary ostia from the annulus plane. A third independent reader performed annulus evaluation using a software tool for semi-automatic detection and measurement of the annulus plane. Intraclass correlation coefficients (ICC) and Bland-Altman analysis was used to compare both manual measurements as well as manual and semi-automatic measurements of annulus parameters. Using the respective measurements we simulated size selection for a Sapien XT transcatheter heart valve (THV). Interchangeability of methods was addressed by calculation of the estimated individual equivalence index γ. There was excellent agreement between both expert observers in manual measurements of the annulus with ICC's in the range 0.89-0.94 for all anatomic parameters. Similar high agreements were observed between semi-automatic and manual measurements, with ICC's in the range of 0.89-0.95. THV size recommendation based on manual versus semiautomatic measurements agreed in 80.7% of cases while agreement between both expert readers concerning THV size recommendation was 80.6%. Semi-automatic measurements of anatomic parameters of the aortic root show high agreement and interchangeability with manual measurements in CT-angiography prior to TAVR.

Rationale and Objectives Basal lung opacities are frequently observed on supine chest x-ray (SCXR) of intensive care patients, causing insecurity among clinicians and radiologists. We sought to determine the diagnostic accuracy of SCXR for basal pneumonia. Materials and Methods We identified 172 patients who received both SCXR and computed tomography within 1 hour. Two readers examined the SCXR and rated findings in both basal zones according to the following scale: 0 = “no pneumonia,” 1 = “possible pneumonia,” 2 = “highly suspected pneumonia.” Computed tomography served as standard of reference. Sensitivity, specificity, and positive and negative predictive values (PPV/NPV) were calculated once pooling 0 and 1 as negative and once pooling 1 and 2 as positive finding. Results When pooling 0 and 1 as negative, sensitivity was 0.45 (right)/0.38 (left), specificity was 0.94/0.97, PPV was 0.76/0.79, and NPV was 0.81/0.84. When pooling 1 and 2 as positive, sensitivity was 0.80/0.75, specificity was 0.62/0.58, PPV was 0.45/0.35, and NPV was 0.88/0.89. The most common findings in false-positive cases were combined pleural effusions and lower lobe atelectasis. Conclusions Interpreting only highly suspicious basal opacities as pneumonia considerably increases the PPV with almost constant NPV. Clinicians and radiologists should be aware of the limitations of SCXR regarding basal pneumonia.

Aims To characterize changes in the myocardium in subjects with prediabetes, diabetes, and healthy controls with preserved left ventricular ejection fraction (LVEF) by using cardiac magnetic resonance imaging (CMR) in a sample from the general population.Methods and results Subjects without history of cardiovascular disease and preserved LVEF but established diabetes, prediabetes, and controls from a population-based cohort underwent contrast-enhanced CMR. Obtained parameters included left ventricular (LV) function and morphology, late gadolinium enhancement as well as T1-mapping and derivation of extracellular volume fraction (ECV) by modified Look-Locker inversion recovery for diffuse fibrosis in a subset of patients. Fibrosis volume and cell volume were calculated and LV remodelling index was calculated by dividing the LV mass by its end-diastolic volume. Among 343 subjects (56.1 +/- 9.2 years, 57% males), 47 subjects were classified as diabetes, 78 as prediabetes, and 218 as controls. Haematocrit values and thus ECV parameters were available in 251 subjects. LV remodelling index was significantly higher in participants with prediabetes and diabetes, independent of body mass index (BMI), hypertension, age, and sex. ECV was decreased in subjects with prediabetes and diabetes compared with healthy controls (23.1 +/- 2.4% and 22.8 +/- 3.0%, both P < 0.007). In contrast, cell volume was significantly higher in subjects with prediabetes and diabetes as compared with controls (109.1 +/- 23.8 and 114.9 +/- 32.3 mL vs. 96.5 +/- 26.9 mL, both P < 0.03, respectively). However, differences in ECV and cell volume attenuated after the adjustment for cardiometabolic risk factors, including age, sex, BMI, and hypertension.Conclusion Subjects with prediabetes and diabetes but preserved LVEF had higher LV remodelling indices, suggesting early detectable changes in the disease process, while diffuse myocardial fibrosis appears to be less relevant at this stage.

