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The purpose of the study was to establish a diagnostic approach to the preparation of patients with colorectal liver metastases considered for transarterial radioembolization (RE). Twenty-two patients sequentially underwent computed tomography (CT; thorax/abdomen), magnetic resonance imaging (MRI; liver; hepatocyte-specific contrast), positron emission tomography (PET/PET-CT; F18-fluoro-desoxy-glucose), and angiography with perfusion scintigraphy [planar imaging; tomography with integrated CT (SPECT-CT)]. The algorithm was continued when no contraindication or alternative treatment option was found. The impact of each test on the therapy decision and RE management was recorded. Patient evaluation using CT revealed contraindications for RE in 4/22 patients (18%). Of the remaining 18 patients, 2 were excluded and 3 were assigned to locally ablative treatment based on MRI and PET results (28%). The remaining 13 patients entered the planning algorithm: SPECT-CT revealed gastrointestinal tracer accumulations in 4 (31%) patients [SPECT, 2 (15%)], making a modified application necessary. In five patients (38%), planar scintigraphy revealed relevant hepatopulmonary shunting. Therapy was finally administered to all 13 patients without therapy-related pulmonary or gastrointestinal morbidity. Each part of the diagnostic algorithm showed a relevant impact on patient management. The sequential approach appears to be suitable and keeps the number of unnecessary treatments and therapy risks to a minimum. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to compare the amount of postoperative bone tunnel enlargement after anatomic double-bundle (DB) and single-bundle (SB) anterior cruciate ligament (ACL) reconstruction 6 to 8 months after surgery., Methods: Twenty-one consecutive patients undergoing anatomic 4-tunnel DB ACL reconstruction and 24 patients undergoing anatomic 2-tunnel SB ACL reconstruction were included in this study. In both groups a hybrid fixation technique with interference screw and extracortical fixation at the tibia and an extracortical fixation technique at the femur were used. Magnetic resonance imaging was performed on the second postoperative day and at a mean of 8 months' follow-up (range, 6.8 to 8.3 months) to assess intraoperative and postoperative bone tunnel enlargement. Tunnel widening was determined in different planes by digitally measuring the diameters of the bone tunnels. Tunnel position was measured and classified according to Harner et al. (femoral) and Stäubli et al. and Petersen et al. (tibial)., Results: Magnetic resonance imaging showed that all bone tunnels were anatomically placed within the area of the original ACL insertion zone. Compared with the intraoperative drill diameter, we observed only a slight increase in tunnel diameter in both groups on the second postoperative day. At 8 months postoperatively, significant bone tunnel widening occurred in all bone tunnels (P < .001). However, no significant differences were found between tunnel enlargement in the DB group and tunnel enlargement in the SB group (P > .05), either on the tibial side or on the femoral side. In 2 cases tibial tunnel communication was noted at follow-up., Conclusions: With the use of anatomic SB and DB ACL reconstruction techniques, the results of bone tunnel enlargement were comparable; no significant difference was observed between the tibial and femoral tunnels., Level of Evidence: Level III, prospective comparative study., (Copyright © 2013 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

Background: Peripheral percutaneous transluminal angioplasty is fraught with a substantial risk of restenosis and reintervention. A drug-eluting balloon (DEB) based on a novel coating was compared with uncoated balloons in patients undergoing femoro-popliteal percutaneous transluminal angioplasty., Methods and Results: Patients with symptomatic femoro-popliteal atherosclerotic disease undergoing percutaneous transluminal angioplasty were randomized to paclitaxel-coated IN.PACT Pacific or uncoated Pacific balloons. The primary end point was late lumen loss at 6 months assessed by blinded angiographic corelab quantitative analyses. Secondary end points were binary restenosis and Rutherford class change at 6 months, and target lesion revascularization plus major adverse clinical events (major adverse events=death, target limb amputation, or target lesion revascularization) at 6 and 12 months. Eighty-five patients (91 cases=interventional procedures) were randomized in 3 hospitals (44 to DEB and 47 to uncoated balloons). Average lesion length was 7.0 ± 5.3 and 6.6 ± 5.5 cm for DEB and control arm, respectively. Procedural success was obtained in all cases. Six-month quantitative angiography showed that DEB were associated with significantly lower late lumen loss (-0.01 mm [95% CI, -0.29; 0.26] versus 0.65 mm [0.37; 0.93], P=0.001) and fewer binary restenoses (3 [8.6%] versus 11 [32.4%], P=0.01). This translated into a clinically relevant benefit with significantly fewer major adverse events for DEB versus uncoated balloons up to 12 months (3 [7.1%] versus 15 [34.9%], P<0.01) as well as target lesion revascularizations (3 [7.1%] versus 12 [27.9%], P=0.02)., Conclusions: Use of IN.PACT Pacific DEB is associated with significant reductions in late lumen loss and restenoses at 6 months, and reinterventions after femoro-popliteal percutaneous transluminal angioplasty up to 1 year of follow-up., Clinical Trial Registration: URL http://www.clinicaltrials.gov. Unique identifier: NCT01083030.

