Publications by authors named "Cornelius Deuschl"

37 Publications

Analysis of brain natriuretic peptide levels following traumatic acute subdural hematoma and the risk of postoperative cerebral infarction.

J Neurotrauma 2021 Sep 3. Epub 2021 Sep 3.

University Hospital Essen, 39081, Neurosurgery, Essen, Germany;

Traumatic acute subdural hematoma (aSDH) is associated with a high mortality rate due to postoperative cerebral infarction. Recently, brain natriuretic peptide (BNP) was considered a reliable biomarker in the acute phase of traumatic brain injuries. We therefore aimed in this study to analyze BNP levels on admission, identify the predictors of their elevation, and assess the relationship between BNP and the risk of postoperative cerebral infarction. Patients with isolated, unilateral, traumatic aSDH who were admitted to our department between July 2017 and April 2020 were enrolled in this study. On admission, cranial computer tomography (CCT) and BNP sampling were simultaneously performed. Additionally, the time between head trauma and BNP sampling (TTS) was assessed. Admission radiographic variables included hematoma volumes, midline shift, and degree of brain edema. Cerebral infarction was detected on postoperative CCT. In total, 130 patients were included in this study. Surgical treatment was performed in 82.3% (n=107) of cases. The multiple regression analysis showed that larger hematoma volumes (p=0.032) and advanced age (p=0.005) were independent predictors of elevated BNP when TTS <24 hours. The binomial logistic regression analysis identified BNP with a cutoff value of <29.4 pg/ml (TTS=3-12 hours, aOR=16.5, p=0.023) as an independent predictor of postoperative cerebral infarction. Elevated BNP levels in the first 24 hours post-trauma were related to larger hematoma volumes and advanced age. Furthermore, an increased risk of postoperative cerebral infarction was identified in patients with lower BNP levels in the posttraumatic period 3-12 hours.
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http://dx.doi.org/10.1089/neu.2021.0169DOI Listing
September 2021

Reconstructive endovascular treatment of basilar artery fenestration aneurysms: A multi-centre experience and literature review.

Neuroradiol J 2021 Sep 3:19714009211042877. Epub 2021 Sep 3.

Department of Radiology, Neuroradiology and Nuclear Medicine, Ruhr-University Bochum, Germany.

Background: Data on outcome after endovascular treatment of basilar artery fenestration aneurysms (BAFAs) is limited. This study presents our multi-centre experience of BAFAs treated by different reconstructive techniques including coils, stent-assisted coiling (SAC), flow diversion and intra-saccular flow disruption with the Woven Endobridge (WEB).

Methods: Retrospective analysis of 38 BAFAs treated endovascularly between 2003 and 2020. The primary endpoint was complete aneurysm obliteration defined as Raymond-Roy occlusion classification (RROC) I on immediate and follow-up (FU) angiography. The secondary endpoints were procedure-related complications, rate of re-treatment, and clinical outcome.

Results: Endovascular treatment was feasible in 36/38 aneurysms (95%). The most frequent strategy was coiling (21/36, 58%), followed by SAC (7/36, 19%), WEB embolization (6/36, 17%) and flow diversion (2/36, 6%). A successful aneurysm occlusion (defined as RROC 1 and 2) on the final angiogram was achieved in 30/36 (83%) aneurysms including all patients presenting with baseline subarachnoid haemorrhage and 25/36 (69%) were occluded completely. Complete occlusion (RROC 1) was more frequently achieved in ruptured BAFAs (15/25, 60% v. 2/11, 18%;  = 0.031). Procedure-related complications occurred in 3/36 (8%) aneurysms. Re-treatment was executed in 12/36 (33%) aneurysms. After a median angiography FU of 38 months, 30/31 (97%) BAFAs were occluded successfully and 25/31 (81%) showed complete occlusion.

Conclusion: Reconstructive endovascular treatment of BAFAs is technically feasible with a good safety profile. Although in some cases re-treatment was necessary, a high rate of final aneurysm occlusion was achieved.
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http://dx.doi.org/10.1177/19714009211042877DOI Listing
September 2021

18 F-FDG-PET/MRI in patients with Graves' orbitopathy.

Graefes Arch Clin Exp Ophthalmol 2021 Aug 18. Epub 2021 Aug 18.

Department of Ophthalmology, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany.

Purpose: Currently, therapeutic management of patients with Graves' orbitopathy (GO) relies on clinical assessments and MRI. However, monitoring of inflammation remains difficult since external inflammatory signs do not necessarily represent the orbital disease activity. Therefore, we aimed to evaluate the diagnostic value of F-FDG-PET/MRI to assess the inflammation of GO patients.

Methods: Enrolled patients with new onset of GO underwent ophthalmological examinations to evaluate the activity (CAS) and severity of GO (NOSPECS), as well as an F-FDG-PET/MRI (Siemens Biograph mMR) with dual time point imaging (immediately post-injection and 60 min p.i.). A subset of PET parameters including maximum standardized uptake value (SUVmax), metabolic target volume (MTV), and total lesion glycolysis (TLG) were obtained separately per eye and per extraocular eye muscle (EOM). EOM thickness was measured on the co-registered MRI.

Results: Of 14 enrolled patients, three showed mild, seven moderate-to-severe, and four sight-threatening GO. Patients with severe GO showed statistically significant higher TLG than patients with mild GO (p = 0.02) and higher MTV than patients with mild (p = 0.03) and moderate (p = 0.04) GO. Correlation between NOSPECS on one hand and MTV and TLG on the other was significant (R = 0.49-0.61).

Conclusion: TLG and MTV derived from FDG-PET appear to be good discriminators for severe vs. mild-to-moderate GO and show a significant correlation with NOSPECS. As expected, PET parameters of individual eye muscles were not correlated with associated eye motility, since fibrosis, and not inflammation, is mainly responsible for restricted motility. In conclusion, F-FDG-PET/MRI can be used for assessment of GO inflammation.
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http://dx.doi.org/10.1007/s00417-021-05339-1DOI Listing
August 2021

Subarachnoid Hemorrhage Early Brain Edema Score (SEBES) as a radiographic marker of clinically relevant intracranial hypertension and unfavorable outcome after subarachnoid hemorrhage.

Eur J Neurol 2021 Jul 22. Epub 2021 Jul 22.

Department of Neurosurgery and Spine Surgery, University Hospital of Essen, Essen, Germany.

Background And Purpose: The severity of early brain edema (EBE) after aneurysm rupture was reported to be strongly associated with the risk of poor outcome after aneurysmal subarachnoid hemorrhage (SAH). Using the recently developed Subarachnoid Hemorrhage Early Brain Edema Score (SEBES), we analyzed the predictors of EBE and its impact on complications related to intracranial pressure (ICP) increase after SAH and on poor outcome.

