Publications by authors named "Max Masthoff"

44 Publications

Diffusion-Weighted Imaging Prior to Percutaneous Sclerotherapy of Venous Malformations-Proof of Concept Study for Prediction of Clinical Outcome.

Diagnostics (Basel) 2022 Jun 9;12(6). Epub 2022 Jun 9.

Clinic for Radiology, University of Muenster and University Hospital of Muenster, 48149 Muenster, Germany.

Prediction of response to percutaneous sclerotherapy in patients with venous malformations (VM) is currently not possible with baseline clinical or imaging characteristics. This prospective single-center study aimed to predict treatment outcome of percutaneous sclerotherapy as measured by quality of life (QoL) by using radiomic analysis of diffusion-weighted (dw) magnetic resonance imaging (MRI) before and after first percutaneous sclerotherapy. In all patients ( = 16) pre-interventional (PRE-) and delta (DELTA-) radiomic features (RF) were extracted from dw-MRI before and after first percutaneous sclerotherapy with ethanol gel or polidocanol foam, while QoL was assessed using the Toronto Extremity Salvage Score (TESS) and the 36-Item Short Form Survey (SF-36) health questionnaire. For selecting features that allow differentiation of clinical response, a stepwise dimension reduction was performed. Logistic regression models were fitted and selected PRE-/DELTA-RF were tested for their predictive value. QoL improved significantly after percutaneous sclerotherapy. While no common baseline patient characteristics were able to predict response to percutaneous sclerotherapy, the radiomics signature of VMs (independent PRE/DELTA-RF) revealed high potential for the prediction of clinical response after percutaneous sclerotherapy. This proof-of-concept study provides first evidence on the potential predictive value of (delta) radiomic analysis from diffusion-weighted MRI for Quality-of-Life outcome after percutaneous sclerotherapy in patients with venous malformations.
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http://dx.doi.org/10.3390/diagnostics12061430DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9222207PMC
June 2022

Image-Guided Embolotherapy of Arteriovenous Malformations of the Face.

Cardiovasc Intervent Radiol 2022 Jul 2;45(7):992-1000. Epub 2022 Jun 2.

Department of Radiology, University Hospital, LMU Munich, Munich, Germany.

Purpose: To evaluate the safety and outcome of image-guided embolotherapy of extracranial arteriovenous malformations (AVMs) primarily affecting the face.

Materials And Methods: A multicenter cohort of 28 patients presenting with AVMs primarily affecting the face was retrospectively investigated. Fifty image-guided embolotherapies were performed, mostly using ethylene-vinyl alcohol copolymer-based embolic agents. Clinical and imaging findings were assessed to evaluate response during follow-up (symptom-free, partial relief of symptoms, no improvement, and progression despite embolization), lesion devascularization (total, 100%; substantial, 76-99%; partial, 51-75%; failure, < 50%; and progression), and complication rates (classified according to the CIRSE guidelines). Sub-analyses regarding clinical outcome (n = 24) were performed comparing patients with (n = 12) or without (n = 12) subsequent surgical resection after embolotherapy.

Results: The median number of embolotherapy sessions was 2.0 (range, 1-4). Clinical outcome after a mean follow-up of 12.4 months (± 13.3; n = 24) revealed a therapy response in 21/24 patients (87.5%). Imaging showed total devascularization in 14/24 patients (58.3%), including the 12 patients with subsequent surgery and 2 additional patients with embolotherapy only. Substantial devascularization (76-99%) was assessed in 7/24 patients (29.2%), and partial devascularization (51-75%) in 3/24 patients (12.5%). Complications occurred during/after 12/50 procedures (24.0%), including 18.0% major complications. Patients with subsequent surgical resections were more often symptom-free at the last follow-up compared to the group having undergone embolotherapy only (p = 0.006).

Conclusion: Image-guided embolotherapy is safe and effective for treating extracranial AVMs of the face. Subsequent surgical resections after embolization may substantially improve patients' clinical outcome, emphasizing the need for multimodal therapeutic concepts.

