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Computational fluid dynamics can be used to analyze the flow pattern and the anatomical predisposition of the airway collapse in patient-specific simulations of sleep apnea patients. Especially the nasal geometry is a major challenge, because of the complex structures and high calculation effort. Due to this limitations the nasal cavity is often excluded. To investigate the influence of the exclusion of the nasal geometry on the flow in the pharynx, four digital models were created. One, which includes the complete nasal structure, and three simplified models, neglecting the nasal geometry using different cutting planes. Airflow simulations using the k-ε turbulence model are performed with an inlet flow rate of 10 l/min. The results show a good agreement of the average velocities. Deviations of the velocity and pressure values occur particularly in the region of the oropharynx and indicate that the type of simplification has a significant influence on the pressure distribution.

Background The composition of the tumor microenvironment (TME) is conditioned by immunity and the inflammatory response. Nutritional and inflammation-based risk scores have emerged as relevant predictors of survival outcome across a variety of hematological malignancies. Methods In this retrospective multicenter trial, we ascertained the prognostic impact of established nutritional and inflammation-based risk scores [Glasgow Prognostic Score (GPS), C-reactive–protein/albumin ratio (CAR), neutrophil–lymphocyte ratio (NLR), prognostic nutritional index (PNI), and prognostic index (PI)] in 209 eligible patients with histologically confirmed CD20+ follicular lymphoma (FL) of WHO grade 1 (37.3%), 1–2 (16.3%), 2 (26.8%) or 3A (19.8%) admitted to the participating centers between January 2000 and December 2019. Characteristics significantly associated with overall or progression-free survival (OS, PFS) upon univariate analysis were subsequently included in a Cox proportional hazard model. Results In the study cohort, the median age was 63 (range 22–90 years). The median follow-up period covered 99 months. The GPS and the CAR were identified to predict survival in FL patients. The GPS was the only independent predictor of OS (p p = 0.001; HR 1.995; 95% CI 1.352–2.944) upon multivariate analysis. Additionally, there was frequent occurrence of progression of disease within 24 months (POD24) in FL patients with a calculated GPS of 2. Conclusion The current results indicate that the GPS predicts especially OS in FL patients. Moreover, GPS was found to display disease-specific effects in regard to FL progression. These findings and potential combinations with additional established prognosticators should be further validated within prospective clinical trials.

Purpose To evaluate heating of a redilatable stent for the treatment of aortic coarctation in neonates and small children in the new imaging modality magnetic particle imaging and established magnetic resonance imaging. Materials and Methods The cobalt-chromium stent (BabyStent, OSYPKA AG, Rheinfelden, Germany) has a stent design which allows for redilatation and adjustment of the diameter from 6 to 16 mm for a use in aortic coarctation. The stent loses its radial integrity while opening at predetermined breaking points at a diameter of 14 mm or 16 mm, respectively. We measured the temperature increase in the stent at different diameters during 7-min magnetic particle imaging and magnetic resonance imaging scans with fiber optic thermometers under static conditions surrounded by air. In magnetic particle imaging, stents with diameters from 6 to 16 mm were tested while in magnetic resonance imaging only stents with diameters of 6 mm and 14 mm were investigated exemplarily. Result In magnetic particle imaging, the measured temperature differences increased up to 4.7 K with growing diameters, whereas the opened stents with discontinuous struts at 14 and 16 mm showed only minimal heating of max. 0.5 K. In contrast to magnetic particle imaging, our measurements showed no heating of the stents during magnetic resonance imaging under identical conditions. Conclusion The BabyStent did show only slight heating in magnetic particle imaging and no detectable temperature increase in magnetic resonance imaging.

During the SARS-CoV-2 pandemic, higher education worldwide had to switch to digital formats. The purpose of this study was to evaluate CoRad-19, a digital teaching tool created by the German Radiological Society for medical students during the COVID-19 pandemic.A total of 13 German-speaking universities implemented CoRad-19 in their curriculum and partially or completely replaced their classes with the online courses. Previous experience and contact with radiology and the participants' opinions regarding the medium of e-learning were surveyed using a custom questionnaire. The subjective level of knowledge regarding the individual modules was also surveyed before and after participation to measure learning effects. The data of 994 medical students from the participating sites were analyzed and compared intraindividually using the Friedman test.From 4/1/2020-10/1/2020, 451 complete data sets from a total of 994 surveys were included. E-learning was rated "very useful" both before and after course participation (4 [IQR 3-4], p = 0.527, r = 0.16). E-learning as a method was also rated as a "very good" medium both before and after participation (4 [IQR 3-4], p = 0.414, r = 0.17). After participation, participants rated radiology as particularly suitable for digital teaching (before: 3 [IQR 3-4] vs. after 4 [IQR 3-4], p = 0.005, r = 0.6). Significant learning gains were measurable in all course modules (p ≤ 0.009). Post-hoc analysis showed interest in radiology to increase significantly after course participation (p = 0.02).In the representative survey, significant learning effects were observed in all course modules. In addition, it should be particularly emphasized that the students' interest in radiology was increased by course participation. Thus, the German Radiological Society provided significant support to German-speaking medical faculties with respect to maintaining excellent education using CoRad-19.· Co-Rad-19 course participation results in measurable subjective learning effects and increases student interest in radiology..· Brendlin AS, Molwitz I, Oechtering TH et al. CoRad-19 - Modular Digital Teaching during the SARS-CoV-2 Pandemic. Fortschr Röntgenstr 2022; 194: 644 - 651.ZIEL: Während der SARS-CoV-2-Pandemie musste die Hochschullehre weltweit auf digitale Formate umstellen. In dieser Studie sollte CoRad-19, ein im Rahmen der COVID-19-Pandemie erstelltes digitales Lehrangebot der Deutschen Röntgengesellschaft (DRG) für Medizinstudierende, evaluiert werden.Insgesamt 13 deutschsprachige Hochschulstandorte haben CoRad-19 in ihr Curriculum implementiert sowie ihre Lehrangebote teilweise oder sogar vollständig durch die Online-Kurse ersetzt. Mithilfe eines eigens entworfenen Fragebogens wurden Vorerfahrungen in und bisherige Kontakte zur Radiologie erfragt sowie die Meinung der Teilnehmenden gegenüber dem Medium E-Learning erhoben. Als Maßstab für den Lernerfolg wurde der subjektive Kenntnisstand bezüglich der einzelnen Module jeweils vor und nach der Teilnahme erhoben. Die Angaben 994 Medizinstudierender aus den beteiligten Standorten wurden analysiert und mittels Friedman-Test intraindividuell verglichen.Vom 01.04.2020–01.10.2020 wurden aus insgesamt 994 Erhebungen 451 vollständige Datensätze inkludiert. E-Learning wurde sowohl vor als auch nach der Teilnahme an den Kursen als „sehr sinnvoll“ eingeschätzt (4 [IQR 3–4], p = 0,527, r = 0,16). Auch E-Learning als Methode wurde sowohl vor als auch nach der Teilnahme als „sehr gutes“ Medium bewertet (4 [IQR 3–4], p = 0,414, r = 0,17). Nach Teilnahme an den Kursen schätzten die Teilnehmenden die Radiologie als besonders geeignet für digitale Lehre ein (vorher: 3 [IQR 3–4] vs. nachher 4 [IQR 3–4], p = 0,005, r = 0,6). In allen Kursmodulen waren signifikante Lernerfolge messbar (p ≤ 0,009). Eine Post-hoc-Analyse zeigte, dass das Interesse an der Radiologie nach Teilnahme an den Kursen signifikant zunahm (p = 0,02).In der repräsentativen Umfrage wurden signifikante Lerneffekte in allen Kursmodulen beobachtet. Zudem ist besonders hervorzuheben, dass das Interesse der Studierenden an der Radiologie durch die Kursteilnahme gesteigert werden konnte. Die DRG konnte den deutschsprachigen medizinischen Fakultäten durch CoRad-19 also wichtige Unterstützung bei der Aufrechterhaltung exzellenter Lehre bieten.· Die Kursteilnahme an CoRad-19 führt zu messbaren subjektiven Lerneffekten und steigert das Interesse Studierender an der Radiologie..· Brendlin AS, Molwitz I, Oechtering TH et al. CoRad-19 – Modular Digital Teaching during the SARS-CoV-2 Pandemic. Fortschr Röntgenstr 2022; 194: 644 – 651.