Methods: All consecutive SAH cases treated between January 2003 and June 2016 with assessable SEBES were included (n = 745). Data on demographic characteristics, medical history, initial severity of SAH, need for conservative ICP treatment and decompressive craniectomy, occurrence of cerebral infarctions and unfavorable outcome at 6 months (modified Rankin scale score > 2) were collected. Univariable and multivariable analyses were performed.

Results: Younger age (<55 years; adjusted odds ratio [aOR] 3.16, 95% confidence interval [CI] 2.28-4.38), female sex (aOR 1.64, 95% CI 1.16-2.31), poor initial clinical condition (World Federation of Neurosurgical Societies score 4-5; aOR 1.74, 95% CI 1.23-2.46), presence of intracerebral hemorrhage (aOR 1.63, 95% CI 1.12-2.36), hypothyroidism (aOR 0.60, 95% CI 0.37-0.98) and renal comorbidity (aOR 0.29, 95% CI 0.11-0.78) were independently associated with SEBES (scores 3-4). There was an independent association between SEBES 3-4 and the need for conservative ICP treatment (aOR 2.43, 95% CI 1.73-3.42), decompressive craniectomy (aOR 2.68, 95% CI 1.84-3.89), development of cerebral infarcts (aOR 2.24, 95% CI 1.53-3.29) and unfavorable outcome (aOR 1.48, 95% CI 1.0-2.17).

Conclusions: SEBES is a reliable predictor of ICP-related complications and poor outcome of SAH. Our findings highlight the need for further research of the impact of patients' demographic characteristics and comorbidities on the severity of EBE after SAH.
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http://dx.doi.org/10.1111/ene.15033DOI Listing
July 2021

Simultaneous paraneoplastic cerebellar degeneration, Lambert-Eaton syndrome and neuropathy associated with AGNA/anti-SOX1 and VGCC antibodies.

Neurol Res Pract 2021 May 24;3(1):30. Epub 2021 May 24.

Department of Neurology, University Hospital Essen, Essen, Germany.

Anti-glial nuclear antibody (AGNA) is an onconeuroal antibody targeting the nuclei of Bergmann glia in the cerebellum and Anti-SRY-related HMG-box 1 (SOX1). It is highly specific for small cell lung cancer (SCLC) and correlates to the appearance of paraneoplastic neurological syndromes such as Lambert-Eaton myasthenic syndrome (pLEMS) and paraneoplastic cerebellar degeneration (PCD) amongst others. Herein, we present a SCLC patient with rapidly progressive PCD, LEMS and axonal polyneuropathy associated with AGNA/SOX1-antibodies, successfully treated with plasma-exchange (PLEX).
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http://dx.doi.org/10.1186/s42466-021-00129-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8142469PMC
May 2021

The Subarachnoid Hemorrhage-Weather Myth: A Long-Term Big Data and Deep Learning Analysis.

Front Neurol 2021 5;12:653483. Epub 2021 May 5.

Department of Neurosurgery and Spine Surgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.

The frequency of aneurysmal subarachnoid hemorrhage (aSAH) presents complex fluctuations that have been attributed to weather and climate changes in the past. In the present long-term big data and deep learning analysis, we have addressed this long-held myth. Bleeding dates and basic demographic data for all consecutive patients ( = 1,271) admitted to our vascular center for treatment of aSAH between January 2003 and May 2020 (6,334 days) were collected from our continuously maintained database. The meteorological data of the local weather station, including 13 different weather and climate parameters, were retrieved from Germany's National Meteorological Service for the same period. Six different deep learning models were programmed using the Keras framework and were trained for aSAH event prediction with meteorological data from January 2003 to June 2017, with 10% of this dataset applied for data validation and model improvement. The dataset from July 2017 to May 2020 was tested for aSAH event prediction accuracy for all six models using the area under the receiver operating characteristic curve (AUROC) as the metric. The study group comprised of 422 (33.2%) male and 849 (66.8%) female patients with an average age of 55 ± 14 years. None of the models showed an AUROC larger than 60.2. From the presented data, the influence of weather and climate on the occurrence of aSAH events is extremely unlikely. The myth of special weather conditions influencing the frequency of aSAH is disenchanted by this long-term big data and deep learning analysis.
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http://dx.doi.org/10.3389/fneur.2021.653483DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8131675PMC
May 2021

Stroke due to Left Atrial Appendage Thrombus after Pulmonary Vein Isolation despite Novel Oral Anticoagulant: A Case Report.

Case Rep Neurol 2021 Jan-Apr;13(1):225-232. Epub 2021 Apr 12.

Department of Neurology, University Hospital Essen, Essen, Germany.

In patients with atrial fibrillation, catheter ablation is suggested to reduce the mortality rate and is thus frequently performed. However, peri- and postprocedural thromboembolic complications as well as high recurrence rates of atrial fibrillation limit its advantages and require concomitant anticoagulation. With the advent of novel oral anticoagulants (NOACs), fixed dosing without routine laboratory monitoring became feasible. Nevertheless, several factors are associated with either an overdose or an insufficient drug activity of NOACs. We report on a patient with atrial fibrillation undergoing catheter ablation and cardioversion suffering from ischemic stroke despite being under oral anticoagulation. It turned out that the drug activity of the NOACs used was repeatedly insufficient in spite of regular intake and adequate dosing. In sum, drug activity controls should be taken into consideration in patients with thrombotic events despite oral anticoagulation with NOACs.
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http://dx.doi.org/10.1159/000515154DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8077527PMC
April 2021

Nusinersen treatment in adult patients with spinal muscular atrophy: a safety analysis of laboratory parameters.

J Neurol 2021 Apr 25. Epub 2021 Apr 25.

Department of Neurology, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany.

Background: Nusinersen is an intrathecally administered antisense oligonucleotide (ASO) that improves motor function in patients with spinal muscular atrophy (SMA). In addition to efficacy, the safety of a therapy is the decisive factor for the success of the treatment. For some ASOs, various organ toxicities have been described, such as thrombocytopenia, renal and liver impairment, or coagulation abnormalities. However, systematic data on laboratory parameters under treatment with nusinersen are mainly available from studies in infants and children. Therefore, our aim was to assess the safety of nusinersen therapy in adult SMA patients.

Methods: Laboratory data from 404 nusinersen injections performed in 50 adult patients with SMA type 2 and type 3 were retrospectively analyzed.

Results: The total observation period was 76.9 patient-years, and patients received up to 12 injections. Our data provides no new safety concerns. In cerebrospinal fluid (CSF), the mean white blood cell count and lactate remained stable over time. Total CSF protein increased by 2.9 mg/dL. No change in mean platelet count was observed under therapy. Only one patient showed sporadic mild thrombocytopenia. Coagulation parameters and inflammatory markers were stable. The mean creatinine level decreased by 0.09 mg/dL. Analysis of mean liver enzyme levels revealed no relevant changes during treatment.

