Search

To review emerging techniques in cardiac magnetic resonance imaging (CMR) and their clinical applications with a special emphasis on new technologies, recent trials, and updated guidelines. The utility of CMR has expanded with the development of new MR sequences, postprocessing techniques, and artificial intelligence-based technologies, which have substantially increased the spectrum, quality, and reliability of information that can be obtained by CMR. The CMR modality has become an irreplaceable tool for diagnosis, treatment guidance and follow-up of patients with ischemic heart disease, myocarditis, and cardiomyopathies. Its role has been further strengthened by recent trials and guidelines. Quantitative mapping techniques are increasingly used for tissue characterization and detection of diffuse myocardial changes including myocardial storage diseases. With state-of-the-art CMR sequences, postprocessing techniques and understanding of their interpretation, CMR makes invaluable contributions to provide state-of-the-art diagnostics and care for cardiac patients in a multidisciplinary team.

Background The rapid progress in oncology research requires numerous new scientific publications. This article aims to provide an overview of criteria-based imaging and response evaluation of lymphoma according to the current status of knowledge. In fact, common criteria for evaluating data, especially imaging response evaluation, are essential for comparability of studies. While criteria-based classifications of solid tumors have been established for some time, there are now increasing classifications of lymphoma diseases. The purpose of this review is to describe the development of criteria-based evaluation of lymphoma diseases with a special focus on imaging up to current guidelines. Methods Literature review based on PubMed including the languages English and German was performed. This review article includes the most important criteria-based response evaluations of lymphoma published between January 1999 and July 2019. Results and Conclusion The two latest classifications of response evaluation of lymphoma are: The Lugano classification, which has been steadily developed over the past 20 years and has been specially adapted to technical progress, as well as the evaluation method RECIL (Response Evaluation Criteria In Lymphoma), which is based on the RECIST (Response Evaluation Criteria in Solid Tumors) classification already established for solid tumors. Significant imaging components of both classifications are the anatomical measurement and measurement of the metabolic response of the manifestation of lymphoma using positron emission tomography (PET/CT). Key Points: Citation Format

Increasing the specific energy, energy density, specific power, energy efficiency and energy retention of electrochemical storage devices are major incentives for the development of all-solid-state batteries. However, a general evaluation of all-solid-state battery performance is often difficult to derive from published reports, mostly due to the interdependence of performance measures, but also due to the lack of a basic reference system. Here, we present all-solid-state batteries reduced to the bare minimum of compounds, containing only a lithium metal anode, β-Li3PS4 solid electrolyte and Li(Ni0.6Co0.2Mn0.2)O2 cathode active material. We use this minimalistic system to benchmark the performance of all-solid-state batteries. In a Ragone-type graph, we compare literature data for thiophosphate-, oxide-, phosphate- and polymer-based all-solid-state batteries with our minimalistic cell. Using fundamental equations for key performance parameters, we identify research targets towards high energy, high power and practical all-solid-state batteries. Considering the interdependence of performance measures and the lack of a basic reference system for all-solid-state batteries, Jurgen Janek and co-workers analyse literature performance data for major types of all-solid-state batteries and benchmark them against minimalistic reference cells.

Stressfrakturen sind in der klinischen Praxis sehr haufig. Sie konnen unterschieden werden in Ermudungsfrakturen, die gesunden Knochen betreffen, und Insuffizienzfrakturen, bei denen der Knochen bereits vorgeschadigt ist. Die konventionelle Rontgenuntersuchung ist die Standardmethode bei Verdacht auf eine Stressfraktur. Ist diese negativ, kann eine Magnetresonanztomographie (MRT) durchgefuhrt werden, die eine deutlich hohere Sensitivitat aufweist und weitere Informationen, wie z. B. Hinweise auf eine pathologische Fraktur, liefern kann. Die Computertomographie (CT) ist geeignet zur exakten Darstellung des Frakturverlaufs und damit zur praoperativen Planung. Als nuklearmedizinisches Verfahren kann die Skelettszintigraphie zum Einsatz kommen, da der Knochenstoffwechsel im Bereich einer Fraktur erhoht ist. Typische Zeichen in Projektionsradiographie sind das Gray Cortex Sign, die Periostreaktion und eine Frakturlinie, die haufig senkrecht zur Kortikalis orientiert ist und die eine parallel verlaufende (oft spindel- oder keilformige) Skleroselinie aufweisen kann. Im Verlauf tritt Kallusmaterial hinzu. In der MRT zeigen sich ein periostales und ein unscharf berandetes medullares Odem, eine Umgebungsreaktion im Weichgewebe und eine T1-hypointense Frakturlinie. In der CT ist die Frakturlinie hypodens und oft mit einem angrenzenden Skleroseareal vergesellschaftet. Fur eine korrekte Diagnosestellung ist es wichtig, mit den geeigneten Modalitaten und den jeweiligen bildgebenden Befunden der Stressfrakturen vertraut zu sein. Bei initial unauffalligem Rontgenbild und fortbestehenden Beschwerden sollte eine MRT durchgefuhrt werden, um andere Ursachen wie eine pathologische Fraktur auszuschliesen.

Autism spectrum disorder (ASD) is a heterogeneous neurodevelopment disorder resulting from different etiological factors, both genetic and/or environmental. These factors can lead to abnormal neuronal development on dendrite and synaptic function at the central nervous system. Recent studies have shown that a subset of ASD patients display increased circulation levels of the tyrosine metabolite, p-cresol, related to chronic intestinal disorders because of dysbiosis of the intestinal microbiota. In particular, abnormal presence of intestinal Clostridium sp. has been linked to high levels of p-cresol in ASD children younger than 8 years. However, the role of p-cresol during development of the central nervous system is unknown. Here, we evaluated in vitro the effect of p-cresol on neurite outgrowth in N2a and PC12 cell lines and dendritic morphology, synaptic density, neuronal activity, and calcium responses in primary rat hippocampal neurons. p-cresol inhibits neural differentiation and neurites outgrowth in N2a and PC12 neuronal cell lines. In hippocampal neuronal cultures, Sholl's analysis shows a decrease in the dendritic arborization of neurons treated with p-cresol. Synaptic density analyzed with the synaptic markers Piccolo and Shank2 is diminished in hippocampal neurons treated with p-cresol. Electrically evoked intracellular calcium rise was drastically, but reversely, blocked by p-cresol, whereas that spontaneous neuronal activity was severely affected by early addition of the metabolite. These findings show that p-cresol alters dendrite development, synaptogenesis, and synapse function of neurons in culture, therefore, neuronal alterations occurring in ASD children may be related to this metabolite and dysbiosis of the intestinal microbiota.