To develop and validate a deep learning–based algorithm for segmenting and quantifying the physiological and diseased aorta in computed tomography angiographies. CTA exams of the aorta of 191 patients (68.1 ± 14 years, 128 male), performed between 2015 and 2018, were retrospectively identified from our imaging archive and manually segmented by two investigators. A 3D U-Net model was trained on the data, which was divided into a training, a validation, and a test group at a ratio of 7:1:2. Cases in the test group (n = 41) were evaluated to compare manual and automatic segmentations. Dice similarity coefficient (DSC), mean surface distance (MSD), and Hausdorff surface distance (HSD) were extracted. Maximum diameter, effective diameter, and area were quantified and compared between both segmentations at eight anatomical landmarks, and at the maximum area of an aneurysms if present (n = 14). Statistics included error calculation, intraclass correlation coefficient, and Bland-Altman analysis. A DSC of 0.95 [0.94; 0.95] and an MSD of 0.76 [0.06; 0.99] indicated close agreement between segmentations. HSD was 8.00 [4.47; 10.00]. The largest absolute errors were found in the ascending aorta with 0.8 ± 1.5 mm for maximum diameter and at the coeliac trunk with − 30.0 ± 81.6 mm2 for area. Results for absolute errors in aneurysms were − 0.5 ± 2.3 mm for maximum diameter, 0.3 ± 1.6 mm for effective diameter, and 64.9 ± 114.9 mm2 for area. ICC showed excellent agreement (> 0.9; p < 0.05) between quantitative measurements. Automated segmentation of the aorta on CTA data using a deep learning algorithm is feasible and allows for accurate quantification of the aortic lumen even if the vascular architecture is altered by disease. • A deep learning–based algorithm can automatically segment the aorta, mostly within acceptable margins of error, even if the vascular architecture is altered by disease. • Quantifications performed in the segmentations were mostly within clinically acceptable limits, even in pathologically altered segments of the aorta.

Background Intravenous morphine administration can adversely affect platelet inhibition induced by P2Y 12 receptor inhibitors after acute myocardial infarction. In contrast, some evidence suggests that opioid agonists may have cardioprotective effects on the myocardium. The aim of this prospective, randomized MonAMI (Impact of Morphine Treatment With and Without Metoclopramide Coadministration on Platelet Inhibition in Acute Myocardial Infarction) trial was, therefore, to investigate the impact of morphine with or without metoclopramide coadministration on myocardial and microvascular injury. Methods and Results Patients with acute myocardial infarction (n=138) were assigned in a 1:1:1 ratio to ticagrelor 180 mg plus: (1) intravenous morphine 5 mg (morphine group); (2) intravenous morphine 5 mg and metoclopramide 10 mg (morphine+metoclopramide group); or (3) intravenous placebo (control group) administered before primary percutaneous coronary intervention. Cardiac magnetic resonance imaging was performed in 104 patients on day 1 to 4 after the index event. Infarct size was significantly smaller in the morphine only group as compared with controls (percentage of left ventricular mass, 15.5 versus 17.9; P =0.047). Furthermore, the number of patients with microvascular obstruction was significantly lower after morphine administration (28% versus 54%; P =0.022) and the extent of microvascular obstruction was smaller (percentage of left ventricular mass, 0 versus 0.74; P =0.037). In multivariable regression analysis, morphine administration was independently associated with a reduced risk for the occurrence of microvascular obstruction (odds ratio, 0.37; 95% CI, 0.14–0.93 [ P =0.035]). There was no significant difference in infarct size ( P =0.491) and extent ( P =0.753) or presence ( P =0.914) of microvascular obstruction when comparing the morphine+metoclopramide group with the control group. Conclusions In this randomized study, intravenous administration of morphine before primary percutaneous coronary intervention resulted in a significant reduction of myocardial and microvascular damage following acute myocardial infarction. This effect was not observed in the morphine plus metoclopramide group. Registration URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02627950.