Conclusion: Our data demonstrate a favorable safety profile of nusinersen therapy in adult SMA patients under longer-term "real-world" conditions. In particular, we found no evidence of clinically relevant platelet declines, coagulopathies, or renal or hepatic organ toxicities, which are common concerns with the use of ASOs.
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http://dx.doi.org/10.1007/s00415-021-10569-8DOI Listing
April 2021

From Acute Cerebrovascular Occlusion to Critical Limb Ischemia: A Multidisciplinary Challenge in a Patient with Ruptured Atrial Papillary Myxoma.

J Vasc Interv Radiol 2021 05 6;32(5):771-773. Epub 2021 Mar 6.

Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstraße 55, 45147 Essen, Germany.

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http://dx.doi.org/10.1016/j.jvir.2021.02.004DOI Listing
May 2021

Orbital aspergillosis: a case report and review of the literature.

BMC Ophthalmol 2021 Jan 8;21(1):22. Epub 2021 Jan 8.

Institute of Medical Microbiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany.

Background: Orbital aspergillosis is a rare sight- and life-threatening fungal infection affecting immunocompromised or otherwise healthy patients. It is often misdiagnosed due to its unspecific clinical and radiologic appearance. Therapeutic delay can have dramatic consequences. However, progress in microbiological diagnostic techniques and therapeutic experience from case series help improve the management of this disease.

Case Presentation: A 78-year-old immunocompetent woman presented at an eye clinic for subacute swelling, reddening, and ptosis of her left upper eyelid. Based on radiologic and histologic considerations, she was treated for idiopathic orbital inflammation, but her condition worsened. After a second biopsy of the orbital mass, aspergillosis was diagnosed. Her condition improved promptly after initiation of an oral voriconazole treatment. Additionally, using a polymerase chain reaction (PCR) assay, A. fumigatus was identified on tissue of both biopsies and its azole susceptibility was examined simultaneously.

Conclusions: In the case described here, oral antifungal treatment was sufficient for the therapy of invasive orbital aspergillosis. Performing fungal PCR on orbital tissue can accelerate the diagnostic process and should be performed in ambiguous cases of slowly growing orbital mass. Finally, interdisciplinary management is the key to optimal treatment of orbital tumours and infections.
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http://dx.doi.org/10.1186/s12886-020-01773-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7792050PMC
January 2021

Demographic, radiographic, molecular and clinical characteristics of primary gliosarcoma and differences to glioblastoma.

Clin Neurol Neurosurg 2021 01 1;200:106348. Epub 2020 Nov 1.

Department of Neurosurgery and Spine Surgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany; German Cancer Consortium, Partner Site University Hospital Essen, Essen, Germany.

Objective: Gliosarcoma (GSC) is a rare histological variant of glioblastoma (GBM). Due to limited evidence regarding clinical, genetic and radiographic characteristics of GSC, this study aimed to analyze independent outcome predictors of GSC, and to address the differences between GSC and GBM concerning the baseline characteristics and patients' survival.

Methods: Patients treated between 2001 and 2018 for the diagnosis of GBM and GSC were included in this study. Patients' records were reviewed for demographic, clinical, genetic and radiographic characteristics. Univariate, multivariate and propensity score matched analyses were performed.

Results: In the GSC sub-cohort (N = 56), patients' age, preoperative clinical status, midline tumor location and tumor size were found to be independently associated with overall survival. As compared to GBM individuals (N = 1249), a temporal location (p = 0.002), presence of eccentric tumor cysts (p < 0.001), a higher ratio of TP53 staining (p = 0.002) and a lower ratio of GFAP staining (p = 0.005) were characteristic for GSC. The diagnosis of GSC was associated with a poorer survival (p = 0.002) independently of the patients' age, sex, clinical status and extent of resection, However, this association was no more significant, when enhancing the multivariate analysis with molecular-genetic characteristics (IDH1 mutation and MGMT promotor methylation status).

Discussion: Certain radiographic and molecular-genetic patterns present the distinct characteristics of GSC. There is an association between the diagnosis of GSC and a poorer outcome. This difference might be linked to different genetic alterations in GBM and GSC. Prospective studies are needed to further elucidate the characteristics of GSC and develop targeted treatment approaches for this rare variant.
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http://dx.doi.org/10.1016/j.clineuro.2020.106348DOI Listing
January 2021

Therapy results of pericallosal aneurysms: A retrospective unicenter study.

Clin Pract 2020 Sep 18;10(3):1257. Epub 2020 Sep 18.

Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany.

This retrospective study aims to compare treatment results of ruptured and unruptured pericallosal artery aneurysms (PAAs) regarding patient outcome and aneurysm recurrence after endovascular treatment (EVT) and neurosurgical treatment (NT). A total of 67 patients with PAA were admitted to our hospital, 44 patients with subarachnoidal hemorrhage (SAH) due to a ruptured PAA and 23 patients with unruptured PAA. The radiographic features of PAA were collected from pre-treatment digital subtraction angiography. In addition, demographic, clinical and radiographic parameters of all patients were recorded. Outcome was measured based on the modified Rankin scale (mRS) at 6 months after admission (favorable mRS score, 0-2 unfavorable mRS score, 3-6). Overall 46 patients underwent EVT and 21 patients NT. Six months after discharge 24 patients with SAH had a favorable outcome (mRS 0-2) and 16 patients an unfavorable outcome (mRS 3-6). Mortality rate of patients with SAH was 9.1% (4/44). Overall aneurysm recurrence was treated in 13 % of patients in the EVT cohort (6/46), whereas patients treated with NT had no recurrence. All patients with unruptured PAA had a favorable outcome. EVT and NT of PAA show comparable good results, although aneurysm recurrence occurs more often after EVT.
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http://dx.doi.org/10.4081/cp.2020.1257DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7512184PMC
September 2020

Radiation exposure of computed tomography imaging for the assessment of acute stroke.

Neuroradiology 2021 Apr 8;63(4):511-518. Epub 2020 Sep 8.

Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany.

Purpose: To assess suspected acute stroke, the computed tomography (CT) protocol contains a non-contrast CT (NCCT), a CT angiography (CTA), and a CT perfusion (CTP). Due to assumably high radiation doses of the complete protocol, the aim of this study is to examine radiation exposure and to establish diagnostic reference levels (DRLs).

Methods: In this retrospective study, dose data of 921 patients with initial CT imaging for suspected acute stroke and dose monitoring with a DICOM header-based tracking and monitoring software were analyzed. Between June 2017 and January 2020, 1655 CT scans were included, which were performed on three different modern multi-slice CT scanners, including 921 NCCT, 465 CTA, and 269 CTP scans. Radiation exposure was reported for CT dose index (CTDI) and dose-length product (DLP). DRLs were set at the 75th percentile of dose distribution.

