52 research outputs found
Magnetic resonance imaging of organ iron before and after correction of iron deficiency in patients with heart failure
No full textAims
Intravenous iron therapy (IVIT) is known to improve functional status in chronic heart failure (CHF) patients. The exact mechanism is not completely understood. We correlated magnetic resonance imaging (MRI) patterns of T2* iron signal in various organs to systemic iron and exercise capacity (EC) in CHF before and after IVIT.
Methods and results
We prospectively analysed 24 patients with systolic CHF for T2* MRI pattern of the left ventricle (LV), small and large intestines, spleen, liver, skeletal muscle, and brain for iron. In 12 patients with iron deficiency (ID), we restored iron deficit by IVIT using ferric carboxymaltose. The effects after 3 months were analysed by spiroergometry and MRI. Patients with vs. without ID showed lower blood ferritin, haemoglobin (76 ± 63 vs. 196 ± 82 μg/L and 12.3 ± 1.1 vs. 14.2 ± 1.1 g/dL, all P < 0.002), and in trend a lower transferrin saturation (TSAT) (19.1 [13.1; 28.2] vs. 25.1 [21.3; 29.1] %, P = 0.05). Spleen and liver iron was lower as expressed by higher T2* value (71.8 [66.4; 93.1] vs. 36.9 [32.9; 51.7] ms, P < 0.002 and 33.5 ± 5.9 vs. 28.8 ± 3.9 ms, and P < 0.03). There was a strong trend for a lower cardiac septal iron content in ID (40.6 [33.0; 57.3] vs. 33.7 [31.3; 40.2] ms, P = 0.07). After IVIT, ferritin, TSAT, and haemoglobin increased (54 [30; 104] vs. 235 [185; 339] μg/L, 19.1 [13.1; 28.2] vs. 25.0 [21.0; 33.7] %, 12.3 ± 1.1 vs. 13.3 ± 1.3 g/L, all P < 0.04). Peak VO2 improved (18.2 ± 4.2 vs. 20.9 ± 3.8 mL/min/kg−1, P = 0.05). Higher peak VO2 at anaerobic threshold was associated with higher blood ferritin, reflecting higher metabolic exercise capacity after therapy (r = 0.9, P = 0.0009). Increase in EC was associated with haemoglobin increase (r = 0.7, P = 0.034). LV iron increased by 25.4% (48.5 [36.2; 64.8] vs. 36.2 [32.9; 41.9] ms, P < 0.04). Spleen and liver iron increased by 46.4 and 18.2%, respectively (71.8 [66.4; 93.1] vs. 38.5 [22.4; 76.9] ms, P < 0.04 and 33.5 ± 5.9 vs. 27.4 ± 8.6 ms, P < 0.007). Iron in skeletal muscle, brain, intestine, and bone marrow remained unchanged (29.6 [28.6; 31.2] vs. 30.4 [29.7; 30.7] ms, P = 0.7, 81.0 ± 6.3 vs. 82.9 ± 9.9 ms, P = 0.6, 34.3 ± 21.4 vs. 25.3 ± 14.1 ms, P = 0.2, 9.4 [7.5; 21.8] vs. 10.3 [6.7; 15.7] ms, P = 0.5 and 9.8 ± 1.5 vs. 13.7 ± 8.9 ms, P = 0.1).
Conclusions
CHF patients with ID showed lower spleen, liver, and in trend lower cardiac septal iron. After IVIT, iron signal of the left ventricle as well as spleen and liver increased. Improvement in EC was associated with increase in haemoglobin after IVIT. In ID, liver, spleen, and brain but not heart iron were associated with markers of systemic ID.Oskar‐Helene‐Heim Stiftung http://dx.doi.org/10.13039/501100008334Open-Access-Publikationsfonds 202
Positive Outcome After a Small-Caliber Gunshot Fracture of the Upper Cervical Spine without Neurovascular Damage.
