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Objective: In patients with peritoneal carcinomatosis (PC) accurate preoperative assessment is essential to determine indication and surgical procedure to ensure optimal outcome. Purpose of our study was to assess the diagnostic accuracy (DA) of multiphasic dynamic contrast-enhanced MRI to determine the extent of PC in correlation with surgical and histopathological findings. Materials and methods: 14 Patients with proven PC were examined on a 1.5T system before peritonectomy and hyperthermic intraperitoneal chemotherapy. Patient preparation included oral application of 2000 mL mannitol solution and 40 mg butylscopolaminiumbromid i.v. Coronal contrast-enhanced multiphasic dynamic T1w 3D gre sequences (T1W DCE) (0.15 mmol Gd-chelate/kg bw) covering the whole abdomen were acquired (TR 2.9 ms, TE 1.1 ms, resolution 2.0 × 2.0 × 1.8 mm, FOV 400 × 400 mm). MRI was assessed by two radiologists and correlated with surgical exploration (SE) and histopathology for each segment based on the peritoneal cancer index proposed by Sugarbaker et al. Results: In total, 182 segments were evaluated. PC was found in 118/121 of 182 segments (reader 1/2) by MRI and in 131 segments by SE. In 4/7 segments MRI was false positive. False negative segments 17/17 in MRI did not result in irresectability. The positive predictive value for PC per segment of MRI was 97%/94%, the negative predictive value 73%/72%, the sensitivity 87%/87% and the specificity 92%/86%. The DA was 88%/87%. Conclusion: T1W DCE is an accurate and clinical valuable tool for the preoperative assessment of peritoneal tumor spread. [ABSTRACT FROM AUTHOR]

The article discusses the historic development of overtime hours in German business. The author suggests how overtime reduction and flexible working hour arrangements can lead to higher employment. Cutting overtime is said to promise reduced costs and open the way for innovation, competitiveness, and additional job creation, especially if coupled with flextime.

The article discusses the political interests which may prevent the reduction of overtime hours in the interest of creating more jobs in Germany. Particularly family men in lower income brackets tend to welcome overtime. Management tends to view overtime as employing reliable resources and minimizing trainee costs. Politicians and work councils have reasons to favor overtime. The author presents countervailing arguments.

The sustainable reduction of greenhouse gas emissions from road transport requires solutions to achieve net-zero carbon dioxide emissions. Therefore, in addition to vehicles with electrified powertrains, such as those implemented in battery electric of fuel cell vehicles, internal combustion engines fueled with e-fuels or biofuels are also under discussion. An e-fuel that has come into focus recently, is hydrogen due to its potential to achieve zero tank-to-wheel and well-to-wheel carbon dioxide emissions when the electrolysis is powered by electricity from renewable sources. Due to the high laminar burning velocity, hydrogen has the potential for engine operation with high cylinder charge dilution by e.g. external exhaust gas recirculation or enleanment, resulting in increased efficiency. On the other hand, the high burning velocity and high adiabatic flame temperatures pose a challenge for engine cooling due to increased heat losses compared to conventional fuels. To further evaluate the use of hydrogen for small passenger car engines, a series production 1 L 3 cylinder gasoline engine provided by Ford Werke GmbH was modified for hydrogen direct injection. The engine was equipped with a high pressure external exhaust gas recirculation system to investigate charge dilution at stoichiometric operation. Due to limitations of the turbocharging system, very lean operation, which can achieve nitrogen oxides raw emissions below 10 ppm, was limited to part load operation below BMEP = 8 bar. Thus, a reduction of the nitrogen oxides emission level at high loads compared to stoichiometric operation was not possible. At stoichiometric operation with external exhaust gas recirculation engine efficiency can be increased significantly. The comparison of stoichiometric hydrogen and gasoline operation shows a reduced indicated efficiency with hydrogen with significant faster combustion of hydrogen at comparable centers of combustion. However, higher boost pressures would allow to achieve even higher indicated efficiencies by charge dilution compared to gasoline engine operation. • Hydrogen direct injection investigated at series production gasoline engine. • Reduced indicated efficiency compared to gasoline at stoichiometric operation. • Charge dilution shows significant potential to increase the indicated efficiency. • Enleanment can achieve near zero raw emission engine operation. • Near zero raw emission engine operation was limited to low part load operation. [ABSTRACT FROM AUTHOR]