Results: DRLs were assessed for each step (CTDI/DLP): NCCT 33.9 mGy/527.8 mGy cm and CTA 13.7 mGy/478.3 mGy cm. Radiation exposure of CTP was invariable and depended on CT device and its protocol settings with CTDI 124.9-258.2 mGy and DLP 1852.6-3044.3 mGy cm.

Conclusion: Performing complementary CT techniques such as CTA and CTP for the assessment of acute stroke increases total radiation exposure. Hence, the revised DRLs for the complete protocol are required, where our local DRLs may help as benchmarks.
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http://dx.doi.org/10.1007/s00234-020-02548-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7966220PMC
April 2021

Estimation of radiation exposure of children undergoing superselective intra-arterial chemotherapy for retinoblastoma treatment: assessment of local diagnostic reference levels as a function of age, sex, and interventional success.

Neuroradiology 2021 Mar 29;63(3):391-398. Epub 2020 Aug 29.

Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany.

Purpose: This study aims to determine local diagnostic reference levels (LDRLs) of intra-arterial chemotherapy (IAC) procedures of pediatric patients with retinoblastoma (RB) to provide data for establishing diagnostic reference levels (DRLs) in pediatric interventional radiology (IR).

Methods: In a retrospective study design, LDRLs and achievable dose (AD) were assessed for children undergoing superselective IAC for RB treatment. All procedures were performed at the flat-panel angiography systems (I) ArtisQ biplane (Siemens Healthineers) and (II) Allura Xper (Philips Healthcare). Patients were differentiated according to age (A1: 1-3 months; A2: 4-12 months; A3: 13-72 months; A4: 73 months-10 years; A5: > 10 years), sex, conducted or not-conducted chemotherapy.

Results: 248 neurointerventional procedures of 130 pediatric patients (median age 14.5 months, range 5-127 months) with RB (68 unilateral, 62 bilateral) could be included between January 2010 and March 2020. The following diagnostic reference values, AD, and mean values could be determined: (A2) DRL 3.9 Gy cm, AD 2.9 Gy cm, mean 3.5 Gy cm; (A3) DRL 7.0 Gy cm, AD 4.3 Gy cm, mean 6.0 Gy cm; (A4) DRL 14.5 Gy cm, AD 10.7 Gy cm, mean 10.8 Gy cm; (A5) AD 8.8 Gy cm, mean 8.8 Gy cm. Kruskal-Wallis-test confirmed a significant dose difference between the examined age groups (A2-A5) (p < 0.001). There was no statistical difference considering sex (p = 0.076) and conducted or not-conducted chemotherapy (p = 0.627). A successful procedure was achieved in 207/248 cases.

Conclusion: We report on radiation exposure during superselective IAC of a pediatric cohort at the German Retinoblastoma Referral Centre. Although an IAC formally represents a therapeutic procedure, our results confirm that radiation exposure lies within the exposure of a diagnostic interventional procedure. DRLs for superselective IAC are substantially lower compared with DRLs of more complex endovascular interventions.
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http://dx.doi.org/10.1007/s00234-020-02540-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7880957PMC
March 2021

18F-FDG-PET/MRI in the diagnostic work-up of limbic encephalitis.

PLoS One 2020 17;15(1):e0227906. Epub 2020 Jan 17.

Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.

Introduction: Limbic encephalitis (LE) is an immune-related, sometimes paraneoplastic process of the central nervous system. Initial diagnosis and treatment are based on the clinical presentation as well as antibody profiles and MRI. This study investigated the diagnostic value of integrated 18F-FDG-PET/MRI in the diagnostic work-up of patients with LE for a cerebral and whole-body imaging concept.

Material And Methods: Twenty patients with suspected LE were enrolled in this prospective study. All patients underwent a dedicated PET/MRI protocol of the brain as well as the whole-body. Two neuroradiologists, one body radiologist and one nuclear medicine physician performed blinded consensus readings of each corresponding MRI and PET/MRI dataset of the brain and whole-body. Diagnostic confidence was evaluated on a Likert scale.

Results: Based on integrated PET/MRI 19 / 20 patients were found to show morphologic and / or metabolic changes indicative of LE, whereas sole MRI enabled correct identification in 16 / 20 patients. Three patients with negative MRI showed metabolic changes of the limbic system or extra-limbic regions, shifting the diagnosis from (negative) MRI to positive for LE in PET/MRI. Whole-body staging revealed suspected lesions in 2/20 patients, identified by MRI and PET, one confirmed as malignant and one false positive. Diagnostic confidence for cerebral and whole-body imaging reached higher scores for PET/MRI (cerebral: 2.7 and whole body: 4.8) compared to MRI alone (cerebral: 2.4 and whole body: 4.5).

Conclusion: LE diagnosis remains challenging for imaging as it shows only subtle imaging findings in most patients. Nevertheless, based on the simultaneous and combined analysis of morphologic and metabolic data, integrated PET/MRI may enable a dual platform for improved diagnostic confidence and overall detection of LE as well as whole-body imaging for exclusion of paraneoplastic LE.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0227906PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6968877PMC
April 2020

Tumour Treating Fields (TTFields) in combination with lomustine and temozolomide in patients with newly diagnosed glioblastoma.

J Cancer Res Clin Oncol 2020 Mar 11;146(3):787-792. Epub 2019 Dec 11.

Division of Clinical Neurooncology, Department of Neurology, University Hospital Essen, University Duisburg-Essen, Essen, Germany.

Purpose: In the EF-14 trial for newly diagnosed glioblastoma (ndGBM) patients addition of Tumour Treating Fields (TTFields) to temozolomide treatment resulted in a significantly improved overall survival (OS). In the NOA-09/CeTeG trial, combination of lomustine and temozolomide was superior to temozolomide monotherapy in patients with O6-methylguanine DNA methyltransferase (MGMT) promoter methylated (MGMTm) ndGBM. We evaluated combination of these two treatment modalities in patients with MGMTm ndGBM. There have been so far no data on the combination of these two efficient regimens.

Methods: This bicentric retrospective analysis investigated 16 patients. Parameters evaluated included safety outcome as measured by Common Toxicity Criteria for Adverse Events (CTCAE), clinical outcomes, and compliance to treatment.

Results: Hematologic adverse events CTCAE ≥ 3 were observed in seven, hepatotoxic adverse events of CTCAE ≥ 3 in four patients. Mild to moderate skin toxicity was detected in six patients. At data cutoff, patients demonstrated a median progression-free survival (PFS) of 20 months. The usage rate of TTFields showed a high median adherence (83%) to the therapy.

