Publications by authors named "Günther Schneider"

57 Publications

Effects of selective heart rate reduction with ivabradine on LV function and central hemodynamics in patients with chronic coronary syndrome.

Int J Cardiol Heart Vasc 2021 Jun 23;34:100757. Epub 2021 Mar 23.

Department of Internal Medicine III, Saarland University Medical Center, Saarland University, Homburg/Saar, Germany.

Objectives: We assessed left ventricular (LV) function and central hemodynamic effects in patients with a heart rate (HR) at rest of ≥70 beats per minute (bpm) and chronic coronary syndrome (CCS) after long-term treatment with ivabradine compared to placebo by cardiac magnetic resonance (CMR) imaging.

Methods And Results: In a randomized, double-blinded, prospective cross-over design, 23 patients (18 male, 5 female) were treated with ivabradine (7.5 mg bid) or placebo for 6 months. CMR imaging was performed at baseline and after 6 and 12 months to determine LV functional parameters.Mean resting HR on treatment with ivabradine was 58 ± 8.2 bpm and 70.2 ± 8.3 bpm during placebo (p < 0.0001).There was no difference in systolic LV ejection fraction (ivabradine 57.4 ± 11.2% vs placebo 53.0 ± 10.9%, p = 0.18), indexed end-diastolic (EDVi) or end-systolic volumes (ESVi). Indexed stroke volume (SVi) (ml/m) remained unchanged after treatment with ivabradine. Volume time curve parameters reflecting systolic LV function (peak ejection rate and time) were unaffected by ivabradine, while both peak filling rate (PFR) and PFR/EDV were significantly increased. Mean aortic velocity (cm/s) was significantly reduced during treatment with ivabradine (ivabradine 6.7 ± 2.7 vs placebo 9.0 ± 3.4, p = 0.01). Aortic flow parameters were correlated to parameters of vascular stiffness. The strongest correlation was revealed for mean aortic velocity with aortic distensibility (AD) (r = -0.86 [-0.90 to -0.85], p < 0.0001).

Conclusion: Long-term reduction of HR with ivabradine in patients with CCS improved diastolic function and reduced mean aortic flow velocity.
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http://dx.doi.org/10.1016/j.ijcha.2021.100757DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8024658PMC
June 2021

Correction to: Diffusion-weighted MRI improves response assessment after definitive radiotherapy in patients with NSCLC.

Cancer Imaging 2021 Feb 9;21(1):21. Epub 2021 Feb 9.

Clinic for Diagnostic and Interventional Radiology, Saarland University Medical Center, Kirrberger Str. 1, 66421, Homburg, Saar, Germany.

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http://dx.doi.org/10.1186/s40644-021-00386-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7871380PMC
February 2021

Diffusion-weighted MRI improves response assessment after definitive radiotherapy in patients with NSCLC.

Cancer Imaging 2021 Jan 21;21(1):15. Epub 2021 Jan 21.

Clinic for Diagnostic and Interventional Radiology, Saarland University Medical Center, Kirrberger Str. 1, 66421, Homburg, Saar, Germany.

Background: Computed tomography (CT) is the standard procedure for follow-up of non-small-cell lung cancer (NSCLC) after radiochemotherapy. CT has difficulties differentiating between tumor, atelectasis and radiation induced lung toxicity (RILT). Diffusion-weighted imaging (DWI) may enable a more accurate detection of vital tumor tissue. The aim of this study was to determine the diagnostic value of MRI versus CT in the follow-up of NSCLC.

Methods: Twelve patients with NSCLC stages I-III scheduled for radiochemotherapy were enrolled in this prospective study. CT with i.v. contrast agent and non enhanced MRI were performed before and 3, 6 and 12 months after treatment. Standardized ROIs were used to determine the apparent diffusion weighted coefficient (ADC) within the tumor. Tumor size was assessed by the longest longitudinal diameter (LD) and tumor volume on DWI and CT. RILT was assessed on a 4-point-score in breath-triggered T2-TSE and CT.

Results: There was no significant difference regarding LD and tumor volume between MRI and CT (p ≥ 0.6221, respectively p ≥ 0.25). Evaluation of RILT showed a very high correlation between MRI and CT at 3 (r = 0.8750) and 12 months (r = 0.903). Assessment of the ADC values suggested that patients with a good tumor response have higher ADC values than non-responders.

Conclusions: DWI is equivalent to CT for tumor volume determination in patients with NSCLC during follow up. The extent of RILT can be reliably determined by MRI. DWI could become a beneficial method to assess tumor response more accurately. ADC values may be useful as a prognostic marker.
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http://dx.doi.org/10.1186/s40644-021-00384-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7818746PMC
January 2021

Gouty tophus in the quadriceps tendon: exclude malignancy.

Lancet 2019 12;394(10215):2197

Department of Orthopaedic Surgery, Saarland University Medical Center, Kirrberger Straße, Homburg, Germany.

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http://dx.doi.org/10.1016/S0140-6736(19)32950-2DOI Listing
December 2019

Evaluation of Gadopiclenol and P846, 2 High-Relaxivity Macrocyclic Magnetic Resonance Contrast Agents Without Protein Binding, in a Rodent Model of Hepatic Metastases: Potential Solutions for Improved Enhancement at Ultrahigh Field Strength.

Invest Radiol 2019 09;54(9):549-558

From the Clinic for Diagnostic and Interventional Radiology, Saarland University Medical Center, Homburg, Germany.

Purpose: The aim of this study was to evaluate in vitro and in vivo the enhancement properties of experimental gadolinium (Gd)-based contrast agents (GBCAs) with different molecular weights and hydration numbers (P846 and gadopiclenol) compared with clinically approved low-molecular, extracellular agents (gadopentetate and gadoterate) at 9.4 T and to discuss influencing factors on r1 relaxivities.

Methods And Materials: All experiments were performed with a 9.4 T animal scanner (Bruker, Germany). We performed relaxometry measurements for all contrast agents in human plasma at 37°C using an IR-RARE sequence. In addition, we compared P846 with gadopentetate and gadopiclenol with gadoterate intraindividually in rats with hepatic colorectal cancer metastases (n = 10 each) acquiring T1-weighted FLASH sequences before and at 10 consecutive time points during 20 minutes. After intravenous contrast agent application, signal-to-noise ratios (SNRs), contrast-to-noise ratios (CNRs), and lesion enhancement (LE) for liver parenchyma and tumors were calculated based on region of interest measurements.