We evaluated attenuation-based 3-dimensional segmentation for the analysis of left ventricular function, using as our standard of reference magnetic resonance imaging and dual-source computed tomography with traditional short-axis planimetry. Twenty patients with known or suspected coronary artery disease were examined prospectively. In all magnetic resonance and computed tomographic datasets, global functional values were determined by 2-dimensional planimetry. Computed tomographic scans were further evaluated by automated 3-dimensional segmentation, and the results were compared by Pearson correlation and Bland-Altman analysis. Agreement between magnetic resonance imaging and dual-source computed tomographic 2-dimensional planimetry was good for all values (end-diastolic volume, bias= -4.2, r=0.99; end-systolic volume, bias=-1.7, r=0.99, stroke-volume, bias=-2.4, r=0.98; ejection fraction, bias=0.26, r=0.94; and myocardial mass, bias= 2.5, r=0.90). By contrast, dual-source computed tomographic 3-dimensional segmentation overestimated end-diastolic volume (bias= -19.1, P <0.001), stroke-volume (bias= -16.9, P <0.001), and myocardial mass (bias= -34.4, P <0.001). Moreover, correlation with magnetic resonance imaging proved disappointing for ejection fraction (r=0.72). Results were similar in a direct comparison between dual-source computed tomographic 2-dimensional planimetry and 3-dimensional segmentation (end-diastolic volume, bias= -14.9, r=0.94; end-systolic volume, bias= -0.5, r=0.90; stroke volume, bias= -14.5, r=0.83; ejection fraction, bias= -2.8, r=0.74; and myocardial mass, bias= -36.8, r=0.79). Due to significant overestimation of volumes and poor correlation of ejection fraction with cine magnetic resonance imaging results, attenuation-based 3-dimensional segmentation compares unfavorably with traditional planimetry. Hence this method should be used with caution, and its time benefits should be weighed against its imprecision of functional analysis. [ABSTRACT FROM AUTHOR]

This paper presents an experimental and theoretical examination of directly injected (DI) propane at a wide range of conditions relevant to spark ignition engines. The investigated conditions comprise the injection of sub- and supercritical propane, with the latter representing a plausible, operational extreme during engine heat soak. Optical imaging is first used to study a wide range of observed spray behaviors, highlighting the sensitivity of DI propane to the engine operating condition. These varying behaviors then prompt further consideration of the thermodynamics involved. This extends thermodynamic arguments recently proposed by the authors in another work, and is able to explain when supercritical injection contains the liquid phase, when shock structures appear and when the spray collapses. Spray regime diagrams are then proposed in order to generalize the observed behaviors. These diagrams reveal several, often overlapping regimes that demarcate choked and unchoked injection, collapsed and multi-plume sprays, and the appearance or disappearance of the liquid phase immediately outside of the injector. [ABSTRACT FROM AUTHOR]

Purpose To assess the effect of different population-averaged arterial-input-functions (pAIF) on pharmacokinetic parameters from dynamic contrast-enhanced MRI (DCE-MRI) and their diagnostic accuracy regarding the detection of potentially malignant prostate lesions. Materials and methods 66 male patients (age 65.4 ± 10.8y) with suspected prostate cancer underwent multiparametric MRI of the prostate including T2-w, DWI-w and DCE-MRI sequences at a 3 T MRI scanner. All detected lesions were categorized based on ACR PI-RADS version 2 and divided into 2 groups (A: PI-RADS ≤ 3, n = 32; B: PI-RADS > 3, n = 34). In each DCE-MRI dataset, pharmacokinetic parameters (Ktrans, Kep and ve) and goodness of fit (chi 2 ) were generated using the Tofts model with 3 different pAIFs (fast, intermediate, slow) as provided by a commercially available postprocessing software. Pharmacokinetic parameters, their diagnostic accuracies and model fits were compared for the 3 pAIFs. Results Ktrans, Kep and ve differed significantly among the 3 pAIFs (all p < .001). Ktrans and Kep were significantly higher in group B compared to group A (all p < .001). For chi 2 , lowest results (representing highest goodness of fit) were found for intermediate pAIF (chi 2 0.073). ROC analyses revealed comparable diagnostic accuracies for the different pAIFs, which were high for Ktrans and Kep and low for ve. Conclusion Choosing various pAIF types causes a high variability in pharmacokinetic parameter estimates. Therefore, it is of great importance to consider this as potential artifact and thus keep AIF type selection constant in DCE-MRI studies. [ABSTRACT FROM AUTHOR]