Level Of Evidence: Level 4, Retrospective study.
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http://dx.doi.org/10.1007/s00270-022-03169-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9226106PMC
July 2022

Aspirin improves transplant-free survival after TIPS implantation in patients with refractory ascites: a retrospective multicentre cohort study.

Hepatol Int 2022 Jun 5;16(3):658-668. Epub 2022 Apr 5.

Medical Clinic B, Department of Gastroenterology, Hepatology, Endocrinology, Infectiology, University Hospital Muenster, 48149, Muenster, Germany.

Background And Aims: Transjugular intrahepatic portosystemic shunt (TIPS) implantation is an established procedure to treat portal hypertension. Impact of administration of aspirin on transplant-free survival after TIPS remains unknown.

Methods: A multicenter retrospective analysis including patients with TIPS implantation between 2011 and 2018 at three tertiary German Liver Centers was performed. N = 583 patients were included. Survival analysis was performed in a matched cohort after propensity score matching. Patients were grouped according to whether aspirin was (PSM-aspirin-cohort) or was not (PSM-no-aspirin-cohort) administered after TIPS. Primary endpoint of the study was transplant-free survival at 12 months after TIPS.

Results: Aspirin improved transplant-free survival 12 months after TIPS with 90.7% transplant-free survival compared to 80.0% (p = 0.001) after PSM. Separated by TIPS indication, aspirin did improve transplant-free survival in patients with refractory ascites significantly (89.6% vs. 70.6% transplant-free survival, p < 0.001), while no significant effect was observed in patients with refractory variceal bleeding (91.1% vs. 92.2% transplant-free survival, p = 0.797).

Conclusion: This retrospective multicenter study provides first data indicating a beneficial effect of aspirin on transplant-free survival after TIPS implantation in patients with refractory ascites.
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http://dx.doi.org/10.1007/s12072-022-10330-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9174324PMC
June 2022

In vivo imaging of microenvironmental and anti-PD-L1-mediated dynamics in cancer using S100A8/S100A9 as an imaging biomarker.

Neoplasia 2022 06 31;28:100792. Epub 2022 Mar 31.

Department of Radiology, University Hospital Muenster, University of Muenster, D-48149 Muenster, Germany; Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, D-79106 Freiburg, Germany.

Purpose: As a promotor of tumor invasion and tumor microenvironment (TME) formation, the protein complex S100A8/S100A9 is associated with poor prognosis. Our aim was to further evaluate its origin and regulatory effects, and to establish an imaging biomarker for TME activity.

Methods: S100A9cells (ko) were created from syngeneic murine breast cancer 4T1 (high malignancy) and 67NR (low malignancy) wildtype (wt) cell lines and implanted into either female BALB/c wildtype or S100A9 mice (n = 10 each). Anti-S100A9-Cy5.5-targeted fluorescence reflectance imaging was performed at 0 h and 24 h after injection. Potential early changes of S100A9-presence under immune checkpoint inhibition (anti-PD-L1, n = 7 vs. rat IgG2b as isotype control, n = 3) were evaluated.

Results: In S100A9mice contrast-to-noise-ratios were significantly reduced for wt and S100A9tumors. No significant differences were detected for 4T1 ko and 67NR ko cells as compared to wildtype cells. Under anti-PD-L1 treatment S100A9 presence significantly decreased compared with the control group.

Conclusion: Our results confirm a secretion of S100A8/S100A9 by the TME, while tumor cells do not apparently release the protein. Under immune checkpoint inhibition S100A9-imaging reports an early decrease of TME activity. Therefore, S100A9-specific imaging may serve as an imaging biomarker for TME formation and activity.
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http://dx.doi.org/10.1016/j.neo.2022.100792DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8983428PMC
June 2022

"Fun slipping into the doctor's role"-The relationship between sonoanatomy teaching and professional identity formation before and during the Covid-19 pandemic.