In light of the steadily increasing need for economical efficacy and capacity utilization it was the aim of this proof-of-concept work to implement an automated logfile-based analysis tool for MRI scanner utilization and to establish a process analysis. As a primary step, analyses of scanner and protocol utilization, parametrization of protocol processes, their durations, age dependency, and scan efficacy were to be tested. Logfiles were continuously extracted from a 1.5 T MR scanner (Philips Achieva) and automatically explored for relevant scan parameters. Parameters were extracted into a database and logically combined to protocol parameters. Visualization was achieved using PowerBI (Microsoft, USA). Data aggregation comprised a day-based and protocol-based strategy. In addition, age- and regional-based testing was performed. The frequency of protocol usage was evaluated and those protocols with frequent usage compared regarding efficacy to those rarely used. After successful technical implementation, 3659 MR exams were available for further analysis. Out of a plethora of parameters, those relevant to the understanding of the scan process were identified. The initial results mirror the daily scanner usage and allow identifying, e. g., shortened scanner usage on Fridays or longer examination times in children. A scan efficacy of 69.6 ± 17.6 % excluding preparation process was identified as a parameter with high potential to be optimized in daily routine. The logfile-based analysis of MR scanner processes was successfully introduced and holds the promise to be extended into a comprehensive analytic tool for the analysis and optimization of scanner processes. In combination with other variables from the departmental or institutional infrastructure or patient-specific information such tool may be developed into a intelligent steering tool. · The automated log file analysis of MR-scanner processes was successfully introduced. · The log file-analysis allows for a detailed analysis of scanner processes. · From a log file-analysis, there is potential benefit to users, applications specialists and developers.· Frydrychowicz A, Boppel T, Sieber V et al. Automatic, log file-based process analysis of a clinical 1.5T MR scanner: a proof-of-concept study. Fortschr Röntgenstr 2021; 193: 919 - 927.ZIEL: Vor dem Hintergrund stetig wachsender Anforderungen bzgl. Effizienzsteigerung und Scannerauslastung war es das Ziel dieser Machbarkeitsstudie, eine automatisierte Logfile-basierte Prozessanalyse an einem MRT-Scanner der klinischen Routine einzurichten, eine Prozessmetrisierung zu erreichen und Auswertungen der Auslastung, Protokollnutzung, Altersabhängigkeiten und Effizienz durchzuführen. Logfiles eines 1,5T-MR-Scanners (Philips Achieva) wurden automatisch exportiert, relevante Daten extrahiert, einer Datenbank zugeführt, zu definierten Ablaufparametern zusammengeführt und mittels PowerBI (Microsoft, USA) visualisiert. Daten wurden tages- und protokollbezogen aggregiert und bezogen auf Regionen und Alterskategorien ausgewertet. Analysen der Häufigkeiten, Identifikation der häufigsten Protokolle und deren Vergleich sowie Effizienzanalysen wurden durchgeführt. Nach erfolgreicher Implementierung standen nach Einschluss von 3659 Untersuchungen eine Vielzahl von Ablaufparametern und Bewertungsmöglichkeiten zur Verfügung. Aus diesen wurden Parameter identifiziert, die den Scannerablauf wiedergeben. Erste Ergebnisse spiegelten erfolgreich die täglichen Prozesse und Unterschiede wider, z. B. die verkürzte Messzeit an Freitagen und längere Untersuchungszeiten bei Kindern. Als optimierungswürdig wurde die um Vorbereitungsprozesse bereinigte Scaneffizienz von 69,6 ± 17,6 % ermittelt, die geringe Unterschiede zwischen häufig und selten genutzten Protokollen aufwies. Die Logfile-basierte Analyse der Scannerabläufe wurde erfolgreich vorgestellt und öffnet weitreichende Möglichkeiten zur Prozessanalyse, Prozessoptimierung und Kombination mit strukturellen Umgebungsvariablen, die zukünftig für eine intelligentere Ablauf- und Prozesssteuerung eingesetzt werden können. · Eine automatisierte Logfile-Analyse der Prozesse eines MRT-Scanners ist erfolgreich eingeführt worden.. · Die Logfile-basierte Analyse erlaubt eine detaillierte Analyse der Abläufe eines Scanners.. · Die Logfile-basierte Prozessanalyse verspricht weitreichenden Nutzen für Anwender, Applikationsspezialist und Entwickler..· Frydrychowicz A, Boppel T, Sieber V et al. Automatic, log file-based process analysis of a clinical 1.5T MR scanner: a proof-of-concept study. Fortschr Röntgenstr 2021; 193: 919 – 927.

In this work a UNet-based normalization method by paired image-to-image translation of Chest CT images was developed. Due to different noise-levels, emphysema quantification shows sincere subordination to the choice of the filterkernel. Images for training and testing of 71 patients were available, reconstructed using the smooth Siemens B20f filterkernel and the sharp B80f _lterkernel. Results were evaluated in regard to the image quality, including a visual assessment by two imaging experts, the L1 distance, the emphysema quantification (emphysema index and Dice overlap of emphysema segmentations). Emphysema quantification was compared to classical normalization methods. Our approach lead to very good image quality in which the mean B20f L1 distance to the B80f could be reduced by about 88:5% and the mean Dice was raised by 189% after normalization. Classical methods were outperformed. Even though small differences between B20f and normalized B80f images were noticed, the normalized images were found to be overall of diagnostic quality.

Breast cancer research 23(1), 36 (2021). doi:10.1186/s13058-021-01413-y, Published by BioMed Central, London