Background: Newborns and small infants have shallow breathing. Objective: To suggest criteria for when respiratory gating is necessary during cardiac MRI in newborns and infants. Materials and methods: One-hundred ten data sets of newborns and infants with ( n = 92, mean age: 1.9 ± 1.7 [SD] years) and without ( n = 18, mean age: 1.6 ± 1.8 [SD] years) navigator gating were analysed retrospectively. The respiratory motion of the right hemidiaphragm was recorded and correlated to age, weight, body surface area and qualitative image quality on a 4-point score. Quantitative image quality assessment was performed (sharpness of the delineation of the ventricular septal wall) as well as a matched-pair comparison between navigator-gated and non-gated data sets. Results: No significant differences were found in overall image quality or in the sharpness of the ventricular septal wall between gated and non-gated scans. A navigator acceptance of >80% was frequently found in patients ages <12 months, body surface area <0.40 m, body weight <10 kg and a size of <80 cm. Conclusion: Sequences without respiratory gating may be used in newborns and small infants, in particular if age <12 months, body surface area <0.40 m, body weight <10 kg and height <80 cm. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: The portosystemic pressure gradient is an important factor defining prognosis in hepatic disease. However, noninvasive prediction of the gradient and the possible reduction by establishment of a TIPSS is challenging. A cohort of patients receiving TIPSS was evaluated with regard to imaging features of collaterals in cross-sectional imaging and the achievable reduction of the pressure gradient by establishment of a TIPSS. Methods: In this study 70 consecutive patients with cirrhotic liver disease were retrospectively evaluated. Patients received either CT or MR imaging before invasive pressure measurement during TIPSS procedure. Images were evaluated with regard to esophageal and fundus varices, splenorenal collaterals, short gastric vein and paraumbilical vein. Results were correlated with Child stage, portosystemic pressure gradient and post-TIPSS reduction of the pressure gradient. Results: In 55 of the 70 patients TIPSS reduced the pressure gradient to less than 12mmHg. The pre-interventional pressure and the pressure reduction were not significantly different between Child stages. Imaging features of varices and portosystemic collaterals did not show significant differences. The only parameter with a significant predictive value for the reduction of the pressure gradient was the pre-TIPSS pressure gradient (r =0.8, p <0.001). Conclusions: TIPSS allows a reliable reduction of the pressure gradient even at high pre-interventional pressure levels and a high collateral presence. In patients receiving TIPSS the presence and the characteristics of the collateral vessels seem to be too variable to draw reliable conclusions concerning the portosystemic pressure gradient. [Copyright &y& Elsevier]

'Athlete's heart' is characterized by an increase in ventricular chamber sizes and myocardial mass (MM), and is mainly observed in endurance athletes. At present, it remains unclear whether cardiac adaptations in long-distance runners differ from those in triathletes. Twenty male triathletes (mean age 38.7 ± 6.2 years) and 20 male marathon runners (mean age 44.1 ± 7.9) underwent cardiac magnetic resonance imaging to calculate left and right ventricular end-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV), ejection fraction (EF), and MM. Late-enhancement (LE) imaging was used to exclude structural alterations or myocardial scarring. EDV, ESV, SV, and EF for the left and right ventricles, as well as MM, did not differ between long-distance runners and triathletes, although the weekly training volume was significantly higher in triathletes (17.05 vs 9.95 h/week, P < 0.0001). There was a significant correlation between weekly training volume and right and left EDV, right and left ESV as well as MM within the study group. Myocardial LE was absent in all athletes. Highly trained male long-distance runners and triathletes have comparable cardiac parameters. However, the extent of physical training seems to be associated with the degree of cardiac adaptation in endurance athletes. The absence of LE supports the idea that athlete's heart is a nonpathological adaptation of the cardiovascular system. [ABSTRACT FROM AUTHOR]