Results: Longitudinal relaxivities (r1) of the low-molecular agents were lower as compared with the experimental compounds. However, r1 of gadopentetate and gadoterate demonstrated only a moderate decrease of r1 at 9.4 T as compared with known data at lower field strengths (gadopentetate: r1 [at 9.4 T], 3.4 mM s/r1 [at 1.5 T], 4.1 mM s/gadoterate: r1 [at 9.4 T], 3.1 mM s/r1 [at 1.5 T], 3.6 mM s). In contrast, r1 of P846 showed a marked reduction at 9.4 T compared with 1.5 T (P846: r1 [at 9.4 T], 6.4 mM s/r1 [at 1.5 T], 32 mM s). Gadopiclenol provided the highest r1 in this study at 9.4 T and the drop of r1 as compared with lower field strength is less apparent (gadopiclenol: r1 [at 9.4 T], 8.7 mM s/r1 [at 1.5 T], 12.7 mM s).In vivo, P846 and gadopiclenol showed significantly higher SNR, CNR, and LE as compared with the low-molecular control agents (mean ± SD; SNRliver [gadopentetate, 18.1 ± 1.2; P846, 27.2 ± 1.5; P < 0.001]; SNRtumor [gadopentetate, 22.6 ± 1.9; P846, 40.1 ± 1.9; P < 0.001]; CNR [gadopentetate, 4.6 ± 1.0; P846, 12.9 ± 0.9; P < 0.001]; LE [gadopentetate, 7.2 ± 1.9; P846, 14.9 ± 1.9; P < 0.001]/SNRliver [gadoterate, 8.8 ± 0.5; gadopiclenol, 12.6 ± 1.3; P < 0.001]; SNRtumor [gadoterate, 11.3 ± 1.2; gadopiclenol, 20.9 ± 2.9; P < 0.001]; CNR [gadoterate, 2.5 ± 0.7; gadopiclenol, 8.3 ± 1.7; P < 0.001]; LE [gadoterate, 4.4 ± 1.2; gadopiclenol, 13.0 ± 2.9; P < 0.001]). Thus, for equal Gd doses, gadopiclenol and P846 increase the CNR of liver metastases by a factor of 2.5 to 3 at 9.4 T compared with gadoterate and gadopentetate.

Conclusions: P846 and gadopiclenol provide superior enhancement at 9.4 T as compared with gadopentetate and gadoterate. However, the macromolecular agent P846 shows a marked decrease of r1 from 1.5 T to 9.4 T. This effect is less apparent for the low-molecular agents gadopiclenol, gadopentetate, and gadoterate. Yet, based on the higher hydration number, r1 of P846 and gadopiclenol are markedly higher as compared with the reference contrast agents. Thus, building compounds with moderately increased molecular size and hydration number, as implemented in gadopiclenol, seems to be a promising way to develop highly effective GBCAs.Advantages for gadopiclenol include a strong enhancement regardless of the external magnetic field strength, pharmacokinetics comparable to those of clinically approved extracellular GBCAs, and the potential to either improve sensitivity in diagnostic magnetic resonance imaging by improving lesion conspicuity or to perform studies with significantly reduced Gd-dose while at the same time providing comparable diagnostic accuracy. However, all this needs to be proven in clinical studies.
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http://dx.doi.org/10.1097/RLI.0000000000000572DOI Listing
September 2019

Percutaneous endovascular tissue sampling of endoluminal tumors using directional atherectomy.

Eur Radiol 2019 Sep 22;29(9):5007-5012. Epub 2019 Feb 22.

Clinic for Diagnostic and Interventional Radiology, Saarland University Medical Center, Kirrberger Straße, Gebäude 50.1, 66421, Homburg, Germany.

Objectives: To evaluate technical feasibility and safety of endovascular tumor specimen sampling using an escalating endovascular biopsy strategy using a directional atherectomy device compared with forceps biopsy and catheter aspiration.

Materials And Methods: Between 2013 and 2017, a cohort of ten consecutive patients (6 male; median age 56, range 39-73 years) was referred for sampling of endovascular masses. Localizations included the abdominal aorta (n = 4), left brachiocephalic vein (n = 2), inferior vena cava (n = 1), and left pulmonary artery (n = 3). For each individual mass, all three endovascular tissue sampling approaches were applied including catheter-based aspiration, straight two-jaw biopsy forceps, and directional atherectomy during a single session.

Results: Aspiration and forceps biopsy did not provide sufficient material for histological analyses. In contrast, technical success for endovascular tumor sampling using directional atherectomy was 100%. After two atherectomy passages, sufficient material was available for each vessel region allowing histologic diagnosis, which revealed sarcoma and chronic inflammation for masses in the aorta, angiosarcoma for brachiocephalic vein, hepatocellular carcinoma for inferior vena cava, and angiosarcoma for pulmonary artery. In case of a histologically benign diagnosis, no malignant tumor proliferation was obvious on follow-up imaging studies after 3 months and 1 year. Thus, the rate of false-negative results was considered 0%. No procedure-associated complications, e.g., vessel perforation, were recorded.

Conclusion: Preliminary results in a limited number of patients proved directional atherectomy beneficial as a safe and feasible technique for endoluminal tissue sampling of vascular masses. Additional large-scale studies are necessary and worthy for further evaluation in clinical practice.

Key Points: • Endovascular masses pose a challenge to appropriate clinical management. • Off-label directional atherectomy proved to be a safe and feasible technique for endoluminal tissue sampling of vascular masses. Furthermore, directional atherectomy was superior to aspiration or forceps biopsy in our small study cohort. • Directional atherectomy may represent the last or only option for tissue probing as a prerequisite for further treatment decisions.
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http://dx.doi.org/10.1007/s00330-019-06015-zDOI Listing
September 2019

Effects of heart rate reduction with ivabradine on vascular stiffness and endothelial function in chronic stable coronary artery disease.

J Hypertens 2019 05;37(5):1023-1031

Department of Internal Medicine III, Saarland University Hospital, University of the Saarland, Kirrbergerstraße, Homburg/Saar.

Introduction: Epidemiological and clinical studies have shown a relevant association between heart rate and cardiovascular mortality. Experimental studies identified vascular effects of heart rate reduction with the If channel inhibitor ivabradine. Therefore, the effects of heart rate reduction on endothelial function and indices of arterial stiffness were examined in patients with stable coronary artery disease in a prospective, placebo-controlled clinical crossover study.

