Publications by authors named "Helmut Prosch"

114 Publications

Characterization of the Hyperintense Bronchus Sign as a Fetal MRI Marker of Airway Obstruction.

Radiology 2021 Aug 25;300(2):423-430. Epub 2021 May 25.

From the Department of Biomedical Imaging and Image-guided Therapy (F.P., A.H., M.W., H.P., D.P., G.K.), Center for Anatomy and Cell Biology (P.C.B.), Department of Pathology (A.S.), Division of Paediatric Surgery, Department of Surgery (M.M.), and Department of Obstetrics and Gynaecology (J.B.), Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria; E. B. Singleton Department of Radiology, Texas Children's Hospital, Houston, Tex (A.R.M.R., C.C.C.); and Division of Anatomy and Developmental Biology, Karl Landsteiner University of Health Sciences, Krems, Austria (G.M.G.).

Background Fetal MRI-based differential diagnosis of congenital lung malformations is difficult because of the paucity of well-described imaging markers. Purpose To characterize the hyperintense bronchus sign (HBS) in in vivo fetal MRI of congenital lung malformation cases. Materials and Methods In this retrospective two-center study, fetal MRI scans obtained in fetuses with congenital lung malformations at US (January 2002 to September 2018) were reviewed for the HBS, a tubular or branching hyperintense structure within a lung lesion on T2-weighted images. The frequency of the HBS and respective gestational ages in weeks and days were analyzed. Areas under the curve (AUCs), 95% CIs, and values of the HBS regarding airway obstruction, as found in histopathologic and postnatal CT findings as the reference standards, were calculated for different gestational ages. Results A total of 177 fetuses with congenital lung malformations (95 male fetuses) and 248 fetal MRI scans obtained at a median gestational age of 25.6 weeks (interquartile range, 8.9 weeks) were included. The HBS was found in 79% (53 of 67) of fetuses with bronchial atresia, 71% (39 of 55) with bronchopulmonary sequestration (BPS), 43% (three of seven) with hybrid lesion, 15% (six of 40) with congenital cystic adenomatoid malformation, and 13% (one of eight) with bronchogenic cyst at a median gestational age of 24.9 weeks (interquartile range, 9.7 weeks). HBS on MRI scans at any gestational age had an AUC of 0.76 (95% CI: 0.70, 0.83; = .04) for the presence of isolated or BPS-associated airway obstruction at histopathologic analysis and postnatal CT. The AUC of HBS on fetal MRI scans obtained until gestational age of 26 weeks (AUC, 0.83; 95% CI: 0.75, 0.91; < .001) was significantly higher ( = .045) than that for fetal MRI scans obtained after gestational age 26 weeks (AUC, 0.69; 95% CI: 0.57, 0.80; = .004). Conclusion The hyperintense bronchus sign is a frequently detectable feature at fetal MRI and is associated with airway obstruction particularly before gestational age 26 weeks. © RSNA, 2021 See also the editorial by Dubinsky in this issue.
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http://dx.doi.org/10.1148/radiol.2021204565DOI Listing
August 2021

Correction to: Radiomics score predicts acute respiratory distress syndrome based on the initial CT scan after trauma.

Eur Radiol 2021 May 4. Epub 2021 May 4.

Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria.

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http://dx.doi.org/10.1007/s00330-021-07995-7DOI Listing
May 2021

A comprehensive review of imaging findings in COVID-19 - status in early 2021.

Eur J Nucl Med Mol Imaging 2021 07 1;48(8):2500-2524. Epub 2021 May 1.

Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.

Medical imaging methods are assuming a greater role in the workup of patients with COVID-19, mainly in relation to the primary manifestation of pulmonary disease and the tissue distribution of the angiotensin-converting-enzyme 2 (ACE 2) receptor. However, the field is so new that no consensus view has emerged guiding clinical decisions to employ imaging procedures such as radiography, computer tomography (CT), positron emission tomography (PET), and magnetic resonance imaging, and in what measure the risk of exposure of staff to possible infection could be justified by the knowledge gained. The insensitivity of current RT-PCR methods for positive diagnosis is part of the rationale for resorting to imaging procedures. While CT is more sensitive than genetic testing in hospitalized patients, positive findings of ground glass opacities depend on the disease stage. There is sparse reporting on PET/CT with [F]-FDG in COVID-19, but available results are congruent with the earlier literature on viral pneumonias. There is a high incidence of cerebral findings in COVID-19, and likewise evidence of gastrointestinal involvement. Artificial intelligence, notably machine learning is emerging as an effective method for diagnostic image analysis, with performance in the discriminative diagnosis of diagnosis of COVID-19 pneumonia comparable to that of human practitioners.
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http://dx.doi.org/10.1007/s00259-021-05375-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8087891PMC
July 2021

Lung Cancer in Austria.

J Thorac Oncol 2021 05;16(5):725-733

Institute of Cancer Research, Department of Medicine I, Medical University of Vienna, Vienna, Austria.

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http://dx.doi.org/10.1016/j.jtho.2020.10.158DOI Listing
May 2021

Prospects and Challenges of Radiomics by Using Nononcologic Routine Chest CT.

Radiol Cardiothorac Imaging 2020 Aug 27;2(4):e190190. Epub 2020 Aug 27.