The purpose of this study was to investigate the prevalence, clinical characteristics, and predictors of negative venous leg ultrasound in acute pulmonary embolism (PE). We retrospectively analyzed a cohort of 168 patients with acute PE (median age 73 years, 44% women) evaluated with complete venous leg ultrasound. A multivariate logistic regression analysis was performed to identify the independent predictors of negative venous ultrasound in acute PE. Venous leg ultrasound was negative for deep venous thrombosis (DVT) in 78 patients (46.4%). Patients with negative venous ultrasound were less likely to have a history of DVT (7.7% vs. 20.0%, p = 0.0273) and had significantly lower D-dimer levels (median 2.5 vs. 6.2 mg/dL p < 0.0001). Negative venous ultrasound was more frequent in PE diagnosed with V/P-SPECT than in PE diagnosed with CT (66.2% vs. 34.0%, p < 0.0001). The prevalence of negative venous ultrasound increased with more peripherally located PE (29.5% for central/lobar, 43.1% for segmental, and 60.6% for subsegmental PE, p = 0.0049). For the multivariate analysis, a diagnosis of PE with V/P-SPECT rather than CT (OR 3.2, p = 0.0056) and lower D-dimer levels (OR 0.94, p = 0.0266) were independent predictors of negative venous ultrasound. In conclusion, venous leg ultrasound was negative for DVT in almost half of patients with acute PE. Negative venous ultrasound was more common in patients with no history of DVT, lower D-dimer levels, PE diagnosed with V/P-SPECT rather than CT, and more peripherally located PE.

Micropatterns applied to proton exchange membranes can improve the performance of polymer electrolyte fuel cells; however, the mechanism underlying this improvement is yet to be clarified. In this study, a patterned membrane electrode assembly (MEA) was compared with a flat one using electrochemical impedance spectroscopy and distribution of relaxation time analysis. The micropattern positively affects the oxygen reduction reaction by increasing the reaction area. However, simultaneously, the pattern negatively affects the gas diffusion because it lengthens the average oxygen transport path through the catalyst layer. In addition, the patterned MEA is more vulnerable to flooding, but performs better than the flat MEA in low-humidity conditions. Therefore, the composition, geometry, and operating conditions of the micropatterned MEA should be comprehensively optimized to achieve optimal performance.

The aim of this investigation was to evaluate predictive CT imaging features and clinical parameters to distinguish infected from sterile fluid collections. Detection of infectious agents by advanced microbiological analysis was used as the reference standard. From April 2018 to October 2019, all patients undergoing CT-guided drainages were prospectively enrolled, if drainage material volume was at least 5 mL. Univariate analysis revealed attenuation (p = 0.001), entrapped gas (p < 0.001), fat stranding (p < 0.001), wall thickness (p < 0.001) and enhancement (p < 0.001) as imaging biomarkers and procalcitonin (p = 0.003) as clinical predictive parameters for infected fluid collections. On multivariate analysis, attenuation > 10 HU (p = 0.038), presence of entrapped gas (p = 0.027) and wall enhancement (p = 0.028) were independent parameters for distinguishing between infected and non-infected fluids. Gas entrapment had high specificity (93%) but low sensitivity (48%), while wall enhancement had high sensitivity (91%) but low specificity (50%). CT attenuation > 10 HU showed intermediate sensitivity (74%) and specificity (70%). Evaluation of the published proposed scoring systems did not improve diagnostic accuracy over independent predictors in our study. In conclusion, this prospective study confirmed that CT attenuation > 10 HU, entrapped gas and wall enhancement are the key imaging features to distinguish infected from sterile fluid collections on CT.

Objective The objective of this study is to find out whether gadolinium accumulation in the dentate nucleus (DN) after repeated gadolinium-based contrast agent (GBCA) administration in multiple sclerosis (MS) patients is related to tissue alteration detectable on transcranial ultrasound. Methods In this case–control study, 34 patients (17 with, and 17 age-, sex-, MS severity-, and duration-matched participants without visually rated DN T1-hyperintensity) who had received 2–28 (mean, 11 ± 7) consecutive 1.5-Tesla MRI examinations with application of linear GBCA were included. Real-time MRI-ultrasound fusion imaging was applied, exactly superimposing the DN identified on MRI to calculate its corresponding echo-intensity on digitized ultrasound image analysis. In addition, cerebellar ataxia and cognitive performance were assessed. Correlation analyses were adjusted for age, MS duration, MS severity, and time between MRI scans. Results DN-to-pons T1-signal intensity-ratios (DPSIR) were larger in patients with visually rated DN T1-hyperintensity compared to those without (1.16 ± 0.10 vs 1.09 ± 0.06; p = 0.01). In the combined group, DPSIR correlated with the cumulative linear-GBCA dose (r = 0.49, p = 0.003), as did the DPSIR change on last versus first MRI (r = 0.59, p = 0.003). Neither DPSIR nor globus pallidus internus-to-thalamus T1-signal intensity-ratios were related to echo-intensity of corresponding ROI’s. DPSIR correlated with the dysarthria (r = 0.57, p = 0.001), but no other, subscore of the International Cooperative Ataxia Rating Scale, and no other clinical score. Conclusions DN gadolinium accumulation is not associated with trace metal accumulation, calcification, or other tissue alteration detectable on ultrasound. A possible mild effect of DN gadolinium accumulation on cerebellar speech function in MS patients, suggested by present data, needs to be validated in larger study samples.