Background The aim of our study was to determine the relation of alcohol consumption and cigarette smoking on continuous-measured hepatic fat fraction (HFF) in a population free of cardiovascular disease. We suggested a direct correlation of alcohol consumption with HFF and increased HFF in former smokers compared to current smokers. Methods Data from 384 subjects (mean age: 56 years, 58% men) of a population-based cohort study (KORA) were included in a cross-sectional design. Liver fat was assessed by 3 Tesla magnetic resonance imaging (MRI) using a multi-echo Dixon sequence and T2-corrected single voxel multi-echo spectroscopy (H-1-MRS). Smoking status was classified as never, former or current smoker and alcohol consumption as non-, moderate (0.1-39.9 g/day for men and 0.1-19.9 g/day for women), or heavy drinker (>= 40 g/day for men and >= 20 g/day for women). Fatty liver disease was defined as HFF >= 5.56%. Results Average HFF was 8.8% by H-1-MRS and 8.5% by MRI. Former smokers showed a higher HFF (MRI: beta = 2.64; p = 0.006) and a higher FLD prevalence (MRI: OR = 1.91; p = 0.006) compared to never smokers. Current smokers showed decreased odds for FLD measured by H-1-MRS after multivariable adjustment (OR = 0.37; p = 0.007) with never smoker as reference. Heavy drinking was positively associated with HFF (H-1-MRS: beta = 2.99; p = 0.003) and showed highest odds for FLD (H-1-MRS: OR = 3.05; p = 0.008) with non-drinker as reference. Moderate drinking showed a positive association with HFF (H-1-MRS: beta = 1.54; p = 0.061 and MRI: beta = 1.75; p = 0.050). Conclusions Our data revealed lowest odds for FLD in current smokers, moderate drinkers showing higher HFF than non-drinkers and heavy drinkers showing highest HFF and odds for FLD. These findings partly conflict with former literature and underline the importance of further studies to investigate the complex effects on liver metabolism.

Shame and guilt can be described as 'self-conscious emotions' and are an essential part of the psychopathology in obsessive-compulsive disorder (OCD). Our primary aim was to explore whether individuals with OCD are processing shame and guilt differently from healthy individuals (N = 20 in both groups; 50% female; age: 20-40 years) on the behavioural and neurobiological level. For the experimental task, participants were scanned with functional magnetic resonance tomography (functional magnetic resonance imaging, 3 T) while imagining neutral, shame inducing and guilt inducing scenarios. In addition to clinical questionnaires, participants were asked to complete questionnaires measuring shame and guilt. The functional data indicate an increased activity in OCD patients in the shame condition in the limbic, temporal and sub-lobar (hypothalamus) areas, in the guilt condition inter alia in frontal, limbic and temporal areas. In summary we found activity in OCD patients in neural networks which are responsible for stimulus filtering, emotion regulation, impulse control and memory. The results from our study may contribute to a better understanding of the origins and maintenance of OCD in association with the pathological processing of shame and guilt on different functional levels.

The purpose of this study was to evaluate differences of plaque composition and morphology within the same patient in different vascular beds using non-invasive MR-plaque imaging. 28 patients (67.8 ± 7.4 years, 8 females) with high Framingham general cardiovascular disease 10-year risk score and mild-to-moderate atherosclerosis were consecutively included in the study. All subjects underwent a dedicated MRI-plaque imaging protocol using TOF and T1w and T2w black-blood-sequences with fat suppression at 1.5 T. The scan was centered on the carotid bulb of the carotid arteries and on the most stenotic lesion of the ipsilateral femoral artery, respectively. Plaques were classified according to the American Heart Association (AHA) lesion type classification and area measurements of lumen, wall and the major plaque components, such as calcification, necrotic core and hemorrhage were determined in consensus by two blinded reviewers using dedicated software (Cascade, Seattle, USA). Plaque components were recorded as maximum percentages of the wall area. Carotid arteries had larger maximum wall and smaller minimum lumen areas (p < 0.001) than femoral arteries, whereas no significant difference was find with respect to the max. NWI (p = 0.87). Prevalence of lipid-rich AHA lesion type IV/V and complicated AHA lesion type VI with hemorrhage/thrombus/fibrous cap rupture was significantly higher in the carotid arteries compared to the femoral arteries. Plaque composition as percentage of the vessel wall differed significantly between carotid and femoral arteries: Max. %necrotic core and max. %hemorrhage were significantly higher in the carotid arteries compared to the femoral arteries (p = 0.001 and p = 0.02, respectively). Max. %calcification did not differ significantly. Average stenotic degree of carotid arteries at duplex was 49.7 ± 12.5 (%). Non-invasive MR plaque-imaging is able to visualize differences in plaque composition across the vascular tree. We observed significant differences in quantitative and qualitative plaque features between carotid and femoral arteries within the same patient, which in the future could help to improve risk stratification in patients with atherosclerosis.

