Search

Computed tomography pulmonary angiography (CT-PA) is frequently used in the diagnostic workup of pulmonary embolism (PE), even in highly radiosensitive patient populations. This study aims to assess CT-PA with reduced z -axis coverage (compared with a standard scan range covering the entire lung) for its sensitivity for detecting PE and its potential to reduce the radiation dose.We retrospectively analyzed 602 consecutive CT-PA scans with definite or possible PE reported. A reduced scan range was defined based on the topogram, where the cranial slice was set at the top of the aortic arch and the caudal slice at the top of the lower hemidiaphragm. Locations of emboli in relation to the reduced scan range were recorded.We included 513 CT-PA scans with definite acute PE in statistical analysis. Patients' median age was 66 (52 to 77) years, 46% were female. Median dose length product was 270.8 (111.3 to 503.9) mGy*cm. Comparing the original and reduced scan ranges, the mean scan length was significantly reduced by 48.0±8.6% (26.8±3.0 vs. 13.9±2.6 cm, P0.001). Single emboli outside the reduced range in addition to emboli within were found in 15 scans (2.9%), while only 1 scan (0.2%) had an embolus outside the reduced range and none within it. The resulting sensitivity of CT-PA with reduced scan range was 99.81% (95% confidence interval: 98.74%-99.99%) for detecting any PE.A reduced scan length in CT-PA, as defined above, would substantially decrease radiation dose while maintaining diagnostic accuracy for detecting PE.

Elevated mean pulmonary arterial pressure (mPAP), or pulmonary hypertension (PH), is associated with vortical blood flow along the main pulmonary artery. We present and validate a method for automated detection and tracking of the PH-related vortex from magnetic resonance 4D flow data that allows estimation of mPAP.The proposed method detects the presence of a PH-related vortex in the main pulmonary artery based on geometrical properties of swirling streamlines and estimates mPAP from the PH-related vortex duration (tVisually and automatically determined tAn automated method for PH-related vortex detection and tracking from magnetic resonance 4D flow data was introduced, which demonstrated very good agreement with visual analysis and accurate estimation of elevated mPAP.

PurposeAccumulating evidence points towards a close relationship between cardiovascular, endocrine and metabolic diseases. The BioPersMed Study (Biomarkers of Personalised Medicine) is a single-centre prospective observational cohort study with repetitive examination of participants in 2-year intervals. The aim is to evaluate the predictive impact of various traditional and novel biomarkers of cardiovascular, endocrine and metabolic pathways in asymptomatic individuals at risk for cardiovascular and/or metabolic disease.ParticipantsBetween 2010 and 2016, we recruited 1022 regional individuals into the study. Subjects aged 45 years or older presenting with at least one traditional cardiovascular risk factor or manifest type 2 diabetes mellitus (T2DM) were enrolled. The mean age of the participants was 57±8 years, 55% were female, 18% had T2DM, 33% suffered from arterial hypertension, 15% were smokers, 42% had hyperlipidaemia, and only 26% were at low cardiovascular risk according to the Framingham ‘Systematic COronary Risk Evaluation’.Findings to dateStudy procedures during screening and follow-up visits included a physical examination and comprehensive cardiovascular, endocrine, metabolic, ocular and laboratory workup with biobanking of blood and urine samples. The variety of assessed biomarkers allows a full phenotyping of individuals at cardiovascular and metabolic risk. Preliminary data from the cohort and relevant biomarker analyses were already used as control population for genomic studies in local and international research cooperation.Future plansParticipants will undergo comprehensive cardiovascular, endocrine and metabolic examinations for the next decades and clinical outcomes will be adjudicated prospectively.

BACKGROUND Quantification of myocardial blood flow (MBF) from dynamic contrast-enhanced (DCE) MRI can be performed using a signal intensity model that incorporates T1 values of blood and myocardium. PURPOSE To assess the impact of T1 values on pixelwise MBF quantification, specifically to evaluate the influence of 1) study population-averaged vs. subject-specific, 2) diastolic vs. systolic, and 3) regional vs. global myocardial T1 values. STUDY TYPE Prospective. SUBJECTS Fifteen patients with chronic coronary heart disease. FIELD STRENGTH/SEQUENCE 3T; modified Look-Locker inversion recovery for T1 mapping and saturation recovery gradient echo for DCE imaging, both acquired in a mid-ventricular short-axis slice in systole and diastole. ASSESSMENT MBF was estimated using Fermi modeling and signal intensity nonlinearity correction with different T1 values: study population-averaged blood and myocardial, subject-specific systolic and diastolic, and segmental T1 values. Myocardial segments with perfusion deficits were identified visually from DCE series. STATISTICAL TESTS The relationships between MBF parameters derived by different methods were analyzed by Bland-Altman analysis; corresponding mean values were compared by t-test. RESULTS Using subject-specific diastolic T1 values, global diastolic MBF was 0.61 ± 0.13 mL/(min·g). It did not differ from global MBF derived from the study population-averaged T1 (P = 0.88), but the standard deviation of differences was large (0.07 mL/(min·g), 11% of mean MBF). Global diastolic and systolic MBF did not differ (P = 0.12), whereas global diastolic MBF using systolic (0.62 ± 0.13 mL/(min·g)) and diastolic T1 values differed (P