Ionic conductivities of Li-ion conducting ceramic electrolytes, mostly evaluated by means of impedance spectroscopy, are a key parameter decisive for their application. Nevertheless, significant deviations in the ionic conductivity of nominally identical samples are reported in literature, which are attributed to material and sample preparation as well as measurement related differences. The goal of this study is a detailed assessment of impedance measurement deviations of 10 identically prepared samples of each Li6.45La3Zr1.6Ta0.4Al0.05O12 (LLZO:Ta:Al) and Li1.3Al0.3Ti1.7(PO4)3 (LATP), respectively. By introducing a harmonized testing procedure for impedance measurement and data analysis, deviations among the participating labs were reduced to differences

Cerebral venous and sinus thrombosis (CVST) after adenovirus-vectored COVID-19 ChAdOx1 nCov-19 (Oxford–AstraZeneca) and Ad26.COV2.S (Janssen/Johnson & Johnson) is a rare complication, occurring mainly in individuals under 60 years of age and more frequently in women. It manifests 4–24 days after vaccination. In most cases, antibodies against platelet factor-4/polyanion complexes play a pathogenic role, leading to thrombosis with thrombocytopenia syndrome (TTS) and sometimes a severe clinical or even fatal course. The leading symptom is headache, which usually increases in intensity over a few days. Seizures, visual disturbances, focal neurological symptoms, and signs of increased intracranial pressure are also possible. These symptoms may be combined with clinical signs of disseminated intravascular coagulation such as petechiae or gastrointestinal bleeding. If TTS-CVST is suspected, checking d-dimers, platelet count, and screening for heparin-induced thrombocytopenia (HIT-2) are diagnostically and therapeutically guiding. The imaging method of choice for diagnosis or exclusion of CVST is magnetic resonance imaging (MRI) combined with contrast-enhanced venous MR angiography (MRA). On T2*-weighted or susceptibility weighted MR sequences, the thrombus causes susceptibility artefacts (blooming), that allow for the detection even of isolated cortical vein thromboses. The diagnosis of TTS-CVST can usually be made reliably in synopsis with the clinical and laboratory findings. A close collaboration between neurologists and neuroradiologists is mandatory. TTS-CVST requires specific regimens of anticoagulation and immunomodulation therapy if thrombocytopenia and/or pathogenic antibodies to PF4/polyanion complexes are present. In this review article, the diagnostic and therapeutic steps in cases of suspected TTS associated CSVT are presented.

Multiple myeloma is a clonal B‑lymphocyte neoplasm of terminally differentiated plasma cells and accounts for approximately 10% of all hematologic malignancies. Reduction of bone mass, seen on computed tomography (CT) as focal osteolysis, or general osteopenia is mainly caused by tumor-induced resorption of bone.Imaging methods are used in multiple myeloma to record the extent of various dimensions of the disease manifestations (damage to bone substance, bone marrow infiltration, extramedullary involvement) and the disease course. The aim of this review article is to summarize and outline the recommendations of the S3 guideline "Diagnostics, therapy and follow-up care for patients with monoclonal gammopathy of unclear significance (MGUS) or multiple myeloma" in terms of radiographic imaging.The use of the conventional X‑ray skeletal status (Paris scheme) is obsolete. When a patient with symptomatic multiple myeloma is initially diagnosed, a whole-body CT should be performed to determine the extent of skeletal damage. The S3 guideline also regards CT as the first imaging modality in relapse and progression.KLINISCHES PROBLEM: Das multiple Myelom ist ein klonales B‑Lymphozyten-Neoplasma aus differenzierten Plasmazellen und macht etwa 10 % aller hämatologischen Malignome aus. Die Reduktion der Knochenmasse, die in der Computertomographie (CT) als fokale Osteolyse sichtbar wird, oder eine allgemeine Osteopenie wird hauptsächlich durch eine tumorinduzierte Knochenresorption verursacht.Bildgebende Verfahren werden beim multiplen Myelom eingesetzt, um die verschiedenen Dimensionen der Erkrankungsmanifestationen (Knochensubstanzschädigung, Knochenmarkinfiltration, extramedulläre Beteiligung) sowie den Verlauf zu erfassen. Ziel dieser Übersichtarbeit ist es, die Empfehlungen der S3-Leitlinie „Diagnostik, Therapie und Nachsorge für Patienten mit monoklonaler Gammopathie unklarer Signifikanz (MGUS) oder multiplem Myelom“ bezüglich der radiologischen Bildgebung zusammenzufassen und zu skizzieren. BEWERTUNG UND EMPFEHLUNG FüR DIE PRAXIS: Der Einsatz des konventionellen Röntgenskelettstatus (Pariser Schema) ist obsolet. Bei Erstvorstellung des Patienten mit symptomatischem multiplem Myelom zum Zeitpunkt der Diagnosestellung soll zur Erfassung des Ausmaßes der Skelettschädigung eine Ganzkörper-CT durchgeführt werden. Die S3-Leitlinie sieht die CT auch im Rezidiv und in der Progression als erste Bildgebungsmodalität an.

Since current battery cell production lines are not flexible regarding format and material, it is necessary to develop new production systems. It is also required to develop this production line as an agile system in order to be able to flexibly counteract unit-specific capacity fluctuations. In addition, only low scrap rates are allowed when integrating new material systems which requires a holistic in-process or in-line control and the associated quality assurance. Agile production systems open up new possibilities for developing the battery cell product. Therefore, this article will present a novel product-production co-design that can be specifically adapted to customer requirements.

“Oxide-Based Solid-State Batteries: A Perspective on Composite Cathode Architecture”The garnet-type phase Li7La3Zr2O12 (LLZO) attracts significant attention as an oxide solid electrolyte to enable safe and robust solid-state batteries (SSBs) with potentially high energy density. However, while significant progress has been made in demonstrating compatibility with Li metal, integrating LLZO into composite cathodes remains a challenge. The current perspective focuses on the critical issues that need to be addressed to achieve the ultimate goal of an all-solid-state LLZO-based battery that delivers safety, durability, and pack-level performance characteristics that are unobtainable with state-of-the-art Li-ion batteries. This perspective complements existing reviews of solid/solid interfaces with more emphasis on understanding numerous homo- and heteroionic interfaces in a pure oxide-based SSB and the various phenomena that accompany the evolution of the chemical, electrochemical, structural, morphological, and mechanical properties of those interfaces during processing and operation. Finally, the insights gained from a comprehensive literature survey of LLZO–cathode interfaces are used to guide efforts for the development of LLZO-based SSBs.

One of the major advantages of SOFCs is their high fuel flexibility. Next to natural gas and hydrogen, which are today's most common fuels for SOFC-systems and cell-/stack-testing respectively, various other fuels are applicable as well. In the literature, a number of promising results show that available fuels as propane, butane, ammonia, gasoline, diesel etc. can be applied. Here, the performance of an anode supported cell operated in specialized single cell test benches with different gaseous and liquid fuels and reformates thereof is presented. Fuels as ammonia, dissolved urea (AddBlue(TM)), methane/steam and ethanol/water mixtures can directly be fed to the cell, whereas propane and diesel require external reforming. It is shown that in case of a stable fuel supply the cell performance with such fuels is similar to that of appropriate mixtures of H-2, N-2, CO, CO2, and steam, if the impact of endothermic reforming or decomposition reactions is considered. Even though a stable fuel cell operation with such fuels is possible in a single cell test bench, it should be pointed out that an appropriate fuel processing will be mandatory on the system level.