Objective: Exact determination of localization and extent of peritoneal carcinomatosis (PC) before peritonectomy and hyperthermic intraperitoneal chemotherapy (HIPEC) is crucial for the clinical outcome. Our study compares dynamic contrast enhanced 3D MRI (T1wDCE) and 18F-FDG PET/CT regarding diagnostic accuracy in correlation with surgical exploration (SE) and histological (HI) results. Materials and methods: 15 patients with PC were examined on a 1.5T MRI and 16 slice PET/CT. MRI: coronal T1wDCE covering the complete abdomen (0.15 mmol Gd-chelate/kg BW, 2000 mL mannitol solution p.o., 40 mg buscopan i.v.). PET-CT: contrast enhanced 16slice CT (120 mL ultravist 370 i.v., 1000 mL mannitol solution p.o., 40 mg buscopan i.v.), PET: 350 MBq 18-FDG i.v., 3 min acquisition time/bed, 60 min after tracer injektion). Assessment by two independent, experienced observers in correlation with results of SE and HI for each abdominal segment based on the peritoneal cancer index (PCI) proposed by Sugarbaker and co-authors. Results: MRI and PET/CT provided reliable detection of PC. One patient had to be excluded from statistical analysis. In summary, 182 segments were assessed (13/patient, 14 patients, one patient excluded from statistical analysis). PC was found in 118 by MRI, 124 by PET/CT. 4 segments were classified false positive for MRI, 2 for PET/CT. False negative segments (MRI: 17, PET/CT: 9) did not result in irresectability. Positive predictive value for PC/segment was 97/98%, negative predictive value 73/84%, sensitivity 87/93%, specificity 92/96%, and diagnostic accuracy 88/94% (MRI/PET/CT). Conclusion: With high diagnostic accuracy for PC of both, MRI and PET/CT, PET/CT provides better diagnostic accuracy and especially better NPV. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: To investigate the feasibility of image fusion of MR-coronary angiography (MRCA) and delayed gadolinium enhancement imaging (LGE) and to assign areas of myocardial infarction to the corresponding supplying coronary arteries. Materials and methods: An interactive segmentation of the coronary arteries was performed in MRCA data sets (n =25). The LGE slices were matched onto the vessel segmentation to perform a fused analysis of coronary artery anatomy and LGE. The results were compared to the segmental model recommended by the American Heart Association (AHA). Standard of reference was the identification of the culprit lesion in the invasive coronary angiography (CA) (n =20). Results: The fused analysis allowed the assignment of MI to the supplying coronary artery in 13/20 patients. The sensitivities/specificities for the assignment of MI to the three main vessels were: LAD 63%/100%, LCX 75%/100%, and RCA 56%/100%, respectively. Using the AHA segmental model the sensitivities/specificities for the correct assignment of MI to the three main vessels were: LAD 88%/58%, LCX 94%/75%, and RCA 77%/73%, respectively. Conclusion: Fusion images of MRCA and LGE provides added diagnostic information in the effort to determine the epicardial vessels responsible for the postischemic myocardial injury and therefore might be helpful to establish appropriate future therapeutic steps. [Copyright &y& Elsevier]

Objectives: To longitudinally assess the value of cardiac functional and viability imaging as a supplement to MR angiography in patients with atherosclerotic disease.Methods: Cardiac MRI was performed in 195 consecutive patients with symptomatic peripheral arterial disease. Of these, 186 patients were followed for 22 +/- 5 months for the presence of cardiac events (cardiac death, acute coronary syndrome and hospitalisation as a result of congestive heart failure).Results: Myocardial viability imaging showed a high prevalence of known (n = 31) and occult myocardial infarctions (MI) (n = 26). Cardiac events occurred more often in patients with reduced ventricular function (ejection fraction (EF) less than 40%, cardiac event in 4/8 patients; EF 40-55%, cardiac event in 10/40 patients; EF greater than 55%, cardiac event in 15/138 patients) as well as in patients with occult MI (8/25 patients) and known MI (11/30 patients). In patients with normal function, the detection of a previous MI was of high relevance to prognosis.Conclusions: Both reduced EF and the presence of MI influence patients' prognoses. Performing cardiac MRI in this patient population may influence further patient management including intensified risk factor intervention. [ABSTRACT FROM AUTHOR]