No full textBACKGROUND
Gunshot wounds to the cervical spine most frequently concur with serious injuries to the spinal cord and cervical vessels and often have a fatal outcome.
CASE REPORT
We describe the case of a 35-year-old male with a complex fracture of the C2 vertebra body and a mandibular fracture after a penetration gunshot to the cervical spine. Computed tomography (CT) at admission revealed the exact extent of the fractures and the small caliber bullet lodged next to the C2 vertebra. In this rare and extremely lucky case no collateral vascular or neurological damage was detected. Eighteen months after surgical bullet removal and posterior C1-C3 fusion complete bone healing of the C2 vertebra was achieved and there were no secondary neurovascular deficits.
CONCLUSIONS
Immediate surgical C1-C3 fixation resulted in an excellent outcome without secondary neurovascular deficits in this rare case of traumatic complex C2 vertebral fracture caused by a gunshot injury
Book Review: Umkhonto We Sizwe: The ANC’s Armed Struggle
No full textBook Title: Umkhonto We Sizwe: The ANC’s Armed StruggleBook Author: Thula SimpsonPenguin: Johannesburg, 2016. 616 p
Segment-by-segment assessment of left ventricular myocardial affection in Anderson-Fabry disease by non-enhanced T1-mapping
No full textBackground: Anderson-Fabry disease (AFD) is an X-linked lysosomal enzyme disorder associated with an intracellular accumulation of sphingolipids, which shorten myocardial T1 relaxation times. Myocardial affection, however, varies between different segments. Purpose: To evaluate the specific segmental distribution and degree of segmental affection in AFD patients. Material and Methods: Twenty-five patients with AFD, 14 patients with hypertrophic cardiomyopathy (HCM), and 21 controls were included. A Modified Look-Locker Inversion Recovery sequence (MOLLI) was used for non-enhanced T1 mapping at 1.5 T in addition to standard cardiac imaging in 10-12 short axis views. T1 values were evaluated with a mixed model ANOVA and regression analysis to determine the best diagnostic cutoff values for T1 for each myocardial segment. Results: Regression analysis showed the best diagnostic cutoff compared to controls in cardiac segments 1-4, 8-9, and 14. Mean differences between T1 for AFD versus HCM were greatest in segment 3, 4, and 9 (99ms, 103ms, 86ms, respectively). Overall T1 times were 88870ms and 903 +/- 14ms (AFD with and without LVH); 1014 +/- 17ms and 1001 +/- 22ms (HCM and controls, P<0.05). Conclusion: Myocardial segments are affected by a varying degree of T1 shortening in AFD patients. Segment-specific cutoff values allow the most specific detection and quantification of the extent of myocardial affection
evaluation of MR-thermometry in vitro
No full textDie Perkutane Laser Diskus Dekompression (PLDD) kommt, als minimal-invasive
Therapie für Bandscheibenvorfälle, in der klinischen Praxis vermehrt zum
Einsatz. Neue offene Hochfeld-MRT-Systeme ermöglichen heute eine hohe
Bildqualität, schnelle Sequenzen und die Option, Interventionen unter MRT-
Kontrolle durchzuführen. Material und Methoden: In dieser Arbeit wurde in
präklinischen Versuchen, die Durchführbarkeit der PLDD im offenen Hochfeld MRT
und die MR-Thermometrie an der Bandscheibe in vitro untersucht und optimiert.