Introduction Intramedullary nails are frequently used for treatment of unstable distal tibia fractures. However, insufficient fixation of the distal fragment could result in delayed healing, malunion or nonunion. Recently, a novel concept for angular stable nailing was developed that maintains the principle of relative stability and introduces improvements expected to reduce nail toggling, screw migration and secondary loss of reduction. The aim of this study was to investigate the biomechanical competence of the novel angular stable intramedullary nail concept for treatment of unstable distal tibia fractures, compared to a conventional nail locking in a human cadaveric model under dynamic loading. Materials and methods Ten pairs of fresh-frozen human cadaveric tibiae with a simulated AO/OTA 42-A3.1 fracture were assigned to 2 groups for reamed intramedullary nailing using either a conventional (non-angular stable) Expert Tibia Nail (ETN) with 3 distal screws or the novel Tibia Nail Advanced (TNA) system with 2 distal angular stable locking low-profile retaining screws. The specimens were biomechanically tested under conditions including initial quasi-static loading, followed by progressively increasing combined cyclic axial and torsional loading in internal rotation until failure of the bone-implant construct. Both tests were monitored by means of motion tracking. Results Initial nail toggling of the distal tibia fragment in varus and flexion under axial loading was lower for TNA compared to ETN, being significant in flexion, P = 0.91 and P = 0.03. After 5000 cycles, interfragmentary movements in terms of varus, flexion, internal rotation, axial displacement, and shear displacement at the fracture site were all lower for TNA compared to ETN, with flexion and shear displacement being significant, P = 0.14, P = 0.04, P = 0.25, P = 0.11 and P = 0.04, respectively. Cycles to failure until both interfragmentary 5° varus and 5° flexion were significantly higher for TNA compared to ETN, P = 0.04. Conclusion From a biomechanical perspective, the novel angular stable intramedullary nail concept provides increased construct stability and maintains it over time while reducing the number of required locking screws without impeding the flexibility of the nail itself and resists better towards loss of reduction under dynamic loading, compared to conventional locking in intramedullary nailed unstable distal tibia fractures.

We demonstrated the feasibility of 7 Tesla sodium (23Na) and chlorine (35Cl) MRI of a solitary enchondroma. For this, we established dedicated sequences on a 7-Tesla whole-body system with the following key parameters for 35Cl MRI: TE/TR = 0.35/60 ms, TRO = 5 ms, α = 90°, Δx3 = (6 mm)3, 3 averages, Tacq = 30 min and for 23Na MRI: TE/TR = 0.4/101 ms, TRO = 10ms; α = 90°; Δx3 = (1.9 mm)3, 3 averages, Tacq = 30 min 18 s. The measured apparent Na+ concentration was 255 mmol/l and was approximately 7-fold higher than the apparent Cl– concentration with about 36 mmol/l. Additionally, repeated proton MRI examinations demonstrated constant but subtle growth (≈ 0.65 ml/year) over 14 years. In conclusion, enchondromas obviously have a high contrast-to-noise ratio when compared with the normal bone marrow in 23Na and 35Cl MRI, which may contribute to detection and differentiation in unclear or subtle cases. Key Points: Citation Format

Background and Objectives: Hip fractures constitute the most debilitating complication of osteoporosis with steadily increasing incidences in the aging population. Their intramedullary nailing can be challenging because of poor anchorage in the osteoporotic femoral head. Cement augmentation of Proximal Femoral Nail Antirotation (PFNA) blades demonstrated promising results by enhancing cut-out resistance in proximal femoral fractures. The aim of this study was to assess the impact of augmentation on the fixation strength of TFN-ADVANCEDTM Proximal Femoral Nailing System (TFNA) blades and screws within the femoral head and compare its effect when they are implanted in centre or anteroposterior off-centre position. Materials and Methods: Eight groups were formed out of 96 polyurethane low-density foam specimens simulating isolated femoral heads with poor bone quality. The specimens in each group were implanted with either non-augmented or cement-augmented TFNA blades or screws in centre or anteroposterior off-centre positions, 7 mm anterior or posterior. Mechanical testing was performed under progressively increasing cyclic loading until failure, in setup simulating an unstable pertrochanteric fracture with a lack of posteromedial support and load sharing at the fracture gap. Varus-valgus and head rotation angles were monitored. A varus collapse of 5° or 10° head rotation was defined as a clinically relevant failure. Results: Failure load (N) for specimens with augmented TFNA head elements (screw/blade centre: 3799 ± 326/3228 ± 478, screw/blade off-centre: 2680 ± 182/2591 ± 244) was significantly higher compared with respective non-augmented specimens (screw/blade centre: 1593 ± 120/1489 ± 41, screw/blade off-centre: 515 ± 73/1018 ± 48), p &lt, 0.001. For both non-augmented and augmented specimens failure load in the centre position was significantly higher compared with the respective off-centre positions, regardless of the head element type, p &lt, 0.001. Augmented off-centre TFNA head elements had significantly higher failure load compared with non-augmented centrally placed implants, p &lt, 0.001. Conclusions: Cement augmentation clearly enhances the fixation stability of TFNA blades and screws. Non-augmented blades outperformed screws in the anteroposterior off-centre position. Positioning of TFNA blades in the femoral head is more forgiving than TFNA screws in terms of failure load.