Objective: Stress perfusion magnetic resonance imaging (MSPMRI) is an established technique for the assessment of myocardial perfusion. Shortcomings at 1.5 T are low signal to noise ratio (SNR) and contrast to noise ratio (CNR). One approach to overcome these shortcomings is to increase field strength and contrast concentration. The aim of our study was to investigate the diagnostic capability of high resolution MSPMRI at 3-T field strength using a 1 M contrast agent.Material and Methods: Fifty-seven patients (62.3 +/- 11.0 years) with symptoms of coronary artery disease (CAD) were examined at 3 T. MMRSPI was assessed using a 2D saturation recovery gradient echo (SR GRE) sequence in short axis orientation (TR 1.9 ms, TE 1.0 ms, flip 12 degrees , 0.1 mmol gadobutrol/kg body weight (bw), 140 microg adenosine/kg bw/min). Perfusion images were assessed visually and semiquantitatively (upslope, peak signal intensity (SI), and myocardial perfusion reserve index (MPRI)). Standard of reference was invasive coronary angiography.Results: Stress-induced hypoperfusion was found in 43 patients. Sensitivity for hemodynamically relevant CAD (stenoses greater than 70%) was 95%/98%, specificity 80%/87%, diagnostic accuracy 91%/95% (reader 1/reader 2). The MPRI was significantly lower in hypoperfused myocardium (1.3 +/- 0.2) compared with normal myocardium (2.6 +/- 0.7).Conclusion: High resolution MMRSPI at 3 T using 1 M contrast agent under daily routine conditions provides reliable detection of stress-induced myocardial hypoperfusion with higher diagnostic accuracy than 1.5-T conditions. [ABSTRACT FROM AUTHOR]

Patients with congenital heart disease frequently have complex cardiac and vascular malformations requiring detailed non-invasive diagnostic evaluation including functional parameters. To evaluate the morphological and functional information provided by a novel 3-D cine steady-state free-precession (SSFP) sequence. Twenty consecutive children (mean age 2.2 years, nine boys) were examined using a 1.5-T MR system including 2-D cine gradient-recalled-echo sequences, static 3-D SSFP and 3-D cine SSFP sequences. Measurement of ventricular structures and volumes showed close agreement between the 3-D cine SSFP sequence and the 2-D cine gradient-recalled-echo and static 3-D SSFP sequences (left ventricular volumes mean difference 1.0–1.9 ml and 8.8–11.4%, respectively; right ventricular volumes 1.7–2.1 ml and 9.9–16.9%, respectively). No systematic bias was observed. 3-D cine MRI provides anatomic as well as functional information with sufficient spatial and temporal resolution in free-breathing infants with congenital heart disease. [ABSTRACT FROM AUTHOR]

For contrast-enhanced imaging techniques relying on strong T1 weighting, 3 T provides increased contrast compared with 1.5 T. The aim of our study was the intraindividual comparison of delayed enhancement MR imaging at 1.5 T and at 3 T. Twenty patients with myocardial infarction were examined at 1.5 T and 3 T. Fifteen minutes after injection of contrast agent (0.1 mmol gadobenate dimeglumine per kg body weight), inversion recovery gradient recalled echo (IR-GRE) sequences were acquired (1.5 T/3 T: TR 11.0/9.9 ms, TE 4.4/4.9 ms, flip 30 degrees /30 degrees , slice thickness 6/6 mm) to assess myocardial viability. Two observers rated image quality (Wilcoxon signed rank test). Quantification of hyperenhanced myocardium and standardized SNR/CNR measurements were performed (Student's t test). There was no significant difference with respect to image quality (1.5 T/3 T: 3.5/3.3, p = 0.34, reader 1; 2.4/2.7, p = 0.12, reader 2) and infarction size (760 +/- 566/828 +/- 677 mm(2) at 1.5 T, 808 +/- 639/826 +/- 726 mm(2) at 3 T, reader 1/reader 2, p > 0.05). Mean SNR in hyperenhanced/normal myocardium was 19.2/6.2 at 1.5 T and 29.5/8.8 at 3 T (p < 0.05). Mean CNR was 14.3 at 1.5 T and 26.0 at 3 T (p < 0.05). Delayed enhancement MR imaging at 3 T is a robust procedure yielding superior tissue contrast at 3 T compared with 1.5 T which is, however, not reflected by increased image quality. [ABSTRACT FROM AUTHOR]

The quality of magnetic resonance (MR) angiography could be substantially improved over the past several years based on the introduction and application of parallel imaging, new sequence techniques, such as, e.g., centric k-space trajectories, dedicated contrast agents, and clinical high-field scanners. All of these techniques have played an important role to improve image resolution or decrease acquisition time for the dedicated examination of a single vascular territory. However, whole-body MR angiography may be the application with the potential to profit most from these technical advances. The present review article describes the technical innovations with a focus on parallel imaging at high field strength and the impact on whole-body MR angiography. The clinical value of advanced whole-body MR angiography techniques is illustrated by characteristic cases. [ABSTRACT FROM AUTHOR]