Computational Imaging Research Laboratory (J.H., G.L) of the Department of Biomedical Imaging and Image-guided Therapy (S.R., F.P., H.P.), Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria; and Department of Information Systems, University of Applied Sciences of Western Switzerland, Sierre, Switzerland (H.M.).

Chest CT scans are one of the most common medical imaging procedures. The automatic extraction and quantification of imaging features may help in diagnosis, prognosis of, or treatment decision in cardiovascular, pulmonary, and metabolic diseases. However, an adequate sample size as a statistical necessity for radiomics studies is often difficult to achieve in prospective trials. By exploiting imaging data from clinical routine, a much larger amount of data could be used than in clinical trials. Still, there is only little literature on the implementation of radiomics in clinical routine chest CT scans. Reasons are heterogeneous CT scanning protocols and the resulting technical variability (eg, different slice thicknesses, reconstruction kernels or timings after contrast material administration) in routine CT imaging data. This review summarizes the recent state of the art of studies aiming to develop quantifiable imaging biomarkers at chest CT, such as for osteoporosis, chronic obstructive pulmonary disease, interstitial lung disease, and coronary artery disease. This review explains solutions to overcome heterogeneity in routine data such as the use of imaging repositories, the standardization of radiomic features, algorithmic approaches to improve feature stability, test-retest studies, and the evolution of deep learning for modeling radiomics features. © RSNA, 2020 See also the commentary by Kay in this issue.
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http://dx.doi.org/10.1148/ryct.2020190190DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7978018PMC
August 2020

Radiomics score predicts acute respiratory distress syndrome based on the initial CT scan after trauma.

Eur Radiol 2021 Aug 17;31(8):5443-5453. Epub 2021 Mar 17.

Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria.

Objectives: Acute respiratory distress syndrome (ARDS) constitutes a major factor determining the clinical outcome in polytraumatized patients. Early prediction of ARDS is crucial for timely supportive therapy to reduce morbidity and mortality. The objective of this study was to develop and test a machine learning-based method for the early prediction of ARDS derived from the first computed tomography scan of polytraumatized patients after admission to the hospital.

Materials And Methods: One hundred twenty-three patients (86 male and 37 female, age 41.2 ± 16.4) with an injury severity score (ISS) of 16 or higher (31.9 ± 10.9) were prospectively included and received a CT scan within 1 h after the accident. The lungs, including air pockets and pleural effusions, were automatically segmented using a deep learning-based algorithm. Subsequently, we extracted radiomics features from within the lung and trained an ensemble of gradient boosted trees (GBT) to predict future ARDS.

Results: Cross-validated ARDS prediction resulted in an area under the curve (AUC) of 0.79 for the radiomics score compared to 0.66 for ISS, and 0.68 for the abbreviated injury score of the thorax (AIS-thorax). Prediction using the radiomics score yielded an f1-score of 0.70 compared to 0.53 for ISS and 0.57 for AIS-thorax. The radiomics score achieved a sensitivity and specificity of 0.80 and 0.76.

Conclusions: This study proposes a radiomics-based algorithm for the prediction of ARDS in polytraumatized patients at the time of admission to hospital with an accuracy that competes and surpasses conventional scores despite the heterogeneous, and therefore more realistic, scanning protocols.

Key Points: • Early prediction of acute respiratory distress syndrome in polytraumatized patients is possible, even when using heterogenous data. • Radiomics-based prediction resulted in an area under the curve of 0.79 compared to 0.66 for the injury severity score, and 0.68 for the abbreviated injury score of the thorax. • Highlighting the most relevant lung regions for prediction facilitates the understanding of machine learning-based prediction.
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http://dx.doi.org/10.1007/s00330-020-07635-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8270830PMC
August 2021

WFUMB position paper on reverberation artefacts in lung ultrasound: B-lines or comet-tails?

Med Ultrason 2021 Feb;23(1):70-73

Hirslanden Kliniken Bern, Beau Site, Salem and Permanence, Bern, Switzerland.

The analysis of vertical reverberation artefacts is an essential component of the differential diagnosis in pulmonary ultra-sound. Traditionally, they are often, but not exclusively, called B-line artefacts (BLA) and/or comet tail artefacts (CTA), but this view is misleading. In this position paper we clarify the terminology and relation of the two lung reverberation artefacts BLA and CTA to spe-cific clinical scenarios. BLA are defined by a normal pleura line and are a typical hallmark of cardiogenic pulmonary edema after exclusion of certain pathologies including pneumonia or lung contusion, whereas CTAs show an irregular pleura line representing a variety of parenchymal lung diseases. The dual approach using low frequency transducers to determine BLA and high frequency transducer to determine the pleural surface is recommended.
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http://dx.doi.org/10.11152/mu-2944DOI Listing
February 2021

Case Report: Afatinib Treatment in a Patient With NSCLC Harboring a Rare Exon 20 Mutation.

Front Oncol 2020 26;10:593852. Epub 2021 Jan 26.

Comprehensive Cancer Center, Vienna, Austria.