Zunächst wurde die MR-Tauglichkeit des Lasers, der Punktionsnadeln und
verschiedener MR-fluoroskopischer Sequenzen an 10 Schweinewirbelsäulen
gezeigt. Anschließend wurden GRE Sequenzen mit unterschiedlichen TE-Zeiten,
mit Hinblick auf die PRF-Thermometrie, an 30 Humankadaverbandscheiben (L1-S1)
untersucht. Eine Korrelation der MR-thermometrisch kalkulierten und der
tatsächlich gemessenen Temperaturen diente zur Beurteilung der jeweiligen
Sequenzen. Ergebnisse: Temperaturkorrelationskoeffizienten: 0,946 (TE 7 ms)
vergl. 0,859 (TE = 2 ms) und 0,792 (TE = 10ms mit ES);
CNRDiskus/Endplatte/CNRDiskus/Spinalnerv/CNRDiskus/Muskel/CNRDiskus/Nadel:
14,3 ± 12,0 (n=10)/10,8 ± 7,5 (n=8)/16,3 ± 11,8 (n=10)/25,5 ± 12,7 (n=10) für
die GRE mit TE = 7ms im Vergleich zu 11,6 ± 11,4 (n=10)/13,1 ± 12,8
(n=10)/22,7 ± 14,7 (n=10)/21,5 ± 17,4 (n=10) für die GRE mit TE = 2ms und 6,8
± 4,6 (n=10)/n=0 /17,5 ± 7,3 (n=10)/20,6 ± 8,9 (n=10) für die GRE mit TE =
10ms mit ES. Korrelation der MR-Läsionen mit den makroskopischen Befunden: R2
= 0,63 (TE =7 ms); R2 = 0,76 (TE = 2ms) und R2 = 0,48 (TE = 10 ms mit ES). Im
statistischen Vergleich korrelierten jene Temperaturverläufe, welche anhand
der GRE mit TE = 7ms berechnet wurden, signifikant (p < 0,05) besser mit der
tatsächlichen Temperatur, als die GRE mit ES und TE = 10 ms (p = 0,001). Eine
statistisch relevante Überlegenheit gegenüber der GRE mit TE = 2ms konnte
nicht belegt werden (p = 0,064). Die Auswertung ergab, dass die eine
ungespoilte GRE Sequenz mit einer TE von 7ms (3D GRE TR/TE/FA 10/7/27°, 15
Schichten, Scandauer 13,1s pro Bild) im Vergleich zu den anderen evaluierten
Sequenzen (3D GRE TR/TE/FA 4,2/2/27°, 15 Schichten, Scandauer 13,2 s; 3D GRE
mit ES TR/TE/FA 6,8/10/35°, 15 Schichten, Scandauer 12,5 s), die beste
Korrelation zwischen gemessener und kalkulierter Temperatur erzielte und den
besten Kompromiss zwischen einer möglichst genauen PRF-Thermometrie und einer
möglichst hohen Qualität der Magnitudenbilder darstellte. Diskussion: Die PRF-
Thermometrie wird heute in der klinischen Praxis bereits für die Kontrolle
hyperthermer Therapien an Prostata und Uterus eingesetzt. Eine PRF-
Thermometrie an der Bandscheibe wurde bis dato nicht evaluiert. Mit dieser
Arbeit konnte erfolgreich die Grundlage für eine klinische Etablierung der
PLDD im offenen Hochfeld MRT unter MR-thermometrischer Kontrolle geschaffen
werden. Die beste Sequenz hierfür war, unter den Vorraussetzungen des offenen
Hochfeld MRT mit vertikalem Magnetfeld, eine ungespoile GRE Sequenz mit einer
TE-Zeit von 7 ms und einem Flipwinkel von 27°.Percutaneous Laser Disc Decompression (PLDD) is becoming increasingly popular
in the treatment of vertebral disc protrusions. New open high-field systems
permit high image quality, fast sequences and the option to perform
interventions under MR-guidance. Materials and methods: With this study the
feasibility of PLDD under MR-thermometry in an open high-field MRI was
investigated in preclinical experiments in vitro. First, the MR-compatibility
of the Laser, the puncture needles and various fluoroscopic sequences was
demonstrated on 10 porcine lumbar spines. Hereafter, GRE sequences with
varying TE-times were evaluated with respect to PRF-thermometry on 30 human
cadaveric lumbar discs (L1-S1). Correlation and regression analysis of MR-
thermometrically calculated and the actually measured temperatures were
performed to assess each investigated sequence. Results: Temperature