Anat Sci Educ 2022 May 29;15(3):447-463. Epub 2022 Apr 29.

Institute of Anatomy and Vascular Biology, Westfälische Wilhelms-University, Münster, Germany.

The various psychological dimensions of professional identity formation (PIF) are an important aspect of the study course for undergraduate medical students. Anatomical learning environments have been repeatedly shown to play a critical role in forming such an identity; however, relevance of PIF during sonoanatomical training remains underexplored. At the end of their basic anatomy studies, third-semester medical students took part in a four-day block course on anatomy and imaging. Anatomical content was revised in small groups using peer teaching and imaging methods, including one hour of hands-on sonoanatomy sessions each day. On-site sonoanatomy was identified as an excellent format to support students' transition from the pre-clinical to clinical phase as medical experts-to-be. Students enjoyed practical exercises and the clinical input, which increased their interest in the medical profession and their academic studies. This study further examined the effects of the transition into an online-only format, necessitated by the current Covid-19 pandemic. A comparison was made between the quantitative and qualitative evaluation data, and the written results of examinations of several on-site (n = 1096, mean age = 22.4 years ± 2.18), and online-only cohorts (n = 230, mean age = 22.6 years ± 2.21). The online-only transition led to a reduction of all PIF-related variables measured, losing identity-related variables, increasing students' stress levels, and reducing their long-term academic performance. Together, this study demonstrates presence of PIF in undergraduate sonoanatomy teaching, and cautions against the uncritical online-only substitution of hands-on learning environments.
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http://dx.doi.org/10.1002/ase.2178DOI Listing
May 2022

Interventional Treatment Options in Children with Extracranial Vascular Malformations.

Hamostaseologie 2022 Apr 9;42(2):131-141. Epub 2022 Mar 9.

Department of Radiology, Ludwig Maximilian University Hospital, Munich, München, Germany.

Extracranial vascular malformations vary greatly and belong to the complex field of orphan diseases and can involve all segments of the vascular tree: arteries, capillaries, and veins, and similarly the lymphatic system. The classification according to the International Society for the Study of Vascular Anomalies (ISSVA) represents an important guidance for selecting appropriate therapy. Although many of the principles of endovascular treatment, including image-guided sclerotherapy and embolization, are similar in adult and pediatric practice, there are some distinct differences regarding the treatment of vascular malformations of children. Thus, it is crucial to involve longer-term plan about managing these chronic diseases and their impact on a growing child. This review provides a detailed overview over the clinical presentation of venous, lymphatic, and arteriovenous malformations in children and emphasizes the specifics of their interventional treatment options, including distinct pediatric dose limitations and procedure-related side effects.
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http://dx.doi.org/10.1055/a-1728-5686DOI Listing
April 2022

Imaging of peripheral vascular malformations - current concepts and future perspectives.

Mol Cell Pediatr 2021 Dec 7;8(1):19. Epub 2021 Dec 7.

Department of Radiology, University Hospital, LMU Munich, Munich, Germany.

Vascular Malformations belong to the spectrum of orphan diseases and can involve all segments of the vascular tree: arteries, capillaries, and veins, and similarly the lymphatic vasculature. The classification according to the International Society for the Study of Vascular Anomalies (ISSVA) is of major importance to guide proper treatment. Imaging plays a crucial role to classify vascular malformations according to their dominant vessel type, anatomical extension, and flow pattern. Several imaging concepts including color-coded Duplex ultrasound/contrast-enhanced ultrasound (CDUS/CEUS), 4D computed tomography angiography (CTA), magnetic resonance imaging (MRI) including dynamic contrast-enhanced MR-angiography (DCE-MRA), and conventional arterial and venous angiography are established in the current clinical routine. Besides the very heterogenous phenotypes of vascular malformations, molecular and genetic profiling has recently offered an advanced understanding of the pathogenesis and progression of these lesions. As distinct molecular subtypes may be suitable for targeted therapies, capturing certain patterns by means of molecular imaging could enhance non-invasive diagnostics of vascular malformations. This review provides an overview of subtype-specific imaging and established imaging modalities, as well as future perspectives of novel functional and molecular imaging approaches. We highlight recent pioneering imaging studies including thermography, positron emission tomography (PET), and multispectral optoacoustic tomography (MSOT), which have successfully targeted specific biomarkers of vascular malformations.
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http://dx.doi.org/10.1186/s40348-021-00132-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8651875PMC
December 2021

Resolving immune cells with patrolling behaviour by magnetic resonance time-lapse single cell tracking.