Soccer is the most popular sport in the world. Soccer players are at high risk for repetitive subconcussive head impact when heading the ball. Whether this leads to long-term alterations of the brain's structure associated with cognitive decline remains unknown. The aim of this study was to evaluate cortical thickness in former professional soccer players using high-resolution structural MR imaging. Fifteen former male professional soccer players (mean age 49.3 [SD 5.1] years) underwent high-resolution structural 3 T MR imaging, as well as cognitive testing. Fifteen male, age-matched former professional non-contact sport athletes (mean age 49.6 [SD 6.4] years) served as controls. Group analyses of cortical thickness were performed using voxel-based statistics. Soccer players demonstrated greater cortical thinning with increasing age compared to controls in the right inferolateral-parietal, temporal, and occipital cortex. Cortical thinning was associated with lower cognitive performance as well as with estimated exposure to repetitive subconcussive head impact. Neurocognitive evaluation revealed decreased memory performance in the soccer players compared to controls. The association of cortical thinning and decreased cognitive performance, as well as exposure to repetitive subconcussive head impact, further supports the hypothesis that repetitive subconcussive head impact may play a role in early cognitive decline in soccer players. Future studies are needed to elucidate the time course of changes in cortical thickness as well as their association with impaired cognitive function and possible underlying neurodegenerative process.

To determine the feasibility of free-breathing, GRAPPA-based, real-time (RT) cine 3T cardiac magnetic resonance imaging (MRI) with high acceleration factors for the assessment of left-ventricular function in a cohort of patients as compared to conventional segmented cine imaging.In this prospective cohort study, subjects with various cardiac conditions underwent MRI involving two RT cine sequences (high resolution and low resolution) and standard segmented cine imaging. Standard qualitative and quantitative parameters of left-ventricular function were quantified.Among 25 subjects, 24 were included in the analysis (mean age: 50.5±21 years, 67% male, 25% with cardiomyopathy). RT cine derived quantitative parameters of volumes and left ventricular mass were strongly correlated with segmented cine imaging (intraclass correlation coefficient [ICC]:0.72 for both RT cines) but correlation for peak ejection and filling rates were moderate to poor for both RT cines (ICC0.40). Similarly, RT cines significantly underestimated peak ejection and filling rates (103.2±178 ml/s). Among patient-related factors, heart rate was strongly predictive for deviation of measurements (p0.05).RT cine MRI at 3T is feasible for qualitative and quantitative assessment of left ventricular function for low and high-resolution sequences but results in significant underestimation of systolic function, peak ejection and filling rates.

The aim of this study was to assess the diagnostic performance of a dynamic, multiphasic contrast-enhanced volume-interpolated sequence with advanced parallel imaging techniques, Dixon fat saturation, and view sharing with 5 hepatic arterial subphases for the detection of focal liver lesions.Twenty-four consecutive patients (13 females, 11 males; mean [SD] age, 58 [15] years) with focal liver lesions were included in this prospective study. The examination was performed at a 3-T magnetic resonance imaging system (MAGNETOM Skyra; Siemens Healthcare, Erlangen, Germany). Five dynamic arterial subphases with a temporal resolution of 2.6 seconds, starting 17 seconds after injection of the hepatobiliary contrast agent gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid (Eovist; Bayer HealthCare, Leverkusen, Germany), were acquired using an accelerated parallel imaging volume-interpolated sequence with view sharing (multiarterial controlled aliasing in parallel imaging results in higher acceleration-Dixon-time-resolved angiography with interleaved stochastic trajectories-volumetric interpolated breath-hold examination [MA-CDT-VIBE]). The fourth of the 5 arterial acquisition phases (ie, at 24.8 seconds after the start of contrast agent injection) was considered the equivalent of a standard hepatic arterial phase (equivalent standard arterial phase [ESAP]). The diagnostic value of all 5 dynamic arterial phases for the detection of focal liver lesions, as compared with the single ESAP, was judged in 2 independent consensus readings. The 2 consensus reading groups were blinded to each others' results. The complete, comprehensive multisequence magnetic resonance imaging examination, including T1-weighted, T2-weighted, and multiphasic contrast-enhanced sequences, served as the standard of reference for lesion detection.Forty-six percent of the patients (11/24) had hypervascular lesions. In 79 % of all patients (19/24), the best arterial parenchymal contrast of one of the MA-CDT-VIBE acquisition phases was considered better than that of the ESAP. In one third of all cases (8/24 for the first and 6/24 for the second consensus reading), MA-CDT-VIBE showed an improved lesion detection rate compared with ESAP, especially in hypervascular lesions (4/11, representing 36% of all patients with hypervascular lesions). There was a high degree of interrater agreement between the 2 consensus reading groups (the Cohen κ, 0.71-1.00; P0.001).Compared with a standard hepatic arterial phase, MA-CDT-VIBE with 5 hepatic arterial subphases demonstrated greater diagnostic accuracy for the detection of hypervascular focal liver lesions and provided a robust and optimized hepatic arterial acquisition phase.

