Institut für Röntgenmdiagnostik

The present study evaluated the evolution of cardiac morphology, function, and late enhancement as a noninvasive marker of myocardial fibrosis, and their inter-relation during enzyme replacement therapy in patients with Fabry's disease using magnetic resonance imaging and color Doppler myocardial imaging. Late enhancement, which was present in up to 50% of patients, was associated with increased left ventricular mass, the failure of a significant regression of hypertrophy during enzyme replacement therapy, and worse segmental myocardial function. Late enhancement may predict the effect of enzyme replacement therapy on left ventricular mass and cardiac function. © 2006 Elsevier Inc. All rights reserved. (Am J Cardiol 2006;97:1515-1518)

Purpose: The treatment of inoperable tracheobronchial stenoses with Palmaz stents is analyzed in terms of the clinical effect, typical complications, and long-term follow-up. Methods: Twenty-seven Palmaz stents were placed in 22 patients with the help of a rigid bronchoscope. Results: Stents were implanted in the distal trachea, the main bronchi, and the lower lobe bronchi. Twenty-one of 22 patients reported an immediate subjective improvement in their respiratory situation. The mean survival time was 12 months; in two patients the stents were well tolerated for up to 40 months. A redilation of three stents was successful up to 33 months. In three cases a dislocation of the stent was observed; after bronchoscopic retraction a new stent was successfully implanted in each case. Conclusion: Treatment of inoperable tracheobronchial stenoses with the Palmaz stent is a safe procedure that provides an immediate improvement of the patient's pulmonary situation. The Palmaz stent shows a minimal complication rate in the long-term follow-up.

Spontaneous rupture of hepatocellular carcinoma (HCC) after transcatheter arterial chemoembolization (TACE) is a rare and life-threatening complication. Pathophysiologic mechanisms are not yet fully known; it is suggested that rupture is preceded by reactive tissue edema and intratumerous bleeding, leading to a rapid expansion of tumour mass with risk of extrahepatic bleeding in the case of subcapsular localisation. This case report discusses a sudden, unexpected lethal complication in a 74 year-old male patient treated with TACE using DC Bead loaded with doxorubicin (DEBDOX) in a progressive multifocal HCC.

The aim of this study is to evaluate the effectiveness and safety of percutaneously placed totally implantable venous-access ports (TIVAPs) of the forearm. Between January 2006 and October 2008, peripheral TIVAPs were implanted in 763 consecutive patients by ultrasound and fluoroscopic guidance. All catheters were implanted under local anesthesia and were tunneled subcutaneously. Indication, technical success, and complications were retrospectively analyzed according to Society of Interventional Radiology (SIR) criteria. Presence of antibiotic prophylaxis, periprocedurally administered drugs (e.g., sedation), and laboratory results at the time of implantation were analyzed. Maintenance during the service interval was evaluated. In total, 327,499 catheter-days were analyzed. Technical success rate was 99.3%. Reasons for initial failure of implantation were either unexpected thrombosis of the subclavian vein, expanding tumor mass of the mediastinum, or failure of peripheral venous access due to fragile vessels. Mean follow-up was 430 days. There were 115 complications observed (15.1%, 0.03 per 100 catheter-days), of which 33 (4.3%) were classified as early (within 30 days from implantation) and 82 (10.7%) as late. Catheter-related venous thrombosis was found in 65 (8.5%) of 763 (0.02 per 100 catheter-days) TIVAPs. Infections were observed in 41 (5.4%) of 763 (0.01 per 100 catheterdays) devices. Other complications observed included dislocation of the catheter tip (0.8%), occlusion (0.1%), or rupture (0.1%) of the port catheter. Dislocated catheters were corrected during a second interventional procedure. In conclusion, implantation of percutaneously placed peripheral TIVAPs shows a high technical success rate and low risk of early complications when ultrasound and fluoroscopic guidance are used. Late complications are observed three times as often as early complications.

