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Background Gadolinium-based contrast agents were not approved in the United States for detecting coronary artery disease (CAD) prior to the current studies. Objectives The purpose of this study was to determine the sensitivity and specificity of gadobutrol for detection of CAD by assessing myocardial perfusion and late gadolinium enhancement (LGE) imaging. Methods Two international, single-vendor, phase 3 clinical trials of near identical design, “GadaCAD1” and “GadaCAD2,” were performed. Cardiovascular magnetic resonance (CMR) included gadobutrol-enhanced first-pass vasodilator stress and rest perfusion followed by LGE imaging. CAD was defined by quantitative coronary angiography (QCA) but computed tomography coronary angiography could exclude significant CAD. Results Because the design and results for GadaCAD1 (n = 376) and GadaCAD2 (n = 388) were very similar, results were summarized as a fixed-effect meta-analysis (n = 764). The prevalence of CAD was 27.8% defined by a ≥70% QCA stenosis. For detection of a ≥70% QCA stenosis, the sensitivity of CMR was 78.9%, specificity was 86.8%, and area under the curve was 0.871. The sensitivity and specificity for multivessel CAD was 87.4% and 73.0%. For detection of a 50% QCA stenosis, sensitivity was 64.6% and specificity was 86.6%. The optimal threshold for detecting CAD was a ≥67% QCA stenosis in GadaCAD1 and ≥63% QCA stenosis in GadaCAD2. Conclusions Vasodilator stress and rest myocardial perfusion CMR and LGE imaging had high diagnostic accuracy for CAD in 2 phase 3 clinical trials. These findings supported the U .S. Food and Drug Administration approval of gadobutrol-enhanced CMR (0.1 mmol/kg) to assess myocardial perfusion and LGE in adult patients with known or suspected CAD.

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. 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 311 myocardial segments in patients were acutely infarcted with mean T Both edema mapping methods indicate high-grade edema with high sensitivity. Nevertheless, edema in acute infarction may be focally underestimated in both mapping methods. · Sensitivity for edema detection is high for both methods.. · Edema may be focally underestimated by T2prep SSFP edema mapping and dcFSE mapping..· 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.ZIEL: Vergleich von richtig positiven und falsch negativen Werten bei myokardialem Ödem-Mapping zweier Methoden. Der Ödemnachweis mittels MRT kann schwierig sein. 76 Patienten (Alter 59 ± 11 Jahre, 15 weiblich) mit akutem Myokardinfarkt (MI) und 10 gesunde Probanden wurden prospektiv in diese am Einzelzentrum durchgeführte Studie eingeschlossen. Im Median 2,5 Tage nach Revaskularisation wurde eine Herz-MRT bei 1,5 T zum Ödem-Mapping durchgeführt: Eine Steady-State-Free-Precession (SSFP)-Mapping-Sequenz mit T 311 Myokardsegmente in Patienten waren akut infarziert, mit einem mittleren T Beide Methoden zum Ödem-Mapping erfassen ein höhergradiges Ödem mit hoher Sensitivität. Dennoch kann ein Ödem mit beiden Mapping-Methoden auch bei akutem Infarkt fokal unterschätzt werden. · Beide Methoden zeigen eine hohe Sensitivität zur Detektion eines Ödems.. · Ödeme können von T2prep-SSFP und dcFSE-Mapping fokal unterschätzt werden..