Der plotzliche Brust- und der plotzliche Unterleibsschmerz gehoren zu den haufigsten Grunden, die Patienten in die Notaufnahme fuhren. Das heterogene Feld der moglichen, zum Teil schwerwiegenden Diagnosen erfordert eine strukturierte und zugige interdisziplinare Abklarung, um die Patienten zeitnah einer adaquaten Therapie zufuhren zu konnen. Die Kenntnis der ublichen Verdachtigen des plotzlichen Brust- und Unterleibsschmerzes ermoglicht dem Radiologen die schnelle Auswahl der geeigneten bildgebenden Methode, die eine Diagnosestellung ohne Zeitverzogerung erlaubt. Neben Schmerzlokalisation und -charakter fliesen Alter, Geschlecht, etwaige Vorerkrankungen und Laborergebnisse in die differenzialdiagnostischen Uberlegungen mit ein. Der erreichte technische Stand der Computertomographie (CT) sichert inzwischen durch die exzellente raumliche und zeitliche Auflosung eine Abklarung der meisten Diagnosen. Im Abdomen sollte aber der Ultraschall weiterhin zumindest zur primaren Evaluation eingesetzt werden. Nur wenn anschliesend noch ein weiterer Bedarf an abdomineller Bildgebung bestehen bleibt, so erfolgt die Abklarung ebenfalls mittels CT. Die Magnetresonanztomographie (MRT) kommt im Notfallsetting des Unterleibsschmerzes kaum zum Einsatz. Falls doch, dann meistens, um die Strahlenexposition bei Kindern oder Schwangeren zu vermeiden. Die Kenntnis der ublichen Diagnosen, die den plotzlichen Brust- oder Unterleibsschmerz hervorrufen, sowie der geeigneten Untersuchungsverfahren und der klassischen radiologischen Zeichen sind essenziell, um Fehler und Zeitverzogerungen in der Notfalldiagnostik des plotzlichen Brust- und Unterleibsschmerzes zu vermeiden.

Supraspinatus (SSP) tendon tears represent a common indication for shoulder surgery. Yet, prediction of postoperative function and tendon retear remains challenging and primarily relies on morphologic magnetic resonance imaging (MRI)-based parameters, supported by patients' demographic data like age, gender, and comorbidities. Considering continuously high retear rates, especially in patients with larger tears and negative prognostic factors, improved outcome prediction could be of high clinical value. Contrast-enhanced ultrasound (CEUS) enables an assessment of dynamic perfusion of the SSP muscle. As a potential surrogate for muscle vitality, CEUS might reflect functional properties of the SSP and support improved outcome prediction after tendon repair. Fifty patients with isolated SSP tendon tears were prospectively enrolled. Preoperatively, SSP muscle perfusion was quantified by CEUS and conventional morphologic parameters like tear size, fatty infiltration, and tendon retraction were assessed by MRI. At six months follow-up, shoulder function, tendon integrity, and muscle perfusion were reassessed. The predictive value of preoperative CEUS for postoperative shoulder function and tendon integrity was evaluated. 35 patients entered the statistical analysis. Preoperative CEUS-based assessment of SSP perfusion significantly correlated with early postoperative shoulder function (Constant, r = 0.48, p < 0.018) and tendon retear (r = 0.67, p < 0.001). CEUS-based subgroup analysis identified patients with exceptionally high, respectively low risk for tendon retear. CEUS-based assessment of the SSP seemed to predict early shoulder function and tendon retear after SSP repair and allowed to identify patient subgroups with exceptionally high or low risk for tendon retear. © 2019 The Authors. Journal of Orthopaedic Research® published by Wiley Periodicals, Inc. on behalf of Orthopaedic Research Society. J Orthop Res 38:1150-1158, 2020.

Imaging bone tumors often causes uncertainty, especially outside dedicated sarcoma treatment centers. Conventional radiography remains the backbone of bone tumor diagnostics, but MR imaging has a role. Radiographs are crucial for assessing the tumor matrix and aggressiveness. MR imaging is the best modality for local staging. This article reviews semiological aspects of bone tumors: patient age, tumor localization, pattern of bone destruction/margins, aggressiveness, growth speed, matrix formation, periosteal reaction, cortical involvement, size, and number of lesions. All aspects are discussed in terms of their appearance on radiographs and MR imaging, with a focus on the correlation between the 2 modalities.

In anode-supported Solid Oxide Fuel Cells the fuel electrode is usually realized by a supporting substrate and an anode functional layer, both based on nickel/zirconia-cermets with different specific microstructural properties. These two layers have to be designed to fulfill the requirements with respect to electronic and ionic conductivity, diffusive gas transport and hydrogen electrooxidation. In this study a physical meaningful modelling approach describing the coupling of the abovementioned processes in a transmission line model is applied to investigate the impact of material and microstructural properties. Selected material and microstructural parameters were varied to elucidate their impact on the area specific resistance of the anode. Performance simulations were carried out over wide temperature and gas composition ranges. The investigations revealed that an increased ionic conductivity of the zirconia matrix enhances penetration depth and performance. The decrease in particle and pore sizes results in a decreased charge transfer resistance but an increased Knudsen diffusion.

An SOFC design based on co-sintering of functional layers on an inert substrate is investigated. Understanding the impact of cell fabrication parameters on cell performance as well as the identification of the key aging mechanisms are important issues. This contribution will demonstrate how advanced correlative multiscale tomography (such as X-ray computed tomography (μ-CT), focused ion beam – scanning electron microscopy (FIB-SEM) tomography and energy dispersive X-ray spectroscopy - scanning transmission electron microscopy (EDXS-STEM)) can be used to identify performance critical cell components and gas transport limitations. The resulting microstructure data can be linked to cell performance measured via electrochemical impedance spectroscopy (EIS). Impedance data from full cells are compared to cathode/anode measurements on symmetrical cell geometry to quantify the different contributions. This exemplifies how performance and microstructural data can help to understand specific contributions to overall cell performance and degradation.

Solid Oxide Fuel Cells often show a significant power loss when integrated in a bipolar stack. In this paper, power limiting factors related to the inhomogeneity of current collection and gas supply are analyzed by means of a Finite Element Method model. The model, which considers the coupling of electronic and ionic charge carrier transport, charge transfer reactions and diffusive gas transport, provides the spatial distribution of the related losses and their dependency on operating conditions, cell- and flowfield-design. Simulation studies proved that in plane gas diffusion losses underneath the contact rib as well as ohmic losses in the cathode underneath the gas channel affect the performance. Variations in flowfield design parameters revealed optimum parameter combinations, which depend on the chosen operating conditions. For technically feasible flowfield design parameters performance losses of approximately 15% are predicted by the model.