Purpose: The evaluation process of potential living kidney donors focusses on renal anatomy and split renal function. This study aimed to evaluate a magnetic resonance imaging (MRI)-based approach for simultaneous evaluation of both and its impact on clinical decision making.Method: Over a 3-year period, 65 potential living kidney donors were consecutively enrolled. The MRI protocol was extended by MR-nephrography to measure split renal function. Standard DTPA-scintigraphy was used for functional comparison.Results: Split renal function showed no systematic bias between the two methods (mean difference 0.3%, p = 0.08). Both methods would have yielded the same clinical decision for donor nephrectomy in 75% of the patients. In 25 % of the patients, one method indicated a relevant side difference while the other did not, and a different clinical decision could have been made based on split renal function alone.Conclusions: MRI proved eligible for comprehensive living kidney donor evaluation and non-inferior to scintigraphy for determining split renal function. In clinical decision making, these two methods would have resulted in the same side for donor nephrectomy in a large proportion of potential donors. Whether MRN will be implemented in clinical practice depends on transplant centre infrastructure and policy. [ABSTRACT FROM AUTHOR]

Purpose:  To compare true positive and false negative results of myocardial edema mapping in two methods. Myocardial edema may be difficult to detect on cardiac MRI., Materials and Methods:  76 patients (age 59 ± 11 years, 15 female) with acute myocardial infarction (MI) and 10 healthy volunteers were prospectively included in this single-center study. 1.5 T cardiac MRI was performed in patients 2.5 days after revascularization (median) for edema mapping: Steady State Free Precession (SSFP) mapping sequence with T 2 -preparation pulses (T 2 prep); and dual-contrast Fast Spin-Echo (dcFSE) signal decay edema mapping. Late gadolinium enhancement (LGE) was used as the reference for expected edema in acute MI., Results:  311 myocardial segments in patients were acutely infarcted with mean T 2 73 ms for T 2 prep SSFP vs. 87 ms for dcFSE edema mapping. In healthy volunteers the mean T 2 was 56 ms for T 2 prep SSFP vs. 50 ms for dcFSE edema mapping. Receiver operating characteristic (ROC) curve for T 2 prep SSFP show area under the curve (AUC) 0.962, p < 0.0001, Youden index J 0.8266, associated criterion > 60 ms, sensitivity 94 %, specificity 89 %. dcFSE ROC AUC 0.979, p < 0.0001, J 0.9219, associated criterion > 64 ms, sensitivity 93 %, specificity 99 %., Conclusion:  Both edema mapping methods indicate high-grade edema with high sensitivity. Nevertheless, edema in acute infarction may be focally underestimated in both mapping methods., Key Points:   · Sensitivity for edema detection is high for both methods.. · Edema may be focally underestimated by T2prep SSFP edema mapping and dcFSE mapping.., Citation Format: · Krumm P, Martirosian P, Rath D et al. Performance of two Methods for Cardiac MRI Edema Mapping: Dual-Contrast Fast Spin-Echo and T2 Prepared Balanced Steady State Free Precession. Fortschr Röntgenstr 2020; 192: 669 - 677., Competing Interests: The authors declare that they have no conflict of interest., (© Georg Thieme Verlag KG Stuttgart · New York.)

Objective: Ischemic mitral regurgitation is a predictor of heart failure resulting in increased mortality in patients with chronic myocardial infarction. It is uncertain whether the presence of papillary muscle (PM) infarction contributes to the development of mitral regurgitation in patients with chronic myocardial infarction (MI). The aim of the present study was to assess the correlation of PM infarction depicted by MRI with mitral regurgitation and left ventricular function., Methods and Materials: 48 patients with chronic MI and recent MRI and echocardiography were retrospectively included. The location and extent of MI depicted by MRI were correlated with left ventricular function assessed by MRI and mitral regurgitation assessed by echocardiography. The presence, location and extent of PM infarction depicted by late gadolinium enhancement (LGE-) MRI were correlated with functional parameters and compared with patients with chronic MI but no PM involvement., Results: PM infarction was found in 11 of 48 patients (23 %) using LGE-MRI. 8/11 patients (73 %) with PM infarction and 22/37 patients (59 %) without PM involvement in MI had ischemic mitral regurgitation. There was no significant difference between location, extent of MI and presence of mitral regurgitation between patients with and without PM involvement in myocardial infarction. In 4/4 patients with complete and in 4/7 patients with partial PM infarction, mitral regurgitation was present. The normalized mean left ventricular end-diastolic volume was increased in patients with ischemic mitral regurgitation., Conclusion: The presence of PM infarction does not correlate with ischemic mitral regurgitation. In patients with complete PM infarction and consequent discontinuity of viable tissue in the PM-chorda-mitral valve complex, the probability of developing ischemic mitral regurgitation seems to be increased. However, the severity of mitral regurgitation is not increased compared to patients with partial or no PM infarction., Key Points: · No correlation between ischemic mitral regurgitation and presence of papillary muscle infarction. · Complete papillary muscle infarction results in dysfunction associated with ischemic mitral regurgitation. · Severity of mitral regurgitation not increased in patients with complete PM infarction., Citation Format: · Bretschneider C, Heinrich H, Seeger A et al. Impact of Papillary Muscle Infarction on Ischemic Mitral Regurgitation Assessed by Magnetic Resonance Imaging. Fortschr Röntgenstr 2018; 190: 42 - 50., Competing Interests: Disclosure The authors report no conflicts of interest in this work., (© Georg Thieme Verlag KG Stuttgart · New York.)