Unlike most other primary epidermal growth factor receptor () mutations in non-small cell lung cancer (NSCLC), exon 20 insertions, comprising approximately 4% to 10% of all mutations, are generally considered to be resistant to EGFR tyrosine kinase inhibitors (TKIs). However, exon 20 insertions are structurally and pharmacologically heterogeneous, with variability in their position and size having implications for response to different EGFR TKIs. The second-generation ErbB family blocker, afatinib, is approved for the first-line treatment of mutation-positive NSCLC and has been shown to have a broad inhibitory profile against common and uncommon mutations. Here, we describe a patient with bilateral multifocal lung adenocarcinoma harboring a very rare exon 20 insertion (c.2317_2319dup3; p.H773dup), who has been receiving treatment with afatinib for 4.5 years. To our knowledge, this is the first report describing long-term benefit for a patient treated with afatinib with this rare exon 20 insertion. We are aware of two further cases with this rare mutation. One patient, also reported here, has early-stage lung adenocarcinoma and has not yet received systemic therapy for NSCLC. The other patient received afatinib in the context of a global compassionate use program and had progressive disease. Our findings may be of clinical relevance for patients carrying tumors with this rare mutation as epidemiological evidence suggests that p.H773dup may function as a driver mutation in NSCLC. Together with previous preclinical and clinical evidence for the activity of afatinib against certain exon 20 insertions, these findings warrant further investigation.
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http://dx.doi.org/10.3389/fonc.2020.593852DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7871906PMC
January 2021

The role of radiological imaging for masses in the prevascular mediastinum in clinical practice.

J Thorac Dis 2020 Dec;12(12):7591-7597

Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.

Tumors in the prevascular compartment of the mediastinum are rare and imaging plays a major role in their detection, (differential) diagnosis, staging, and follow-up. The prevascular compartment is bordered anteriorly by the posterior aspect of the sternum, posteriorly by the ventral aspect of the pericardium, cranially by the thoracic outlet, and caudally by the diaphragm. In many cases, the diagnosis of a lesion in the prevascular compartment is an incidental finding either on chest radiograph (CR) or on computed tomography (CT) scans. The differential diagnosis of masses in the pre-vascular mediastinum include primarily tumors arising from the thymus or the thyroid gland, lymphomas and germ cell tumors. The differential diagnosis of mediastinal masses is primarily based on the location of the mass, its tissue composition (i.e., fat content, calcifications) and the age of the patient. The imaging method of choice is CT, as it combines a high spatial and temporal resolution with the ability to determine tissue composition and detect fluid components, as well as areas of fat and calcifications. MRI is used as a more specific problem-solving tool to discriminate solid lesions from cystic lesions or to provide evidence of minimal fat content in teratoma and thymic rebound. The role of PET/CT in the evaluation of tumors other than lymphomas in the prevascular compartment is still under discussion.
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http://dx.doi.org/10.21037/jtd-20-964DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7797866PMC
December 2020

Cardiopulmonary recovery after COVID-19: an observational prospective multicentre trial.

Eur Respir J 2021 04 29;57(4). Epub 2021 Apr 29.

Dept of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria.

Background: After the 2002/2003 severe acute respiratory syndrome outbreak, 30% of survivors exhibited persisting structural pulmonary abnormalities. The long-term pulmonary sequelae of coronavirus disease 2019 (COVID-19) are yet unknown, and comprehensive clinical follow-up data are lacking.

Methods: In this prospective, multicentre, observational study, we systematically evaluated the cardiopulmonary damage in subjects recovering from COVID-19 at 60 and 100 days after confirmed diagnosis. We conducted a detailed questionnaire, clinical examination, laboratory testing, lung function analysis, echocardiography and thoracic low-dose computed tomography (CT).

Results: Data from 145 COVID-19 patients were evaluated, and 41% of all subjects exhibited persistent symptoms 100 days after COVID-19 onset, with dyspnoea being most frequent (36%). Accordingly, patients still displayed an impaired lung function, with a reduced diffusing capacity in 21% of the cohort being the most prominent finding. Cardiac impairment, including a reduced left ventricular function or signs of pulmonary hypertension, was only present in a minority of subjects. CT scans unveiled persisting lung pathologies in 63% of patients, mainly consisting of bilateral ground-glass opacities and/or reticulation in the lower lung lobes, without radiological signs of pulmonary fibrosis. Sequential follow-up evaluations at 60 and 100 days after COVID-19 onset demonstrated a vast improvement of symptoms and CT abnormalities over time.

Conclusion: A relevant percentage of post-COVID-19 patients presented with persisting symptoms and lung function impairment along with radiological pulmonary abnormalities >100 days after the diagnosis of COVID-19. However, our results indicate a significant improvement in symptoms and cardiopulmonary status over time.
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http://dx.doi.org/10.1183/13993003.03481-2020DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7736754PMC
April 2021

Application of the Kaiser score to increase diagnostic accuracy in equivocal lesions on diagnostic mammograms referred for MR mammography.

Eur J Radiol 2021 Jan 30;134:109413. Epub 2020 Nov 30.

Department of Radiology, Rajiv Gandhi Cancer Institute and Research Centre, Delhi, India.

Introduction: We aimed to interpret MR mammography (MRM) using the Kaiser scores for equivocal or inconclusive lesions on mammography (MG).