Methods And Results: Twenty-three patients (18 men and 5 women) with a resting heart rate (HR) of at least 70 beats per minute (bpm) and stable coronary artery disease were enrolled in this study. In a cross-over design, all patients were treated with ivabradine (Iva, 7.5 mg b.i.d.) and placebo for 6 months each. Iva reduced heart rate by 11.4 bpm (Iva 58.8 ± 8.2 bpm vs. placebo 70.2 ± 8.3 bpm, P < 0.0001). Augmentation index (AIx75), carotid-femoral pulse wave velocity (cfPWV) and central aortic blood pressure were measured using applanation tonometry (SphygmoCor). HRR by Iva increased AIx75 by 12.4% (Iva 24.3 ± 10.5% vs. placebo 21.3 ± 10.1%, P < 0.05) and reduced cfPWV by 14.1% (Iva 6.3 ± 1.7 m/s vs. placebo 7.3 ± 1.4 m/s, P < 0.01). Iva increased mean central blood pressure by 7.8% (Iva 107.5 ± 15.4 mmHg vs. placebo 99.1 ± 12.2 mmHg, P < 0.001). Endothelial function was determined measuring the flow-mediated vasodilation (FMD) of the brachial artery. HRR by Iva increased FMD by 18.5% (Iva 7.3 ± 2.2% vs. placebo 6.0 ± 2.0%, P < 0.001). Aortic distensibility was characterized by MRI. HRR by Iva increased aortic distensibility by 33.3% (Iva 0.003 ± 0.001/mmHg vs. placebo 0.002 ± 0.010/mmHg, P < 0.01) and circumferential cyclic strain by 37.1% (Iva 0.062 ± 0.027 vs. placebo 0.039 ± 0.018, P < 0.0001).

Conclusion: Heart rate reduction with Iva increased endothelium-dependent vasodilation and reduced arterial stiffness in patients with stable CAD. These findings corroborate and expand the results collected in experimental studies and indicate the importance of heart rate as a determinant of vascular function.
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http://dx.doi.org/10.1097/HJH.0000000000001984DOI Listing
May 2019

Effects of Liver Fibrosis Progression on Tissue Relaxation Times in Different Mouse Models Assessed by Ultrahigh Field Magnetic Resonance Imaging.

Biomed Res Int 2017 18;2017:8720367. Epub 2017 Jan 18.

Clinic for Diagnostic and Interventional Radiology, Saarland University Medical Center, Kirrberger Str. 100, Bdg. 50.1, 66421 Homburg, Germany.

Recently, clinical studies demonstrated that magnetic resonance relaxometry with determination of relaxation times T1 and T2 may aid in staging and management of liver fibrosis in patients suffering from viral hepatitis and steatohepatitis. In the present study we investigated T1 and T2 in different models of liver fibrosis to compare alternate pathophysiologies in their effects on relaxation times and to further develop noninvasive quantification methods of liver fibrosis. MRI was performed with a fast spin echo sequence for measurement of T1 and a multigradient echo sequence for determination of T2. Toxic liver fibrosis was induced by injections of carbon tetrachloride (1.4 mL CCl per kg bodyweight and week, for 3 or 6 weeks) in BALB/cJ mice. Chronic sclerosing cholangitis was mimicked using the ATP-binding cassette transporter B4 knockout  ) mouse model. Untreated BALB/cJ mice served as controls. To assess hepatic fibrosis, we ascertained collagen contents and fibrosis scores after Sirius red staining. T1 and T2 correlate differently to disease severity and etiology of liver fibrosis. T2 shows significant decrease correlating with fibrosis in CCl treated animals, while demonstrating significant increase with disease severity in   mice. Measurements of T1 and T2 may therefore facilitate discrimination between different stages and causes of liver fibrosis.
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http://dx.doi.org/10.1155/2017/8720367DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5286538PMC
February 2017

First report of an aneurysmal bone cyst presenting as subungual mass.

J Cutan Pathol 2016 Aug 13;43(8):711-6. Epub 2016 May 13.

Bone Tumor Reference Center at the Institute of Pathology, University Hospital Basel, Basel, Switzerland.

Painful subungual tumor masses in the toes usually emerge as glomus tumors or subungual exostoses. We present a patient with an aneurysmal bone cyst located subungually in whom the diagnosis was delayed due to inadequate diagnostic procedures, which led to marked destruction of the distal phalanx of the great toe of the right foot. After biopsy, the distal phalanx could not be preserved due to critical soft tissue involvement and the size of the process. Thus, we describe this rare entity to encourage clinicians to establish the diagnosis by biopsy of a tissue swelling of unclear origin and duration that does not resolve after a short time. Imaging examinations are useful in demonstrating periosteal involvement and extension of the lesion and can be helpful in the diagnostic algorithm. An interdisciplinary approach is a top priority to ensure optimal treatment.
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http://dx.doi.org/10.1111/cup.12722DOI Listing
August 2016

Right and Left Ventricular Function and Mass in Male Elite Master Athletes: A Controlled Contrast-Enhanced Cardiovascular Magnetic Resonance Study.

Circulation 2016 May 12;133(20):1927-35. Epub 2016 Apr 12.

From Institute of Sports and Preventive Medicine, Saarland University, Saarbrücken, Germany (P.B., L.L., N.K., W.K., T.M., J.S.); Clinic of Diagnostic and Interventional Radiology, Saarland University Medical Center, Homburg, Germany (G.S.); and Clinic of Pediatric Cardiology, Saarland University Medical Center, Homburg, Germany (A.R., H.A.-K.).

Background: It is under debate whether the cumulative effects of intensive endurance exercise induce chronic cardiac damage, mainly involving the right heart. The aim of this study was to examine the cardiac structure and function in long-term elite master endurance athletes with special focus on the right ventricle by contrast-enhanced cardiovascular magnetic resonance.

Methods And Results: Thirty-three healthy white competitive elite male master endurance athletes (age range, 30-60 years) with a training history of 29±8 years, and 33 white control subjects pair-matched for age, height, and weight underwent cardiopulmonary exercise testing, echocardiography including tissue-Doppler imaging and speckle tracking, and cardiovascular magnetic resonance. Indexed left ventricular mass and right ventricular mass (left ventricular mass/body surface area, 96±13 and 62±10 g/m(2); P<0.001; right ventricular mass/body surface area, 36±7 and 24±5 g/m(2); P<0.001) and indexed left ventricular end-diastolic volume and right ventricular end-diastolic volume (left ventricular end-diastolic volume/body surface area, 104±13 and 69±18 mL/m(2); P<0.001; right ventricular end-diastolic volume/body surface area, 110±22 and 66±16 mL/m(2); P<0.001) were significantly increased in athletes in comparison with control subjects. Right ventricular ejection fraction did not differ between athletes and control subjects (52±8 and 54±6%; P=0.26). Pathological late enhancement was detected in 1 athlete. No correlations were found for left ventricular and right ventricular volumes and ejection fraction with N-terminal pro-brain natriuretic peptide, and high-sensitive troponin was negative in all subjects.