Die funktionelle Lungenbildgebung mittels MRT stellt aufgrund der geringen Spindichte, der großen Anzahl von Luftgewebegrenzflächen sowie der Bewegungsartefakte durch Atmung bzw. Herzkontraktion eine große Herausforderung dar. Ein interessanter Ansatz ist die sauerstoffverstärkte funktionelle Lungenbildgebung, die Sauerstoff als inhalatives Kontrastmittel verwendet [6]. Mittels der sauerstoffgestützten T1-Bildgebung [9, 10, 17, 18] ist eine quantitative Messung des Sauerstofftransfers in der Lunge möglich. Dabei sind Störungen von Ventilation, Diffusion und Perfusion jedoch nicht zu trennen. Die sauerstoffgestützte T2 * -Bildgebung dagegen [13] zeigt das Potenzial zu einer direkten Messung der Ventilation. Die Relaxationszeiten bei 1,5 T sind nicht immer ideal. Insbesondere T2 * ist sehr kurz. Bei niedrigen Feldstärken verändern sich die Relaxationszeiten und es eröffnen sich neue Möglichkeiten. Diese werden im Folgenden dargestellt.

In vitro studies have shown impairment of energy metabolism in cardiac fibroblasts from Fabry patients. A recent in vivo study reported an association between cardiac energy metabolism and increased myocardial mass in Fabry patients. We therefore assessed possible disturbances of cardiac energy metabolism in Fabry patients by in vivo 31 P-MR-spectroscopy. Additionally, the effect of enzyme replacement therapy (ERT) on cardiac energetics was tested.

Purpose: To determine sensitivity, specificity and inter-observer variability of different whole-body MRI (WB-MRI) sequences in patients with multiple myeloma (MM). Methods and materials: WB-MRI using a 1.5 T MRI scanner was performed in 23 consecutive patients (13 males, 10 females; mean age 63 ± 12 years) with histologically proven MM. All patients were clinically classified according to infiltration (low-grade, n = 7; intermediate-grade, n = 7; high-grade, n = 9) and to the staging system of Durie and Salmon PLUS (stage I, n = 12; stage II, n = 4; stage III, n = 7). The control group consisted of 36 individuals without malignancy (25 males, 11 females; mean age 57 ± 13 years). Two observers independently evaluated the following WB-MRI sequences: T1w-TSE (T1), T2w-TIRM (T2), and the combination of both sequences, including a contrast-enhanced T1w-TSE with fatsaturation (T1 ± CE/T2). They had to determine growth patterns (focal and/or diffuse) and the MRI sequence that provided the highest confidence level in depicting the MM lesions. Results were calculated on a per-patient basis. Results: Visual detection of MM was as follows: T1, 65% (sensitivity)/85% (specificity); T2, 76%/81%; T1 ± CE/T2, 67%/88%. Inter-observer variability was as follows: T1, 0.3; T2, 0.55; T1 ± CE/T2, 0.55. Sensitivity improved depending on infiltration grade (T1: 1 = 60%; 2 = 36%; 3 = 83%; T2: 1 = 70%; 2 = 71%; 3 = 89%; T1 ± CE/T2: 1 = 50%; 2 = 50%; 3 = 89%) and clinical stage (T1: 1 = 58%; 2 = 63%; 3 = 79%; T2: 1 = 58%; 2 = 88%; 3 = 100%; T1 ± CE/T2: 1 = 50%; 2 = 63%; 3 = 100%). T2w-TIRM sequences achieved the best reliability in depicting the MM lesions (65% in the mean of both readers). Conclusions: T2w-TIRM sequences achieved the highest level of sensitivity and best reliability, and thus might be valuable for initial assessment of MM. For an exact staging and grading the examination protocol should encompass unenhanced and enhanced T1w-MRI sequences, in addition to T2w-TIRM.