Methods: Retrospective IRB-approved evaluation of 3623 MG for which MRM was deployed as a problem-solving tool, after inclusion-exclusion criteria were met. Three readers with different levels of experience assigned a final score from 1 to 11 based on the previously established tree classification system. Area under the curve (AUC) derived from receiver operating characteristic (ROC) analysis was used to determine the overall diagnostic performance for all lesions and separately for mass and non-mass enhancement. Sensitivity, specificity, and likelihood ratio values were obtained at different cut-off values of >4, > 5, and > 8 to rule in and rule out malignancy.

Result: Histopathology of 183 mass and 133 non-mass enhancement (NME) lesions show benign etiology in 95 and malignant in 221. The AUC was 0.796 [0.851 for mass and 0.715 for NME]. Applying the Kaiser score upgraded 202 lesions with correct prediction in 77 %, and downgraded 28 lesions with correct prediction in 60.8 %. Using a score <5 instead of <4 to rule out malignancy improved our diagnostic ability to correctly identify 100 % benign lesions. Applying Kaiser score correctly downgraded 60.8 % (17/28) lesions; thus avoiding biopsies in these. Using a high cut-off value>8 to rule-in malignancy, we correctly identified 59.7 % of lesions with 80 % specificity and positive likelihood ratio of 3.

Conclusion: The Kaiser score has clinical translation benefits when used as a problem-solving tool for inconclusive MG findings.
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http://dx.doi.org/10.1016/j.ejrad.2020.109413DOI Listing
January 2021

European Cancer Organisation Essential Requirements for Quality Cancer Care (ERQCC): Lung cancer.

Lung Cancer 2020 12 4;150:221-239. Epub 2020 Sep 4.

European Cancer Organisation; Iridium Kankernetwerk and University of Antwerp, Wilrijk-Antwerp, Belgium.

European Cancer Organisation Essential Requirements for Quality Cancer Care (ERQCC) are written by experts representing all disciplines involved in cancer care in Europe. They give patients, health professionals, managers and policymakers a guide to essential care throughout the patient journey. Lung cancer is the leading cause of cancer mortality and has a wide variation in treatment and outcomes in Europe. It is a major healthcare burden and has complex diagnosis and treatment challenges. Care must only be carried out in lung cancer units or centres that have a core multidisciplinary team (MDT) and an extended team of health professionals detailed here. Such units are far from universal in European countries. To meet European aspirations for comprehensive cancer control, healthcare organisations must consider the requirements in this paper, paying particular attention to multidisciplinarity and patient-centred pathways from diagnosis, to treatment, to survivorship.
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http://dx.doi.org/10.1016/j.lungcan.2020.08.017DOI Listing
December 2020

Pearls and pitfalls in lung cancer staging.

BJR Open 2020 8;2(1):20200019. Epub 2020 Jul 8.

Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria.

Lung cancer is the third most common cancer in the UK and is the leading cause of death. Radiology plays a central role in the diagnostic work-up of patients with suspected and known lung cancer. Tumour assessment includes both local staging, as well as distant staging. Local staging objectives include the assessment of technical resectability with regard to the evaluation of tumour size and invasion of surrounding structures. Distant staging objectives aim to identify distant metastasis in lymphatic and extra lymphatic tissues. CT, positron emission tomography/CT, MRI, and ultrasound are routinely used imaging techniques for staging in patients with lung cancer. In this review, we will consider the pitfalls of these examinations that radiologists potentially face during the work-up of patients with lung cancer.
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http://dx.doi.org/10.1259/bjro.20200019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7594898PMC
July 2020

Later-Line Treatment with Lorlatinib in - and -Rearrangement-Positive NSCLC: A Retrospective, Multicenter Analysis.

Pharmaceuticals (Basel) 2020 Nov 7;13(11). Epub 2020 Nov 7.

Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Klinik Floridsdorf, Brünner Strasse 68, 1210 Vienna, Austria.

In clinical practice, patients with -rearrangement-positive non-small-cell lung cancer commonly receive sequential treatment with ALK tyrosine kinase inhibitors. The third-generation agent lorlatinib has been shown to inhibit a wide range of resistance mutations and thus offers potential benefit in later lines, although real-world data are lacking. This multicenter study retrospectively investigated later-line, real-world use of lorlatinib in patients with advanced - or -positive lung cancer. Fifty-one patients registered in a compassionate use program in Austria, who received second- or later-line lorlatinib between January 2016 and May 2020, were included in this retrospective real-world data analysis. Median follow-up was 25.3 months. Median time of lorlatinib treatment was 4.4 months for -positive and 12.2 months for -positive patients. -positive patients showed a response rate of 43.2%, while 85.7% percent of the -positive patients were considered responders. Median overall survival from lorlatinib initiation was 10.2 and 20.0 months for the - and -positive groups, respectively. In the -positive group, lorlatinib proved efficacy after both brigatinib and alectinib. Lorlatinib treatment was well tolerated. Later-line lorlatinib treatment can induce sustained responses in patients with advanced - and -positive lung cancer.
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http://dx.doi.org/10.3390/ph13110371DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7694976PMC
November 2020

Langerhans Cell Histiocytosis of the Orbit: Spectrum of Clinical and Imaging Findings.

J Pediatr 2021 03 4;230:174-181.e1. Epub 2020 Nov 4.