The DRG-ÖRG IRP (Deutsche Röntgengesellschaft-Österreichische Röntgengesellschaft international radiomics platform) represents a web-/cloud-based radiomics platform based on a public-private partnership. It offers the possibility of data sharing, annotation, validation and certification in the field of artificial intelligence, radiomics analysis, and integrated diagnostics. In a first proof-of-concept study, automated myocardial segmentation and automated myocardial late gadolinum enhancement (LGE) detection using radiomic image features will be evaluated for myocarditis data sets. The DRG-ÖRP IRP can be used to create quality-assured, structured image data in combination with clinical data and subsequent integrated data analysis and is characterized by the following performance criteria: Possibility of using multicentric networked data, automatically calculated quality parameters, processing of annotation tasks, contour recognition using conventional and artificial intelligence methods and the possibility of targeted integration of algorithms. In a first study, a neural network pre-trained using cardiac CINE data sets was evaluated for segmentation of PSIR data sets. In a second step, radiomic features were applied for segmental detection of LGE of the same data sets, which were provided multicenter via the IRP. First results show the advantages (data transparency, reliability, broad involvement of all members, continuous evolution as well as validation and certification) of this platform-based approach. In the proof-of-concept study, the neural network demonstrated a Dice coefficient of 0.813 compared to the expert's segmentation of the myocardium. In the segment-based myocardial LGE detection, the AUC was 0.73 and 0.79 after exclusion of segments with uncertain annotation.The evaluation and provision of the data takes place at the IRP, taking into account the FAT (fairness, accountability, transparency) and FAIR (findable, accessible, interoperable, reusable) criteria. It could be shown that the DRG-ÖRP IRP can be used as a crystallization point for the generation of further individual and joint projects. The execution of quantitative analyses with artificial intelligence methods is greatly facilitated by the platform approach of the DRG-ÖRP IRP, since pre-trained neural networks can be integrated and scientific groups can be networked.In a first proof-of-concept study on automated segmentation of the myocardium and automated myocardial LGE detection, these advantages were successfully applied.Our study shows that with the DRG-ÖRP IRP, strategic goals can be implemented in an interdisciplinary way, that concrete proof-of-concept examples can be demonstrated, and that a large number of individual and joint projects can be realized in a participatory way involving all groups. · The DRG-ÖRG IRP is a web/cloud-based radiomics platform based on a public-private partnership.. · The DRG-ÖRG IRP can be used for the creation of quality-assured, structured image data in combination with clinical data and subsequent integrated data analysis.. · First results show the applicability of left ventricular myocardial segmentation using a neural network and segment-based LGE detection using radiomic image features.. · The DRG-ÖRG IRP offers the possibility of integrating pre-trained neural networks and networking of scientific groups..· Overhoff D, Kohlmann P, Frydrychowicz A et al. The International Radiomics Platform - An Initiative of the German and Austrian Radiological Societies. Fortschr Röntgenstr 2021; 193: 276 - 287.ZIEL: Die DRG-ÖRG-IRP (Deutsche Röntgengesellschaft-Österreichische Röntgengesellschaft Internationale Radiomics-Plattform) stellt eine web-/cloudbasierte Radiomics-Plattform auf Grundlage einer öffentlich-privaten Partnerschaft dar. Sie bietet die Möglichkeit der gemeinsamen Nutzung von Daten, Annotation, Validierung und Zertifizierung auf dem Gebiet der künstlichen Intelligenz, Radiomics-Analyse und integrierten Diagnostik. In einer ersten Proof-of-Concept-Studie soll die automatisierte Myokardsegmentation sowie die automatisierte myokardiale Late-Gadolinum-Enhancement (LGE)-Detektion mittels radiomischer Bildmerkmale für Myokarditis-Datensätze evaluiert werden. Die DRG-ÖRP-IRP kann zur Erstellung qualitätsgesicherter, strukturierter Bilddaten in Kombination mit klinischen Daten und anschließender integrierter Datenanalyse genutzt werden und zeichnet sich durch die folgenden Leistungskriterien aus: Nutzungsmöglichkeit multizentrischer vernetzter Daten, automatisiert berechnete Qualitätsparameter, Bearbeitung von Annotationsaufgaben, Konturerkennung mittels herkömmlicher Verfahren sowie Verfahren der künstlichen Intelligenz und der Möglichkeit einer gezielten Einbindung von Algorithmen.In einer ersten Studie wurde ein anhand kardialer CINE-Datensätze vortrainiertes neuronales Netz zur Segmentierung von PSIR-Datensätzen evaluiert. In einem zweiten Schritt wurden radiomische Bildmerkmale zur segmentalen Detektion von LGE der gleichen Datensätze, welche multizentrisch über die IRP zu Verfügung gestellt wurden, angewendet. Erste Ergebnisse zeigen die Vorteile (Datentransparenz, Zuverlässigkeit, breite Einbindung aller Mitglieder, kontinuierliche Evolution sowie Validierung und Zertifizierung) dieses plattformbasierten Ansatzes auf. In der Proof-of-Concept-Studie konnte im Vergleich zur Segmentierung des Myokards durch den Experten das neuronale Netzwerk einen Dice-Koeffizienten von 0,813 nachweisen. Im Rahmen der segmentbasierten myokardialen LGE-Detektion ergab sich ein AUC von 0,73 bzw. ein AUC von 0,79 nach Ausschluss von Segmenten mit unsicherer Annotation.Die Auswertung und Bereitstellung der Daten findet auf der IRP unter Berücksichtigung der FAT-Kriterien (Fairness, Accountability, Transparency) sowie FAIR-Kriterien (findable, accessible, interoperable, reusable) statt. Es konnte gezeigt werden, dass die DRG-ÖRP-IRP als Kristallisationspunkt für die Generierung weiterer Einzel- und Verbundprojekte genutzt werden kann. Die Durchführung von quantitativen Analysen mit Verfahren der künstlichen Intelligenz wird hierbei durch den Plattformansatz der DRG-ÖRP-IRP erheblich erleichtert, da vorab trainierte neuronale Netze integriert und wissenschaftliche Gruppen vernetzt werden können.In einer ersten Proof-of-Concept-Studie zur automatisierten Segmentation des Myokards sowie zur automatisierten myokardialen LGE-Detektion konnten diese Vorteile erfolgreich angewendet werden.Somit zeigt sich, dass sich mittels der DRG-ÖRP-IRP strategische Ziele interdisziplinär umsetzen, konkrete alltagstaugliche Proof-of-Concept-Beispiele aufzeigen sowie möglichst partizipativ unter Einbindung aller Gruppierungen eine Vielzahl an Einzel- und Verbundprojekten realisieren lassen. · Die DRG-ÖRG-IRP ist eine web-/cloudbasierte Radiomics-Plattform auf Grundlage einer öffentlich-privaten Partnerschaft.. · Die DRG-ÖRG-IRP ist nutzbar für die Erstellung qualitätsgesicherter, strukturierter Bilddaten in Kombination mit klinischen Daten und anschließender integrierter Datenanalyse.. · Erste Ergebnisse zeigen die Anwendbarkeit linksventrikulärer myokardialer Segmentierung mittels neuronalen Netzwerks und segmentbasierte LGE-Detektion mittels radiomischer Bildmerkmale.. · Die DRG-ÖRG-IRP bietet die Möglichkeit der Integration vorab trainierter neuronaler Netze und Vernetzung wissenschaftlicher Gruppen..· Overhoff D, Kohlmann P, Frydrychowicz A et al. The International Radiomics Platform – An Initiative of the German and Austrian Radiological Societies. Fortschr Röntgenstr 2021; 193: 276 – 288.