correlation coefficients: 0.946 (TE 7 ms) compared to 0.859 (TE = 2 ms) and
0,792 (TE = 10ms and ES);
CNRDiskus/Endplatte/CNRDiskus/Spinalnerv/CNRDiskus/Muskel/CNRDiskus/Nadel:
14.3 ± 12.0 (n=10)/10.8 ± 7.5 (n=8)/16.3 ± 11.8 (n=10)/25.5 ± 12.7 (n=10) for
GRE sequence with TE = 7ms compared to 11.6 ± 11.4 (n=10)/13.1 ± 12,8
(n=10)/22.7 ± 14,7 (n=10)/21.5 ± 17.4 (n=10) for GRE sequence with TE = 2ms
and 6.8 ± 4.6 (n=10)/n=0 /17.5 ± 7.3 (n=10)/20.6 ± 8.9 (n=10) for GRE sequence
with TE = 10ms and ES. Correlation of MR-lesions with macroscopic findings
upon regression analysis: R2 = 0.63 (TE =7 ms); R2 = 0.76 (TE = 2ms) und R2 =
0.48 (TE = 10 ms and ES). Upon statistical comparison with temperature data
from the GRE with TE = 10ms and ES, those temperature curves calculated from
the GRE sequence with TE = 7ms were more precise (p = 0.001). A statistically
relevant (p < 0.05) superiority of the GRE with TE = 7ms compared to the GRE
with TE = 2ms could not be shown (p = 0.064). In summary, the unspoiled GRE
with TE = 7ms (3D GRE TR/TE/FA 10/7/27°, 15 slices, scan duration 13,1s per
image) was shown to have the best temperature correlation with actually
measured temperatures and proved to best he best compromise between precise
PRF-thermometry and high image quality of magnitude images compared to the
other two investigated GRE sequences (3D GRE TR/TE/FA 4,2/2/27°, 15 slices,
scan duration 13,2 s and 3D GRE and ES TR/TE/FA 6,8/10/35°, 15 slices, scan
duration 12,5 s). Discussion: PRF-thermometry is in clinical use today for
hyperthermal treatment of the prostate and the uterus. To date, PRF-
thermometry to monitor interventions in the intervertebral disc has not been
investigated. With this study, the basis for clinical application and
implementation of MR-thermometrically monitored PLDD in the open high-field
MRI was provided. An unspoiled GRE sequence with TE = 7ms and a flip angle of
27° was deemed to be the best fit for this purpose
Clinical utility of postprocessed low-dose radiographs in skeletal imaging
No full textObjectives: Radiography remains the mainstay of diagnostic and follow-up imaging. In view of the risks and the increasing use of ionizing radiation, dose reduction is a key issue for research and development. The introduction of digital radiography and the associated access to image postprocessing have opened up new opportunities to minimize the radiation dosage. These advances are contingent upon quality controls to ensure adequate image detail and maintenance of diagnostic confidence. The purpose of this study was to investigate the clinical applicability of postprocessed low-dose images in skeletal radiography.
Methods: In our study setting, the median radiation dose for full dose X-rays was 9.61 dGy*cm2 for pelvis, 1.20 dGy*cm2 for shoulder and 18.64 dGy*cm2 for lumbar spine exams. Based on these values, we obtained 200 radiographs for each anatomic region in four consecutive steps, gradually reducing the dose to 84%, 71%, 60% and 50% of the baseline using an automatic exposure control (AEC). 549 patients were enrolled for a total of 600 images. All X-rays were postprocessed with a spatial noise reduction algorithm. Two radiologists assessed the diagnostic value of the radiographs by rating the visualization of anatomical landmarks and image elements on a five-point Likert scale. A mean-sum score was calculated by averaging the two reader's total scores. Given the non-parametric distribution, we used the Mann-Whitney U test to evaluate the scores.