Vienna Nord Hospital, Department of Pediatrics, Neonatology and Adolescent Medicine, Vienna, Austria; CCRI, St. Anna Kinderkrebsforschung, Vienna, Austria; Sigmund Freud Private University, Vienna, Austria. Electronic address:

Objective: To evaluate the clinical and imaging characteristics of orbital lesions of pediatric Langerhans cell histiocytosis (LCH).

Study Design: A retrospective analysis of clinical data and central review of magnetic resonance imaging scans in patients with LCH, enrolled into one of the consecutive international trials LCH I-III, or submitted for a second opinion between 1994 and 2015.

Results: Data from 31 children (34 involved orbits) were analyzed. Orbital LCH was the only disease manifestation in 15, part of a multifocal skeletal in 5, or a multisystem LCH in 11 patients. Orbital LCH was part of the initial disease presentation in 23 or developed at relapse in 8 cases. Orbital involvement was unilateral in 28 and bilateral in 3 patients (34 affected orbits). Proptosis was present in 9 patients. Frontal and zygomatic bone were most commonly affected. All orbital lesions were extraconal. Associated extraorbital imaging findings were dural tail sign in 19, neurodegeneration in 8, and hypothalamic-pituitary mass in 3 patients. Sixteen patients (52%) had at least 1 documented disease relapse. Permanent consequences were prominent proptosis in 1, diabetes insipidus in 8, growth hormone deficiency in 2, radiologic neurodegeneration in 8, and clinical neurodegeneration in 3 patients.

Conclusions: Predominantly unilateral orbital LCH can be the only disease manifestation or part of a disseminated disease. Orbital lesions in LCH are exclusively extraconal, typically located at the roof and the lateral wall of the orbit. The optimal treatment approach of unifocal LCH of the orbit remains controversial and warrants a prospective evaluation.
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http://dx.doi.org/10.1016/j.jpeds.2020.10.056DOI Listing
March 2021

Imaging features and differential diagnoses of non-neoplastic diffuse mediastinal diseases.

Insights Imaging 2020 Oct 15;11(1):111. Epub 2020 Oct 15.

Radiodiagnostic and Interventional Radiology, CHUV-University Hospital, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland.

Acute or chronic non-neoplastic diffuse mediastinal diseases have multiple causes, degrees of severity, and a wide range of management. Some situations require emergency care while others do not need specific treatment. Although the diagnosis may be suspected on chest X-ray, it is mainly based on CT. A delayed recognition is not uncommonly observed. Some findings may prompt the radiologist to look for specific associated injuries or lesions.This pictorial review will successively describe the various non-neoplastic causes of diffuse mediastinal diseases with their typical findings and major differentials.First, pneumomediastinum that can be provoked by extra- or intra-thoracic triggers requires the knowledge of patient's history or recent occurrences. Absence of any usual etiological factor should raise suspicion of cocaine inhalation in young individuals.Next, acute mediastinitis may be related to post-operative complications, esophageal perforation, or contiguous spread of odontogenic or retropharyngeal infections. The former diagnosis is not an easy task in the early stage, owing to the similarities of imaging findings with those of normal post-operative appearance during the first 2-3 weeks.Finally, fibrosing mediastinitis that is linked to an excessive fibrotic reaction in the mediastinum with variable compromise of mediastinal structures, in particular vascular and airway ones. Differential diagnosis includes tumoral and inflammatory infiltrations of the mediastinum.
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http://dx.doi.org/10.1186/s13244-020-00909-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7561640PMC
October 2020

[Radiological manifestations of pulmonary diseases in COVID-19].

Radiologe 2020 Oct;60(10):908-915

Universitätsklinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich.

Clinical Issue: Since its emergence in late 2019, the disease caused by the novel coronavirus, termed COVID-19, has been declared a pandemic by the World Health Organization. Reference standard for the diagnosis of COVID-19 is a positive reverse transcription polymerase chain reaction (RT-PCR) test. While the RT-PCR shows a high specificity, its sensitivity depends on the duration of symptoms, viral load, quality of the sample, and the assay used.

Standard Radiological Methods: Chest radiography and computed tomography (CT) of the chest are the imaging modalities primarily used for assessment of the lung manifestations, extent, and complications of COVID-19 pneumonia.

Performance: Sensitivity and specificity of chest radiography is low. While sensitivity of CT for detecting COVID-19 pneumonia is high-averaging around 90%-its specificity is low-between 25 and 33%.

Practical Recommendations: Indications for imaging in patients with suspected or diagnosed COVID-19 infection should be carefully considered to minimize the risk of infection for medical personnel and other patients. Imaging, particularly CT, can assess disease extent, complications, and differential diagnoses. COVID-19 pneumonia typically presents with bilateral, subpleural areas of ground glass opacifications with or without consolidations. During the course of the disease features resembling organizing pneumonia can occur. Follow-up examinations after recovery from COVID-19 pneumonia should focus on fibrotic changes of the lung parenchyma.
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http://dx.doi.org/10.1007/s00117-020-00749-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7477740PMC
October 2020

Variability of computed tomography radiomics features of fibrosing interstitial lung disease: A test-retest study.

Methods 2021 04 4;188:98-104. Epub 2020 Sep 4.

Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria.

