Publications by authors named "Isabel Molwitz"

10 Publications

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Are muscle parameters obtained by computed tomography associated with outcome after esophagectomy for cancer?

Clin Nutr 2021 Jun 1;40(6):3729-3740. Epub 2021 May 1.

Department of Intensive Care Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.

Background & Aims: Esophageal cancer patients often suffer from cancer-related malnutrition and, as a result, sarcopenia. Whether sarcopenia worsens the outcome after esophagectomy is unclear. Inconsistent study results are partly caused by varying cut-off values used for defining sarcopenia. To overcome this challenge, a new statistical approach is proposed in this study: analyzing the linear association of computer tomography derived muscle parameters with important clinical short- and long-term outcomes post esophagectomy, regardless of cut-offs.

Methods: Skeletal muscle index (SMI), quantifying muscle mass, was assessed with computed tomography (CT) in 98 patients undergoing esophagectomy. Muscle radiation attenuation (MRA) was measured to evaluate muscle quality. To evaluate the influence of the SMI and MRA on post-surgery complications, logistic regression models were used. To analyze the relationship of lengths of stay to muscle parameters, the competing risk approach introduced by Fine and Gray was applied. For survival analysis, log-rank test and Cox proportional hazards regression modeling were used.

Results: Neither a relevant association of SMI nor MRA with pneumonia and esophagoenteric leak were observed. Furthermore, no relevant association to lengths of stay in intensive care or hospital were detected. If the SMI increased, the odds for pleural effusion and pleural empyema decreased, but the odds of a pulmonary embolism increased. Univariate, unadjusted long-term survival analysis revealed that lower MRA and lower SMI were associated with shorter survival (P = 0.03). However, if the analysis was adjusted for confounders, e.g., Charlson Comorbidity Index, no relevant association regarding long-term survival was detected.

Conclusion: Consequently, poor muscle status, determined by CT imaging, does not justify denying a patient an oncologic resection. The Charlson Comorbidity Index, however, was superior for preoperative risk stratification.
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http://dx.doi.org/10.1016/j.clnu.2021.04.040DOI Listing
June 2021

Gender trends in authorships and publication impact in Academic Radiology-a 10-year perspective.

Eur Radiol 2021 May 19. Epub 2021 May 19.

Charité Universitaetsmedizin Berlin corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany.

Objectives: To analyze the development of publication numbers of female authors in high-, medium-, and low-impact radiological journals.

Methods: In this bibliometric analysis, gender of the first (FA) and senior author (SA) was assigned to all original research articles and reviews, published in 10 high-, medium-, and low-impact radiological journals in 2007/8 and 2017/18. The adjusted event rate (AER) and adjusted odds ratio (AOR) were calculated using mixed logistic and multinomial logistic regression models to assess and compare female publications according to impact factor, journal, author position, and combination.

Results: The proportion of female FA and female SA in N = 6979 (2007/2008) and N = 7383 (2017/2018) articles increased to 29.1% and 16.1% in 2017/2018, respectively. While most female authorships were continuously observed in medium-impact journals, the strongest increase occurred for both female FA (AOR 2.0; p < .0001) and SA (AOR 2.1; p < .0001) in low-impact journals. Female SA published significantly more often in a low- (AOR 1.5) or medium- (AOR 1.8) than in a high-ranking journal. Among the high-ranking journals, female FA published most frequently in European Radiology (32.4%; 95% CI [29.3-35.8]; p < .0001), female SA in Investigative Radiology (15.9%; 95% CI [13.7-18.4]; p < .0001). Male same-sex authorships decreased (AOR 0.9), but remained at least twice as common as all-female or mixed authorships.

Conclusion: The increase in female authorship is reflected in all impact areas. Female FA and SA increased most in low-ranking journals but are most common in medium-ranking journals. Female SA remain rare, especially in high impact journals.

Key Points: • Compared to the proportion of female radiologists worldwide, female senior authors are underrepresented in all impact areas, in particular in high-impact journals. • Among the included high-ranking radiological journals, female first authors and senior authors were strongest represented in European Radiology and Investigative Radiology, while across all impact areas they mostly published in medium-ranking journals. • Female author combinations were more frequent in low- and medium- than in high-ranking journals, whereas male author combinations remained more common than female senior author collaborations in all impact areas.
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http://dx.doi.org/10.1007/s00330-021-07928-4DOI Listing
May 2021

Time series analysis of the in-hospital diagnostic process in suspected pulmonary embolism evaluated by computed tomography: An explorative study.