Stressful life events evidently have an impact on development of allergic diseases, but the mechanism linking stress to pathological changes of immune system function is still not fully understood. The aim of our study was to investigate the relationship between stressful life events, neuropeptide and cytokine concentrations in children as well as the association between early stressful life events and atopic eczema (AE). Within the LISA plus (Life style - Immune system - Allergy) study, blood samples from children of 6 years of age were analyzed for concentration of the neuropeptides vasoactive intestinal peptide (VIP), somatostatin (SOM), substance P (SP) and the Th1/Th2 cytokines IFN-γ and IL-4. Life events such as severe disease or death of a family member, unemployment or divorce of the parents were assessed with a questionnaire filled in by the parents. Furthermore, lifetime prevalence of AE and incidence after the assessment period of life events were compared. Our data suggest that separation/ divorce of parents increase childrens risk of developing AE later in life. Children with separated/divorced parents showed high VIP levels and high concentrations of the Th2 cytokine IL-4 in their blood. Severe diseases and death of a family member were neither associated with neuropeptide levels nor with cytokine concentrations. Unemployment of the parents was associated with decreased IFN-γ concentrations in childrens blood but not with neuropeptide levels. Thus, the neuropeptide VIP might be a mediator between stressful life events and immune regulation contributing to the Th2-shifted immune response in children with separated/divorced parents.

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.

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.

Purpose To compare left ventricular global function index (LVGFI) and quantitative late gadolinium enhancement (LGE) in patients with unrecognized myocardial infarction (UMI), recognized myocardial infarction (RMI) and without myocardial infarction (MI). Material and methods Under waiver of the Institutional Review Board 235 patients (age 63.5 ± 10.5 years, 57 female) were retrospectively evaluated. All patients had undergone cardiac MRI at 1.5T for symptoms of CAD. 67 patients (29%) had suffered a known RMI before. Functional imaging and full-intensity late gadolinium enhancement (LGE) imaging were evaluated for LVGFI and quantitative LGE mass. Results Of 168 patients without history of RMI, 48 patients (29%) had UMI, 120 patients had no MI. LVGFI was lower in RMI patients (34 ± 8% [range 16;52]), and UMI patients (35 ± 8% [range 10;51]), compared to patients with no MI (38 ± 7% [range 16;55]) respectively and similar between RMI and UMI patients. RMI patients had full-intensity LGE in 11 ± 6% of left ventricular myocardial mass (LVMM). UMI patients had LGE in 9 ± 5% of LVMM. RMI patients had significantly more LGE than UMI patients (p = 0.0096). Conclusion LGE quantification is effective to assess infarction scar size in RMI and UMI patients. LVGFI provides information on cardiac function and morphology but does not allow for a reliable differentiation between patients with and without history of MI, due small differences and wide overlap of LVGFI values for all three patient groups. This may be a reason why LVGFI is not applied in clinical routine.

© 2019 SAE International; Ford Motor Company. All rights reserved. Compressed natural gas (CNG) is an attractive, alternative fuel for spark-ignited (SI), internal combustion (IC) engines due to its high octane rating, and low energy-specific CO 2 emissions compared with gasoline. Directly-injected (DI) CNG in SI engines has the potential to dramatically decrease vehicles' carbon emissions; however, optimization of DI CNG fueling systems requires a thorough understanding of the behavior of CNG jets in an engine environment. This paper therefore presents an experimental and modeling study of DI gaseous jets, using methane as a surrogate for CNG. Experiments are conducted in a non-reacting, constant volume chamber (CVC) using prototype injector hardware at conditions relevant to modern DI engines. The schlieren imaging technique is employed to investigate how the extent of methane jets is impacted by changing thermodynamic conditions in the fuel rail and chamber. Post-processing of these optical results presents challenges because of the similarity between the density of methane and the background nitrogen. A methodology to interpret the jet extent in the high-speed movies is therefore proposed and used to quantify methane jet propagation and structure. The processed experimental results are compared 1D gas dynamics models and previously established jet penetration correlations. Exploiting the theory of underexpanded gas jets and using simple arguments, several experimental trends are qualitatively captured by the 1D model.

In accordance with the Climate Action Plan 2050, Germany is to become predominantly greenhouse gas-neutral by 2050. However, it is not possible to fully decarbonize the transportation sector when vehicles are powered by combustion engines that use fossil fuels. This is also the case if the entire remaining potential for optimizing combustion engines and vehicles is exhausted. In order to achieve the CO2 emission targets, suitable concepts are therefore necessary.