Objective: This large-scale randomized study aimed to show the noninferiority in terms of diagnostic performance of gadoterate meglumine-enhanced versus gadobutrol-enhanced 3-T MR angiography (MRA) using digital subtraction angiography (DSA) as the reference standard in patients with peripheral arterial occlusive disease (PAOD)., Subjects and Methods: In this prospective international randomized double-blind phase IV trial, 189 patients were enrolled. Of them, 156 could be included in the per-protocol population for on-site assessments and 154 for off-site readings. Subjects underwent peripheral MRA, after injection of 0.1 mmol/kg of either gadoterate meglumine or gadobutrol, and DSA within 30 days. The diagnostic accuracy was evaluated and compared using a noninferiority analysis. Secondary endpoints included sensitivity, specificity, diagnostic confidence, contrast-to-noise ratio, and signal-to-noise ratio evaluations., Results: The percentage agreement between MRA and DSA for stenosis detection was similar for on-site readings for both groups (mean ± SD, 80.6% ± 16.1% with gadoterate meglumine vs 77.1% ± 19.6% with gadobutrol; 3.5% difference), and the same was true for off-site readings (73.9% ± 16.9% with gadoterate meglumine vs 75.1% ± 13.8% with gadobutrol; 1.1% difference). The noninferiority of gadoterate meglumine to gadobutrol was shown for both on- and off-site readings. Sensitivity in detecting significant stenosis (> 50%) was 72.3% for gadoterate meglumine versus 70.6% for gadobutrol, whereas specificity (92.6% vs 92.3%), diagnostic confidence (87.0% vs 86.0%), signal-to-noise ratio (165.5 vs 161.0), and contrast-to-noise ratio (159.5 vs 155.3) did not differ statistically significantly between the two groups., Conclusion: Gadoterate meglumine was found to be not inferior to gadobutrol in terms of diagnostic performance in patients with PAOD undergoing 3-T contrast-enhanced MRA. No statistically significant differences were detected between the two MRA groups.

Rationale and Objectives: Magnetic resonance (MR) imaging (MRI) provides information that can be used to estimate the symptom onset in patients with wake-up stroke (WUS). Time-resolved MR angiography (MRA) is the fastest available MR sequence technique for vessel assessment, and the different phases acquired can provide information about cerebral perfusion. The aim of this study was to evaluate the diagnostic performance of time-resolved MRA both for the assessment of vessel morphology and for the feasibility of perfusion., Materials and Methods: Nineteen patients with WUS were included. Image quality and vessel pathologies were evaluated and correlated to time-of-flight-MRA (n = 14), computed tomography-angiography (n = 4), sonography (n = 12), and conventional angiography (n = 6). The temporal delay of signal enhancement in all pixels of the time-resolved MRA measurement after contrast injection was evaluated and compared to dynamic susceptibility contrast-enhanced (DSC) perfusion imaging (n = 13)., Results: Time-resolved MRA resulted in the diagnosis of large vessel disease in 14 of 19 patients, involving the internal carotids (n = 4), the vertebral arteries (n = 3), and the circle of Willis (n = 10). All severe vascular pathologies which influence patients' acute stroke therapy were obtained by time-resolved MRA. Overestimation of stenoses in two of 14 patients resulted in sensitivity and specificity of 100% and 71%, respectively. Time-to-peak (TTP) estimations were hampered by movement artifacts in four patients (31%). Compared to DSC, the area of TTP delay was comparable in size and localization without relevant overestimation or underestimation., Conclusions: Time-resolved MRA is a valuable technique in patients with WUS with high sensitivity and high negative predictive value. Cerebral perfusion estimation can be performed in selected cases for therapy decision but can be hampered by patient movement., (Copyright © 2015 AUR. Published by Elsevier Inc. All rights reserved.)