Objectives: To investigate the effect of different iodine concentrations at either constant injection or iodine administration rates but constant total iodine load on contrast enhancement of liver, pancreas and spleen by multidetector row CT. Materials and methods: One hundred and twenty consecutive patients (70 ± 6 years) underwent triphasic liver CT at a four-channel multidetectorrow CT using the non-ionic contrast medium iopromide. Patients were divided into six equal groups-I: 150 ml, 240 mg/ml at 4 ml/s; II: 120 ml, 300 mg/ml at 4 ml/s; III: 97.3 ml, 370 mg/ml at 4 ml/s; IV: 150 ml, 240 mg/ml at 5 ml/s; V: 120 ml, 300 mg/ml, 60 ml at 6 ml/s, 60 ml at 3 ml/s; VI: 97.3 ml, 370 mg/ml at 3.3 ml/s. ROIs were measured in the liver, the pancreas, and the spleen in unenhanced, arterial, portal venous, and equilibrium phase. Results: At a constant injection rate of 4 ml/s, pancreatic enhancement over baseline only in the arterial phase was significantly higher at 370 mg/ml (58 ± 15 HU versus 59 ± 18 HU versus 74 ± 20 HU for groups I-III, respectively (p < 0.02)). Comparison of different iodine concentrations at constant iodine administration rate (groups II, IV and VI) and of all six protocols revealed no significant differences at either phase. Conclusions: At a constant iodine load and constant injection rates, the high-iodinated contrast agent iopromide at 370 mg/ml improves pancreatic enhancement in the arterial phase. At constant iodine load and constant iodine administration rates, there is no significant effect of different iodine concentrations.

Energetic differences between viable and non-viable myocardium in patients with recent myocardial infarction are not an effect of differences in wall thinninga multivoxel 31 P-MR-spectroscopy and MRI study Abstract To evaluate multivoxel 31 P-MR spectroscopy (MRS) for assessment of energy metabolism in patients with myocardial infarction (MI) in correlation to left ventricular (LV) wall thickness and the outcome of revascularization. Thirty patients with subacute anterior myocardial infarction and planned revascularization were enrolled. 3D-chemical shift imaging was applied to determine PCr/ ATP ratios in two areas: infarcted/ anterior and noninfarcted/septal myocardium. MRI was used to evaluate LV function and wall thickness, and was repeated 6 months after revascularization to assess myocardial viability. Fifteen volunteers were controls. Fifteen patients showed normalization of wall motion abnormalities after revascularization (Group 1; viable), 15 not (Group 2; non-viable). Regarding infarcted/anterior myocardium, Group 2 had lower PCr/ATP ratios (0.81± 0.60 vs 1.17±0.25), and PCr/ATP ratios were reduced in both groups compared to controls (1.45±0.29). Regarding noninfarcted/septal myocardium, again Group 2 had lower ratios (0.93±0.53 vs 1.31±0.38); however, compared to controls (1.51± 0.32) a reduction of PCr/ATP ratios was only found in Group 2. For both myocardial regions, no correlations between PCr/ATP ratios and LV wall thickness were detected. The more severe energetic alteration in irreversibly damaged myocardium is not an effect of differences of wall thinning. Additional alterations of noninfarcted, adjacent myocardium can be detected.

Magnetic resonance imaging (MRI) of the heart has been used to evaluate cardiac function since imaging of the heart with high temporal resolution became possible by cine MRI. In contrast to echocardiography, radionuclide, and catheter ventriculography, this technique makes no assumptions concerning the shape of the ventricle. Additionally, functional analysis of both left (LV) and right (RV) ventricles can be made in a single examination. Most studies performed to establish normal values for a population have employed volunteers who were younger than patients with cardiac disease. This may be problematic because echocardiography has demonstrated significant age-and gender-related differences in both cardiac function and cardiac mass even in healthy subjects . Normal values need to be defined because MRI is rapidly becoming established as the gold standard for examining cardiac function. This study therefore analyzed age-and gender-specific differences in cardiac mass and function in both ventricles in a single examination.