The European Union overall greenhouse gas (GHG) emission target is an 80 % – 95 % reduction from the GHG emissions emitted in 1990, the German target of 95 % reduction is even tougher.

Never before have the challenges for future propulsion systems been more demanding than these days. It is important to consider the very complex goals in terms of primary functionality, environmental compatibility and cost efficiency to a balanced extent. Based on a detailed analysis the 48V technology turned out as the most effective approach considering the trade-off between CO2 and cost (Figure 1).

Background Long-term intensive training induces physiological, morphological, and functional adaption of the athlete’s heart. Purpose To evaluate the development of athlete’s heart during a mid-term follow-up of competitive athletes using cardiac magnetic resonance (CMR). Material and Methods Eighteen competitive long-distance runners and triathletes (age 43 ± 13 years, 3 women) were prospectively examined in a longitudinal follow-up study 5.05 ± 0.6 years after baseline. CMR at 1.5-T was performed for functional and late gadolinium enhancement (LGE) imaging. Left ventricular (LV) and right ventricular (RV) end-diastolic volume (LVEDV, RVEDV) as well as ejection fraction (LVEF, RVEF), LV myocardial mass (LVMM), and atrial sizes were determined and compared to baseline in matched pairs statistics for paired difference. Results LVEDV (197 ± 38 mL vs. 196 ± 38 mL, paired difference −0.9 mL, P = 0.7) and LVEF (62 ± 7% vs. 62 ± 5%, paired difference 0.1%, P = 0.9) did not change during the follow-up period, whereas LVMM increased significantly (149 ± 31 g vs.164 ± 32 g, paired difference 14 g, P 2 vs. 25 ± 6 cm2, paired difference 0.5 cm2, P = 0.17) and right atrial size increased significantly (30 ± 5 cm2 vs. 32 ± 4 cm2, paired difference 2 cm2, P = 0.0054). Conclusion This study supports the theory of ongoing remodeling in an athlete’s heart. Predominantly the right heart can further enlarge in a mid-term period. This response seems not linearly dependent on a steady, decreased, or increased training volume.

PURPOSE To introduce a dual-contrast fast spin-echo (dcFSE) sequence for signal decay mapping of myocardial edema. MATERIALS AND METHODS After consultation with the Institutional Review Board, 22 acute myocardial infarction (MI) patients were examined with magnetic resonance imaging (MRI) at 1.5T 2 days after revascularization. Edema was evaluated in 16 myocardial segments with an exponential fit for signal decay time (SDT) in dcFSE mapping and T2 signal intensity ratio for single-contrast FSE. Myocardial viability was evaluated in late gadolinium enhancement (LGE). A control group of 10 volunteers was examined for edema imaging. SDT was compared in segment groups: 1) with LGE in MI, 2) penumbra, 3) remote from LGE, 4) controls. Groups 1/3 and 3/4 were tested on difference. Three phantoms providing similar T2 but different T1 relaxation times (low, intermediate, high) were examined with dcFSE and multicontrast spin echo sequence as a reference. RESULTS The SDT/T2 ratio for segment groups was 1) 82msec/1.7 in segments with LGE; 2) 65msec/1.6 for penumbra, 3) 62msec/1.7 for remote segments, and 4) 50msec/1.6 in controls. In dcFSE group 1/3 (P < 0.0001) and in group 3/4 (P = 0.0002) SDT was significantly different. In single-contrast FSE the T2 ratio was not significantly different for both tests: 1/3 P = 0.1889; 3/4 P = 0.8879. T2 -overestimation of dcFSE was 23% in low, 29% in intermediate, and 35% in highly T1 contaminated phantoms. CONCLUSION dcFSE signal decay edema mapping is feasible in volunteers and patients. DcFSE SDT is superior to T2 ratio for detection of high-grade and diffuse myocardial edema. J. Magn. Reson. Imaging 2016;44:186-193.