Objectives Longitudinal hemodynamic follow-up is important in the management of pulmonary hypertension (PH). This study aimed to evaluate the potential of MR 4-dimensional (4D) flow imaging to predict changes in the mean pulmonary arterial pressure (mPAP) during serial investigations. Methods Forty-four adult patients with PH or at risk of developing PH repeatedly underwent routine right heart catheterization (RHC) and near-term MR 4D flow imaging of the main pulmonary artery. The duration of vortical blood flow along the main pulmonary artery was evaluated from MR 4D velocity fields using prototype software and converted to an MR 4D flow imaging-based mPAP estimate (mPAPMR) by a previously established model. The relationship of differences between RHC-derived baseline and follow-up mPAP values (ΔmPAP) to corresponding differences in mPAPMR (ΔmPAPMR) was analyzed by means of regression and Bland-Altman analysis; the diagnostic performance of ΔmPAPMR in predicting mPAP increases or decreases was investigated by ROC analysis. Results Areas under the curve for the prediction of mPAP increases and decreases were 0.92 and 0.93, respectively. With the natural cutoff ΔmPAPMR = 0 mmHg, mPAP increases (decreases) were predicted with an accuracy, sensitivity, and specificity of 91% (91%), 85% (89%), and 94% (92%), respectively. For patients in whom 4D flow allowed a point estimate of mPAP (mPAP > 16 mmHg), ΔmPAPMR correlated strongly with ΔmPAP (r = 0.91) and estimated ΔmPAP bias-free with a standard deviation of 5.1 mmHg. Conclusions MR 4D flow imaging allows accurate non-invasive prediction and quantification of mPAP changes in adult patients with PH or at risk of developing PH. Trial registration ClinicalTrials.gov identifier: NCT00575692 and NCT01725763 Key Points • MR 4D flow imaging allows accurate non-invasive prediction of mean pulmonary arterial pressure increases and decreases in adult patients with or at risk of developing pulmonary hypertension. • In adult patients with mean pulmonary arterial pressure > 16 mmHg, MR 4D flow imaging allows estimation of longitudinal mean pulmonary arterial pressure changes without bias with a standard deviation of 5.1 mmHg.

Guidelines for previous negative biopsy (PNB) cohorts with a suspicion of prostate cancer (PCa) after positive multiparametric (mp) magnetic-resonance-imaging (MRI) often favour the fusion-guided targeted prostate-biopsy (TB) only approach for Prostate Imaging-Reporting and Data System (PI-RADS) ≥3 lesions. However, recommendations lack direct biopsy performance comparison within biopsy naïve (BN) vs. PNB patients and its prognostication of the whole mount pathology report (WMPR), respectively. We suppose, that the combination of TB and concomitant TRUS-systematic biopsy (SB) improves the PCa detection rate of PI-RADS 2, 3, 4 or 5 lesions and the International Society of Urological Pathology (ISUP)-grade predictability of the WMPR in BN- and PNB patients.Patients with suspicious mpMRI, elevated prostate-specific-antigen and/or abnormal digital rectal examination were included. All PI-RADS reports were intramurally reviewed for biopsy planning. We compared the PI-RADS score substratified TB, SB or combined approach (TB/SB) associated BN- and PNB-PCa detection rate. Furthermore, we assessed the ISUP-grade variability between biopsy cores and the WMPR.According to BN (Despite csPCa is more frequently found in BN patients, the TB/SB method always detected a significantly higher number of csPCa within PI-RADS 3, 4 or 5 reports of our BN and PNB group. The TB/SB strategy predicts the ISUP-grade best in the total and BN cohort and in general shows the lowest upgrading rates, emphasizing its value not only in BN but also PNB patients.