Conclusions: Based on our results, chronic right ventricular damage in elite endurance master athletes with lifelong high training volumes seems to be unlikely. Thus, the hypothesis of an exercise-induced arrhythmogenic right ventricular cardiomyopathy has to be questioned.
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http://dx.doi.org/10.1161/CIRCULATIONAHA.115.020975DOI Listing
May 2016

Organ-Preserving Surgical Treatment of a Horseshoe Kidney Occupied by a Large Renal Cell Carcinoma with Extensive Venous Invasion: A Case Report.

Urol Int 2018 11;100(2):245-247. Epub 2016 Feb 11.

Department of Urology, Saarland University Medical Center, Homburg/Saar, Germany.

The horseshoe kidney is one of the most common congenital disorders affecting the urogenital system. Following a fusion of the lower kidney poles, which in turn lead to the formation of an isthmus, this anatomical variation is accompanied by other characteristic properties like an incomplete ascension, ventral rotation of the pelvices as well as atypical vascular supply. Even though renal carcinoids and Wilms tumors are more common in horseshoe kidneys, the incidence of renal cell carcinomas seems to be unaffected. Here we report the case of a locally advanced renal cell carcinoma with extensive venous invasion occurring in a horseshoe kidney and its complex surgical management. The whole primary tumor as well as a majority of venous tumor thrombi could be removed by a combination of 2/3 nephrectomy and cavotomy with thrombectomy. During 1 year of follow-up, the patient neither suffered from a tumor relapse, nor did he require renal replacement therapy. Thus, we conclude that even in cases of RCC where advanced disease is associated with complex anatomical situations, organ-preserving surgical treatment should be pursued to achieve excellent functional and oncological results.
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http://dx.doi.org/10.1159/000443671DOI Listing
September 2018

P03277-A New Approach to Achieve High-Contrast Enhancement: Initial Results of an Experimental Extracellular Gadolinium-Based Magnetic Resonance Contrast Agent.

Invest Radiol 2015 Dec;50(12):835-42

From the *Clinic of Diagnostic and Interventional Radiology, Saarland University Medical Center, Homburg, Germany; †Guerbet Research, Aulnay-sous-Bois, France; and ‡Institute for Clinical and Experimental Surgery, Saarland University Medical Center, Homburg, Germany.

Objectives: This study aims to compare the enhancement properties of an experimental high-relaxivity extracellular gadolinium chelate (P03277) with a standard extracellular contrast agent (gadobutrol) in vivo in a rat model of hepatic colorectal cancer metastases and in vitro by relaxometry measurements.

Materials And Methods: Ten rats with hepatic colorectal cancer metastases were examined using a 9.4 T animal scanner (Bruker, Germany). Each animal was subjected to 2 contrast-enhanced magnetic resonance imaging experiments separated by 2 days receiving 0.1 mmol/kg body weight gadobutrol and 0.1 mmol/kg body weight P03277 intravenously in a random manner. T1-weighted self-gated fast low-angle shot sequences (time to repetition/time to echo, 45/2.5 milliseconds; flip angle, 45 degrees; acquisition time, 1:23 minutes; voxel size, 0.2 × 0.2 × 1.0 mm) were acquired before and at 10 consecutive time points after contrast injection. We assessed signal-to-noise ratio (SNR) of tumor (SNRtumor) and normal liver tissue (SNRliver), contrast-to-noise ratio, and lesion enhancement (LE). In addition, relaxation rates of P03277 and gadobutrol were assessed in vitro in human plasma at 37°C at a field strength of 9.4 T.Statistical analyses included paired t tests and Wilcoxon matched pairs signed rank tests.

Results: SNRliver, SNRtumor, contrast-to-noise ratio, and LE were significantly higher (P < 0.05) using P03277 for all time points as compared with gadobutrol. Both agents demonstrated comparable contrast kinetics with an early peak enhancement immediately after application (initial percent LE: gadobutrol, 84%; P03277, 156%) and an early and continuous washout during the examination period (final percent LE: gadobutrol, 36%; P03277, 63%). In vitro evaluation of relaxivities demonstrated markedly higher R1 for P03277 (8.6 mM s) as compared with gadobutrol (4.2 mM s).

Conclusions: This study provides the first in vivo and in vitro data of P03277, an experimental extracellular MR contrast agent. P03277 demonstrates significantly better enhancement properties as compared with gadobutrol in experimental hepatic colorectal cancer metastases. In addition, in vitro data demonstrate superior relaxivities of P03277 at a broad spectrum of different field strengths. Hence, this new agent has the potential to improve lesion conspicuity and subsequently sensitivity in diagnostic imaging for both clinical magnetic resonance imaging at 1.5 or 3 T and ultra-high field applications between 4.7 and 9.4 T.
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http://dx.doi.org/10.1097/RLI.0000000000000192DOI Listing
December 2015

IAEA randomised trial of optimal single dose radiotherapy in the treatment of painful bone metastases.

Radiother Oncol 2015 Jul 27;116(1):10-4. Epub 2015 May 27.

IAEA, Division of Human Health, Vienna, Austria.

Background: To determine the optimal single-dose radiotherapy schedule for pain from bone metastases in a multi-centre, international, randomised trial.

Patients And Methods: 651 patients were randomised to either 8Gy (n=325) or 4Gy (n=326) radiotherapy. Pain at 4, 8, 12, 24 and 52weeks was assessed using a Categorical Scale (CS) and a Visual Analogue Scale (VAS). The primary endpoint was response at 4weeks.

Results: There was no significant difference in patient demographics and other co-variates. The complete response (CR) rate and ORR (complete or partial response) for all follow-up times were higher after 8Gy (p=0.02). The Kaplan-Meier actuarial rate (categorical scale) at 4weeks for ORR was 80% after 8Gy compared to 68% after 4Gy (p=0.0015). 117 re-treatments were given of which 72 were in the 4Gy group and 45 in 8Gy arm (p=0.01).

Conclusions: There was a marked consistent difference in pain relief at all time points in favour of 8Gy. These data reinforce the case for single dose 8Gy radiotherapy to be recommended for metastatic bone pain in all healthcare settings.
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http://dx.doi.org/10.1016/j.radonc.2015.05.008DOI Listing
July 2015

Carotid ultrasound for pulmonary arteriovenous malformation screening.

Open Med (Wars) 2015 11;10(1):285-293. Epub 2015 May 11.

Department of Otorhinolaryngology, Essen University Hospital, 45147 Essen, Germany.

Objective: In patients with hereditary hemorrhagic telangiectasia (HHT), pulmonary arteriovenous malformations (PAVMs) can cause serious neurological complications. Our aim was to evaluate the potential of contrast-enhanced Doppler ultrasound (CE-US) of the common carotid artery as a screening test for detection of PAVMs.