To evaluate the feasibility of a CAIPIRINHA-Dixon-TWIST (CDT)-VIBE sequence for improving image quality and temporal resolution in dynamic contrast-enhanced MRI (DCE-MRI) of the prostate.44 male patients (age 63.9 ± 8.9 years) with clinically suspected prostate cancer underwent DCE-MRI at a 3T MRI scanner (Magnetom Skyra, Siemens Healthcare, Erlangen, Germany) using a CDT-VIBE sequence (spatial resolution=3×1.2×1.2mm(3), temporal resolution=5s, total scan duration=4:10 min) with body-weight-adapted administration of contrast agent (Gadobutrol, Bayer Healthcare, Berlin, Germany). To investigate effects on image quality, the same sequence was acquired three times per patient during the late phase: 1. with the same protocol as in the arterial phase (VS5), 2. without view-sharing (no view-sharing, NVS) using a 2-fold CAIPIRINHA acceleration R=2 (temporal resolution=15s, NVS15) and 3. NVS using a 6-fold CAIPIRINHA acceleration R=6 (temporal resolution=5s, NVS5). SNR and CNR were evaluated with the subtraction method. Image quality of the three sequences (VS5, NVS15, NVS5) was subjectively assessed by 2 blinded radiologists using a 5-point Likert scale (5 being excellent). Perfusion profiles of visually normal prostate and of malignant lesions as characterized by Wash-In, Wash-Out, time-to-peak (TTP) and initial area under the curve (iAUC) from the original datasets (temporal resolution=5s) and from datasets with a downsampled temporal resolution (15s) were compared.In 20 of 44 included patients, potentially malignant lesions were identified in which 16 had histologically confirmed prostate cancer. SNR was highest for VS5 and NVS15, and lowest for NVS5 (p.001). Concordantly, subjective image quality was comparable for VS5 and NVS15 (sum score 23.20 ± 1.03 vs 23.53 ± 1.34) and significantly lower for NVS5 (sum score 9.83 ± 2.32; p.001). Perfusion parameters of macroscopically normal prostate tissue and suspect lesions differed significantly between original datasets and datasets with simulated lower temporal resolution, with the latter showing higher Wash-In (p=.002), lower Wash-Out (p=.003), higher Time-to-Peak (p.001) and lower iAUC (p.001).CDT-VIBE can be readily exploited for DCE-MRI of the prostate preserving the diagnostic image quality while providing high temporal resolution for quantitative diagnostic assessment of enhancement curves in malignant lesions.

Stress urinary incontinence (SUI) is a largely ousted but significant medical, social, and economic problem. Surveys suggest that nowadays approximately 10% of the male and 15% of the female population suffer from urinary incontinence at some stage in their lifetime. In women, two major etiologies contribute to SUI: degeneration of the urethral sphincter muscle controlling the closing mechanism of the bladder outflow and changes in lower pelvic organ position associated with degeneration of connective tissue or with mechanical stress, including obesity and load and tissue injury during pregnancy and delivery. In males, the reduction of the sphincter muscle function is sometimes due to surgical interventions as a consequence of prostate cancer treatment, benign prostate hyperplasia, or of neuropathical origin. Accordingly, for women and men different therapies were developed. In some cases, SUI can be treated by physical exercise, electrophysiological stimulation, and pharmacological interventions. If this fails to improve the situation, surgical interventions are required. In standard procedures, endoprostheses for mechanical support of the weakened tissue or mechanical valves for a bladder outflow control are implanted. In 20% of cases treated, repeat procedures are required as implants yield all sorts of side effects in time. Based on preclinical studies, the application of an advanced therapy medicinal product (ATMP) such as implantation of autologous cells may be a curative and long-lasting therapy for SUI. Cellular therapy could also be an option for men suffering from incontinence caused by injury of the nerves controlling the muscular sphincter system. Here we briefly report on human progenitor cells, especially on mesenchymal stromal cells (MSCs), their expansion and differentiation to smooth muscle or striated muscle cells in vitro, labeling of cells for in vivo imaging, concepts of improved, precise, yet gentle application of cells in muscle tissue, and monitoring of injected cells in situ.