Purpose: To prospectively assess current limitations and complication rates of the transbrachial access technique for endovascular treatment of peripheral vascular pathologies. Methods: In total, 150 patients (112 men; mean age 66.3±10.0 years) with arterial occlusive disease underwent endovascular therapy via a transbrachial access. Periprocedure data (sheath size, dose area product, fluoroscopy time, and procedure duration) were analyzed. Postprocedure complications of the puncture sites were categorized as minor (local hematoma, pseudoaneurysm, embolization, dissection, minor bleeding) and major (thrombotic occlusion, hematoma requiring surgery, major bleeding, nerve injury). Results: The minor and major complication rates were 14.0% (n=21) and 2.7% (n=4). The most frequent major complication was thrombotic occlusion of the brachial artery requiring surgical treatment (3/150, 2%). There was only one temporary palsy of the median nerve and no stroke. Local hematoma (15, 10%), pseudoaneurysm (3, 2%), or a combination of both (3, 2%) dominated the minor complications. The average dose area product and fluoroscopy time were 12,752.1±9524.5 cGy*cm2 and 24.3±18.4 minutes, respectively, though procedure duration was acceptable (121.8±48.9 minutes). Conclusion: Complication rates of the transbrachial access for endovascular treatment of peripheral or visceral artery occlusive disease are tolerably low, making it a safe and an important alternative to the transfemoral access in selected cases, though the radiation exposure is rather high.

PURPOSE The purpose of this study was to assess the influence of region of interest (ROI) size and positioning on perfusion and permeability parameters as well as on interobserver and intraobserver variability of dynamic contrast-enhanced (DCE-MRI) of primary renal cell carcinoma (RCC) and metastases. MATERIALS AND METHODS Thirty-nine DCE-MRI examinations of 34 patients with primary RCC and 20 examinations of 9 patients with RCC metastases obtained at 1.5 T were evaluated. Pretreatment and posttreatment analysis with antiangiogenic therapy was performed in 4 patients with primary RCCs and 5 patients with metastases. The ROIs of the whole tumor (wROI), the circular edge (cROI), a user-defined arbitrary small region (sROI), and a semiautomated segmented ROI were independently defined by 2 readers on 1 slice on arterial phase DCE-MRI images or on parametric plasma-flow maps. Analysis with a 2-compartment exchange model provided 4 parameters: plasma flow (FP), plasma volume (vp), permeability-surface product (PS), and extravascular-extracellular volume (ve). Interobserver and intraobserver parameter correlations were calculated using the intraclass correlation coefficient, and within-subject variability were considered on the basis of the coefficient of variation. Differences in measurement values of variable ROI size were assessed with paired t test. RESULTS Mean values of FP and vp with sROIs were significantly higher than those with wROI, cROI, and semiautomated segmented ROI placement in tumor or metastases. Values of ve showed no significant difference between ROI sizes. The highest interobserver and intraobserver correlation with 0.99/0.98 for metastases and 0.97/0.98 for primary RCCs, respectively, was observed for all parameters when defining wROIs on dynamic images. Perfusion parameters of wROI measurements for FP (dynamic, 0.97; parametric maps, 0.96) and vp (0.95/0.89) showed higher interobserver correlation than did permeability parameters ve (0.64/0.6) and PS (0.79/0.5) in primary RCCs. The wROIs showed also the lowest within-subject coefficients of variation for perfusion parameters FP and vp compared with cROI and sROIs in primary RCCs and metastases. CONCLUSIONS The ROI size and positioning do substantially influence quantitative perfusion and permeability parameters in DCE-MRI. The best interobserver and intraobserver correlation can be obtained when defining a whole-tumor ROI. The perfusion parameters are the most reliable, whereas the permeability parameters are more susceptible to interobserver variability. No significant differences between placing ROIs on morphological or parametric images were observed.

To determine the prognostic impact of radiologically enlarged lymph nodes ≥ 10 mm on the survival of patients with metastatic colorectal cancer.The prospective, randomized, open-label FIRE-3/AIO KRK0306 trial evaluated the first-line therapy of patients with KRAS exon 2 wild-type metastatic colorectal cancer with fluorouracil, folinic acid and irinotecan plus either cetuximab or bevacizumab. In the RAS wild-type population (n = 400), adequately evaluable baseline computed tomographies (n = 339) were reviewed for enlarged regional and distant lymph nodes. Their prognostic relevance was retrospectively analyzed in uni- and multivariable Cox proportional hazard regressions.Median overall survival was 21.7 months in patients with enlarged lymph nodes and 33.2 months in patients without (hazard rate ratio [HR] = 1.61, 95% confidence interval [CI], 1.23-2.09; P 0.001). This was confirmed in multivariable analysis (HR = 1.37, 95% CI, 1.02-1.83; P = 0.036). Progression-free survival of patients with enlarged lymph nodes showed a consistent but insignificant trend (9.9 vs. 11.1 months; HR = 1.23, 95% CI, 0.98-1.54; P = 0.072). Enlarged lymph nodes were also associated with BRAF-mutations (P = 0.004).The presence of radiologically enlarged lymph nodes in baseline staging has a negative prognostic value beyond established and potential prognostic parameters.