Cardiac magnetic resonance (CMR)-derived left ventricular (LV) global longitudinal strain (GLS) provides incremental prognostic information on various cardiovascular diseases but has not yet been investigated comprehensively in patients with Takotsubo syndrome (TS). This study evaluated the prognostic value of feature tracking (FT) GLS, tissue tracking (TT) GLS, and fast manual long axis strain (LAS) in 147 patients with TS, who underwent CMR at a median of 2 days after admission. Long-term mortality was assessed 3 years after the acute event. In contrast to LV ejection fraction and tissue characteristics, impaired FT-GLS, TT-GLS and fast manual LAS were associated with adverse outcome. The best cutoff points for the prediction of long-term mortality were similar with all three approaches: FT-GLS &minus, 11.28%, TT-GLS &minus, 11.45%, and fast manual LAS &minus, 10.86%. Long-term mortality rates were significantly higher in patients with FT-GLS &gt, &minus, 11.28% (25.0% versus 9.8%, p = 0.029), TT-GLS &gt, 11.45% (20.0% versus 5.4%, p = 0.016), and LAS &gt, 10.86% (23.3% versus 6.6%, p = 0.014). However, in multivariable analysis, diabetes mellitus (p = 0.001), atrial fibrillation (p = 0.001), malignancy (p = 0.006), and physical triggers (p = 0.006) outperformed measures of myocardial strain and emerged as the strongest, independent predictors of long-term mortality in TS. In conclusion, CMR-based longitudinal strain provides valuable prognostic information in patients with TS, regardless of the utilized technique of assessment. Long-term mortality, however, is mainly determined by comorbidities.

Background: Prediction of histological tumor size by post-neoadjuvant therapy (NAT) ultrasound and magnetic resonance imaging (MRI) was evaluated in different breast cancer subtypes.Methods: Imaging was performed after 12-week NAT in patients enrolled into three neoadjuvant WSG ADAPT subtrials. Imaging performance for prediction of tumor size was analyzed across increasing size ranges (≤10, ≤20 and ≤30 mm) and summarized using positive (PPV) and negative predictive values (NPV).Results: 248 and 588 patients had MRI and ultrasound, respectively. Tumor size was over- or underestimated by 10, >20 or >30 mm) decreased from 0.89 and 0.74 to 0.69 and 0.22. Across all tumor size ranges, ultrasound demonstrated higher PPV than MRI in HR+/HER2+ tumors while both methods had a similarly low PPV in HR-/HER2- and HR-/HER2+ tumors. MRI had a higher NPV than ultrasound with the exception of HR-/HER2- tumors measuring ≤10 and ≤20 mm where both methods had similar NPV. Conclusions: Ultrasound is less likely than MRI to underestimate the size of HR+/HER2+ tumors while MRI is associated with a lower risk to overestimate the size of HR+/HER2+ and HR-/HER2+ tumors. These findings may help to select the most optimal imaging approach for planning surgery after NAT. Trial registration: Clinicaltrials.gov, NCT01815242 (registration March 21, 2013, NCT01817452 (registration March 25, 2013), NCT01779206 (registration January 30, 2013).

Objective The aim of this study was to compare aortic flow patterns in patients after David valve-sparing aortic root replacement with physiologically shaped sinus prostheses or conventional tube grafts in healthy volunteers. Methods Twelve patients with sinus prostheses (55 ± 15 years), 6 patients with tube grafts (58 ± 12 years), 12 age-matched, healthy volunteers (55 ± 6 years), and 6 young, healthy volunteers (25 ± 3 years) were examined with time-resolved 3-dimensional magnetic resonance phase contrast imaging (4D Flow MRI). Primary and secondary helical, as well as vortical flow patterns, were evaluated. Aortic arch anatomy as a flow influencing factor was determined. Results Compared with volunteers, both sinus prostheses and tube grafts developed more than 4 times as many secondary flow patterns in the ascending aorta (sinus prostheses n = 1.6 ± 0.8; tube grafts n = 1.3 ± 0.6; age-matched, healthy volunteers n = 0.3 ± 0.5; young, healthy volunteers n = 0; P < .012) associated with a kinking of the prosthesis itself or at its distal anastomosis. As opposed to round aortic arches in volunteers (n = 16/18), cubic or gothic-shaped arches predominated in patients (n = 16/18, P < .001). In all but 3 volunteers, 2 counter-rotating helices were confirmed in the ascending aorta and were defined as a primary flow pattern. This primary flow pattern did not develop in patients who underwent valve-sparing aortic root replacement. Conclusions In patients after valve-sparing aortic root replacement, there was an increased number of secondary flow patterns in the ascending aorta. This seems to be related to surgically altered aortic geometry with kinking. Because flow alterations are known to affect wall shear stress, there seems to be an increased risk for vessel wall remodeling. Compared with previous 4D Flow MRI studies, primary flow patterns in the ascending aorta in healthy subjects were confirmed to be more complex. This underlines the importance of thorough examination of 4D Flow MRI data.

Generative adversarial networks (GANs) have shown impressive results for photo-realistic image synthesis in the last couple of years. They also offer numerous applications in medical image analysis, such as generating images for data augmentation, image reconstruction and image synthesis for domain adaptation. Despite the undeniable success and the large variety of applications, GANs still struggle to generate images of high resolution.

Due to the periodic contraction of the heart, a pulse-shaped course of the blood velocity is caused in the aortic system. The speed at which this pulse wave moves is called pulse wave velocity (PWV). Since it depends, among other parameters, on the elasticity of the vascular wall, it can be used clinically as an indicator of atherosclerotic changes and, above all, as a measure of the risk of stroke for hypertensive patients. PWV can be determined non-invasively if the blood flow in the aorta is measured via flow-sensitive MRI. Within the scope of this work, existing phase-contrast (PC) image analysis algorithms, resulting in the PWV, were embedded in a graphical user interface (GUI). These algorithms were only able to evaluate PC images which were acquired on a Philips tomograph. Therefore they have been extended for the analysis of PC images acquired on a Siemens tomograph.

We report the case of an HeartMate III left ventricular assist device (LVAD) thrombosis triggered by a shock from an automatic implantable cardioverter defibrillator, releasing a left ventricular thrombus sucked in the LVAD inflow cannula. With LVAD low flow only the increase in motor temperature gave a hint of the thrombosis and a computer tomography scan confirmed the diagnosis. Pump exchange was performed with an uneventful outcome.