Eur J Radiol 2021 Jul 8;140:109758. Epub 2021 May 8.

Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. Electronic address:

Purpose: This retrospective study aims to analyze the distribution of demand and the duration of the diagnostic workup of suspected pulmonary embolism (PE) using computed tomography pulmonary angiography (CTPA).

Methods: Time data from physical examination to report creation were identified for each CTPA in 2013 and 2018 at a tertiary hospital. Multivariable multinomial logistic and linear regression models were used to evaluate differences between 3 time intervals (I1: 6am-2pm, I2: 2pm-10pm, I3: 10pm-6am). A cosinor model was applied to analyze the amount of CTPA per hour.

Results: The relative demand for CTPA from the emergency room was lower in l1 compared to l2 and l3 (I1/I2: odds ratio (OR) 0.84, 95 % confidence interval (CI) 0.78-0.91; I1/I3: OR 0.80, 95 % CI 0.72-0.89; peak 4:23 pm). Requests for in-patients displayed a tendency towards I1 (I1/2: OR 1.15, 95 % CI 1.06-1.24; l1/l3: OR 1.19, 95 % CI 1.07-1.33; peak 1:54 pm). The time from CTPA request to study was shorter in I3 compared to I1 and I2 in 2013 (I1/I3: ratio 5.23, 95 % CI 3.38-8.10; I2/I3: ratio 3.50, 95 % CI 2.24-5.45) and 2018 (I1/I3: ratio 2.27, 95 % CI 1.60-3.22; I2/I3: ratio 2.11, 95 % CI 1.50-2.97). This applied similarly to fatal cases (I1/I3: ratio 2.91, 95 % CI 1.78-4.75; I2/I3: ratio 2.45, 95 % CI1.52-3.95).

Conclusions: The temporal distribution of demand for CTPA depends on the sector of patient care and the processing time differs substantially during the day. Time series analysis can reveal such coherences and may help to optimize workflows in radiology departments.
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http://dx.doi.org/10.1016/j.ejrad.2021.109758DOI Listing
July 2021

Time series analysis of the demand for COVID-19 related chest imaging during the first wave of the SARS-CoV-2 pandemic: An explorative study.

PLoS One 2021 3;16(3):e0247686. Epub 2021 Mar 3.

Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

Objectives: The aim of this study was to investigate possible patterns of demand for chest imaging during the first wave of the SARS-CoV-2 pandemic and derive a decision aid for the allocation of resources in future pandemic challenges.

Materials And Methods: Time data of requests for patients with suspected or confirmed coronavirus disease 2019 (COVID-19) lung disease were analyzed between February 27th and May 27th 2020. A multinomial logistic regression model was used to evaluate differences in the number of requests between 3 time intervals (I1: 6am - 2pm, I2: 2pm - 10pm, I3: 10pm - 6am). A cosinor model was applied to investigate the demand per hour. Requests per day were compared to the number of regional COVID-19 cases.

Results: 551 COVID-19 related chest imagings (32.8% outpatients, 67.2% in-patients) of 243 patients were conducted (33.3% female, 66.7% male, mean age 60 ± 17 years). Most exams for outpatients were required during I2 (I1 vs. I2: odds ratio (OR) = 0.73, 95% confidence interval (CI) 0.62-0.86, p = 0.01; I2 vs. I3: OR = 1.24, 95% CI 1.04-1.48, p = 0.03) with an acrophase at 7:29 pm. Requests for in-patients decreased from I1 to I3 (I1 vs. I2: OR = 1.24, 95% CI 1.09-1.41, p = 0.01; I2 vs. I3: OR = 1.16, 95% CI 1.05-1.28, p = 0.01) with an acrophase at 12:51 pm. The number of requests per day for outpatients developed similarly to regional cases while demand for in-patients increased later and persisted longer.