We set out to investigate the prevalence of May-Thurner syndrome (MTS) in a cohort of patients diagnosed with iliofemoral deep vein thrombosis at a large medical referral center. We retrospectively analyzed a cohort of 496 patients who were referred to the emergency unit of a large medical referral center with suspected venous thromboembolism (VTE) and were diagnosed with deep vein thrombosis of the iliac veins and/or the thigh on ultrasound. We retrospectively assessed the presence of MTS in the primary ultrasound examination and on additional imaging (available in n = 193 patients). Across all 496 patients with iliofemoral deep vein thrombosis, the median age was 70 years. 238 patients (48 %) were female. The thrombosis was left-sided in 263 cases (53 %), right-sided in 208 cases (42 %) and bilateral in 24 cases (5 %). In the subgroup of patients with left-sided and bilateral thrombosis, the growth pattern was classified as ascending in 142 patients (50 %), descending in 104 patients (36 %) and unclear in 41 patients (14 %). Additional imaging tests were available in 193 patients: 119 patients (41 %) underwent CT, 18 patients (6 %) MRI and 30 patients (10 %) underwent phlebography. Within the subgroup of patients with left-sided and bilateral thrombosis, MTS was confirmed in 88 patients (31 %), and the imaging findings in 17 patients (6 %) were highly suspicious of MTS. Differentiation was not possible in 86 patients (30 %) and MTS was excluded in 96 patients (33 %). Underlying MTS is not uncommon in the selected cohort of patients with deep iliofemoral vein thrombosis at a large referral center and should be excluded by imaging. · May-Thurner syndrome (MTS) is a relatively frequent cause of deep vein thrombosis.. · MTS should be excluded in patients with left-sided or bilateral iliofemoral thrombosis.. · Cross-sectional imaging is helpful in this setting.. · Approximately one third of patients in this subgroup show signs of MTS..· Heller T, Teichert C, Hafer J et al. Prevalence of May-Thurner Syndrome in Patients with Deep Vein Thrombosis at a Large Medical Referral Center. Fortschr Röntgenstr 2019; 191: 1107 - 1117.ZIEL: In der vorliegenden Arbeit wurde untersucht, mit welcher Häufigkeit bei Patienten mit einer tiefen Becken-Bein-Venenthrombose an einem Universitätsklinikum ein May-Thurner-Syndrom (MTS) vorliegt. Wir untersuchten retrospektiv ein Kollektiv von 496 Patienten, die mit der Verdachtsdiagnose einer tiefen Beinvenenthrombose in den Jahren 2013–2017 in der Notaufnahme eines Klinikums der Maximalversorgung vorgestellt wurden und bei denen eine tiefe Becken-Oberschenkel-Venenthrombose mittels farbcodierter Duplexsonografie bestätigt wurde. Bei diesen Patienten wurde die primäre Ultraschalluntersuchung sowie weiterführende Bildgebung (verfügbar bei n = 236) gezielt auf das Vorliegen eines MTS hin analysiert. Die 496 Patienten mit Thrombose im Becken-Oberschenkel-Bereich waren im Median 70 Jahre alt, 238 (48 %) waren weiblich. Die Lokalisation der Thrombosen war bei 263 Patienten (53 %) links, bei 208 Patienten (42 %) rechts und bei 24 Patienten (5 %) beidseits. In der Subgruppe der 287 links- oder beidseits lokalisierten Thrombosen waren 142 (50 %) aszendierend, 104 (36 %) deszendierend und 41 (14 %) bezüglich der Wuchsrichtung nicht differenzierbar. In der Gruppe der 287 Patienten mit links- oder beidseits lokalisierten Thrombosen lagen bei 119 (41 %) Patienten eine zusätzliche CT, bei 18 (6 %) eine MRT und bei 30 (10 %) eine Phlebografie vor. In der Subgruppe der 287 links- und beidseits lokalisierten Thrombosen konnte bei 88 Patienten (31 %) ein MTS bestätigt werden, bei 17 (6 %) bestand der hochgradige Verdacht, bei 86 (30 %) war eine Differenzierung nicht möglich und bei 96 (33 %) konnte ein MTS ausgeschlossen werden. In dem selektierten Kollektiv von Patienten mit Becken-Oberschenkel-Venenthrombosen an einem Universitätsklinikum ist ein zugrunde liegendes MTS nicht selten und sollte bildgebend ausgeschlossen werden. · Das May-Thurner-Syndrom (MTS) ist eine relativ häufige Ursache von tiefen Venenthrombosen.. · Bei links- oder beidseits lokalisierten Thrombosen sollte ein MTS ausgeschlossen werden.. · Hierfür ist eine ergänzende Schnittbildgebung sinnvoll.. · Bei etwa einem Drittel der Patienten in dieser Subgruppe findet sich ein MTS..· Heller T, Teichert C, Hafer J et al. Prevalence of May-Thurner Syndrome in Patients with Deep Vein Thrombosis at a Large Medical Referral Center. Fortschr Röntgenstr 2019; 191: 1107 – 1117.

Four positive electrodes are extracted from two high-power and two high-energy Li-ion battery consumer cells, and then analyzed by focused ion beam-scanning electron microscopy (FIB-SEM) tomography. The active material phase, carbon black-binder phase and pore phase are quantitatively evaluated using adequate 3D analysis techniques by their volume fractions, surface areas, particle size distributions and tortuosities. The active material phase is composed of LiCoO2 (Sanyo 1500 mA h), or LiNiCoAlO2 (Sony 2600 mA h) or one of two LiNiCoAlO2-LiCoO2 blends (Kokam high-power 350 mA h and high-energy 560 mA h). Special emphasis was put on the three-dimensional distribution of the submicron-sized (yet highly agglomerated) carbon black-binder phase. Vacuum infiltration with a two-component silicone resin gave greyscale contrast between the carbon black-binder and pore phases for contour description at voxel sizes from 30 to 50 nm. This study elucidates the cathode microstructural features for high-energy and high-power application and provides a complete parameter set of commercial electrodes with differing chemical composition. This information can be used by the scientific community as input parameters in simulations and models, filling the gap between the experimental and the simulation fields.