Magnetic resonance imaging-based markers of schizophrenia have been repeatedly shown to separate patients from healthy controls at the single-subject level, but it remains unclear whether these markers reliably distinguish schizophrenia from mood disorders across the life span and generalize to new patients as well as to early stages of these illnesses. The current study used structural MRI-based multivariate pattern classification to (i) identify and cross-validate a differential diagnostic signature separating patients with first-episode and recurrent stages of schizophrenia (n = 158) from patients with major depression (n = 104); and (ii) quantify the impact of major clinical variables, including disease stage, age of disease onset and accelerated brain ageing on the signature's classification performance. This diagnostic magnetic resonance imaging signature was then evaluated in an independent patient cohort from two different centres to test its generalizability to individuals with bipolar disorder (n = 35), first-episode psychosis (n = 23) and clinically defined at-risk mental states for psychosis (n = 89). Neuroanatomical diagnosis was correct in 80% and 72% of patients with major depression and schizophrenia, respectively, and involved a pattern of prefronto-temporo-limbic volume reductions and premotor, somatosensory and subcortical increments in schizophrenia versus major depression. Diagnostic performance was not influenced by the presence of depressive symptoms in schizophrenia or psychotic symptoms in major depression, but earlier disease onset and accelerated brain ageing promoted misclassification in major depression due to an increased neuroanatomical schizophrenia likeness of these patients. Furthermore, disease stage significantly moderated neuroanatomical diagnosis as recurrently-ill patients had higher misclassification rates (major depression: 23%; schizophrenia: 29%) than first-episode patients (major depression: 15%; schizophrenia: 12%). Finally, the trained biomarker assigned 74% of the bipolar patients to the major depression group, while 83% of the first-episode psychosis patients and 77% and 61% of the individuals with an ultra-high risk and low-risk state, respectively, were labelled with schizophrenia. Our findings suggest that neuroanatomical information may provide generalizable diagnostic tools distinguishing schizophrenia from mood disorders early in the course of psychosis. Disease course-related variables such as age of disease onset and disease stage as well alterations of structural brain maturation may strongly impact on the neuroanatomical separability of major depression and schizophrenia.

RATIONALE AND OBJECTIVE The objective of this study was to assess an optimized renal multiphase computed tomography angiography (MP-CTA) protocol regarding reduction of contrast volume. MATERIALS AND METHODS Thirty patients underwent MP-CTA (12 phases, every 3.5 seconds, 80 kV/120 mAs) using 30 mL of contrast medium. The quality of MP-CTA was assessed quantitatively measuring vessel attenuation, image noise, and contrast-to-noise ratio. MP-CTA was evaluated qualitatively regarding depiction of vessels, cortex differentiation, and motion artifacts (grades 1-4, 1 = best). Mean effective radiation dose was registered. Results were compared to standard renal computed tomography angiography (CTA) (80 mL). Student t test was applied, if variables followed normal distribution. For other variables, nonparametric Mann-Whitney U test was used. RESULTS All acquisitions were successfully performed, and no patient had to be excluded from the study. MP-CTA enabled high attenuation (aorta: 503 ± 91 HU, renal arteries: 450 ± 73 HU/456 ± 72 HU) at adequate image noise (13.7 ± 1.5) and good contrast-to-noise ratio (34.2 ± 10.2). Good attenuation of renal veins was observed (286 ± 43 HU/282 ± 42 HU). Arterial enhancement was significantly higher compared to renal CTA (aorta: 396 ± 90 HU, renal arteries: 331 ± 74 HU/333 ± 80 HU; P

X-ray chest radiography is an inexpensive and broadly available tool for initial assessment of the lung in clinical routine, but typically lacks diagnostic sensitivity for detection of pulmonary diseases in their early stages. Recent X-ray dark-field (XDF) imaging studies on mice have shown significant improvements in imaging-based lung diagnostics. Especially in the case of early diagnosis of chronic obstructive pulmonary disease (COPD), XDF imaging clearly outperforms conventional radiography. However, a translation of this technique towards the investigation of larger mammals and finally humans has not yet been achieved. In this letter, we present the first in-vivo XDF full-field chest radiographs (32 × 35 cm2) of a living pig, acquired with clinically compatible parameters (40 s scan time, approx. 80 µSv dose). For imaging, we developed a novel high-energy XDF system that overcomes the limitations of currently established setups. Our XDF radiographs yield sufficiently high image quality to enable radiographic evaluation of the lungs. We consider this a milestone in the bench-to-bedside translation of XDF imaging and expect XDF imaging to become an invaluable tool in clinical practice, both as a general chest X-ray modality and as a dedicated tool for high-risk patients affected by smoking, industrial work and indoor cooking.