Background and aim of the study Aortic hemodynamics influence the integrity of the vessel wall and cardiac afterload. The aim of this study was to compare hemodynamics distal to biological (BV) and mechanical aortic valve (MV) replacements by in vitro 4D Flow MRI excluding confounding factors of in-vivo testing potentially influencing hemodynamics. Methods Two BV (Perimount MagnaEase [Carpentier-Edwards], Trifecta [Abbott]) and two MV (On-X [CryoLife], prototype trileaflet valve) were scanned in a flexible aortic phantom at 3T using a recommended 4D Flow MR sequence. A triphasic aortic flow profile with blood-mimicking fluid was established. Using GTFlow (Gyrotools), area and velocity of the ejection jet were measured. Presence and extent of sinus vortices and secondary flow patterns were graded on a 0 to 3 scale. Results A narrow, accelerated central ejection jet (Area = 27 ± 7% of vessel area, Velocity = 166 ± 13 cm/s; measured at sinotubular junction) was observed in BV as compared to MV (Area = 53 ± 13%, Velocity = 109 ± 21 cm/s). As opposed to MV, the jet distal to BV impacted the outer curvature of the ascending aorta and resulted in large secondary flow patterns (BV: n = 4, grades 3, 3, 2, 1; MV: n = 1, grade 1). Sinus vortices only formed distal to MV. Although physiologically configured, they were larger than normal (grade 3). Conclusions In contrast to mechanical valves, biological valve replacements induced accelerated and increased flow patterns deviating from physiological ones. While it remains speculative whether this increases the risk of aneurysm formation through wall shear stress changes, findings are contrasted by almost no secondary flow patterns and typical, near-physiological sinus vortex formation distal to mechanical valves.

Introduction Multiparametric magnetic resonance imaging (mpMRI)/ultrasound fusion-guided biopsy, in short “targeted biopsy (TB)”, is becoming more attractive as it improves the detection of clinically significant prostate cancer (CaP). The accuracy of fusion-guided biopsies is limited due to false positive radiological findings as well as to histological evidence for cancer in radiologically inconspicuous regions of the prostate. We aimed to analyze histomorphological findings on mpMRI lesions highly suspicious for CaP classified as PI-RADS 4 or PI-RADS 5 (Prostate Imaging - Recording and Data System) but cancer-negative in the biopsy of this region of interest (ROI), and to compare them with findings in radiologically inconspicuous regions. Materials and methods We re-evaluated prostate biopsies from 57 patients who underwent TB in combination with systematic standard biopsy (SB) from June 2017 to July 2018 at the University Hospital Schleswig Holstein Campus Luebeck. Out of 143 ROIs, 34 PI-RADS 4/5 cancer-negative lesions were identified and subjected to comprehensive histomorphological reevaluation. Contralateral cancer-negative SBs were used as control. Chi-square test was used for statistical analysis. Results The frequency of histomorphological alterations including stromal, glandular, vascular, and inflammatory alterations were 97% and 79.2% in prostatic tissues from cancer-negative TBs and SBs, respectively. Stromal, glandular, and inflammatory alterations were present in the majority of biopsies from both TBs and SBs. Statistical analysis revealed no significant difference between TBs and SBs with regard to stromal, glandular, and inflammatory alterations. However, vascular abnormalities were exclusively detected in TBs (18.2%). Conclusion The frequency of histomorphological alterations is slightly higher in prostate tissues from TBs compared to SB. Only vascular alterations seem to be distinct for TBs. However, it has to be assumed that additional factors influence the false-negative rate of mpMRI/ultrasound fusion-guided TB.

To illustrate the potential of magnetic particle imaging (MPI) for stent lumen imaging in comparison with clinical computed tomography (CT) and magnetic resonance imaging (MRI). Imaging of eight tracer-filled, stented vessel phantoms and a tracer-filled, non-stented reference phantom for each diameter was performed on a preclinical MPI scanner: eight commercially available coronary stents of different dimensions (diameter: 3–4 mm; length: 11–38 mm) and materials (stainless steel, platinum–chromium) were implanted into silicone vessel phantoms. For comparison, all vessel phantoms were also visualized by MRI and CT. Two radiologists assessed the images regarding stent-induced artifacts using a 5-point grading scale. The visualization of all stented vessel phantoms was achieved without stent-induced artifacts with MPI. In contrast, MRI and CT images revealed multiform stent-induced artifacts. Given its clinical introduction, MPI has the potential to overcome the disadvantages of MRI and CT concerning the visualization of the stent lumen.

Currently generative adversarial networks (GANs) are rarely applied to medical images of large sizes, especially 3D volumes, due to their large computational demand. We propose a novel multi-scale patch-based GAN approach to generate large high resolution 2D and 3D images. Our key idea is to first learn a low-resolution version of the image and then generate patches of successively growing resolutions conditioned on previous scales. In a domain translation use-case scenario, 3D thorax CTs of size \(512^3\) and thorax X-rays of size \(2048^2\) are generated and we show that, due to the constant GPU memory demand of our method, arbitrarily large images of high resolution can be generated. Moreover, compared to common patch-based approaches, our multi-resolution scheme enables better image quality and prevents patch artifacts.

Purpose Portal and mesenteric hemodynamics is greatly altered in portal hypertension patients. This study utilizes 4D flow magnetic resonance imaging (MRI) to visualize and quantify changes in abdominal hemodynamics in patients with portal hypertension undergoing meal challenge. Materials and Methods Twelve portal hypertension patients and six healthy subjects participated in the study. Baseline MRI was acquired after 5 hours of fasting. Postmeal MRI was obtained 20 minutes after subjects ingested EnSure Plus (574 mL). Imaging was performed at 3T using 4D flow MRI with an undersampled radial acquisition. Flow measurements were performed blinded to subject status (fasting/meal). Flow values for each vessel were compared before and after the meal challenge using paired Student's t-tests (P < 0.05). Results After meal challenge, significant increases in blood flow were observed in supraceliac aorta, portal vein, superior mesenteric vein, and artery in both groups (P < 0.05). In patients, hepatic artery (P = 0.001) and splenic vein (P = 0.045) flow decreased while azygos vein flow (P = 0.002) increased. Conclusion Portal venous flow regulation to adjust the increasing mesenteric venous flow after a meal challenge may be impaired in patients with cirrhosis. The ability to comprehensively quantify the hemodynamic response of the abdominal vasculature to a meal challenge using 4D flow MRI reveals the potential of this technique to noninvasively characterize portal hypertension hemodynamics. J. Magn. Reson. Imaging 2015;42:1009–1017.

Paraneoplastic autoimmune encephalopathic syndromes have been described most often in association with small cell lung cancer or breast cancer, tumours of the ovaries, testes, lymphoma and thymoma. Antibodies associated with paraneoplastic encephalopathies are, among others, anti-Hu, anti-Ma2 and, in part, anti-N-methyl-D-aspartate(NMDA)-receptor antibodies. Here, we present the case of a 72-year-old patient hospitalised due to progressive cognitive decline and disorientation. Diagnostic workup revealed paraneoplastic anti-amphiphysin associated limbic encephalitis on the basis of an aortic angiosarcoma with metastases to kidney, muscle and bones. Highly aggressive chemotherapy as well as immunosuppressive therapy and cytoreductive laparoscopic nephrectomy were initiated. However, follow-up revealed further tumour progress and a worsening of neurological symptoms.