The objective of this study was to evaluate the morphology of glioblastoma on structural pretreatment magnetic resonance imaging (MRI), defining imaging prognostic factors. We conducted a retrospective analysis of MR images from 114 patients harboring a primary glioblastoma, derived from two neurosurgical departments. Tumor segmentation was carried out in a semi-automated fashion. Tumor compartments comprised contrast-enhancing volume (CEV+), perifocal hyperintensity on fluid-attenuated inversion recovery (FLAIR) images (FLAIR+) excluding CEV+, and a non-enhancing area within the CEV+ lesion (CEV−). Additionally, two ratios were calculated from these volumes, the edema-tumor ratio (ETR) and necrosis-tumor ratio (NTR). All patients received surgical resection, followed by concomitant radiation and chemotherapy. Tumor segmentation revealed the strongest correlation between the CEV+ volume and the CEV−, presenting intratumoral necrosis (p

PurposeTo evaluate technical success and long-term outcome of CT-guided radiofrequency ablation (RFA) of spinal osteoid osteomas (OO) and osteoblastomas (OB) in six different European centres.MethodsEighty-seven patients with spinal OO (77) or OB (10) were treated with CT-guided RFA, after three-dimensional CT-guided access planning. Patient's long-term outcome was assessed by clinical examination and questionnaire-based evaluation including 10-point visual analogue scales (VAS) regarding the effect of RFA on severity of pain and limitations of daily activities. Clinical success was defined as a reduction of >30% in the VAS score and patient's satisfaction.ResultsOverall, RFA was technically successful in 82/87 cases (94.3%) with no major complications; clinical success was achieved in 78/87 cases (89.7%). The OO/OB were localized in the cervical (n=9/3), the thoracic (n=27/1), the lumbar (n=29/4), and the sacral spine (n=12/2). A decrease in severity of pain after RFA was observed in 86/87 patients (98.9%) with a persistent mean reduction of overall pain score from 8.040.96 to 1.46 +/- 1.95 (p

In state-of-the-art, anode-supported, solid oxide fuel cells (SOFC) the fuel electrode is made of two different porous Ni/stabilized zirconia layers, both with specified phase compositions and microstructural characteristics. It is generally assumed that electro-oxidation of fuel takes place in the thinner anode functional layer (AFL) adjacent to the electrolyte, while gas diffusion takes place in the thicker anode substrate (AS). This assumption is not always applicable and established models fail. This paper introduces a generally valid equivalent circuit model by means of a three-channel transmission line model (3CTLM) that considers electro-oxidation, ionic conduction and gas diffusion. It is parameterized by (i) impedance measurements on model-electrodes, (ii) conductivity measurements, (iii) FIB/SEM-tomography and (iv) gas theory. The complex impedance curve is derived by a newly developed numerical routine that uses calculation steps from network analysis. A model validation is performed by comparing measured and simulated impedance spectra of anode-supported SOFCs varying in AFL thickness from 3 to 22 μm. The 3CTLM is capable of predicting the impedance of any Ni/stabilized zirconia anode design. A model-based optimization is demonstrated, selecting different ionic conducting phases in AFL and AS for combinations of Ni/10Sc1CeSZ, Ni/8YSZ and Ni/3YSZ, across a temperature range of 600–900 °C.

Technical electrodes in fuel cells rely on complex multiphase microstructures that facilitate electronic, ionic and gas transport to active reaction sites distributed in the electrode volume. In such electrodes, material and microstructural properties of the porous electrode likewise determine the cell performance and different losses related to gas diffusion, electronic / ionic transport or the charge transfer at the active reaction sites might dominate the electrode resistance. Impedance spectroscopy is a powerful tool to evaluate and quantify the losses within a porous electrode. In this contribution it will be shown how impedance spectroscopy, an impedance data analysis by the distribution of relaxation times (DRT) (1,2) and a subsequent transmission line modeling (TLM) can provide physicochemically meaningful information about technical electrodes applied in solid oxide cells (SOC) (3-7) and polymer electrolyte fuel cells (PEFC) (4,5). Limitations in TLM will be discussed and it will be shown that the well-established straight-forward approach of CNLS-fitting might lead to physicochemically incorrect results. Possible countermeasures as a pre-identification of TLM-parameters by means of separate electrical measurements and microstructural analysis or an appropriate selection of operating parameters during impedance analysis will be presented. An example for the application of TLM in electrode development and microstructural design of the multiphase microstructure will be discussed and examples how the TLM-approach can be used to optimize an electrode in consideration of available materials and producible microstructures will be shown. (1) S. Dierickx, A. Weber and E. Ivers-Tiffée, Electrochim Acta, 355, p. 136764 (2020). (2) A. Weber, tm - Technisches Messen, 88 (1), p. 1 (2021). (3) C. Endler-Schuck, J. Joos, C. Niedrig, A. Weber and E. Ivers-Tiffée, Solid State Ionics, 269, p. 67 (2015). (4) M. Heinzmann, A. Weber and E. Ivers-Tiffée, J. Power Sources, 402, p. 24 (2018). (5) M. Heinzmann, A. Weber and E. Ivers-Tiffée, J. Power Sources, 444, p. 227279 (2019). (6) S. Dierickx, J. Joos, A. Weber and E. Ivers-Tiffée, Electrochim Acta, 265, p. 736 (2018). (7) S. Dierickx, T. Mundloch, A. Weber and E. Ivers-Tiffée, J. Power Sources, 415, p. 69 (2019).

In multimodal radiologic imaging, contrast-enhanced ultrasound (CEUS) is increasingly used. One of the advantages of CEUS is the possibility of repeated application of contrast media without decreasing renal function or affecting the thyroid gland. Small solid liver lesions can be diagnosed and detected with high accuracy. Moreover, solid lesions in other abdominal organs can also be characterized. Frequent applications for solid lesions in the near field concern thyroid tumors and lymph nodes. For prostate diagnostics, CEUS can be used with an endorectal probe and perfusion imaging. This review explains how the additional (semi-)quantitative perfusion analysis, especially time-intensity curve (TIC) analyses, and wash-in/wash-out kinetics of integrated or external perfusion software programs facilitate new options in dynamic assessment of microvascularization during tumor follow-up care and even minimally invasive tumor therapy.Kontrastmittelultraschall (CEUS) und auch die Perfusionsdiagnostik finden in der multimodalen radiologischen Diagnostik immer mehr Verbreitung und Anwendungsgebiete. Einer der Vorteile ist die wiederholte Applikation von (intravasalem) Kontrastmittel ohne Beeinträchtigung der Nierenfunktion oder der Schilddrüse. Bereits kleinste solide Leberläsionen lassen sich mit hoher diagnostischer Sicherheit detektieren und charakterisieren. Es können aber auch solide Läsionen anderer abdominaler Organe beurteilt werden. Häufige Anwendungen bezüglich solider Läsionen im Nahfeldbereich sind Schilddrüsentumoren und Lymphknoten. Bei der Prostatadiagnostik kommt CEUS mit endoluminalen Sonden und Perfusionsauswertung zum Einsatz. In der vorliegenden Übersichtsarbeit wird erläutert, wie mit ergänzender (semi)quantitativer Perfusionsauswertung, insbesondere Wash-in- und Wash-out-Kinetik oder Time-Intensity-Curve(TIC)-Analysen, durch parametrische geräteinterne und externe Perfusionssoftware neue Optionen einer dynamischen Mikrovaskularisationsbeurteilung eröffnet werden, insbesondere beim Therapiemonitoring oder auch bei der Durchführung gezielter Interventionen zur Tumortherapie.