Purpose Recent studies have suggested that intraluminal thrombi show contrast enhancement on carotid black-blood T1w MRI. The aim of this study was to evaluate the significance of intraluminal contrast enhancement (iCE) regarding symptom status in patients with spontaneous cervical artery dissection (sCAD). Methods 33 consecutive patients (19 men) with sCAD received a brain MRI (DIFF, T2w, T2*w, FLAIR) and a multi-sequence 3T-MRI with fat-saturated high-resolution black-blood T1w-sequences pre- and post-contrast, contrast-enhanced MR angiography and TOF images of carotid and vertebral arteries. Presence/absence of iCE, vessel occlusion and vessel wall hematoma (hyperintense in T1w pre-contrast) were analysed by two radiologists in consensus decision. Results 44 of 132 analysed vessels had a vessel wall hematoma, consistent with sCAD. In 17 of 44 dissected vessels an acute ischemic stroke was found. 16 of 17 (94.1 %) vessels ipsilateral to ischemic stroke demonstrated iCE, compared to 9 of 44 (20.4 %) dissected vessels without stroke (P Conclusion iCE, which is suggestive of intraluminal thrombus formation, is strongly correlated with ischemic symptoms in patients with sCAD. Key points Citation Format

Purpose Experimental neuroimaging provides a wide range of methods for the visualization of brain anatomic morphology down to subcellular detail. Still, each technique-specific detection mechanism presents compromises among the achievable field-of-view size, spatial resolution, and nervous tissue sensitivity, leading to partial sample coverage, unresolved morphologic structures, or sparse labeling of neuronal populations and often also to obligatory sample dissection or other sample invasive manipulations. X-ray phase-contrast imaging computed tomography (PCI-CT) is an experimental imaging method that simultaneously provides micrometric spatial resolution, high soft-tissue sensitivity, and exvivo full organ rodent brain coverage without any need for sample dissection, staining or labeling, or contrast agent injection. In the present study, we explored the benefits and limitations of PCI-CT use for invitro imaging of normal and cancerous brain neuromorphology after invivo treatment with synchrotron-generated x-ray microbeam radiation therapy (MRT), a spatially fractionated experimental high-dose radiosurgery. The goals were visualization of the MRT effects on nervous tissue and a qualitative comparison of the results to the histologic and high-field magnetic resonance imaging findings. Methods and Materials MRT was administered invivo to the brain of both healthy and cancer-bearing rats. At 45days after treatment, the brain was dissected out and imaged exvivo using propagation-based PCI-CT. Results PCI-CT visualizes the brain anatomy and microvasculature in 3 dimensions and distinguishes cancerous tissue morphology, necrosis, and intratumor accumulation of iron and calcium deposits. Moreover, PCI-CT detects the effects of MRT throughout the treatment target areas (eg, the formation of micrometer-thick radiation-induced tissue ablation). The observed neurostructures were confirmed by histologic and immunohistochemistry examination and related to the micro-magnetic resonance imaging data. Conclusions PCI-CT enabled a unique 3D neuroimaging approach for exvivo studies on small animal models in that it concurrently delivers high-resolution insight of local brain tissue morphology in both normal and cancerous micro-milieu, localizes radiosurgical damage, and highlights the deep microvasculature. This method could assist experimental small animal neurology studies in the postmortem evaluation of neuropathology or treatment effects. &nbsp

Objective To evaluate volumetric and densitometric properties of the adrenal glands in patients with unilateral and bilateral disease in comparison to normal controls. Design 77 patients (56 male and 21 female) diagnosed with primary aldosteronism (PA) with a mean age of 53±10 years were prospectively enrolled. Unenhanced and contrast enhanced CT scans were analyzed for adrenal volumes and mean densities. f These values were compared with normal controls and between PA subtypes. Results Adrenals containing an aldosterone producing adenoma (APA, n=56) had on average higher attenuation values as compared to adrenals with bilateral adrenal hyperplasia (BAH, n=21). Mean adrenal gland volume in PA patients was not significantly different between PA subtypes. In comparison to normal adrenal glands, volumes were significantly higher in PA patients (p < 0.0001) including adrenals contralateral to APAs, which were significantly larger in comparison to controls. Conclusion Independent of subtype differentiation, adrenal volumetry reveals higher adrenal volumes in PA patients in comparison to normal controls. These findings provide indirect evidence for a general adrenal growth dysregulation in the context of PA. This article is protected by copyright. All rights reserved.