Conclusions: The demand for COVID-19 related chest imaging displayed distinct distribution patterns depending on the sector of patient care and point of time during the SARS-CoV-2 pandemic. These patterns should be considered in the allocation of resources in future pandemic challenges with similar disease characteristics.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0247686PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7928469PMC
March 2021

[Digital teaching with, during and after COVID-19].

Radiologe 2021 01 8;61(1):64-66. Epub 2021 Jan 8.

Diagnostische und Interventionelle Radiologie und Nuklearmedizin, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland.

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http://dx.doi.org/10.1007/s00117-020-00794-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7791335PMC
January 2021

Magnetic resonance imaging of midtarsal sprain: Prevalence and impact on the time of return to play in professional soccer players.

Eur J Radiol 2021 Feb 24;135:109491. Epub 2020 Dec 24.

Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Center for Radiology and Endoscopy, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany. Electronic address:

Background: Ankle sprain is a common injury in professional soccer, but to date midtarsal sprain has not been investigated in this context. The purpose of this study was to determine the prevalence of midtarsal sprain by MRI and to assess its impact on the time of return to play in professional soccer players.

Methods: We included 52 professional soccer players who underwent 59 MRI examinations after acute ankle trauma between January 2012 and September 2019. Images were retrospectively reviewed in consensus by two radiologists for assessment of midtarsal sprain and ankle sprain. Ligaments were graded as i) normal, ii) partial tear, or iii) complete tear. Time to return to play (RTP) for each athlete was retrieved from team medical records. A Kruskal-Wallis test and Dunn's pairwise tests were used to calculate differences in RTP time between groups with i) isolated midtarsal sprain, ii) isolated lateral ankle sprain, and iii) combined midtarsal and lateral ankle sprain.

Results: MRI revealed isolated ankle sprain in 24 of 59 MRI examinations (40.6 %). Acute midtarsal ligament injury was present in 15 examinations (25.4 %). Four of the 15 examinations (26.7 %) had isolated midtarsal injuries and eleven of the 15 examinations (73.3 %) had concomitant ankle sprain. RTP time was 39 days (range 9-70 days) for isolated midtarsal sprain. RTP time was significantly higher for athletes with combined ankle and midtarsal sprain (47 days, range 15-74 days) when compared to athletes with isolated ankle sprain (24 days, range 2-59 days) (p = .019).

Conclusion: Our MRI study reveals that midtarsal sprain is a frequent injury in professional soccer players with ankle sprain. Midtarsal ligament findings on MRI combined with evidence of lateral ankle sprain is associated with a longer time of return to play compared to isolated lateral ligament injuries.

Level Of Evidence: Retrospective study, observational study.
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http://dx.doi.org/10.1016/j.ejrad.2020.109491DOI Listing
February 2021

Dual-Energy Computed Tomography for Fat Quantification in the Liver and Bone Marrow: A Literature Review.

Rofo 2020 Dec 10;192(12):1137-1153. Epub 2020 Sep 10.

Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

Background:  With dual-energy computed tomography (DECT) it is possible to quantify certain elements and tissues by their specific attenuation, which is dependent on the X-ray spectrum. This systematic review provides an overview of the suitability of DECT for fat quantification in clinical diagnostics compared to established methods, such as histology, magnetic resonance imaging (MRI) and single-energy computed tomography (SECT).

Method:  Following a systematic literature search, studies which validated DECT fat quantification by other modalities were included. The methodological heterogeneity of all included studies was processed. The study results are presented and discussed according to the target organ and specifically for each modality of comparison.

Results:  Heterogeneity of the study methodology was high. The DECT data was generated by sequential CT scans, fast-kVp-switching DECT, or dual-source DECT. All included studies focused on the suitability of DECT for the diagnosis of hepatic steatosis and for the determination of the bone marrow fat percentage and the influence of bone marrow fat on the measurement of bone mineral density. Fat quantification in the liver and bone marrow by DECT showed valid results compared to histology, MRI chemical shift relaxometry, magnetic resonance spectroscopy, and SECT. For determination of hepatic steatosis in contrast-enhanced CT images, DECT was clearly superior to SECT. The measurement of bone marrow fat percentage via DECT enabled the bone mineral density quantification more reliably.