Vaccine-induced cerebral venous and sinus thrombosis (VI-CVST) is a rare complication in recipients of the adenovirus-vectored coronavirus disease 2019 (COVID-19) vaccine ChAdOx1 nCov-19 (Vaxzevria®; AstraZeneca).Development of a diagnostic and therapeutic standard.Analysis of clinical and basic research findings, expert opinions, and experience with our own cases.VI-CVST usually manifests on day 4-24 after vaccination, mostly in individuals aged 60 years, and women. In the majority there is an immune pathogenesis caused by antibodies against platelet factor 4/polyanion complexes, leading to thrombotic thrombocytopenia which can result in severe, sometimes fatal, course. The cardinal symptom is headache worsening within days which, however, also can be of variable intensity. Other possible symptoms are seizures, visual disturbance, focal neurological deficits and signs of increased intracranial pressure. If VI-CVST is suspected, the determination of plasma D‑dimer level, platelet count, and screening for heparin-induced thrombocytopenia (HIT-2) are essential for treatment decision-making. Magnetic resonance imaging (MRI) with venous MR-angiography is the neuroimaging modality of choice to confirm or exclude VI-CVST. On T2* susceptibility-weighted MRI, the clot in the sinuses or veins produces marked susceptibility artifacts ("blooming"), which also enables the detection of isolated cortical venous thromboses. MRI/MR-angiography or computed tomography (CT)/CT-angiography usually allow-in combination with clinical and laboratory findings-reliable diagnosis of VI-CVST.The clinical suspicion of VI-CVST calls for urgent laboratory and neuroimaging workup. In the presence of thrombocytopenia and/or pathogenic antibodies, specific medications for anticoagulation and immunomodulation are recommended.HINTERGRUND: Die vakzininduzierte zerebrale Venen- und Sinusthrombose (VI-CVST) nach Applikation der COVID-19-Vakzine ChAdOx1 nCov-19 (Vaxzevria®; AstraZeneca) ist eine seltene Impfkomplikation.Entwicklung eines diagnostischen und therapeutischen Standards.Es werden Grundlagenarbeiten und Expertenempfehlungen sowie Erfahrungen in eigenen Fällen ausgewertet.Die VI-CVST tritt i. d. R. 4–24 Tage nach der Impfung auf, vorwiegend bei unter 60-Jährigen und bei Frauen. Meist spielt eine Immungenese durch Antikörper gegen Plättchenfaktor-4/Polyanion-Komplexe eine pathogenetische Rolle, die zu thrombotischer Thrombozytopenie und z. T. schweren klinischen, auch tödlichen Verläufen führt. Leitsymptom ist der Kopfschmerz, der meist während einiger Tage an Intensität zunimmt und variabel sein kann. Auch Krampfanfälle, Sehstörungen, fokal-neurologische Symptome und Zeichen des erhöhten Hirndrucks sind möglich. Bei Verdacht auf VI-CVST ist die Kontrolle von D‑Dimeren, Thrombozytenzahl und Screening auf eine heparininduzierte Thrombozytopenie (HIT2) therapeutisch richtungweisend. Bildgebende Methode der Wahl zur Bestätigung bzw. Ausschluss der VI-CVST ist die Magnetresonanztomographie (MRT) mit venöser MR-Angiographie (MRA). In MRT-T2*- und suszeptibilitätsgewichteten (SWI) Sequenzen verursacht der Thrombus ausgeprägte Suszeptibilitätsartefakte (Blooming), so dass auch isolierte Thrombosen kortikaler Venen detektiert werden können. Mit der MRT/MRA bzw. Computertomographie (CT)/CT-Angiographie kann die Diagnose einer VI-CVST in Synopse mit den klinischen und Laborbefunden meist zuverlässig gestellt werden.Die VI-CVST erfordert die rasche labormedizinische und radiologische Diagnostik. Bei Nachweis einer Thrombozytopenie und/oder pathogener Antikörper werden spezifische Therapien zur Antikoagulation und Immunmodulation empfohlen.

BACKGROUND Mapping of T1 and T2 relaxation times in cardiac MRI is an invaluable tool for the diagnosis and risk stratification of a wide spectrum of cardiac diseases. PURPOSE To investigate the global and regional reproducibility of native T1 and T2 mapping and to analyze the influence of demographic factors, physiological parameters, slice position, and myocardial regions on reproducibility. STUDY TYPE Prospective single-center cohort-study. POPULATION Fifty healthy volunteers (29 female, 21 male) with a mean age of 39.4 ± 13.7 years. FIELD STRENGTH/SEQUENCE Each volunteer was investigated twice at 1.5 T using a modified look-locker inversion-recovery (MOLLI) sequence (T1 mapping) and a T2-prepared steady-state free precession (SSFP) sequence (T2 mapping). ASSESSMENT Global T1 and T2 values were quantified for the entire left ventricle in three short-axis slices. Regional T1 and T2 values were measured for each myocardial segment and for myocardial segments grouped by slice position and anatomical region. STATISTICAL TESTS Test-retest reproducibility was assessed using intraclass correlation coefficient (ICC) and Bland-Altman statistics. A P value

The transfer of electrons across and along biological membranes drives the cellular energetics. In the context of artificial cells, it can be mimicked by minimal means, while using synthetic alternatives of the phospholipid bilayer and the electron-transducing proteins. Furthermore, the scaling up to biologically relevant and optically accessible dimensions may provide further insight and allow assessment of individual events but has been rarely attempted so far. Here, we visualized the mediated transmembrane oxidation of encapsulated NADH in giant unilamellar vesicles via confocal laser scanning and time-correlated single photon counting wide-field microscopy. To this end, we first augmented phospholipid membranes with an amphiphilic copolymer in order to check its influence on the oxidation kinetics spectrophotometrically. Then, we scaled up the compartments and followed the process microscopically.