Crossed cerebellar diaschisis (CCD) is the phenomenon of hypoperfusion and hypometabolism of the contralateral cerebellar hemisphere caused by dysfunction of the related supratentorial region. Our aim was to analyze its influence on morphologic and functional outcome in acute ischemic stroke. Subjects with stroke caused by a large vessel occlusion of the anterior circulation were selected from an initial cohort of 1644 consecutive patients who underwent multiparametric CT including whole-brain CT perfusion. Two experienced readers evaluated the posterior fossa in terms of CCD absence (CCD−) or presence (CCD+). A total of 156 patients formed the study cohort with 102 patients (65.4%) categorized as CCD− and 54 (34.6%) as CCD+. In linear and logistic regression analyses, no significant association between CCD and final infarction volume (β = −0.440, p = 0.972), discharge mRS ≤ 2 (OR = 1.897, p = 0.320), or 90-day mRS ≤ 2 (OR = 0.531, p = 0.492) was detected. CCD+ patients had larger supratentorial cerebral blood flow deficits (median: 164 ml vs. 115 ml; p = 0.001) compared to CCD−patients. Regarding complications, CCD was associated with a higher rate of parenchymal hematomas (OR = 4.793, p = 0.035). In conclusion, CCD is frequently encountered in acute ischemic stroke caused by large vessel occlusion of the anterior circulation. CCD was associated with the occurrence of parenchymal hematoma in the ipsilateral cerebral infarction but did not prove to significantly influence patient outcome.

Radioembolization (RE) with 90yttrium (90Y) resin microspheres generally employs a sandwich technique with separate sequential administration of contrast medium (CM), followed by vehicle (e.g., glucose 5% [G5] solution), then 90Y resin microspheres (in G5), then G5, and then CM again to avoid contact of CM and microspheres under fluoroscopic guidance. This study evaluates the visualization quality and safety of a modified sandwich technique with a 50/50-mixture of CM (Imeron 300) and G5 for administration of 90Y resin microspheres. A retrospective analysis of 81 RE procedures in patients with primary or secondary liver tumors was performed. The quality of angiographic visualization of the hepatic vessels was assessed before the first injection and immediately before the whole dose has been injected. Visualization and flow rate were graded on a 5-point scale: 1 = very good to 5 = not visible/no antegrade flow. Univariate logistic regression models and multiple linear regression models were used to evaluate the prognostic variables associated with visualization and flow scores. Visualization quality was inversely related to flow rate, the lower the flow rate the better the grade of the visualization. Visualization quality was also inversely related to body-mass-index (BMI). Performing RE with the 50/50-CM/G5 mixture resulted in a mean injection time for 1 GBq of 15 min. No clinically significant adverse events, including radiation-induced liver disease were reported. RE with a 50/50-mixture of CM and G5 for administration of 90Y resin microspheres in a modified sandwich technique is a safe administration alternative and provides good visualization of hepatic vessels, which is inversely dependent on flow rate and BMI. Injection time was reduced compared with our experience with the standard sandwich technique.

OBJECTIVES The aim of this study was to compare single-slice and 3-dimensional (3D) analysis for magnetic resonance renography (plasma flow [FP], plasma volume [VP], and glomerular filtration rate [GFR]) and for dynamic contrast-enhanced magnetic resonance imaging (MRI) of renal tumors (FP, VP, permeability-surface area product), respectively. MATERIAL AND METHODS We prospectively included 22 patients (43 kidneys with 22 suspicious renal lesions) and performed preoperative and postoperative imaging before and after partial nephrectomy, respectively. Of the 22 renal lesions, 15 turned out to be renal cell carcinoma and were included in the tumor analysis, altogether leading to 86 renal and 15 tumor MRI scans, respectively. Dynamic contrast-enhanced MRI was performed with a time-resolved angiography with stochastic trajectories sequence (spatial resolution, 2.6 × 2.6 × 2.6 mm3; temporal resolution, 2.5 seconds) at 3 T (Magnetom Verio; Siemens Healthcare Sector) after injection of 0.05 mmol/kg body weight Gadobutrol (Bayer Healthcare Pharmaceuticals). Analysis was performed using regions of interest encompassing a single central slice and the whole kidney/tumor, respectively. A 2-compartment model yielding FP, VP, GFR, or tumor permeability-surface area product was used for kinetic modelling. Modelling was performed based on relative contrast enhancement to account for coil-related inhomogeneity. Significance in difference, agreement, and goodness of fit of the data to the curve was assessed with paired t tests, Bland-Altman plots, and χ2 test, respectively. RESULTS Bland-Altman analysis revealed a good agreement between both types of measurement for kidneys and tumors, respectively. Results between single-slice and whole-kidney regions of interest showed significant differences for Fp (single slice, 256.1 ± 104.1 mL/100 mL/min; whole kidney, 217.2 ± 92.5 mL/100 mL/min; P < 0.01). Regarding VP and GFR, no significant differences were observed. The χ2 test showed a significantly better goodness of fit of the data to the curve for whole kidneys (0.30% ± 0.18%) than for single slices (0.43% ± 0.26%) (P < 0.01). In contrast to renal assessment, tumor analysis showed no significant differences regarding functional parameters and χ test, respectively. CONCLUSION In dynamic contrast-enhanced MRI of the kidney, both 3D whole-organ/tumor and single-slice analyses provide roughly comparable values in functional analysis. However, 3D assessment is considerably more precise and should be preferred if available.