Cardiac magnetic resonance imaging (MRI) represents the established reference standard method for the assessment of cardiac function and non-invasive evaluation of myocardial tissue in a variety of clinical questions, wherein quantification of cardiac parameters gains growing diagnostic and differential-diagnostic importance. This review aims to summarize established and newly emerging quantitative parameters, which are assessed in routine cardiac MRI. Interrelations and interdependencies between metrics are explained, and common factors affecting quantitative results are discussed. The review is based on a PubMed literature research using the search terms "cardiac magnetic resonance" and "quantification", "recommendations", "quantitative evaluation/assessment", "reference method", "reference/normal values", "pitfalls" or "artifacts" published between 2000-2019. Quantitative functional, phase contrast, and perfusion imaging, as well as relaxation time mapping techniques give opportunity for assessment of a large number of quantitative cardiac MRI parameters in clinical routine. Application of these techniques allows for characterization of function, morphology and perfusion of the heart beyond visual analysis of images, either in primary evaluation and comparison to normal values or in patients' follow-up and treatment monitoring. However, with implementation of quantitative parameters in clinical routine, standardization is of particular importance as different acquisition and evaluation strategies and algorithms may substantially influence results, though not always immediately apparent. · Clinical cardiac MRI provides numerous functional and morphological quantitative parameters.. · Quantitative cardiac MRI enables assessment of diffuse and global myocardial alterations.. · Standardized data acquisition/evaluation is the prerequisite for diagnostic use of quantitative cardiac MRI parameters..· Reiter U, Reiter C, Kräuter C et al. Quantitative Clinical Cardiac Magnetic Resonance Imaging. Fortschr Röntgenstr 2020; 192: 246 - 256. Die kardiale Magnetresonanztomografie (MRT) stellt sowohl in der Beurteilung der Herzfunktion als auch zur nichtinvasiven Gewebsanalyse des Myokards in vielen klinischen Fragestellungen die Referenz-Standard-Methode dar. Speziell die Quantifizierung kardialer Parameter nimmt eine immer zentralere diagnostische und differenzialdiagnostische Rolle ein. Im vorliegenden Review sollen etablierte und vielversprechende neue quantitative Herz-MRT-Parameter der klinischen Routine zusammengefasst, ihre Zusammenhänge beschrieben sowie ihre Abhängigkeiten von substanziellen Einflussfaktoren dargestellt werden. Die Übersichtsarbeit basiert auf einer PubMed-Literaturrecherche zu den Begriffen „cardiac magnetic resonance“ und „quantification“, „recommendations“, „quantitative evaluation/assessment“, „reference method“, „reference/normal values“, „pitfalls“ sowie „artifacts“ innerhalb des Publikationszeitraums 2000–2019. Funktionelle, Phasenkontrast- und Perfusionsbildgebung sowie Relaxationszeit-Kartierung ermöglichen die Erfassung einer Vielzahl quantitativer Herz-MRT-Parameter. Diese erlauben eine über die visuelle Beurteilung von Herz-MRT-Bildern hinausgehende Charakterisierung der Funktion, Morphologie und Perfusion des Herzens, sei es im Vergleich zu Normalwerten oder im Therapieverlauf. Bei der Interpretation ausgewerteter Herz-MRT-Parameter in der klinischen Routine muss allerdings zunehmend auf Standardisierung geachtet werden, da Aufnahmetechniken und Auswertealgorithmen quantitative Ergebnisse maßgeblich – jedoch mitunter nicht unmittelbar erkennbar – beeinflussen können. · Die Routine-Herz-MRT erlaubt die Bestimmung einer Vielzahl funktioneller und morphologischer quantitativer Parameter.. · Quantitative Herz-MRT-Parameter ermöglichen die Erfassung diffuser und globaler myokardialer Veränderungen.. · Standardisierte Aufnahmetechniken und Auswertealgorithmen sind zentrale Voraussetzung zur diagnostischen Interpretation quantitativer Herz-MRT-Parameter..· Reiter U, Reiter C, Kräuter C et al. Quantitative Clinical Cardiac Magnetic Resonance Imaging. Fortschr Röntgenstr 2020; 192: 246 – 256.

While an enormous number of studies have documented pathological alterations of the myocardial native longitudinal relaxation time (T1) and the fraction of the extracellular myocardial volume (ECV), it has also become clear that continuously evolving T1 mapping sequence, acquisition and evaluation techniques have a substantial impact on quantitative results, making the translation of reported findings into routine clinical use particularly challenging. To provide a basis for the discussion of pathological myocardial T1 and ECV alterations, the present review aims to summarize the methodological aspects of myocardial T1 mapping along with technical and physiological factors influencing results and normal ranges of myocardial native T1 and ECV reported across studies.

Non-invasive identification and differentiation of myocardial diseases represents the primary objectives of cardiac magnetic resonance (CMR) longitudinal relaxation time (T1) and extracellular volume (ECV) mapping. Given the fact that myocardial T1 and ECV values overlap throughout and within left ventricular phenotypes, a central issue to be addressed is whether and to what extent myocardial T1 and ECV mapping provides additional or superior diagnostic information to standard CMR imaging, and whether native T1 mapping could be employed as a non-contrast alternative to late gadolinium enhancement (LE) imaging. The present review aims to summarize physiological and pathophysiological alterations in native T1 and ECV values and summarized myocardial T1 and ECV alterations associated with cardiac diseases to support the translation of research findings into routine CMR imaging.