Purpose: To evaluate the accuracy of 64-row-multidetector computed tomography (MDCT) with different slice thickness (0.625 vs. 1.25 mm) in assessing the cerebellar arteries., Materials and Methods: A total of 21 consecutive patients who underwent computed tomography angiography (CTA) of the cervicocranial arteries (64-row MDCT; slice thickness, 0.625 mm) because of suspicion of cerebral ischemia were enrolled retrospectively. The MDCT data set was secondarily reconstructed to a slice thickness of 1.25 mm. The examinations were reviewed by three independent blinded observers. Recorded parameters for reconstructed slice thicknesses of 0.625 compared to 1.25 mm were visualization and edge enhancement (based on a developed phantom reference model) of the cerebellar arteries including anterior and posterior inferior cerebellar arteries and the superior cerebellar artery., Results: With 0.625-mm slices, significantly more vessel segments were visualized and edge enhancement was superior compared to 1.25-mm slices by the three readers, and a significant difference for the interaction between vessel segments and the slice thickness was found (P<.001). Furthermore, for a slice thickness of 1.25 mm, there was a significant difference in visualization (P=.0042) and edge enhancement (P=.0015) of vessel segments between the three readers, whereas for thinner slices (0.625 mm), no significant differences were found (P=.412, P=.465)., Conclusions: MDCT with slice thickness of 0.625 mm is superior to 1.25 mm reconstructed slice thickness regarding the visualization of cerebellar arteries, representative for smallest assessable arteries in CTA. This is paralleled by a sharper edge enhancement of the vessel contours resulting from a reduced partial volume effect. Conclusively, cranial CTA protocols should be routinely optimized to generate submillimeter slices for diagnostic purposes and digital storage as additional diagnostic value can be expected., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Purpose: Paclitaxel-coated balloon catheters inhibit restenosis after coronary and peripheral angioplasty (PCI,PTA). The aim of this study was to investigate paclitaxel plasma levels and laboratory parameters following PTA with paclitaxel-coated balloons (PCB) in peripheral arteries., Materials and Methods: This single treatment arm, multicenter study included 14 patients with Rutherford stage 1 - 5 with occlusions of up to 5 cm or ≥ 70 % diameter stenosis of the superficial femoral or popliteal arteries (SFA, PA). PTA was performed using up to three PCB catheters. The paclitaxel plasma levels and safety laboratory parameters were determined by collecting blood samples pre-intervention, immediately post-intervention, at 0.5, 1, 2, 4, 8, 24 hours and 1 and 4 weeks post-intervention (p. i.). Vital signs were monitored to assess clinical safety., Results: PTA was performed successfully in all patients. Paclitaxel plasma levels were always below a level and duration known to cause systemic side effects. A mean peak paclitaxel plasma level (40 ng/ml) was reached immediately p. i. and decreased rapidly below detectable levels in more than half of the patients already 2 hours p. i. The paclitaxel plasma concentrations returned to values below detectable levels at 24 hours p. i. in all patients. Laboratory parameters and vital signs did not give any reason for safety concerns. No adverse events associated with balloon coating were observed., Conclusion: The results of 14 patients with peripheral arterial occlusive disease show no systemic bioavailability of paclitaxel > 24 hours after PTA with one or more PCB catheters, indicating that the PCB catheter is safe with regard to possible systemic effects., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: The diagnostic value of perfusion CT in dementia patients was retrospectively evaluated in comparison to the Mini-Mental State Examination (MMSE)., Material and Methods: The perfusion CT database of 55 subjects was investigated. All patients underwent an unenhanced, contrast-enhanced, and perfusion CT of the head. The clinical evaluation of the degree of dementia was performed with the MMSE. In the perfusion CT data, 24 ROI were marked. Then blood volume (BV), blood flow (BF), and mean transit time (MTT) were calculated and compared with the ipsilateral and contralateral regions and with the degree of dementia., Results: With increasing degree of dementia, a significant decrease of the occipital and temporal BV was found. A significant decrease of the BF in the frontal lobe, basal ganglia, and occipital region was found. Concurrently, the MTT increased significantly in the basal ganglia region. The group with Alzheimer's disease showed significant regional hypoperfusion compared with the group of cognitively normal subjects in the frontal, basal ganglia, occipital, and temporal region., Conclusions: The cerebral perfusion decreased with increasing degree of dementia. The inexpensive and widely available perfusion CT reveals information about regional differences of cerebral perfusion, which may be useful in differentiating severity and types of dementia.

Somatostatin receptor (SSTR) scintigraphy is currently used as one standard imaging modality in neuroendocrine tumors (NETs). However, future optimization of NET imaging may be achieved with positron emission tomography based methods utilizing more sensitive and specific tracers in combination with computed tomography or magnetic resonance imaging. Here we established an orthotopic mouse model that reflects relevant aspects of human pancreatic NETs such as SSTR expression, dense vascularization and metastatic disease. This model was then utilized to test the feasibility of combined magnetic resonance imaging and animal positron emission tomography. Orthotopic implantation of amphicrine, SSTR-positive pancreatic AR42J cells resulted in rapidly growing tumors, with concomitant metastatic spread into abdominal lymph nodes and peritoneal cavity. Primary tumors as well as their metastases expressed the neuroendocrine markers chromogranin A and synaptophysin. For imaging experiments, the SSTR ligands (68)Ga-DOTATOC or (68)Ga-DOTANOC were injected intravenously, and animals were subsequently examined in an animal positron emission tomography scanner and a clinical 3T (tesla) magnetic resonance imager. All animals showed radionuclide accumulation in the primary tumor. Definite anatomical correlation was achieved using digital image fusion of the positron emission tomography and magnetic resonance imaging data. (68)Ga-DOTANOC strongly accumulated in the tumor tissue (mean 6.6-fold vs. control tissues) when compared to (68)Ga-DOTATOC, which showed a higher renal clearance. In good agreement with the biodistribution data, the kidney-to-tumor ratio was higher for (68)Ga-DOTATOC (2.43-fold vs. 1.75-fold). Consequently, (68)Ga-DOTANOC achieved better signal enhancement in the primary tumor and allowed for detection of metastatic lesions. In summary, we established a novel orthotopic pancreatic SSTR-positive tumor model and used this model to provide proof of principle for the diagnostic combination of SSTR-based molecular imaging and magnetic resonance imaging. Specifically, the animal model allowed the comparative evaluation of (68)Ga-DOTANOC and (68)Ga-DOTATOC, with (68)Ga-DOTANOC providing better tumor-specific accumulation and renal activity. We conclude that this animal model will be of innovative value for further investigation in the imaging of NETs., ((c)2008 S. Karger AG, Basel)