Conclusions: This analysis provides first indication that the combination of TTFields/lomustine/temozolomide is safe and feasible. The observed survival outcomes might suggest potential beneficial effects.
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http://dx.doi.org/10.1007/s00432-019-03106-8DOI Listing
March 2020

A novel V272D presenilin mutation associated with logopenia, disorientation, and apraxia in an autosomal-dominant Alzheimer's disease family.

Neurobiol Aging 2020 01 7;85:154.e5-154.e7. Epub 2019 Aug 7.

Chair of Geriatric Medicine, University Essen, and Geriatric Centre Haus Berge, Contilia Group, Essen, Germany; Department of Neurology, Philipps-University Marburg, Marburg, Germany. Electronic address:

In the present study, a novel mutation in the presenilin 1 gene was discovered in an Iraq-native patient with early-onset Alzheimer's disease, who presented with speech impairment and memory decline at age 46 years. Magnetic resonance imaging showed a frontotemporal atrophy. Sanger sequencing identified a heterozygous T to A transversion at position 815 (c.815T>A) in the presenilin 1 gene (PSEN1), resulting in a novel missense mutation at codon 272 from valine to aspartate (V272D). We tested this PSEN1 mutation in vitro and found V272D resulted in an altered Aβ42/40 ratio.
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http://dx.doi.org/10.1016/j.neurobiolaging.2019.07.002DOI Listing
January 2020

Treatment allocation of ruptured anterior communicating artery aneurysms: The influence of aneurysm morphology.

Clin Neurol Neurosurg 2019 Nov 30;186:105506. Epub 2019 Aug 30.

Department of Neurosurgery, University Hospital, University of Duisburg-Essen, Essen, Germany.

Objectives: Since publication of the ISAT study, the majority of neurovascular centers adhere to "coil first" policy for patients with subarachnoid hemorrhage (SAH). However, final allocation in favor of coiling or clipping is based on anatomic features of ruptured intracranial aneurysms with respect to clinical characteristics of SAH. In this study, we analyzed the parameters relevant for treatment allocation of ruptured anterior communicating artery aneurysms (AComAA).

Patients And Methods: From our institutional SAH database, all cases with ruptured AComAA, which underwent diagnostic subtraction angiography (DSA) with subsequent treatment allocation, were included. The radiographic features of AComAA were collected from pre-treatment DSA. In addition, demographic, clinical and radiographic parameters of SAH were recorded. The variables selected through univariate analyses were subsequently evaluated using multivariate regression analysis.

Results: Of 300 SAH patients in the final analysis, the majority of the cases underwent endovascular coiling (n = 221, 73.7%). The following aneurysm features were associated with treatment modality in the univariate analysis: maximal sack size (p = 0.034), perpendicular height (p = 0.007), aspect ratio (p < 0.001) and sack/neck-ratio (p = 0.001). Accordingly, the following cutoffs for these variables were defined upon the receiver operating characteristics curves: 5 mm for sack size, 6 mm for perpendicular height, 1.6 for aspect ratio and sack/neck-ratio. In the multivariate analysis, aspect ratio of 1.6 was the only independent predictor of treatment allocation (p = 0.005; aOR = 2.57; 95% CI 1.33-4.96), which remained significant (p = 0.003; aOR = 2.77; 95% CI 1.41-5.45) after adjusting for patients' age, WFNS & Fisher grades, as well as intracerebral hematoma volume.

Conclusion: Although not-routinely assessed during initial allocation treatment, our retrospective analysis proved that aspect ratio is a reliable predictor of treatment allocation of ruptured AComAA. Except for large space-occupying ICH commonly obligating the microsurgical treatment, other clinical and radiographic characteristics of SAH do not seem to be of clinical relevance for the selection of treatment modality.
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http://dx.doi.org/10.1016/j.clineuro.2019.105506DOI Listing
November 2019

Outcomes After Onyx Embolization as Primary Treatment for Cranial Dural Arteriovenous Fistula in the Past Decade.

Acad Radiol 2020 06 21;27(6):e123-e131. Epub 2019 Aug 21.

Institute for diagnostic and interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany; Center for Neuroradiology, Clinic Hirslanden, Zurich, Switzerland.

Rationale And Objectives: This retrospective single-center study aims to evaluate endovascular therapy (EVT) of cranial dural arteriovenous fistulas (dAVF) with ethylene vinyl alcohol (EVOH) copolymer (Onyx) regarding occlusion rates, complications, and recurrences.

Material And Methods: From January 2008 to April 2018, 75 patients with dAVF (41 men, 34 women; mean age 56 years) underwent EVT with the nonadhesive liquid embolic agent as primary treatment. Patient records and angiograms were reviewed for demographic data, symptoms, fistula type and size, number of EVTs, amount of embolic material, occlusion rates, and recurrences.

Results: Seventy-five patients with dAVFs were primarily embolized with EVOH in 96 EVTs. According to the Merland-Cognard classification the majority of dAVFs treated were type 4 (42.7%), followed by type 2a (18.7%), type 2a+b (17.3%), type 1 (8%), type 2b (5.3%), type 3 (5.3%), and type 5 (2.7%). Complete occlusion (CO) of the dAVF was achieved in 45/75 (60%) of cases after a single EVT and in 58 (77%) patients after one or several EVTs. Seven patients (9%) required additional surgical therapy for CO. Successful treatment was achieved for 70/75 (93%) patients including 10 (13%) patients with residual dAVFs type 1-2a. Recurrence after CO occurred in one (1.3%) patient and four (5.3%) patients remained refractory to therapy with dAVFs type > 2a. Procedure-related permanent morbidity occurred in 4/75 (5.3%) patients.

Conclusion: For more than a decade transarterial EVOH embolization has established as the first-line treatment for cranial dAVFs with high cure rates and low rates of complications and recurrences. Additional neurosurgical therapy is rarely required for curative treatment.
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http://dx.doi.org/10.1016/j.acra.2019.07.021DOI Listing
June 2020

Comparison of L-Methyl-11C-Methionine PET With Magnetic Resonance Spectroscopy in Detecting Newly Diagnosed Glioma.

Clin Nucl Med 2019 Jun;44(6):e375-e381

Nuclear Medicine Unit, Department of Imaging and Clinical Pathology, Rovigo, Italy.

Aims: Amino acid PET and magnetic resonance spectroscopy (MRS) are at the forefront of noninvasive imaging techniques used for detection and subtyping of glioma-suspicious lesions. In this pilot study, we compare L-methyl-C-methionine PET and MRS for their ability to predict glioma subtypes.

Methods: Nineteen patients with histologically, confirmed newly diagnosed glioma underwent preoperative L-methyl-C-methionine PET and MRS in 1 diagnostic session. According to the molecular portfolio and histopathologic diagnosis, patients were subdivided in isocitrate dehydrogenase (IDH) wild-type glioblastoma, IDH wild-type grade II/III glioma, IDH-mutant grade II/III glioma without 1p/19q codeletion, and with 1p/19q codeletion subgroups. Maximum tumor-to-brain ratio (TBRmax), creatine, choline, and N-acetyl aspartate peaks were correlated with postoperative histopathologic tumor diagnoses.