Methods: A total of 124 consecutive patients with HHT or a positive family history underwent screening for PAVMs with CE-US and thoracic contrast-enhanced magnetic resonance angiography (CE-MRA). CE-US was performed after receiving (D)-galactose microparticulate, and CE-MRA with gadobenate dimeglumine. Twenty-five patients with confirmed PAVMs were referred to conventional pulmonary catheter angiography (PA). Findings on CE-US and CE-MRA were evaluated using contingency tables and McNemar's test.

Results: Using CE-MRA as the reference test, CE-US had a sensitivity of 100%, a specificity of 87%, and a negative predictive value of 100%. In 25 patients who underwent PA, PAVMs that had been diagnosed on CE-US and CE-MRA were confirmed. Of the PAVMs detected by CE-MRA, 24% were not identified on PA.

Conclusion: CE-US is a simple, minimally invasive screening method that can easily be performed in different settings. CE-US can predict PAVMs with high probability of success. CE-US may be a simple alternative to transthoracic echocardiography in the assessment of PAVMs in certain HHT-patients.
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http://dx.doi.org/10.1515/med-2015-0040DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5152993PMC
May 2015

Uncovered stent implantation in complicated acute aortic dissection type B.

J Thorac Cardiovasc Surg 2014 Dec 1;148(6):3003-11. Epub 2014 Aug 1.

Clinic of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg, Germany.

Objective: To retrospectively evaluate the technical feasibility and midterm results of uncovered thoracoabdominal stent placement in complicated acute aortic dissection Stanford type B (cAADB).

Patients And Methods: Fourteen consecutive patients (3 females; range, 44-71 years) with cAADB who had symptomatic gastrointestinal malperfusion and claudication underwent immediate uncovered stent implantation (diameter, 7-28 mm; length, 40-100 mm) into the true lumen of the thoracoabdominal aorta (n = 23) and visceral arteries (n = 5).

Results: Stenting resulted in elimination of gastrointestinal ischemia and symptoms in 13 of 14 patients; persisting symptoms led to secondary surgical revascularization in only 1 patient. More than 1 stent (≤ 4) was placed in 7 patients (2 celiac, 1 mesenteric, 2 renal, 8 aorto-iliac). Follow-up computed tomographic angiography (CTA) revealed collapse of 4 aortic stents (diameter, 9-25 mm; length, 100 mm) at 1 week in the absence of symptoms. Balloon reexpansion was possible in all 4 stents, but recollapse occurred within 1 month. Despite stent collapse, the patients remained asymptomatic; ultrasonography and CTA documented sufficient perfusion of the visceral arteries in all patients. Follow-up ranged from 6 months to 5 years (average, 2.5 years). Except for the patient who underwent iliacomesenteric bypass for unspecific abdominal pain, no other patient required additional interventional or surgical therapy.

Conclusions: Acute aortic dissection with suspicion of visceral ischemia should prompt for immediate intervention. Thoracoabdominal uncovered stent implantation is a technically feasible and effective minimally invasive approach that provided successful relief of acute visceral ischemia and claudication in cAADB. Stent size should be less than the normal aortic diameter to avoid possible stent collapse.
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http://dx.doi.org/10.1016/j.jtcvs.2014.07.053DOI Listing
December 2014

The issues and tentative solutions for contrast-enhanced magnetic resonance imaging at ultra-high field strength.

Wiley Interdiscip Rev Nanomed Nanobiotechnol 2014 Nov-Dec;6(6):559-73. Epub 2014 Sep 4.

Clinic of Diagnostic and Interventional Radiology (Geb. 50.1), Saarland University Medical Center, Homburg, Germany.

Magnetic resonance imaging (MRI) performed at ultra-high field strengths beyond 3 Tesla (T) has become increasingly prevalent in research and preclinical applications. As such, the inevitable clinical implementation of such systems lies on the horizon. The major benefit of ultra-high field MRI is the markedly increased signal-to-noise ratios achievable, enabling acquisition of MR images with simultaneously greater spatial and temporal resolution. However, at field strengths higher than 3 T, the efficacy of Gd(III)-based contrast agents is diminished due to decreased r1 relaxivity, somewhat limiting imaging of the vasculature and contrast-enhanced imaging of tumors. There have been extensive efforts to design new contrast agents with high r1 relaxivities based on macromolecular compounds or nanoparticles; however, the efficacy of these agents at ultra-high field strengths has not yet been proven. The aim of this review article is to provide an overview of the basic principles of MR contrast enhancement processes and to highlight the main factors influencing relaxivity. In addition, challenges and opportunities for contrast-enhanced MRI at ultra-high field strengths will be explored. Various approaches for the development of effective contrast agent molecules that are suitable for a broad spectrum of applied field strengths will be discussed in the context of the current literature.
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http://dx.doi.org/10.1002/wnan.1291DOI Listing
June 2015

Liver abscess complicated by diaphragm perforation and pleural empyema leads to the discovery of interleukin-1 receptor-associated kinase 4 deficiency.

Pediatr Infect Dis J 2014 Jul;33(7):767-9

From the *Department of General Pediatrics and Neonatology, Saarland University Medical Center, Homburg/Saar; †Department of Pediatric Pulmonology and Immunology, Charité Hospital, Humboldt University; ‡Department of Immunology, Laboratory Berlin Charité Vivantes, Berlin; §Departments of Pediatric Oncology and Hematology, and ¶Diagnostic and Interventional Radiology, Saarland University Medical Center, Homburg/Saar; ‖Institute of Transfusion Medicine, University of Ulm; **Institute of Clinical Transfusion Medicine and Immunogenetics, German Red-Cross Blood Service Baden-Württemberg-Hessen, Ulm; and ††Department of Pediatric Surgery, Saarland University Medical Center, Homburg/Saar, Germany.

Interleukin-1 receptor-associated kinase 4 (IRAK-4) deficiency predisposes to severe invasive bacterial infections in infancy and early childhood, often with a fatal course caused by a defect in Toll-like receptor and interleukin-1 receptor signaling. Despite severe invasive infections, acute phase responses are often diminished. We report the successful treatment of a child with multiple liver abscesses, diaphragm perforation and pleural empyema, accompanied by strong acute phase responses as a unique presentation of IRAK-4 deficiency.
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http://dx.doi.org/10.1097/INF.0000000000000277DOI Listing
July 2014

Effect of renal denervation on left ventricular mass and function in patients with resistant hypertension: data from a multi-centre cardiovascular magnetic resonance imaging trial.

Eur Heart J 2014 Sep 6;35(33):2224-31b. Epub 2014 Mar 6.