Background Quantification of myocardial blood flow (MBF) from dynamic contrast‐enhanced (DCE) MRI can be performed using a signal intensity model that incorporates T1 values of blood and myocardium. Purpose To assess the impact of T1 values on pixelwise MBF quantification, specifically to evaluate the influence of 1) study population‐averaged vs. subject‐specific, 2) diastolic vs. systolic, and 3) regional vs. global myocardial T1 values. Study Type Prospective. Subjects Fifteen patients with chronic coronary heart disease. Field Strength/Sequence 3T; modified Look–Locker inversion recovery for T1 mapping and saturation recovery gradient echo for DCE imaging, both acquired in a mid‐ventricular short‐axis slice in systole and diastole. Assessment MBF was estimated using Fermi modeling and signal intensity nonlinearity correction with different T1 values: study population‐averaged blood and myocardial, subject‐specific systolic and diastolic, and segmental T1 values. Myocardial segments with perfusion deficits were identified visually from DCE series. Statistical Tests The relationships between MBF parameters derived by different methods were analyzed by Bland–Altman analysis; corresponding mean values were compared by t‐test. Results Using subject‐specific diastolic T1 values, global diastolic MBF was 0.61 ± 0.13 mL/(min·g). It did not differ from global MBF derived from the study population‐averaged T1 (P = 0.88), but the standard deviation of differences was large (0.07 mL/(min·g), 11% of mean MBF). Global diastolic and systolic MBF did not differ (P = 0.12), whereas global diastolic MBF using systolic (0.62 ± 0.13 mL/(min·g)) and diastolic T1 values differed (P

To analyze differences in systolic and diastolic left ventricular (LV) as well as left atrial (LA) function parameters obtained from identical cardiac magnetic resonance (MR) imaging techniques during inspiratory breath-holding and breathing (breath-hold to breathing differences).56 subjects without signs of heart failure (23/33 male/female, age 58 ± 14 years) underwent 3 T MR cine real-time and transmitral phase contrast imaging with the same spatial and temporal resolution during inspiratory breath-holding and free breathing. LV and LA volumetric function parameters were derived from segmentation of cine series, transmitral peak velocities and early-diastolic myocardial peak velocity from phase contrast series. Corresponding breath-hold and breathing parameters were compared by Bland-Altman analysis; repeatability of breath-hold and breathing measurements was quantified by variance component analysis. p 0.05 was regarded as statistically significant.Mean differences between results obtained during inspiratory breath-holding vs. breathing were significant for LV volumetric function (end-diastolic volume=-7 mL, p = 0.002; end-systolic volume=-7 mL, p 0.001; ejection fraction = 3 %, p 0.001; peak ejection rate = 22 mL/s, p = 0.002; early-diastolic peak filling rate=-34 mL/s, p = 0.025), LA volumetric function (maximum volume=-6 mL, p 0.001; total ejection fraction=-4%, p 0.001; active ejection fraction=-2%, p = 0.013; before contraction ejection fraction=-4%, p 0.001) and early-diastolic velocities (transmitral=-6 cm/s, p 0.001; tissue velocity=-1.8 cm/s, p 0.001). Standard deviations of breath-hold-to-breathing differences exceeded the corresponding repeatabilities of breath-hold and breathing measurements.Systolic and diastolic LV and LA function parameters acquired during inspiratory breath-holding and breathing differ, and large inter-individual breath-hold-to-breathing variations are possible. Thus, the breathing state should be taken into account, especially when comparing results in patient follow-up acquired in different respiratory states.

The Tel2 (also known as Telo2) and Tti1 proteins control the cellular abundance of mammalian PIKKs and are integral components of mTORC1 and mTORC2. Here we report that Tel2 and Tti1 are targeted for degradation within mTORC1 by the SCFFbxo9 ubiquitin ligase to adjust mTOR signalling to growth factor availability. This process is primed by CK2, which translocates to the cytoplasm to mediate mTORC1-specific phosphorylation of Tel2/Tti1, subsequent to growth factor deprivation. As a consequence, mTORC1 is inactivated to restrain cell growth and protein translation whereas relief of feedback inhibition activates the PI(3)K/TORC2/Akt pathway to sustain survival. Significantly, primary human multiple myelomas exhibit high levels of Fbxo9. In this setting, PI(3)K/TORC2/Akt signalling and survival of multiple myeloma cells is dependent on Fbxo9 expression. Thus, mTORC1-specific degradation of the Tel2 and Tti1 proteins represents a central mTOR regulatory mechanism with implications in multiple myeloma, both in promoting survival and in providing targets for the specific treatment of multiple myeloma with high levels of Fbxo9 expression.