Results: Median dosage at full dose accounted for 38.4%, 48 and 53.2% of the German reference dose area product for shoulder, pelvis and lumbar spine, respectively. The applied radiation was incrementally reduced to 21.5%, 18.4% and 18.7% of the respective reference value for shoulder, pelvis and lumbar spine. Throughout the study, we observed an estimable tendency of superior quality at higher dosage in overall image quality. Statistically significant differences in image quality were restricted to the 50% dose groups in shoulder and lumbar spine images. Regardless of the applied dosage, 598 out of 600 images were of sufficient diagnostic value.
Conclusion: In digital radiography image postprocessing allows for extensive reduction of radiation dosage. Despite a trend of superior image detail at higher dose levels, overall quality and, more importantly, diagnostic utility of low-dose images was not significantly affected. Therefore, our results not only confirm the clinical utility of postprocessed low-dose radiographs, but also suggest a widespread deployment of this advanced technology to ensure further dose limitations in clinical practice.
Advances in knowledge: The diagnostic image quality of postprocessed skeletal radiographs is not significantly impaired even after extensive dose reduction by up to 20% of the reference value
High Revision Rate After Transphyseal ACL Reconstruction in Skeletally Immature Patients
No full textObjectives: There remains considerable debate regarding the optimal management of anterior cruciate ligament (ACL) injuries in skeletally immature patients. This study aims to evaluate the clinical outcomes of transphyseal ACL reconstruction in patients with open growth plates. Methods: This retrospective study included skeletally immature patients with full-thickness ACL tears and confirmed open physis. ACL reconstructions were performed using a four-strand semitendinosus autograft, with an additional gracilis tendon graft if needed. The surgical technique emphasized tibial and femoral physeal-sparing tunnel placement to minimize disruption of the growth plates. Clinical assessment included measurements for limb length discrepancy, knee stability, and growth disturbances. Functional outcomes were evaluated using IKDC 2000, Lysholm, and KOOS scores, while ligament stability was assessed with KT-1000 arthrometer measurements at routine follow-up. Results: A total of 31 consecutive patients (15 females, 16 males; mean age 13.6 ± 1.8 years, range 9–16 years) were included. Mean follow-up was 49 ± 26 months (range 18–93 months). The mean time to return to sports was 8.8 ± 4.4 months. Eight patients (26%) experienced ACL graft rupture and underwent revision ACL reconstruction. One additional patient required partial meniscectomy. The overall revision rate was 29%. The mean subjective IKDC score was 91.8 ± 7.2, with Lysholm and KOOS scores of 96.6 ± 7.9 and 94.2 ± 5.3, respectively. No significant growth disturbances were noted. The mean side-to-side difference in KT-1000 testing was 2.2 ± 1.5 mm. Patients who underwent revision ACL reconstruction showed significantly greater length growth compared with those with intact ACL reconstruction (p = 0.02). Spearman correlation revealed a significant association between length growth and anterior tibial translation (p = 0.02, r = 0.46). Conclusions: Transphyseal ACL reconstruction in skeletally immature patients provides favorable clinical and radiological outcomes, with minimal risk of growth disturbance. Most patients returned to pre-injury levels of athletic activity. However, the high revision rate emphasizes the complexity of managing ACL injuries in this population
Left atrial diverticulum - An unexpected finding in routine transesophageal echocardiography
No full textWe report a 55-year-old male patient with lone paroxysmal atrial fibrillation who underwent routine transesophageal echocardiography (TOE) at our institution. In a mid-esophageal 125 degrees three-chamber angulation, a distinct thinning of the left atrial (LA) wall was observed, forming a 7 x 4 mm canal with only a small membrane separating the LA from the pericardial space. Cardiac magnetic resonance imaging diagnosed a small LA diverticulum. To the best of our knowledge, this is the first manuscript describing detection of a small LA diverticulum via TOE
Endometrial stromal sarcoma
No full textwith selective polyvinyl alcohol embolization of a pulmonary metastasis after recurrent hemoptysis and expansive growt
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