Objectives: To investigate the intra- and inter-scanner repeatability and reproducibility of CT radiomics features (RF) of fibrosing interstitial lung disease (fILD).

Methods: For this prospective, IRB-approved test-retest study, CT data of sixty fILD patients were acquired. Group A (n = 30) underwent one repeated CT scan on a single scanner. Group B (n = 30) was scanned using two different CT scanners. All CT data were reconstructed using different reconstruction kernels (soft, intermediate, sharp) and slice thicknesses (one and three millimeters), resulting in twelve datasets per patient. Following ROI placement in fibrotic lung tissue, 86 RF were extracted. Intra- and inter-scanner RF repeatability and reproducibility were assessed by calculating intraclass correlation coefficients (ICCs) for corresponding kernels and slice thicknesses, and between lung-specific and non-lung-specific reconstruction parameters. Furthermore, test-retest lung volumes were compared.

Results: Test-retest demonstrated a majority of RF is highly repeatable for all reconstruction parameter combinations. Intra-scanner reproducibility was negatively affected by reconstruction kernel changes, and further reduced by slice thickness alterations. Inter-scanner reproducibility was highly variable, reconstruction parameter-specific, and greatest if either soft kernels and three-millimeter slice thickness, or lung-specific reconstruction parameters were used for both scans. Test-retest lung volumes showed no significant difference.

Conclusion: CT RF of fILD are highly repeatable for constant reconstruction parameters in a single scanner. Intra- and inter-scanner reproducibility are severely impacted by alterations in slice thickness more than reconstruction kernel, and are reconstruction parameter-specific. These findings may facilitate CT data and RF selection and assessment in future fILD radiomics studies collecting data across scanners.
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http://dx.doi.org/10.1016/j.ymeth.2020.08.007DOI Listing
April 2021

Ultrasound Curricula of Student Education in Europe: Summary of the Experience.

Ultrasound Int Open 2020 Jun 31;6(1):E25-E33. Epub 2020 Aug 31.

Department of Radiological, Oncologic and Anatomo-pathologic Sciences, University of Rome La Sapienza, Roma, Italy.

Despite the increasing role of ultrasound, structured ultrasound teaching is only slowly being integrated into the curricula of medical schools and universities all over Europe. To survey the current situation at European universities regarding the integration of ultrasound in student medical education and to report on models of student ultrasound training from selected European universities. A questionnaire survey focusing on the implementation of curricular ultrasound education was sent out to the 28 presidents of the national ultrasound societies of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB), who were asked to distribute the questionnaires to the medical universities of their countries. Overall, 53 questionnaires were returned from 46 universities in 17 European countries. In most of the universities (40/46 universities, 87%), the theoretical background of ultrasound is taught. However, in only a minority of universities is ultrasound integrated in anatomy courses (8/46 universities, 17%) or basic science courses (16/46 universities, 35%). Practical skills in ultrasound are taught in 56% of the universities (26/46 universities) and tested in a practical exam in seven of the responding universities (15%). The number of hours in which ultrasound was taught ranged from one to 58 (mean, seven). The respondents reported that lack of time and limited faculty funding were major hurdles. According to our survey, only a minority of European universities has integrated ultrasound into the preclinical curriculum thus far. Future EFSUMB initiatives will continue to promote the introduction of ultrasound as an integrative part of the core curriculum of student medical education, and the preparation of proper teaching material.
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http://dx.doi.org/10.1055/a-1183-3009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7458842PMC
June 2020

Alectinib following brigatinib: an efficient sequence for the treatment of advanced anaplastic lymphoma kinase-positive lung cancer patients.

Anticancer Drugs 2021 01;32(1):105-110

Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute for Lung Research and Pulmonary Oncology.

Anaplastic lymphoma kinase (ALK)-translocations are present in up to 5% of non-small cell lung cancer (NSCLC), most of them being adenocarcinomas. Even though the availability of five potent ALK-inhibitors for the treatment of ALK-positive NSCLC patients, there is no consensus about the ideal therapy sequence. Alectinib has been so far successfully and routinely used as first-line therapy, especially in patients presenting central nervous system lesions; however, with the very recent European approval of brigatinib in the first line, a new treatment option is now available for ALK+ patient collective. In this case series, efficient systemic and intracranial responses to alectinib late-line treatment following brigatinib therapy are reported. This therapeutic sequence is going to gain therefore more importance in a near future.
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http://dx.doi.org/10.1097/CAD.0000000000000989DOI Listing
January 2021

Automatic lung segmentation in routine imaging is primarily a data diversity problem, not a methodology problem.

Eur Radiol Exp 2020 08 20;4(1):50. Epub 2020 Aug 20.

Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel, 18-20, Vienna, Austria.

Background: Automated segmentation of anatomical structures is a crucial step in image analysis. For lung segmentation in computed tomography, a variety of approaches exists, involving sophisticated pipelines trained and validated on different datasets. However, the clinical applicability of these approaches across diseases remains limited.

Methods: We compared four generic deep learning approaches trained on various datasets and two readily available lung segmentation algorithms. We performed evaluation on routine imaging data with more than six different disease patterns and three published data sets.