Klinik für Innere Medizin/Kardiologie, Deutsches Herzzentrum Berlin, Berlin, Germany.

Aims: Sympathetic stimulation induces left ventricular hypertrophy and is associated with increased cardiovascular risk. Catheter-based renal denervation (RDN) has been shown to reduce sympathetic outflow and blood pressure (BP). The present multi-centre study aimed to investigate the effect of RDN on anatomic and functional myocardial parameters, assessed by cardiac magnetic resonance (CMR), in patients with resistant hypertension.

Methods And Results: Cardiac magnetic resonance was performed in 72 patients (mean age 66 ± 10 years) with resistant hypertension (55 patients underwent RDN, 17 served as controls) at baseline and after 6 months. Clinical data and CMR results were analysed blindly. Renal denervation significantly reduced systolic and diastolic BP by 22/8 mm Hg and left ventricular mass index (LVMI) by 7.1% (46.3 ± 13.6 g/m(1.7) vs. 43.0 ± 12.6 g/m(1.7), P < 0.001) without changes in the control group (41.9 ± 10.8 g/m(1.7) vs. 42.0 ± 9.7 g/m(1.7), P = 0.653). Ejection fraction (LVEF) in patients with impaired LVEF at baseline (<50%) significantly increased after RDN (43% vs. 50%, P < 0.001). Left ventricular circumferential strain as a surrogate of diastolic function in the subgroup of patients with reduced strain at baseline increased by 21% only in the RDN group (-14.8 vs. -17.9; P = 0.001) and not in control patients (-15.5 vs. -16.4, P = 0.508).

Conclusions: Catheter-based RDN significantly reduced BP and LVMI and improved EF and circumferential strain in patients with resistant hypertension, occurring partly BP independently.
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http://dx.doi.org/10.1093/eurheartj/ehu093DOI Listing
September 2014

Splenosis mimicking hepatic adenoma.

J Clin Exp Hepatol 2013 Dec 27;3(4):351-2. Epub 2013 Nov 27.

Department of Medicine II, Saarland University Medical Center, Homburg, Germany.

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http://dx.doi.org/10.1016/j.jceh.2013.11.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3940380PMC
December 2013

Subacute liver failure by pseudocirrhotic metastatic breast cancer infiltration.

Ann Hepatol 2013 Sep-Oct;12(5):834-6

Department of Medicine II,Saarland University Medical Center, Homburg, Germany.

Hepatic metastases are common in the clinical course of breast cancer and typically appear as mass lesions. This report describes the case of a 70-year-old woman with a history of breast cancer and no previously known liver disease presenting with the first episode of variceal bleeding and subacute hepatic failure. Imaging studies indicated liver cirrhosis without signs of malignant focal lesions. Comprehensive diagnostic work-up was negative for specific causes of liver disease and provided no evidence for tumor recurrence. Finally transjugular liver biopsy revealed a marked diffuse desmoplastic infiltration by breast cancer cells. Malignant pseudocirrhosis is an unusual pattern of metastatic, tumor spread representing a rare but important differential diagnosis of progressive liver failure. Liver biopsy is the key procedure to establish the diagnosis as imaging studies may mimic cirrhosis.
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April 2014

Comparison of self-gated and prospectively triggered fast low angle shot (FLASH) sequences for contrast-enhanced magnetic resonance imaging of the liver at 9.4 T in a rat model of colorectal cancer metastases.

Invest Radiol 2013 Oct;48(10):738-44

Clinic for Diagnostic and Interventional Radiology, Saarland University Medical Center, 66421 Homburg, Germany.

Objective: The aim of this study was to compare a retrospectively self-gated fast low angle shot sequence (RSG-FLASH) with a prospectively triggered fast low angle shot sequence (PT-FLASH) using an external trigger device for dynamic contrast-enhanced magnetic resonance imaging of the liver at 9.4 T in a rat model of colorectal cancer metastases.

Materials And Methods: In 10 rats with hepatic metastases, we acquired an axial RSG-FLASH sequence through the liver. A FLASH sequence with prospective triggering (PT-FLASH) using an external trigger device was acquired at the same location with the same imaging parameters. After intravenous injection of 0.2 mmol/kg body weight of Gd-DTPA, alternating acquisitions of both sequences were performed at 4 consecutive time points.Signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and lesion enhancement were obtained for liver tumors and parenchyma. In addition, we assessed the total acquisition times of the different imaging approaches for each acquisition, including triggering and gating. Two independent readers performed a qualitative evaluation of each sequence. Statistical analyses included paired t tests and Wilcoxon matched pairs signed rank tests.

Results: No statistically significant differences in SNR, CNR, or lesion enhancement were observed. Qualitative assessments of the sequences were comparable. However, acquisition times of PT-FLASH were significantly longer (mean [SD], 160.6 [25.7] seconds; P < 0.0001) and markedly variable (minimum, 120 seconds; maximum, 209 seconds), whereas the RSG-FLASH approach demonstrated a constant mean (SD) acquisition time of 59.0 (0) seconds.

Conclusions: The RSG-FLASH and PT-FLASH sequences do not differ qualitatively or quantitatively regarding SNR, CNR, and lesion enhancement for magnetic resonance imaging of the liver in the rats at 9.4 T. However, the variability of acquisition times for the PT-FLASH sequences is a major factor of inconsistency, and we therefore consider this approach as inappropriate for dynamic contrast-enhanced studies with multiple-measurement time points. In contrast, the RSG-FLASH sequence represents a fast, consistent, and reproducible technique suitable for contrast-agent kinetic studies in experimental small-animal imaging of the abdomen.
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http://dx.doi.org/10.1097/RLI.0b013e318294dd0eDOI Listing
October 2013

Calf bioimpedance spectroscopy for determination of dry weight in hemodialysis patients: effects on hypertension and left ventricular hypertrophy.

Kidney Blood Press Res 2013 17;37(1):58-67. Epub 2013 Mar 17.

Internal Medicine II, Martin-Luther-University Medical Centre, Halle, Germany.

Background/aims: Dry weight estimation in hemodialysis patients is still a substantial problem. Despite meticulous clinical assessment, fluid overload is common, leading to hypertension and left ventricular hypertrophy (LVH). Segmental calf bioimpedance spectroscopy (cBIS) is a novel tool for dry weight assessment. Here we tested the hypothesis, that its clinical routine use reduces arterial hypertension and left ventricular mass.

Methods: Left ventricular mass (determined by magnetic resonance imaging), blood pressure and antihypertensive medication (defined daily doses, ddd) were assessed at baseline (BL). Thereafter post-dialytic target weight was reduced until cBIS-defined dry weight was reached (DW). During a 6-month follow up, DW was re-evaluated monthly by cBIS and end-dialytic weight was adjusted correspondingly. At the end, left ventricular mass, blood pressure and antihypertensive medication were determined a 3rd time (follow-up, FU).