Multiparametric magnetic resonance imaging (mpMRI) improves diagnostic accuracy in re-biopsies of men with prostate cancer (PC) suspicion, but predictive value is limited despite the use of the new Prostate Imaging Reporting and Data System (PI-RADS). Prognostic value of the PC-specific biomarker prostate cancer gene 3 (PCA3) added to the PI-RADS score was evaluated. The study was a retrospective analysis of the institutional database for men with MR-guided biopsy (MR-GB) for suspicious lesion in mpMRI and who had an additional pre-MR-GB PCA3 testing for ongoing PC suspicion. All men had ≥1 negative ultrasound GB. Lesions were retrospectively scored by PI-RADS in three MRI sequences (T2w, DCE, and DWI). PCA3 was analyzed with cutoffs of 25 and 35. The prognostic value of mpMRI and PCA3 and the additional value of both were explored. Tumor detection rate (49 men, mean PSA 10 ng/ml, lesion size 40 mm2) was 45 % (22/49 patients). In the subgroup of PI-RADS IV°, 17/17 patients had PC; in PI-RADS III° (intermediate) 5/15 had PC, and all 5 had a PCA3 >35. PCA3 >35 had no additional prognostic value in the whole cohort. Out of the 10/15 PC negative patients (PI-RADS III°), PCA3 was

Direct stem cell therapies for functionally impaired tissue require a sufficient number of cells in the target region and a method for verifying the fate of the cells in the subsequent time course. In vivo MRI of iron labeled mesenchymal stem cells has been suggested to comply with these requirements. The study was conducted to evaluate proliferation, migration, differentiation and adhesion effects as well as the obtained iron load of an iron labeling strategy for mesenchymal stem cells. After injection into the porcine urethral sphincter, the labeled cells were monitored for up to six months using MRI. Mesenchymal stem cells were labeled with ferucarbotran (60/100/200 µg/mL) and ferumoxide (200 µg/mL) for the analysis of migration and viability. Phantom MR measurements were made to evaluate effects of iron labeling. For short and long term studies, the iron labeled cells were injected into the porcine urethral sphincter and monitored by MRI. High resolution anatomical images of the porcine urethral sphincter were applied for detection of the iron particles with a turbo-spin-echo sequence and a gradient-echo sequence with multiple TE values. The MR images were then compared with histological staining. The analysis of cell function after iron labeling showed no effects on proliferation or differentiation of the cells. Although the adherence increases with higher iron dose, the ability to migrate decreases as a presumed effect of iron labeling. The iron labeled mesenchymal stem cells were detectable in vivo in MRI and histological staining even six months after injection. Labeling with iron particles and subsequent evaluation with highly resolved three dimensional data acquisition allows sensitive tracking of cells injected into the porcine urethral sphincter for several months without substantial biological effects on mesenchymal stem cells.

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.

Background Three-vessel coronary artery disease (CAD) comes along with globally reduced myocardial perfusion potentially restricting the demarcation of regional hypoperfusion in stress perfusion cardiac magnetic resonance imaging (MRI). Purpose To evaluate whether stress perfusion cardiac MRI is capable of detecting myocardial hypoperfusion in patients with 3-vessel CAD reliably. Material and Methods Two hundred and five patients with symptoms of CAD were included. The examination protocol comprised imaging of myocardial perfusion at stress (0.14 mg/kg/min adenosine for 4 min) using a 2D saturation recovery gradient echo sequence after administration of gadobutrol (0.1 mmol/kg body weight). Perfusion sequences were assessed qualitatively by two experienced observers. Coronary angiography served as standard of reference. Results Sensitivity and specificity for hemodynamically relevant stenoses in patients with 0-, 1-, 2-, 3-vessel coronary artery disease were 100%/91%, 91%/73%, 90%/71%, 92%/64%; positive/negative predictive value, 67%/100%, 91%/73%, 83%/81%, 93%/58%; diagnostic accuracy, 93%/87%/83%/87%, respectively. The negative predictive value in patients with 3-vessel CAD was lower than in patients with 0- and 2-vessel CAD and the specificity lower than in patients with no CAD whereas the positive predictive value was higher than in patients with no CAD. The other proportions did not differ significantly between the groups. Conclusion The diagnostic value of stress perfusion cardiac MRI in patients with 3-vessel CAD is comparable to results in patients with 1- or 2-vessel CAD. In the rare event that stress perfusion images do not depict regional hypoperfusion in patients with severe 3-vessel CAD, myocardial ischemia could be identified by reduced semi-quantitative perfusion parameters.