Results: Maximum tumor-to-brain ratio was highest in glioblastoma patients (4.18) followed by patients with IDH wild-type grade II and III glioma (3.41). The latter TBRmax values were higher compared with those in patients with IDH-mutant grade II/III glioma without 1p/19q codeletion (1.95) and in patients with IDH-mutant 1p/19q codeleted grade II and III glioma (2.79). Magnetic resonance spectroscopy marker distribution showed no clear trend. Receiver operating characteristic analysis revealed TBRmax to be the best performing parameter in identifying IDH status (area under the curve, 0.67) and all spectroscopy markers combined in identifying glioma subgroups (area under the curve, 0.68), respectively.

Conclusions: L-Methyl-C-methionine PET and MRS bear limited potential in glioma subgrouping. L-Methyl-C-methionine PET appears to be superior in differentiating IDH status, whereas MRS is more helpful in glioma subgrouping.
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http://dx.doi.org/10.1097/RLU.0000000000002577DOI Listing
June 2019

F-FDG PET/MRI vs MRI in patients with recurrent adenoid cystic carcinoma.

Head Neck 2019 01 13;41(1):170-176. Epub 2018 Dec 13.

Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.

Objectives: To evaluate and compare the diagnostic potential of F-fluorodeoxyglucose positron emission tomography/magnetic resonance imaging ( FDG-PET/MRI) and MRI for recurrence diagnostics after primary therapy in patients with adenoid cystic carcinoma (ACC).

Methods: A total of 32 dedicated head and neck F-FDG PET/MRI datasets were included in this analysis. MRI and F-FDG PET/MRI datasets were analyzed in separate sessions by two readers for tumor recurrence or metastases.

Results: Lesion-based sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy were 96%, 84%, 90%, 93%, and 91% for F-FDG PET/MRI and 77%, 94%, 95%, 73%, and 84% for MRI, resulting in a significantly higher diagnostic accuracy of F-FDG PET/MRI compared to MRI (P < .005).

Conclusion: F-FDG PET/MRI is superior to MRI in detecting local recurrence and metastases in patients with ACC of the head and neck. Especially concerning its negative predictive value, F-FDG PET/MRI outperforms MRI.
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http://dx.doi.org/10.1002/hed.25485DOI Listing
January 2019

Post-treatment Antiplatelet Therapy Reduces Risk for Delayed Cerebral Ischemia due to Aneurysmal Subarachnoid Hemorrhage.

Neurosurgery 2019 12;85(6):827-833

Department of Neurosurgery, University Hospital, University of Duisburg-Essen, Essen, Germany.

Background: Delayed cerebral ischemia (DCI) has a strong impact on outcome of patients with aneurysmal subarachnoid hemorrhage (SAH). Positive effect of antiplatelet therapy on DCI rates has been supposed upon smaller SAH series.

Objective: To analyze the benefit/risk profile of antiplatelet use in SAH patients.

Methods: This retrospective case-control study was based on institutional observational cohort with 994 SAH patients treated between January 2003 and June 2016. The individuals with postcoiling antiplatelet therapy (aspirin with/without clopidogrel) were compared to a control group without antiplatelet therapy. Occurrence of DCI, major/minor bleeding events in the follow-up computed tomography scans, and favorable outcome at 6 mo after SAH (modified Rankin scale < 3) were compared in both groups.

Results: Of 580 patients in the final analysis, 329 patients received post-treatment antiplatelet medication. There were no significant differences between the compared groups with regard to basic outcome confounders. Aspirin use was independently associated with reduced DCI risk (P < .001, adjusted odds ratio = 0.41, 95% confidence interval 0.24-0.65) and favorable outcome (P = .02, adjusted odds ratio = 1.78, 95% confidence interval 1.06-2.98). Regarding bleeding complications, aspirin was associated only with minor bleeding events (P = .02 vs P = .51 for major bleeding events).

Conclusion: Regular administration of aspirin might have a positive impact on DCI risk and outcome of SAH patients, without increasing the risk for clinically relevant bleeding events. In our SAH cohort, dual antiplatelet therapy showed no additional benefit on DCI risk, but increased the likelihood of major bleeding events.
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http://dx.doi.org/10.1093/neuros/nyy550DOI Listing
December 2019

Hybrid 11C-MET PET/MRI Combined With "Machine Learning" in Glioma Diagnosis According to the Revised Glioma WHO Classification 2016.

Clin Nucl Med 2019 Mar;44(3):214-220

Department of Nuclear Medicine, Radiology, NeuroRadiology, Clinical Pathology, S. Maria della Misericordia Hospital, Rovigo, Italy.

Purpose: With the advent of the revised WHO classification from 2016, molecular features, including isocitrate dehydrogenase (IDH) mutation have become important in glioma subtyping. This pilot trial analyzed the potential for C-methionine (MET) PET/MRI in classifying glioma according to the revised WHO classification using a machine learning model.

Methods: Patients with newly diagnosed WHO grade II-IV glioma underwent preoperative MET-PET/MRI imaging. Patients were retrospectively divided into four groups: IDH wild-type glioblastoma (GBM), IDH wild-type grade II/III glioma (GII/III-IDHwt), IDH mutant grade II/III glioma with codeletion of 1p19q (GII/III-IDHmut1p19qcod) or without 1p19q-codeletion (GII/III-IDHmut1p19qnc). Within each group, the maximum tumor-to-brain-ratio (TBRmax) of MET-uptake was calculated. To gain generalizable implications from our data, we made use of a machine learning algorithm based on a development and validation subcohort. A support vector machine model was fit to the development subcohort and evaluated on the validation subcohort. Receiver operating characteristic (ROC) analysis served as metric to assess model performance.

Results: Of a total of 259 patients, 39 patients met the inclusion criteria. TBRmax was highest in the GBM cohort (TBRmax 3.83 ± 1.30) and significantly higher (P = 0.004) compared to GII/III-IDHmut1p19qnc group, where TBRmax was lowest (TBRmax 2.05 ± 0.94). ROC analysis showed poor AUC for glioma subtyping (AUC 0.62) and high AUC of 0.79 for predicting IDH status. In the GII/III-IDHmut1p19qcod group, TBR values were slightly higher than in the IDHmut1p19qnc group.

Conclusions: MET-PET/MRI imaging in pre-operatively classifying glioma entities appears useful for the assessment of IDH status. However, a larger trial is needed prior to translation into the clinical routine.
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http://dx.doi.org/10.1097/RLU.0000000000002398DOI Listing
March 2019

Nigrosome 1 visibility at susceptibility weighted 7T MRI-A dependable diagnostic marker for Parkinson's disease or merely an inconsistent, age-dependent imaging finding?