Results: Eleven out of 15 patients were available for analysis after 6 months. Left ventricular mass showed a declining trend during the study period (Mean±SD; BL 145±54 g; DW 142±55 g; FU 137±52 g; p=0.61, linear mixed model). Comparable results were obtained for systolic blood pressure (BL 158±18 mmHg; DW 144±19 mmHg; FU 149±21 mmHg; p=0.07), and antihypertensive medication (BL 3.28±2.82ddd; DW 2.86±2.81ddd; FU 3.36±3.05ddd; p=0.37).

Conclusions: We conclude that attainment of dry weight assessed by cBIS tends to reduce left ventricular mass and blood pressure while antihypertensive medication remains unchanged. While the study was underpowered, its results provide an important hypothesis generating data basis for the design of larger studies.
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http://dx.doi.org/10.1159/000343400DOI Listing
January 2014

A 77-year-old woman with dyspnea and cardiac mass.

Chest 2012 Aug;142(2):523-527

Department of Thoracic and Cardiovascular Surgery, Saarland University Hospital, Homburg/Saar, Germany.

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http://dx.doi.org/10.1378/chest.11-1825DOI Listing
August 2012

Comparison of retrospectively self-gated and prospectively triggered FLASH sequences for cine imaging of the aorta in mice at 9.4 Tesla.

Invest Radiol 2012 Apr;47(4):259-66

Clinic for Diagnostic and Interventional Radiology, Saarland University Hospital, Homburg, Germany.

Objective: A critical problem in cardiovascular MRI in small rodents is adjusting the sequence acquisition to the high heart and respiratory rates. The aim of this study was to compare a retrospectively self-gated fast low angle shot navigator (RSG-FLASH) sequence with a conventional prospectively triggered (PT-FLASH) sequence for cine imaging of the ascending aorta in mice at 9.4 T.

Material And Methods: Ten C57/BL6 mice were examined with a horizontal bore 9.4 Tesla MRI animal scanner using a dedicated 2 × 2 phased-array surface coil. We acquired a RSG-FLASH sequence (RSG-FLASH sequences (repetition time (TR) / echo time (TE) = 6.5/2.5 ms, flip angle (FA) = 10 degrees, field of view (FOV) = 2 × 2 cm, matrix = 384 × 384, slice thickness = 1 mm, 25 movie frames) perpendicular to the ascending aorta using the IntraGate technique. At the same position, we performed a PT-FLASH sequence (TR/TE = 6.5/2.1 ms, FA = 10 degrees, FOV = 2 × 2 cm, matrix = 384 × 384, slice thickness = 1 mm) in which the maximum number of movie frames had to be adjusted to the interval between two R-peaks (RR interval) of the electrocardiogram (ECG) with: number of frames = RR interval / TR." Cross-sectional vessel areas at end-systole (AES) and end-diastole (AED) were measured to determine the aortic strain (ΔA = (AES-AED)/AED). Two blinded readers rated the sequences for presence of flow and trigger artifacts and their influence on the depiction of the blood/vessel-wall interface. Irregularities in displaying the cardiac cycle and the overall suitability of the sequence for aortic strain evaluation were assessed using a 5-level ordinal scale. Statistical differences were analyzed using Student t test and Wilcoxon signed rank test (P < 0.05). Intra- and interobserver variability was evaluated using Bland-Altman analyses.

Results: No significant differences were noted between techniques regarding the measured vessel areas (AED: P = 0.07, AES: P = 0.34), ΔA: P = 0.1). Similarly, there were no significant differences in heart (P = 0.06) and respiratory (P = 0.24) rates. The acquisition time for RSG-FLASH sequence was significantly shorter (P = 0.04). Significantly fewer flow and trigger artifacts were noted by both readers with the RSG-FLASH sequence. Likewise, both readers considered the RSG-FLASH sequence to be superior for depiction of the blood/vessel-wall interface. The RSG-FLASH sequence was also rated superior regarding irregularities in displaying the cardiac cycle and in terms of overall suitability for evaluation of AED, AES, and aortic strain (P < 0.05 each).

Conclusion: RSG-FLASH is preferable for cine imaging of the aorta. It provides the same quantitative data as PT-FLASH cine imaging but is less prone to flow and trigger artifacts. RSG-FLASH permits more homogeneous depiction of the cardiac cycle and is faster than the PT-FLASH sequence. PT-FLASH is more prone to misregistration of the respiratory cycle or the ECG by the external monitoring device used for acquisition. This effect may be even more pronounced in animals with disease models that are less stable in terms of heart and respiration rate during anesthesia.
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http://dx.doi.org/10.1097/RLI.0b013e31823d3eb6DOI Listing
April 2012

Atypical extensive extratemporal hyperpneumatization of the skull base including the cervical spine: case report and review of the literature.

Spine (Phila Pa 1976) 2012 Feb;37(3):E199-202

Department of Diagnostic and Interventional Radiology, Saarland University Hospital, Homburg/Saar, Germany.

Study Design: Case report and clinical discussion.

Objective: To describe a rare case of hyperpneumatization of the skull base including the cervical spine with the atlas bone.

Summary Of Background Data: Initial imaging studies of physically traumatized patients consist of conventional radiographs. An atypical radiolucency is often misdiagnosed as a primary malignancy or a secondary osteolytic metastasis. Further imaging studies may reveal an underlying atypical hyperpneumatization as a very rare benign differential diagnosis. Pathophysiologically, embryological developmental anomalies as well as an elevated pressure to the middle and inner ear are discussed.

Methods: We present a symptomatic 40-year-old man with conventional radiographs, after computed tomography and magnetic resonance imaging examinations.

Results: Imaging studies reveal an uncommon radiolucency of the skull base including the atlas bone, free air beneath the mastoid bone, stylomastoid foramen, epidural air adjacent to the atlas bone, and surrounding soft-tissue emphysema.

Conclusion: Atypical radiolucency may represent a very rare benign hyperpneumatization of the skull base, which may include the craniocervical junction. Because of microfractures of the thinned and consecutive, less stable bones, this also can lead to free air and soft-tissue emphysema, which has not been described previously. Special care should be taken to identify epidural free air because of a possible communication of the epidural space with the external environment. Harmful activities and especially high-speed trauma could result in fractures of the cervical spine due to decreased stability of the hyperpneumatized bones.
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http://dx.doi.org/10.1097/BRS.0b013e3182283102DOI Listing
February 2012

Solid hypervascular liver lesions: accurate identification of true benign lesions on enhanced dynamic and hepatobiliary phase magnetic resonance imaging after gadobenate dimeglumine administration.