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.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.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.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.· 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.· 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.Die ischämische Mitralinsuffizienz ist ein negativer Prädiktor für eine Herzinsuffizienz und für eine hierdurch bedingte erhöhte Mortalität von Patienten mit chronischem Myokardinfarkt (MI). Ein kausaler Zusammenhang zwischen Papillarmuskelinfarkt (PMI) und ischämisch bedingter Mitralinsuffizienz ist unsicher. Ziel der vorgestellten Studie war es, den Zusammenhang von PMI in der MRT und Mitralinsuffizienz sowie linksventrikulärer Funktion zu untersuchen.48 Patienten mit chronischem MI und aktuellem MRT und Echokardiografie wurden retrospektiv eingeschlossen. Lokalisation und Ausmaß des MI in der MRT wurden mit der linksventrikulären Funktion in der MRT und der Mitralinsuffizienz in der Echokardiografie korreliert. Vorhandensein, Lokalisation und Ausmaß eines PMI in der Late-Gadolinium Enhancement (LGE-) MRT wurden mit diesen Funktionsparametern korreliert und mit Patienten mit chronischem MI ohne PMI verglichen.Bei 11 von 48 Patienten (23 %) konnte mittels LGE-MRT ein PMI nachgewiesen werden. Eine ischämische Mitralinsuffizienz bestand bei 8/11 Patienten mit PMI (73 %) und bei 22/37 Patienten mit MI ohne PMI (59 %). Es ergab sich kein signifikanter Unterschied hinsichtlich Lokalisation und Ausmaß des MI und der Mitralinsuffizienz zwischen Patienten mit und ohne PMI. Bei 4/4 Patienten mit vollständigem und bei 4/7 Patienten mit partiellem PMI bestand eine Mitralinsuffizienz. Das mittlere enddiastolische Volumen war bei Patienten mit Mitralinsuffizienz erhöht.Es ergibt sich kein eindeutiger Zusammenhang zwischen dem Vorhandensein eines PMI und der Entwicklung einer ischämischen Mitralinsuffizienz. Bei Patienten mit vollständigem PMI scheint aufgrund einer Unterbrechung der Kontinuität vitalen Gewebes des Papillarmuskel-Chorda-Mitralklappen Komplex ein erhöhtes Risiko für das Auftreten einer ischämischen Mitralinsuffizienz zu bestehen. Der Schweregrad der Mitralinsuffizienz ist im Vergleich zu Patienten mit partiellem oder ohne PMI nicht erhöht.· Kein Zusammenhang zwischen Vorhandensein eines Papillarmuskelinfarkts und ischämischer Mitralinsuffizienz. · Vollständiger Papillarmuskelinfarkt führt zu Funktionsstörung und ist mit ischämischer Mitralinsuffizienz assoziiert. · Schweregrad der Mitralinsuffizienz bei vollständigem Papillarmuskelinfarkt nicht höher.