Objectives of this study were to compare radial time-resolved phase contrast magnetic resonance imaging (4D Flow-MRI) with perivascular ultrasound (pvUS) and to explore a porcine model of acute pre-hepatic portal hypertension (PHTN). Abdominal 4D Flow-MRI and pvUS in portal and splenic vein, hepatic and both renal arteries were performed in 13 pigs of approximately 60 kg. In six pigs, measurements were repeated after partial portal vein (PV) ligature. Inter- and intra-reader comparisons and statistical analysis including Bland–Altman (BA) comparison, paired Student’s t tests and linear regression were performed. PvUS and 4D Flow-MRI measurements agreed well; flow before partial PV ligature was 322 ± 30 ml/min in pvUS and 297 ± 27 ml/min in MRI (p = 0.294), and average BA difference was 25 ml/min [−322; 372]. Inter- and intra-reader results differed very little, revealed excellent correlation (R 2 = 0.98 and 0.99, respectively) and resulted in BA differences of −5 ml/min [−161; 150] and −2 ml/min [−28; 25], respectively. After PV ligature, PV flow decreased from 356 ± 50 to 298 ± 61 ml/min (p = 0.02), and hepatic arterial flow increased from 277 ± 36 to 331 ± 65 ml/min (p = n.s.). The successful in vivo comparison of radial 4D Flow-MRI to perivascular ultrasound revealed good agreement of abdominal blood flow although with considerable spread of results. A model of pre-hepatic PHTN was successfully introduced and acute responses monitored. • Radial 4D Flow-MRI in the abdomen was successfully compared to perivascular ultrasound. • Inter- and intra-reader testing demonstrated excellent reproducibility of upper abdominal 4D Flow-MRI. • A porcine model of acute pre-hepatic portal hypertension was successfully introduced. • 4D Flow-MRI successfully monitored acute changes in a model of portal hypertension.

Because of its complex geometry, assessment of right ventricular (RV) function is more difficult than it is for the left ventricle (LV). Because gene-targeted mouse models of cardiomyopathy may involve remodeling of the right heart, the purpose of this study was to develop high-resolution functional magnetic resonance imaging (MRI) for in vivo quantification of RV volumes and global function in mice. Thirty-three mice of various age were studied under isoflurane anesthesia by electrocardiogram-triggered cine-MRI at 7 T. MRI revealed close correlations between RV and LV stroke volume and cardiac output ( r = 0.97, P < 0.0001 each). Consistent with human physiology, murine RV end-diastolic and end-systolic volumes were significantly higher compared with LV volumes ( P < 0.05 each). MRI in mice with LV heart failure due to myocardial infarction revealed significant structural and functional changes of the RV, indicating RV dysfunction. Hence, MRI allows for the quantification of RV volumes and global systolic function with high accuracy and bears the potential to evaluate mechanisms of RV remodeling in mouse models of heart failure.

Objective The anatomically shaped sinus prosthesis (Uni-Graft W SINUS; Braun, Melsungen, Germany) used in valve-sparing aortic root replacement promises physiological hemodynamics believed to grant physiologic valve function. Using time-resolved 3-dimensional magnetic resonance phase contrast imaging (4D Flow MRI), we analyzed sinus vortex formation and transvalvular pressure gradients in patients with sinus prosthesis compared with age-matched and young healthy volunteers. Methods Twelve patients with sinus prosthesis (55 ± 15 years), 12 age-matched and 6 young healthy volunteers (55 ± 6 years, 25 ± 3 years, respectively) were examined at 3T with a 4D flow magnetic resonance imaging sequence. Sinus vortices visualized by streamlines and time-resolved particle paths were graded on a 4-point Likert scale. Time resolved pressure differences of the left ventricular outflow tract and the ascending aorta to a reference point in the aortic bulb as well as the transvalvular pressure gradient were evaluated. Results 4D flow visualizations revealed a propensity of the sinus prosthesis toward intermediate (50%) and large (28%) vortices compared with age-matched volunteers with small (61%) and intermediate (36%) vortices. Vortices in sinus prostheses had a similar configuration compared with those in volunteers. The peak transvalvular pressure gradient did not vary significantly between patients and age-matched volunteers (4.0 ± 0.9 mm Hg, 3.8 ± 0.7 mm Hg, P = .373), its temporal evolution resembled that of volunteers with a prolonged positive phase in patients. Conclusions Hemodynamics closely relating to those of volunteers were confirmed in sinus prostheses, believed to grant physiological valve function. Minor differences are presumably attributed to graft compliance and temporal resolution of the acquisition. Nevertheless, long-term deterioration of valve function as it was described for straight grafts could potentially be decelerated using sinus prostheses.

CT-based lung emphysema quantification is sensitive to the kernel used for image reconstruction. In this paper, we present and evaluate three methods for normalization of CT images reconstructed with different kernels to homogenize image sharpness and pixel noise. For 56 subjects, chest CT images reconstructed with a soft kernel (B20f) and a medium sharp kernel (B50f) were acquired. Normalization of the B50f images was performed using a Laplacian frequency decomposition, an edge-preserving frequency decomposition, and a heuristic filter-based method. To compare the normalization methods, emphysema indices (EIs) were computed from the normalized images and compared to the baseline EIs computed from the B20f images. Further, volume overlaps of the detected emphysema regions were computed. Average differences in EI between kernels decreased for all normalization methods. Laplacian and edge-preserving frequency normalization show a similar agreement with the baseline EI, however, emphysema regions detected after Laplacian frequency normalization show degraded volume overlaps likely caused by haloing artifacts in the normalized images. Overall, edge-preserving frequency decomposition shows the best normalization performance yet high computational demands.

Traditionally, magnetic resonance imaging (MRI) of flow using phase contrast (PC) methods is accomplished using methods that resolve single-directional flow in two spatial dimensions (2D) of an individual slice. More recently, three-dimensional (3D) spatial encoding combined with three-directional velocity-encoded phase contrast MRI (here termed 4D flow MRI) has drawn increased attention. 4D flow MRI offers the ability to measure and to visualize the temporal evolution of complex blood flow patterns within an acquired 3D volume. Various methodological improvements permit the acquisition of 4D flow MRI data encompassing individual vascular structures and entire vascular territories such as the heart, the adjacent aorta, the carotid arteries, abdominal, or peripheral vessels within reasonable scan times. To subsequently analyze the flow data by quantitative means and visualization of complex, three-directional blood flow patterns, various tools have been proposed. This review intends to introduce currently used 4D flow MRI methods, including Cartesian and radial data acquisition, approaches for accelerated data acquisition, cardiac gating, and respiration control. Based on these developments, an overview is provided over the potential this new imaging technique has in different parts of the body from the head to the peripheral arteries.