PLoS One 2017 10;12(10):e0185489. Epub 2017 Oct 10.

Department of Neuroradiology, University Hospital Giessen, Giessen, Germany.

Background: Visualisation of nigrosome 1, a substructure of the healthy substantia nigra, was restricted in susceptibility weighted MR imaging in almost all patients with Parkinson's disease studied so far. The purpose of this study was to determine the degree of visibility of this substructure in subjects without Parkinson's disease and to examine the potential link between increasing brain iron accumulation with age and its detectability.

Methods: In 46 subjects (21 women, 25 men; 19 to 75 y; mean age: 44.5; SD: 15.6) examined with susceptibility weighted MR imaging at 7T visibility of nigrosome 1 was rated and classified. We assessed differences related to age and to signal intensities in the substantia nigra, red nucleus and putamen as correlates of the individual iron concentration.

Results: In 93% nigrosome 1was at least unilaterally clearly present. In 24% at least one-sided limited visibility was observed. Using predefined classification criteria the specificity of the visibility across all age groups reached approximately 94%. We found no correlation with increasing iron concentrations with age.

Conclusion: Aging with a related increase in iron concentration probably does not affect the visibility of nigrosome 1 at 7T SWI MRI. Our results support the role of this feature as a future differential diagnostic tool but further large-scale prospective studies are needed to better define the extent of a "limited visibility" to which an individual can be considered healthy.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0185489PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5634553PMC
October 2017

18 F-FDG PET/MR imaging in patients with suspected liver lesions: Value of liver-specific contrast agent Gadobenate dimeglumine.

PLoS One 2017 6;12(7):e0180349. Epub 2017 Jul 6.

Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Duisburg-Essen, Germany.

Objectives: To evaluate the added value of the application of the liver-specific contrast phase of Gadobenate dimeglumine (Gd-BOPTA) for detection and characterization of liver lesions in 18F-FDG PET/MRI.

Methods: 41 patients with histologically confirmed solid tumors and known / suspected liver metastases or not classifiable lesions in 18F-FDG PET/CT were included in this study. All patients underwent a subsequent Gd-BOPTA enhanced 18F-FDG PET/MRI examination. MRI without liver-specific contrast phase (MRI1), MRI with liver-specific contrast phase (MRI2), 18F-FDG PET/MRI without liver-specific contrast phase (PET/MRI1) and with liver-specific contrast phase (PET/MRI2) were separately evaluated for suspect lesions regarding lesion dignity, characterization, conspicuity and confidence.

Results: PET/MRI datasets enabled correct identification of 18/18 patients with malignant lesions; MRI datasets correctly identified 17/18 patients. On a lesion-based analysis PET/MRI2 provided highest accuracy for differentiation of lesions into malignant and benign lesions of 98% and 100%. Respective values were 95% and 100% for PET/MRI1, 93% and 96% for MRI2 and 91% and 93% for MRI1. Statistically significant higher diagnostic confidence was found for PET/MRI2 and MRI2 datasets compared to PET/MRI1 and MRI1, respectively (p < 0.001).

Conclusion: The application of the liver-specific contrast phase in 18F-FDG PET/MRI further increases the diagnostic accuracy and diagnostic confidence for correct assessment of benign and malignant liver lesions.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0180349PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5500282PMC
September 2017

Imaging children suffering from lymphoma: an evaluation of different F-FDG PET/MRI protocols compared to whole-body DW-MRI.

Eur J Nucl Med Mol Imaging 2017 Sep 22;44(10):1742-1750. Epub 2017 May 22.

Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, D-45147, Essen, Germany.

Objectives: The objectives of this study were to evaluate and compare the diagnostic potential of different PET/MRI reading protocols, entailing non-enhanced / contrast-enhanced and diffusion-weighted F-FDG PET/MR imaging and whole-body diffusion-weighted MRI for lesion detection and determination of the tumor stage in pediatric lymphoma patients.

Methods: A total of 28 F-FDG PET/MRI datasets were included for analysis of four different reading protocols: (1) PET/MRI utilizing sole unenhanced T2w and T1w imaging, (2) PET/MRI utilizing additional contrast enhanced sequences, (3) PET/MR imaging utilizing unenhanced, contrast enhanced and DW imaging or (4) WB-DW-MRI. Statistical analyses were performed on a per-patient and a per-lesion basis. Follow-up and prior examinations as well as histopathology served as reference standards.

Results: PET/MRI correctly identified all 17 examinations with active lymphoma disease, while WB-DW-MRI correctly identified 15/17 examinations. Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy were 96%, 96.5%, 97%, 95%, and 96% for PET/MRI; 97%, 96.5%, 97%, 96.5%, and 97% for PET/MRI; 97%, 96.5%, 97%, 96.5%, and 97% for PET/MRI and 77%, 96%, 96%, 78.5% and 86% for MRI-DWI.

Conclusion: F-FDG PET/MRI is superior to WB-DW-MRI in staging pediatric lymphoma patients. Neither application of contrast media nor DWI leads to a noticeable improvement of the diagnostic accuracy of PET/MRI. Thus, unenhanced PET/MRI may play a crucial role for the diagnostic work-up of pediatric lymphoma patients in the future.
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http://dx.doi.org/10.1007/s00259-017-3726-0DOI Listing
September 2017

Evaluation of Ga-DOTATOC PET/MRI for whole-body staging of neuroendocrine tumours in comparison with Ga-DOTATOC PET/CT.

Eur Radiol 2017 Oct 24;27(10):4091-4099. Epub 2017 Apr 24.

Department of Diagnostic and Interventional Radiology and Neuroradiology, Medical Faculty, University Duisburg-Essen, 45122, Essen, Germany.

Objectives: To compare the diagnostic performance of Ga-DOTATOC PET/MRI and Ga-DOTATOC PET/CT in the whole-body staging of patients with neuroendocrine tumours (NET).

Methods: Thirty patients with histopathologically confirmed NET underwent PET/CT and PET/MRI in a single-injection protocol. PET/CT and PET/MRI scans were prospectively evaluated with regard to lesion count, localization, nature (NET/non-NET), and conspicuity (four-point scale). Histopathology and follow-up imaging served as the reference standards. The proportions of NET and non-NET lesions rated correctly were compared using McNemar's chi-squared test. The Wilcoxon test was used to assess differences in SUVmax and lesion conspicuity. The correlation between the SUVmax for the same lesions from each modality was analysed using Pearson's correlation coefficient (r).