In recent years, Greenhouse gas (GHG) reduction has become the major driver for new technological developments in the transportation sector since CO2 emissions emitted by vehicles represent a significant part. In Europe for example, Greenhouse gases produced by Road Transportation comprise about 20% of anthropogenic CO2, which is only 5% less than the biggest contribution coming from Heat and Electricity production. Although GHG emissions in Europe tend to go down, further efforts have to be undertaken in order to reduce the CO2(+CH4/N2O)-concentration in the atmosphere even more in order to limit global warming. For 2030, the European Commission has targeted a CO2- reduction of 40% compared to 1990 levels which also implies a stepwise reduction in fleet-averaged CO2 levels for newly registered passenger car vehicles. In 2021 therefore a fleet average of 95 g/km was fixed which would correspond to 4.1 litre gasoline or 3.6 litre Diesel per 100 kilometres. Due to thermodynamical limitations, those numbers will not be achievable with conventional Diesel and Gasoline-based powertrain technology alone, which implies the necessity for OEMs to develop and apply new technology in order to provide sustainable, profitable and attractive vehicle solutions. Beside disruptive powertrain solutions such as battery electric vehicles, which require high investments in production and infrastructure development, there are also new more evolutionary powertrain concepts based on Low-Carbon-fuels, which do have a lot of promising features. If those new fuels are carefully selected, existing powertrain technology could be preserved with small modifications in fuel and tank system, which of course would strongly reduce required manufacturing investments. Even vehicles, which are already on the market could contribute to a sustainable mobility if the chosen fuels are compatible with conventional powertrain technology

Objective: To directly compare the diagnostic performance of targeted MRI-guided biopsy (MR-GB) and systematic transrectal ultrasound-guided biopsy (TRUS-GB). Methods: Thirty-five patients with at least one negative TRUS-GB, persistently elevated or rising prostate-specific antigen and a lesion suspicious for prostate cancer (PC) on multiparametric MRI (mpMRI) scored by using the Prostate Imaging Reporting and Data System (PI-RADS) were included. A median of three targeted biopsies per lesion were obtained and systematic TRUS-GB was performed subsequently by an independent urologist without knowledge of the MRI findings. Definite pathology reports were analyzed for anatomical location and criteria of clinical significance. Results: The tumor detection rate was significantly higher with MR-GB compared with TRUS-GB (16/35, 46% and 8/35, 23%, respectively, p < 0.05). MR-GB detected PC in all patients with positive TRUS-GB. All tumors detected by MR-GB exhibited at least one criterion of clinical significance. PC lesions showed a significantly higher PI-RADS sum score compared with benign lesions. Conclusions: MR-GB is more effective compared with TRUS-GB in detecting clinically significant PC in men after previous negative TRUS-GB. PI-RADS scores give additional information and could be part of the decision-making process when considering retrial biopsy. Additional systematic biopsy can be omitted in patients undergoing targeted MR-GB.

To measure blood perfusion in extramedullary myeloma by contrast-enhanced sonography, correlate it with specific hematologic parameters, and determine their utility for local and systemic response monitoring.Twenty-five consecutive patients (14 male and 11 female; median age, 68 years) with extramedullary myeloma were included. After intravenous administration of 2.4 mL of sulfur hexafluoride, extramedullary myeloma masses were examined for 60 seconds. All patients underwent contrast-enhanced sonography at baseline, and 15 were monitored additionally (3 weeks during therapy). Average peak perfusion, regional blood flow (RBF), and regional blood volume (RBV) were calculated. Baseline perfusion parameters were compared with short-term follow-up sonographic data and serologic biomarkers (M gradient). For validation of extramedullary myeloma and systemic myeloma, patients underwent midterm (3 months) imaging and serologic diagnosis.Patients with baseline β2-microglobulin (B2M) greater than 3.5 mg/L (n = 17) showed higher perfusion parameters compared with baseline B2M less than 3.5 mg/L (n = 8). At short-term follow-up, patients were classified by serologic criteria as responders (n = 9) and nonresponders (n = 6) and by sonographic criteria as responders (n = 10) and nonresponders (n = 5). In sonographic responders, mean peak, RBV, and RBF dropped from 59.13, 1446.09, and 71.52 (artificial units) at baseline to 29.30, 364.19, and 34.64 at follow-up (P.05), whereas in nonresponders, perfusion parameters increased from 33.18, 789.82, and 36.92 at baseline to 51.14, 1491.06, and 65.34 at follow-up (P.05). Prediction of a midterm course of systemic myeloma using serologic data yielded sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 0.66, 0.77, 0.66, and 0.77, whereas sonographic results (judged by RBV) yielded values of 0.66, 0.55, 0.5, and 0.71. Separate prediction of a local (extramedullary myeloma) response by sonography yielded sensitivity, specificity, PPV, and NPV of 0.8, 1.0, 1.0, and 0.71.Contrast-enhanced sonography is a valuable tool for short-term monitoring of the treatment response in extramedullary myeloma.