Purpose: To investigate the value of gadoxetic acid-enhanced three-dimensional T1-weighted MR cholangiography (T1w-MRC) in comparison to three-dimensional T2-weighted MR cholangiopancreaticography (T2w-MRCP) in patients with primary sclerosing cholangitis (PSC). Materials and Methods: Thirty-four MR exams in 29 patients (46.0 ± 16.1 years; 19 men, 10 women) scanned within a 14-month period were retrospectively included. Two abdominal radiologists independently evaluated image quality regarding image contrast, image quality degradation due to artifacts, and visualization quality of ducts. The order of biliary tree branches that were visualized and reader preference toward each method were recorded. Helpfulness of T1w-MRC was scored in consensus. Confirmatory endoscopic retrograde cholangiopancreaticography (ERCP) performed within 3 months of the MR examination was available in 8 patients. Results: Image quality of T1w-MRC and T2w-MRCP was graded good to excellent in all cases. There were advantages for both T1w-MRC (functional information, less degradation due to artifacts) and T2w-MRCP (higher order of visualized branches, better branch depiction). Both readers showed preference for T2w-MRCP; however, both readers found gadoxetic acid–enhanced T1w-MRC helpful in the majority of cases. Conclusion: Gadoxetic acid-enhanced T1w-MRC is complementary to, but should not replace, T2w-MRCP. T1w-MRC is a useful adjunct to T2w-MRCP for morphologic evaluation and provides additional diagnostic information. J. Magn. Reson. Imaging 2012;36:632–640. © 2012 Wiley Periodicals, Inc.

Purpose: To compare 3D magnetic resonance imaging (3D MRI) with transesophageal echocardiography (TEE) for the detection of complex aortic plaques (≥4 mm thick, ulcerated, or containing mobile thrombi). Materials and Methods: In all, 99 consecutive patients with acute cryptogenic stroke and ≥3 mm thick aortic plaques in TEE were prospectively included. 3D MRI comprised T1-weighted bright blood MRI with complete aortic coverage (spatial resolution 1 mm3). Wall thickness and occurrence of complex plaques in ascending aorta (AAo), aortic arch (AA), and descending aorta (DAo) and image quality for each segment was rated for MRI and TEE. Results: MRI detected more complex plaques than TEE (MRI vs. TEE): AAo 13 vs. 7; AA 37 vs. 11; differences were smaller in the DAo: 101 vs. 70. Image quality was higher for MRI in AAo and AA (P < 0.001) and superior for TEE in DAo (P < 0.001). MRI revealed additional complex plaques in the proximal aorta in 19 of 58 patients (32.8%) categorized as cryptogenic after complete routine diagnostics including TEE. Conclusion: Due to improved visualization of the aorta 3D MRI allows to detect more complex plaques than TEE. This renders 3D MRI particularly valuable for patients with cryptogenic stroke and for trials evaluating optimal treatment in aortic atherosclerosis. J. Magn. Reson. Imaging 2012;36:604–611. © 2012 Wiley Periodicals, Inc.

It was the aim to analyse the impact of age, aortic arch geometry, and size on secondary flow patterns such as helix and vortex flow derived from flow-sensitive magnetic resonance imaging (4D PC-MRI). 62 subjects (age range = 20–80 years) without circumscribed pathologies of the thoracic aorta (ascending aortic (AAo) diameter: 3.2 ± 0.6 cm [range 2.2–5.1]) were examined by 4D PC-MRI after IRB-approval and written informed consent. Blood flow visualisation based on streamlines and time-resolved 3D particle traces was performed. Aortic diameter, shape (gothic, crook-shaped, cubic), angle, and age were correlated with existence and extent of secondary flow patterns (helicity, vortices); statistical modelling was performed. Helical flow was the typical pattern in standard crook-shaped aortic arches. With altered shapes and increasing age, helicity was less common. AAo diameter and age had the highest correlation (r = 0.69 and 0.68, respectively) with number of detected vortices. None of the other arch geometric or demographic variables (for all, P ≥ 0.177) improved statistical modelling. Substantially different secondary flow patterns can be observed in the normal thoracic aorta. Age and the AAo diameter were the parameters correlating best with presence and amount of vortices. Findings underline the importance of age- and geometry-matched control groups for haemodynamic studies. • Secondary blood flow patterns (helices, vortices) are commonly observed in the aorta • Secondary flow patterns predominantly depend on patient age and aortic diameter • Geometric factors show a lesser impact on blood flow patterns than age and diameter • Future analyses of flow patterns should incorporate age- and diameter dependencies

Unlike other magnetic resonance angiographic techniques, phase contrast imaging (PC-MRI) offers co-registered morphologic images and velocity data within a single acquisition. While the basic principle of PC-MRI dates back almost 3 decades, novel time-resolved three-dimensional PC-MRI (4D PC-MRI) approaches have become increasingly researched over the past years. So-called 4D PC-MRI includes three-directional velocity encoding in a three-dimensional imaging volume over time, thereby providing the opportunity to comprehensively analyze human hemodynamics in vivo. Moreover, its large volume coverage offers the option to study systemic hemodynamic effects. Additionally, this offers the possibility to re-visit flow in any location of interest without being limited to predetermined two-dimensional slices. The attention received for hemodynamic research is partially based on flow-based theories of atherogenesis and arterial remodeling. 4D PC-MRI can be used to calculate flow-related vessel wall parameters and may hence serve as a diagnostic tool in preemptive medicine. Furthermore, technical improvements including the availability of sufficient computing power, data storage capabilities, and optimized acceleration schemes for data acquisition as well as comprehensive image processing algorithms have largely facilitated recent research progresses. We will present an overview of the potential of this relatively young imaging paradigm. After acquisition and processing the data in morphological and phase difference images, various visualization strategies permit the qualitative analysis of hemodynamics. A multitude of quantitative parameters such as pulse wave velocities and estimates of wall shear stress which might serve as future biomarkers can be extracted. Thereby, exciting new opportunities for vascular imaging and diagnosis are available.