Conclusion:  DECT is an overall valid method for fat quantification in the liver and bone marrow. In contrast to SECT, it is especially advantageous to diagnose hepatic steatosis in contrast-enhanced CT examinations. In the bone marrow DECT fat quantification allows more valid quantification of bone mineral density than conventional methods. Complementary studies concerning DECT fat quantification by split-filter DECT or dual-layer spectral CT and further studies on other organ systems should be conducted.

Key Points: · DECT fat quantification in the liver and bone marrow is reliable.. · DECT is clearly superior to SECT in contrast-enhanced CT images.. · DECT bone marrow fat quantification enables better bone mineral density determination.. · Complementary studies with split-filter DECT or dual-layer spectral CT as well as studies in other organ systems are recommended..

Citation Format: · Molwitz I, Leiderer M, Özden C et al. Dual-Energy Computed Tomography for Fat Quantification in the Liver and Bone Marrow: A Literature Review. Fortschr Röntgenstr 2020; 192: 1137 - 1152.
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http://dx.doi.org/10.1055/a-1212-6017DOI Listing
December 2020

Rechtsventrikuläres Pseudoaneurysma nach Perikardiozentese: radiologische Diagnostik einer seltenen Entität.

Rofo 2021 Feb 12;193(2):200-203. Epub 2020 Aug 12.

Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

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http://dx.doi.org/10.1055/a-1212-2611DOI Listing
February 2021

Work and Training Conditions of German Residents in Radiology - Results from a Nationwide Survey Conducted by the Young Radiology Forum in the German Roentgen Society.

Rofo 2020 May 9;192(5):458-470. Epub 2020 Jan 9.

Department of Infectious Diseases and Respiratory Medicine, Charité - University Hospital Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.

Purpose:  Good training is the basis for high job satisfaction and high-quality patient care in radiology. The aim of this survey was to record the current state of working conditions for residents in radiology training in Germany and to focus on the aspects of training and psychosocial workload. The description of the actual state should help to identify possible problem areas and to develop improvement approaches.

Materials And Methods:  At the beginning of 2018, we sent an electronic questionnaire to the German Roentgen Society (DRG), the German Association of Chairmen in Academic Radiology (KLR), the Chief Physician Forum of the DRG (CAFRAD) and the Forum of Registered Radiologists (FUNRAD) with the request to forward it to radiology residents. With 63 questions, the questionnaire covered seven essential areas of medical working and training conditions. In order to ensure interdisciplinary comparability, most questions were identical to previous surveys among residents of other disciplines.

Results:  643 residents started the survey. 501 (78 %) questionnaires were fully processed and included in the final analysis. 65 % of respondents were satisfied with their current job situation. At the same time, shortcomings, especially with regard to the reconciliation of family and work as well as scientific and clinical work, became clear. Only 36 % of participants with children were satisfied with the compatibility of family and work at their workplace. Only 31 % of the researchers were satisfied with their research conditions. In addition, residents experienced a high psychosocial workload.

Conclusion:  Job satisfaction is high among radiology residents in direct comparison to other disciplines. However, based on this survey, adjustments to working conditions and training in radiology seem necessary to maintain the health of the physicians concerned, to encourage motivation for scientific work and to enhance development opportunities, especially for women, through a better compatibility of work and family life. The present survey identifies strategies and leadership tools that can help to achieve this.

Key Points:  Residents in radiology training ... · have a relatively high job satisfaction.. · experience a high psychosocial workload.. · evaluate the compatibility of family and work as in need of improvement.. · are interested in research, but evaluate research conditions as insufficient.

Citation Format: · Oechtering TH, Panagiotopoulos N, Völker M et al. Work and Training Conditions of German Residents in Radiology - Results from a Nationwide Survey Conducted by the Young Radiology Forum in the German Roentgen Society. Fortschr Röntgenstr 2020; 192: 458 - 469.
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http://dx.doi.org/10.1055/a-1047-1075DOI Listing
May 2020

Metastasen der Skelettmuskulatur als seltene Erstmanifestation eines Magenkarzinoms.

Rofo 2018 10 17;190(10):972-974. Epub 2018 Apr 17.

Department for Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Germany.

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http://dx.doi.org/10.1055/a-0591-5464DOI Listing
October 2018
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