Results: According to the reference standard, there were 197 lesions (142 NET, 55 non-NET). Lesion-based analysis showed a higher proportion of correctly rated NET lesions on PET/MRI than on PET/CT (90.8% vs. 86.7%, p = 0.031), whereas on PET/CT there was a higher proportion of correctly rated non-NET lesions (94.5% vs. 83.6%, p = 0.031). SUVmax was strongly correlated (r = 0.86; p < 0.001) and did not differ significantly (p = 0.35) between the modalities. Overall conspicuity and NET lesion conspicuity were higher on PET/MRI (both p < 0.01).

Conclusions: Ga-DOTATOC PET/MRI yielded a higher proportion of correctly rated NET lesions and should be regarded as a valuable alternative to Ga-DOTATOC PET/CT in whole-body staging of NET patients.

Key Points: • Ga-DOTATOC PET/MRI correctly identified more NET lesions than Ga-DOTATOC PET/CT. • Ga-DOTATOC PET/MRI provides better NET lesion conspicuity than Ga-DOTATOC PET/CT. • SUVmax values from the two modalities are strongly correlated and do not differ significantly.
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http://dx.doi.org/10.1007/s00330-017-4803-2DOI Listing
October 2017

Response assessment of bevacizumab therapy in GBM with integrated 11C-MET-PET/MRI: a feasibility study.

Eur J Nucl Med Mol Imaging 2017 Aug 3;44(8):1285-1295. Epub 2017 Mar 3.

Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstrasse 55, D-45122, Essen, Germany.

Background: The objective of this study was to evaluate the potential of integrated 11C-MET PET/MR for response assessment of relapsed glioblastoma (GBM) receiving bevacizumab treatment.

Methods: Eleven consecutive patients with relapsed GBM were enrolled for an integrated 11C-MET PET/MRI at baseline and at follow-up. Treatment response for MRI was evaluated according to Response Assessment in Neuro-oncology (RANO) criteria and integrated 11C-MET PET was assessed by the T/N ratio.

Results: MRI showed no patient with complete response (CR), six of 11 patients with PR, four of 11 patients with SD, and one of 11 patients with progressive disease (PD). PET revealed metabolic response in five of the six patients with partial response (PR) and in two of the four patients with stable disease (SD), whereas metabolic non-response was detected in one of the six patients with PR, in two of the four patients with SD, and in the one patient with PD. Morphological imaging was predictive for PFS and OS when response was defined as CR, PR, SD, and non-response as PD. Metabolic imaging was predictive when using T/N ratio reduction of >25 as discriminator. Based on the morphologic and metabolic findings of this study a proposal for applying integrated PET/MRI for treatment response in relapsed GBM was developed, which was significantly predictive for PFS and OS (P = 0.010 respectively 0,029, log).

Conclusions: This study demonstrates the potential of integrated 11C-MET-PET/MRI for response assessment of GBM and the utility of combined assessment of morphologic and metabolic information with the proposal for assessing relapsed GBM.
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http://dx.doi.org/10.1007/s00259-017-3661-0DOI Listing
August 2017

Computed Tomography- and Magnetic Resonance Image-based Analysis of the Anatomical Variations of the Sylvian Fissure and Characteristics of the Middle Cerebral Artery.

Clin Pract 2017 Jan 3;7(1):890. Epub 2017 Feb 3.

Department of Neurosurgery, University Hospital Essen , Germany.

The aim of this cross sectional anatomical study is to determine the distribution of the defined anatomical variations of the Sylvian fissure (SF) in a normal population and to analyze its bilateral superposable presentation. Furthermore, we examined the course of the middle cerebral artery (MCA) and the division of the MCA branches in relation to the SF types. A total of 300 cranial CT scans - 100 CT angiography datasets and 86 MRIs of patients without intracranial pathologies - were reviewed. The SF was categorized in five types based on Yasargils description and our previous publication. The length, diameter and branches of the MCA were measured and compared to the SF types. SPSS 23.0 for Windows® was used for statistical analysis. We analyzed data of 300 patients (171 male, 129 female; mean age 51.6years). Symmetric and mirror-imaged coherence of the SF was found in 266 patients (88.7%, χ(8)=3.04, p=0.932). The distribution of the SF types showed significant differences in patients younger than 60 years compared to older patients. A bifurcation was observed in 72.0%. A trifurcation was observed in 12.0% and a in 16.0% of patients. There was no significant difference of the measured diameters or length of the M1 segments according to the SF types. In this CT and MRI based anatomical study we could show that a twisted and narrow SF occurred more frequently in patients younger than 60 years of age. The SF has a high congruence intra-individually. The anatomical condition might influence the size and configuration of the proximal MCA, which in turn might influence the surgeon's choice of the approach to the SF. Preoperative evaluation on the basis of the presented data, may help to decide for an appropriate approach to the SF.
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http://dx.doi.org/10.4081/cp.2017.890DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5304263PMC
January 2017

Whole-body staging of female patients with recurrent pelvic malignancies: Ultra-fast 18F-FDG PET/MRI compared to 18F-FDG PET/CT and CT.

PLoS One 2017 22;12(2):e0172553. Epub 2017 Feb 22.

Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.

Objectives: To evaluate the diagnostic feasibility of an ultra-fast 18F-FDG PET/MRI protocol, including T2-w and contrast-enhanced T1-w imaging as well as metabolic assessment (PET) in comparison to 18F-FDG PET/CT and CT for whole-body staging of female patients with suspected recurrence of pelvic malignancies.

Methods: 43 female patients with suspected tumor recurrence were included in this study. Suspicion was based on clinical follow-up and abnormal findings on imaging follow-up. All patients underwent a PET/CT and a subsequent PET/MRI examination. Two readers were asked to evaluate ultra-fast PET/MRI, PET/CT as well as CT datasets of PET/CT separately for suspect lesions regarding lesion count, lesion localization and lesion characterization. Statistical analyses were performed both, on a per-patient and a per-lesion basis.

Results: Tumor relapse was present in 38 of the 43 patients. Based on CT readings 25/38 tumor relapses were correctly identified. PET/CT enabled correct identification of 37/38 patients, PET/MRI correctly identified 36 of the 38 patients with recurrent cancer. On a lesion-based analysis PET/MRI enabled the correct detection of more lesions, comprising a lesion-based sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of 50%, 58%, 76%, 31%, and 53% for CT, 97%, 83%, 93%, 94%, and 92% for PET/CT and 98%, 83%, 94%, 94%, and 94% for PET/MRI, respectively. Mean scan duration of ultra-fast PET/MRI, PET/CT and whole-body CT amounted to 18.5 ± 1 minutes, 18.2 ± 1 minutes and 3.5 minutes, respectively.

Conclusion: Ultra-fast PET/MRI provides equivalent diagnostic performance and examination time when compared to PET/CT and superior diagnostic performance to CT in restaging female patients suspected to have recurrent pelvic cancer.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0172553PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5321458PMC
August 2017
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