Background: Percutaneous mitral valve repair (MVR) with the MitraClip(®) system in patients with mitral regurgitation (MR) is known to reduce symptoms and to improve cardiac morphology and function. MitraClip has been approved for cardiac magnetic resonance imaging (MRI). To date, however, no systematic analysis exists on cardiac MRI in patients undergoing the MitraClip procedure., Objective: The aim of this study was to (1) prove feasibility and robustness of cardiac MRI and (2) visualize effects of the procedure on cardiac morphology and function by cardiac MRI., Methods: 27 consecutive patients (age 77.5 ± 7.6 years) with symptomatic moderate to severe MR undergoing the MitraClip(®) procedure were prospectively included. Cardiac MRI at 1.5 T was performed before and at 3 months after intervention. Cardiac morphology and function were evaluated using steady-state free precession (SSFP) cine sequences by assessment of left ventricular enddiastolic and endsystolic diameters (LVEDD, LVESD) and volumes (EDV, ESV), ejection fraction (LVEF) and stroke volume (SV), diameter of mitral annulus, and myocardial mass (MM). Planimetry of the left atrium (LA) was performed in identical slices in a four-chamber view., Results: Around the clip an extinction artifact was observed which did not disturb the evaluation of cardiac morphology and function. At follow-up, we observed significant decreases of LVEDD (58.0 to 53.3 mm, p < 0.0001), EDV (167 to 159 mL, p = 0.0006) and ESV (101 to 89 mL, p < 0.0001), diameter of mitral annulus (41.4 to 37.9 mm, p < 0.0001), myocardial mass (148.4 to 144.5 g, p = 0.0004) and LA size (40.2 to 37.6 cm(2), p < 0.0001). LVEF improved (43.3 to 46.7 %, p = 0.0041)., Conclusions: Cardiac MRI is feasible and robust in patients with MitraClips. The clinical benefit of a successful MitraClip intervention is paralleled by significant improvements of cardiac morphology and function which can be monitored and validated using MRI in clinical follow-up examinations.

Intensive endurance training can induce abnormal ECG patterns at rest. These alterations are differentiated into minor, mildly or distinctly abnormal ECG patterns. Echocardiographic data imply a correlation between the extent of these alterations and cardiac parameters like cardiac volume or wall thickness. In comparison to echocardiography, cardiac magnetic resonance imaging (MRI) is characterized by high reproducibility and accuracy. The aim of this study was to investigate the correlation between ECG alterations and cardiac parameters in highly trained asymptomatic male endurance athletes as assessed using cardiac MRI. Forty-five asymptomatic male endurance athletes (mean age 40 ± 8.9 years., range 19-59 years., 13 ± 5 h of training per week) underwent a cardiac MRI examination in addition to a resting ECG. Based on the ECG patterns at rest, the athletes were divided into groups with normal or minor (group 1) and mild or distinct (group 2) alterations. Steady-state free-precession cine MRI was used to calculate left and right ventricular end-diastolic volume, end-systolic volume, stroke volume, ejection fraction, and myocardial mass (MM). Late enhancement imaging was used to exclude structural alterations or myocardial scarring. Athletes in group 1 and 2 did not differ significantly in terms of age, height, body weight, body mass index or hours of training per week. Athletes with mildly or distinctly abnormal ECG patterns showed a significantly higher MM than athletes with minor ECG alterations at rest or normal resting ECG values (156.4 ± 18.4 g vs. 140.5 ± 20.0 g; p = 0.0103). The differences persisted when the values were corrected for body surface area (80.0 ± 7.4 g/m² vs. 73.4 ± 8.3 g; p = 0.0093). All other assessed cardiac parameters did not differ between the two groups. Pathological myocardial enhancement was detected only in one patient with a minor abnormal ECG. Male asymptomatic endurance athletes with mildly or distinctly abnormal ECG patterns at rest are characterized by a higher myocardial mass than comparable athletes with minor alterations or normal ECG at rest. Thus, the extent of ECG-abnormalities seems to be mainly the result of an increase in myocardial mass. Additionally, the absence of mild or distinct ECG alterations does not exclude the presence of pathological late gadolinium enhancement.