Purpose: Sudden cardiac death [SCD] in competitive athletes is caused by a diverse set of cardiovascular diseases such as hypertrophic and dilated cardiomyopathy [HCM/DCM], myocarditis, coronary anomalies or even coronary artery disease. In order to identify potential risk factors responsible for SCD, elite athletes underwent cardiac magnetic resonance [CMR] imaging. Materials and Methods: 73 male [M] and 22 female [F] athletes (mean age 35.2 ± 11.4 years) underwent CMR imaging. ECG-gated breath-hold cine SSFP sequences were used for the evaluation of wall motion abnormalities and myocardial hypertrophy as well as for quantitative analysis (left and right ventricular [LV, RV] end-diastolic and end-systolic volume [EDV, ESV], stroke volume [SV], ejection fraction [EF] and myocardial mass [MM]). Furthermore, left and right atrial sizes were assessed by planimetry and delayed enhancement imaging was performed 10 minutes after the application of contrast agent. Coronary arteries were depicted using free-breathing Flash-3 D MR angiography. Results: The quantitative analyses showed eccentric hypertrophy of the left ventricle (remodeling index [MM/LV-EDV]: M 0.75, F 0.665), enlargement of the RV volumes (RV-EDV: M 122.6 ± 19.0 ml/m², F 99.9 ± 7.2 ml/m²) and an increased SV (LV-SV: M 64.7 ± 10.0 ml/m², F 56.5 ± 5.7 ml/m²; RV-SV; M 66.7 ± 10.4 ml/m², F 54.2 ± 7.1 ml/m²). Abnormal findings were detected in 6 athletes (6.3 %) including one benign variant of coronary anomaly and abnormal late gadolinium enhancement in 2 cases. None of the athletes showed wall motion abnormalities or signs of myocardial ischemia. Conclusion: CMR imaging of endurance athletes revealed abnormal findings in more than 5 % of the athletes. However, the prognostic significance remains unclear. Thus, cardiac MRI cannot be recommended as a routine examination in the care of athletes. Key points: Citation Format

In the past decades the incidence of acute and chronic disorders of the Achilles tendon associated with sport-induced overuse has steadily increased. Besides acute complete or partial ruptures, achillodynia (Achilles tendon pain syndrome), which is often associated with tendon degeneration, represents the most challenging entity regarding clinical diagnostics and therapy. Therefore, the use of imaging techniques to differentiate tendon disorders and even characterize structure alterations is of growing interest. This review article discusses the potential of different imaging techniques with respect to the diagnosis of acute and chronic tendon disorders. In this context, the most commonly used imaging techniques are magnetic resonance imaging (MRI), B-mode ultrasound, and color-coded Doppler ultrasound (US). These modalities allow the detection of acute tendon ruptures and advanced chronic tendon disorders. However, the main disadvantages are still the low capabilities in the detection of early-stage degeneration and difficulties in the assessment of treatment responses during follow-up examinations. Furthermore, differentiation between chronic partial ruptures and degeneration remains challenging. The automatic contour detection and texture analysis may allow a more objective and quantitative interpretation, which might be helpful in the monitoring of tendon diseases during follow-up examinations. Other techniques to quantify tendon-specific MR properties, e. g. based on ultrashort echo time (UTE) sequences, also seem to have great potential with respect to the precise detection of degenerative tendon disorders and their differentiation at a very early stage. Key Points: Citation Format