Results: Using different deep learning approaches, mean Dice similarity coefficients (DSCs) on test datasets varied not over 0.02. When trained on a diverse routine dataset (n = 36), a standard approach (U-net) yields a higher DSC (0.97 ± 0.05) compared to training on public datasets such as the Lung Tissue Research Consortium (0.94 ± 0.13, p = 0.024) or Anatomy 3 (0.92 ± 0.15, p = 0.001). Trained on routine data (n = 231) covering multiple diseases, U-net compared to reference methods yields a DSC of 0.98 ± 0.03 versus 0.94 ± 0.12 (p = 0.024).

Conclusions: The accuracy and reliability of lung segmentation algorithms on demanding cases primarily relies on the diversity of the training data, highlighting the importance of data diversity compared to model choice. Efforts in developing new datasets and providing trained models to the public are critical. By releasing the trained model under General Public License 3.0, we aim to foster research on lung diseases by providing a readily available tool for segmentation of pathological lungs.
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http://dx.doi.org/10.1186/s41747-020-00173-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7438418PMC
August 2020

Pulmonary embolism during the COVID-19 pandemic: Decline in diagnostic procedures and incidence at a university hospital.

Res Pract Thromb Haemost 2020 Jul 25;4(5):835-841. Epub 2020 Jun 25.

Clinical Division of Haematology and Haemostaseology, Department of Medicine I Medical University of Vienna Vienna Austria.

Background: The COVID-19 pandemic has focused medical attention on treating affected patients and protecting others from infection. However, concerns have been raised regarding the pandemic´s impact and associated containment measures (eg curfew, lockdown) on non-coronavirus disease 2019 (COVID-19)-related acute medical diseases.

Objectives: To investigate changes in the incidence of pulmonary embolism (PE) during the COVID-19 pandemic compared to the period before the pandemic and reference periods in previous years.

Methods: In this single-center study, we explored all diagnostic imaging tests performed for suspected PE between weeks 1 and 17 of the years 2018, 2019, and 2020. Incidence of PE (ie, primary outcome) was analyzed. Secondary outcomes included number of imaging tests for suspected PE.

Results: Compared to weeks 1 to 11, 2020, an abrupt decline in PE diagnosis (mean weekly rate, 5.2; 95% confidence interval [CI], 3.8-6.6 vs 1.8; 95% CI, 0.0-3.6) and imaging tests (mean weekly rate, 32.5; 95% CI, 27.5-37.6 vs. 17.3; 95% CI, 11.6-23.1) was observed from week 12, with beginning of the containment measures and public lockdown in Austria. Compared to weeks 12 to 17 of 2018 and 2019, PE incidence and imaging tests were similarly decreased from 5.3 (95% CI, 3.6-7.1) to 1.8 (95% CI, 0.0-3.6) and 31.5 (95% CI, 27.1-35.9) to 17.3 (95% CI, 11.6-23.1), respectively. The median simplified pulmonary embolism severity index (sPESI) score of PE patients during the pandemic was higher than in all other PE patients (3; interquartile range, 1-3 vs 1; interquartile range, 0-2;  = .002).

Conclusion: Our study demonstrates that the COVID-19 pandemic has an impact on non-COVID-19-related acute diseases as shown by the decline in incidence of PE and imaging procedures for diagnostic workup. Further studies from other hospitals are needed to confirm our findings.
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http://dx.doi.org/10.1002/rth2.12391DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7276790PMC
July 2020

Particular findings on lung CT in patients undergoing immunotherapy for bronchogenic carcinoma.

Wien Klin Wochenschr 2020 Aug 20;132(15-16):467-474. Epub 2020 May 20.

Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.

Background: Immune checkpoint inhibitors have become a valuable tool in the therapeutic strategy against metastasized non-small cell lung cancer (NSCLC) as they represent an effective and safe treatment option for many patients; however, the treatment response and side effects of this class of drugs can considerably differ compared to classical chemotherapeutics. The aim of this study was to highlight specific radiological pulmonary findings of NSCLC patients treated with immune checkpoint inhibitors.

Methods And Results: Medical records and images of prospectively collected data from 70 patients with advanced NSCLC, treated with immune checkpoint inhibitors, were reviewed. Of the patients two experienced an initial increase in tumor size, followed by a decrease in tumor size that was described as pseudoprogression. Another patient developed a sarcoid-like reaction accompanied by clinical improvements and radiological treatment response. A further two patients developed immune checkpoint-associated pulmonary injury that was clinically and radiologically classified as pneumonitis, which responded well to anti-inflammatory treatment.

Conclusion: Management of patients with NSCLC using immune checkpoint inhibitors requires a knowledge of specific clinical and radiological findings. Both oncologists and radiologists have to be aware of the most common types, including atypical response patterns, such as a sarcoid-like reaction and pseudoprogression as well as of the pulmonary side effects that can encompass pneumonitis.
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http://dx.doi.org/10.1007/s00508-020-01667-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7445205PMC
August 2020

Medical Student Ultrasound Education, a WFUMB Position Paper, Part II. A consensus statement of ultrasound societies.

Med Ultrason 2020 May;22(2):220-229

Department Allgemeine Innere Medizin (DAIM), Kliniken Hirslanden Beau Site, Salem und Permanence, Bern, Switzerland Ultrasound Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.