Beta-2-microglobulin is a serum maker of tumor burden in hematologic malignancies. We aimed to correlate serum β2-microglobulin levels in patients with multiple myeloma (MM) to tumor mass determined by whole-body MRI.We retrospectively included patients with newly diagnosed, untreated MM who underwent whole-body MRI at our institution between 2003 and 2011. Patients with a glomerular filtration rate of less than 60 mL/min were excluded from analysis because β2-microglobulin levels are increased in renal failure. Thirty patients could be included. Whole-body MRI examinations (T1-weighted turbo spin-echo and STIR sequences) were assessed by two musculoskeletal radiologists in consensus for focal lesions and the presence of diffuse myeloma infiltration. The presence of diffuse infiltration was confirmed by histology as the reference standard. MM was staged according to the Durie and Salmon PLUS staging system.According to whole-body MRI findings, MM was classified as Durie and Salmon PLUS stage I (low grade) in 13 patients, stage II (intermediate grade) in six patients, and stage III (high grade) in 11 patients. As we expected, most patients with stage I disease (12/13) had normal β2-microglobulin levels (≤ 3 mg/L). Higher β2-microglobulin values were associated with a higher stage of disease (p0.05). However, five of six patients with stage II MM and five of 11 patients with stage III MM showed normal β2-microglobulin levels. Thus, 10 of 17 patients (58.8%) with substantial infiltration in the bone marrow showed false-negative β2-microglobulin levels.Serum β2-microglobulin levels correlate with tumor stage in MM. However, it may be misleading as a marker of tumor load in a subset of patients with substantial myeloma infiltration in the bone marrow. Whole-body MRI may display the full tumor load and correctly show the extension of myeloma infiltrates.

To find out whether the use of accelerated 2D-selective parallel-transmit excitation MRI for diffusion-weighted EPI (pTX-EPI) offers advantages over conventional single-shot EPI (c-EPI) with respect to different aspects of image quality in the MRI of the pancreas.The MRI examinations of 33 consecutive patients were evaluated in this prospective and IRB-approved study. PTX-EPI was performed with a reduced (zoomed) FOV of 230 × 118 mm(2). The 2D-RF pulse of pTX-EPI was accelerated, i.e. shortened by a factor of 1.7 (pTX-acceleration factor). C-EPI used a full-FOV of 380 × 285 mm(2). In a qualitative analysis, two experienced readers evaluated 3 different aspects of image quality on 3- to 5-point Likert scales. Additionally, apparent diffusion coefficients (ADCs) were determined in both c-EPI and pTX-EPI in normal-appearing pancreatic tissue using regions of interests (ROIs). Mean ADC values and standard deviations were compared between the two techniques.The reduced-FOV pTX-EPI was superior to c-EPI with respect to overall image quality (p0.0001) and identifiability of the pancreatic ducts (p0.01). Artifacts were significantly less severe in pTX-EPI (p0.01). The mean ADC values of c-EPI (1.29 ± 0.19 × 10(-3)mm(2)/s) and pTX-EPI (1.27 ± 0.17 × 10(-3)mm(2)/s) did not differ significantly between the two techniques (p=0.44). The variation within the ROIs as measured by the standard deviation was significantly lower in pTX-EPI (0.095 × 10(-3)mm(2)/s) than in c-EPI (0.135 × 10(-3)mm(2)/s), p0.05.PTX-accelerated EPI with spatially-selective excitation and reduced FOV leads to substantial improvements in DWI of the pancreas with respect to different aspects of image quality without significantly influencing the ADC values.