Invest Radiol 2011 Apr;46(4):225-39

Department of Diagnostic Radiology, Ospedale Cà Foncello, Treviso, Italy.

Purpose: To evaluate hepatobiliary phase magnetic resonance imaging with gadobenate dimeglumine for differentiation of benign hypervascular liver lesions from malignant or high-risk lesions.

Methods And Materials: Retrospective assessment was performed of 550 patients with 910 hypervascular lesions (302 focal nodular hyperplasia [FNH], 82 nodular regenerative hyperplasia [NRH], 59 hepatic adenoma or liver adenomatosis [HA/LA], 329 hepatocellular carcinomas [HCC], 12 fibrolamellar-HCC [FL-HCC], 21 peripheral cholangiocarcinomas [PCC], 105 metastases). Imaging was performed before and during the arterial, portal-venous, equilibrium, and hepatobiliary phases after gadobenate dimeglumine administration (0.05 mmol/kg). Histologic confirmation was available for ≥1 lesion per patient, except for patients with suspected FNH (diagnosis based on characteristic enhancement/follow-up). Lesion differentiation (benign/malignant) on the basis of contrast washout and lesion enhancement (hypo-/iso-/hyperintensity) was assessed (sensitivity, specificity, accuracy, PPV, and NPV) relative to histology or final diagnosis.

Results: On portal-venous or equilibrium phase images, washout was not seen for 208 of 526 (39.5%) malignant (HCC, FL-HCC, PCC, metastases) and high-risk (HA/LA) lesions. Conversely, only 5 of 384 (1.3%) true benign lesions (FNH/NRH) showed washout. Taking washout as indicating malignancy, the sensitivity, specificity, and accuracy for malignant lesion identification during these phases was 61.8%, 98.7%, and 77.4%. On hepatobiliary phase images, 289 of 302 FNH, 82 of 82 NRH, 1 of 59 HA or LA, 62 of 341 HCC or FL-HCC, and 2 of 105 metastases were hyperintense or isointense. Taking iso- or hyperintensity as an indication for lesion benignity, the sensitivity, specificity, accuracy, PPV, and NPV for benign lesion identification was 96.6%, 87.6%, 91.4%, 85.1%, and 97.3%, respectively.

Conclusions: Hepatobiliary phase imaging with gadobenate dimeglumine is accurate for distinguishing benign lesions from malignant or high-risk lesions. Biopsy should be considered for hypointense lesions on hepatobiliary phase images after gadobenate dimeglumine.
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http://dx.doi.org/10.1097/RLI.0b013e3181feee3aDOI Listing
April 2011

Solid focal liver lesions: dynamic and late enhancement patterns with the dual phase contrast agent gadobenate dimeglumine.

J Gastrointest Cancer 2010 Dec;41(4):221-32

Department of Radiology, University of Brescia, Brescia, Italy.

Introduction: The purpose of this paper is to illustrate contrast enhancement patterns of solid focal liver lesions on dynamic and late phase imaging with gadobenate dimeglumine (Gd-BOPTA).

Imaging Findings: Unenhanced T2- and T1-weighted, dynamic T1-weighted (arterial, portal-venous, and equilibrium) and late phase (1-3 h) Gd-BOPTA-enhanced MR imaging of different focal liver lesions (nodular regenerative hyperplasia, hepatic adenoma, liver adenomatosis, hepatocellular carcinoma, peripheral cholangiocarcinoma, hypervascular metastases, and hypovascular metastases) are shown. Dynamic imaging was performed using GRE T1-w sequences after the bolus injection of 0.1 mmol/kg Gd-BOPTA; late-phase imaging was obtained at 1-3 h after contrast injection.

Conclusions: Dynamic imaging with Gd-BOPTA provides the same information as with conventional gadolinium-based extracellular contrast agents, while late-phase imaging gives additional information for lesion identification and characterization.
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http://dx.doi.org/10.1007/s12029-010-9145-0DOI Listing
December 2010

Contrast-enhanced MRA of the renal and aorto-iliac-femoral arteries: comparison of gadobenate dimeglumine and gadofosveset trisodium.

Eur J Radiol 2011 Feb 12;77(2):358-68. Epub 2009 Aug 12.

Department of Radiology, Università G D'Annunzio, Chieti, Italy.

Rationale And Objectives: Dedicated contrast agents are now available for contrast-enhanced magnetic resonance angiography (CE-MRA). This study retrospectively compares the safety and diagnostic performance data from Phase III regulatory trials performed to evaluate gadobenate dimeglumine (MultiHance(®)) and gadofosveset trisodium (Vasovist®)) for renal and peripheral CE-MRA.

Materials And Methods: Similar examination and blinded assessment methodology was utilized in all studies to determine the safety and diagnostic performance of the agents for detection of significant (>50%) steno-occlusive disease. Digital Subtraction Angiography (DSA) was used as the standard of truth. Diagnostic performance data (sensitivity, specificity, predictive values [PVs], and likelihood ratios [LRs]) were compared (Chi-square test).

Results: CE-MRA with gadobenate dimeglumine was more specific (92.4% vs. 80.5%, p < 0.0001) and accurate (83.6% vs. 77.1%, p = 0.022) than CE-MRA with gadofosveset in the detection of significant renal artery stenosis. The average sensitivity was higher for gadofosveset (74.4% vs. 67.3%, p = 0.011) in peripheral vessels although gadobenate dimeglumine was more specific (93.0% vs. 88.2%, p < 0.0001) with no difference in accuracy (86.6% vs. 86.3%, p = 0.66). PPVs were higher (p < 0.0001) for gadobenate dimeglumine in both vascular territories. Pre- to post-test shifts in the probability of detecting significant disease were greater after gadobenate dimeglumine. Adverse events in the renal and peripheral studies were reported by 9.2% and 7.7% of patients after gadobenate dimeglumine compared with 30.3% and 22.1% of patients after gadofosveset.

Conclusion: The diagnostic performance of CE-MRA for the detection of significant steno-occlusive disease is similar with gadofosveset and gadobenate dimeglumine although the rate of adverse events appears higher with gadofosveset.
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http://dx.doi.org/10.1016/j.ejrad.2009.07.020DOI Listing
February 2011

MRI and contrast enhanced MR angiography in a patient with right aortic arch and aberrant left subclavian artery.

Clin Res Cardiol 2009 Sep 10;98(9):573-7. Epub 2009 Jul 10.

Clinic of Diagnostic and Interventional Radiology, Saarland University Hospital, Homburg, Germany.

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http://dx.doi.org/10.1007/s00392-009-0043-zDOI Listing
September 2009