Ultrasound is becoming a fundamental first-line diagnostic tool for most medical specialties and an innovative tool to teach anatomy, physiology and pathophysiology to undergraduate and graduate students. However, availability of structured training programs during medical school is lagging behind and many physicians still acquire all their ultrasound skills during postgraduate training.There is wide variation in medical student ultrasound education worldwide. Sharing successful educational strategies from early adopter medical schools and learning from leading education programs should advance the integration of ultrasound into the university medical school curricula. In this overview, we present current approaches and suggestions by ultrasound societies concerning medical student educa-tion throughout the world. Based on these examples, we formulate a consensus statement with suggestions on how to integrate ultrasound teaching into the preclinical and clinical medical curricula.
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http://dx.doi.org/10.11152/mu-2599DOI Listing
May 2020

Imaging in corona virus disease 2019 (COVID-19)-A Scoping review.

Eur J Radiol Open 2020 11;7:100237. Epub 2020 May 11.

Dept. Of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Austria.

Coronavirus Disease-2019 (COVID-19) originated in the Wuhan, Hubei Province, China in November 2019 and has since been declared a pandemic by the WHO. COVID-19 is an acute infectious disease, primarily affecting the respiratory system. Currently, real-time reverse transcription polymerase chain reaction (RT-PCR) performed on respiratory specimens is considered the reference by which to diagnose COVID-19. However, the limitations of RT-PCR, specifically, the fact that it is time-consuming and inadequate for the assessment of disease severity, have affected the process of epidemiological disease containment and has taken a toll on the healthcare management chain. As the risk of infection for other patients and personnel must be kept to a minimum, the indications for imaging have to be carefully considered. Imaging is primarily performed in patients with a negative RT-PCR, but a high clinical suspicion of COVID-19, or, in patients with diagnosed COVID-19 who are suffering from moderate to severe symptoms. In this article, we review the typical imaging findings in COVID-19, the differential diagnoses, and common complications.
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http://dx.doi.org/10.1016/j.ejro.2020.100237DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7211691PMC
May 2020

COVID-19 patients and the radiology department - advice from the European Society of Radiology (ESR) and the European Society of Thoracic Imaging (ESTI).

Eur Radiol 2020 Sep 20;30(9):4903-4909. Epub 2020 Apr 20.

Department Radiology, Mercy University Hospital, Cork, Ireland.

This document from the European Society of Radiology (ESR) and the European Society of Thoracic Imaging (ESTI) aims to present the main imaging features, and the role of CT scan in the early diagnosis of COVID-19, describing, in particular, the typical findings which make it possible to identify the disease and distinguish it from bacterial causes of infection, and to define which category of patients may benefit from CT imaging. The precautions that must be taken when performing scans to protect radiologists and technologists from infection will be described. The organisational measures that can be taken within radiology departments in order to cope with the influx of patients, while continuing to manage other emergency and time-sensitive activity (e.g. oncology, other infectious diseases etc.), will be discussed. KEY POINTS: • Bilateral ground glass opacities are typical CT manifestations of COVID-19. • Crazy paving and organising pneumonia pattern are seen at a later stage. • Extensive consolidation is associated with a poor prognosis.
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http://dx.doi.org/10.1007/s00330-020-06865-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7170031PMC
September 2020

Deep learning detection and quantification of pneumothorax in heterogeneous routine chest computed tomography.

Eur Radiol Exp 2020 04 17;4(1):26. Epub 2020 Apr 17.

Computational Imaging Research Lab, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria.

Background: Automatically detecting and quantifying pneumothorax on chest computed tomography (CT) may impact clinical decision-making. Machine learning methods published so far struggle with the heterogeneity of technical parameters and the presence of additional pathologies, highlighting the importance of stable algorithms.

Methods: A deep residual UNet was developed and evaluated for automated, volume-level pneumothorax grading (i.e., labelling a volume whether a pneumothorax was present or not), and pixel-level classification (i.e., segmentation and quantification of pneumothorax), on a retrospective series of routine chest CT data. Ground truth annotations were provided by radiologists. The fully automated pixel-level pneumothorax segmentation method was trained using 43 chest CT scans and evaluated on 9 chest CT scans with pixel-level annotation basis and 567 chest CT scans on a volume-level basis.

Results: This method achieved a receiver operating characteristic area under the curve (AUC) of 0.98, an average precision of 0.97, and a Dice similarity coefficient (DSC) of 0.94. This segmentation performance resulted to be similar to the inter-rater segmentation accuracy of two radiologists, who achieved a DSC of 0.92. The comparison of manual and automated pneumothorax quantification yielded a Pearson correlation coefficient of 0.996. The volume-level pneumothorax grading accuracy was evaluated on 567 chest CT scans and yielded an AUC of 0.98 and an average precision of 0.95.

Conclusions: We proposed a deep learning method for the detection and quantification of pneumothorax in heterogeneous routine clinical data that may facilitate the automated triage of urgent examinations and enable treatment decision support.
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http://dx.doi.org/10.1186/s41747-020-00152-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7165213PMC
April 2020

Thyroid atrophy and pancreatic involution after cancer Immunotherapy.

Rofo 2020 Jul 19;192(7):688-690. Epub 2020 Mar 19.

Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital University Hospital Bern, Switzerland.

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http://dx.doi.org/10.1055/a-1108-1934DOI Listing
July 2020
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