EBioMedicine 2021 Nov 4;73:103670. Epub 2021 Nov 4.

Clinic for Radiology, Translational Research Imaging Centre, University Hospital Muenster, Muenster, Germany.

Background: Immune cells show distinct motion patterns that change upon inflammatory stimuli. Monocytes patrol the vasculature to screen for pathogens, thereby exerting an early task of innate immunity. Here, we aimed to non-invasively analyse single patrolling monocyte behaviour upon inflammatory stimuli.

Methods: We used time-lapse Magnetic Resonance Imaging (MRI) of the murine brain to dynamically track single patrolling monocytes within the circulation distant to the actual site of inflammation in different inflammatory conditions, ranging from a subcutaneous pellet model to severe peritonitis and bacteraemia.

Findings: Single patrolling immune cells with a velocity of <1 µm/s could be detected and followed dynamically using time-lapse MRI. We show, that due to local and systemic stimuli the slowly patrolling behaviour of monocytes is altered systemically and differs with type, duration and strength of the underlying stimulus.

Interpretation: Using time-lapse MRI, it is now possible to investigate the behaviour of single circulating monocytes over the course of the systemic immune response. Monocyte patrolling behaviour is altered systemically even before the onset of clinical symptoms distant to and depending on the underlying inflammatory stimulus.

Funding: This study was supported by the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation) - CRC 1009 - 194468054 to AZ, CF and - CRC 1450 - 431460824 to MM, SN, HB, AZ, CF, the Joachim Herz Foundation (Add-on Fellowship for Interdisciplinary Life Sciences to MM), the Interdisciplinary Centre for Clinical Research (IZKF, core unit PIX) and the Medical Faculty of the University of Muenster (MEDK fellowship to FF and IF).
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http://dx.doi.org/10.1016/j.ebiom.2021.103670DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8581510PMC
November 2021

Recurrence of Hepatic Encephalopathy after TIPS: Effective Prophylaxis with Combination of Lactulose and Rifaximin.

J Clin Med 2021 Oct 17;10(20). Epub 2021 Oct 17.

Clinic for Radiology, University Hospital Muenster, 48149 Muenster, Germany.

Background: Transjugular intrahepatic portosystemic shunt (TIPS) implantation is an established procedure to treat portal hypertension with hepatic encephalopathy (HE) as a common complication. There is lack of evidence concerning HE prophylaxis after TIPS.

Methods: N = 233 patients receiving TIPS between 2011 and 2018 at a German tertiary care center were included. Of them, 21% (n = 49) had a history of HE. The follow-up period was 12 months. The risk factors of post-TIPS HE were analyzed via multivariate analysis. The efficacy of prophylactic medication regimens was studied. The results show that 35.6% (n = 83) received no medication (), 36.5% (n = 85) received lactulose monoprophylaxis (), 2.6% (n = 6) rifaximin monoprophylaxis () and 25.3% (n = 59) lactulose and rifaximin () of which 64.4% received l-ornithin-l-aspartate () additionally () and 36.6% did not ().

Results: Multivariate analysis revealed higher age ( = 0.003) and HE episodes prior to TIPS ( = 0.004) as risk factors for HE after TIPS. has no prophylactic effect. prevents HE recurrence at 1, 3 and 12 months after TIPS ( = 0.003, = 0.003, = 0.006) but does not prevent HE in patients with no history of HE ( = 0.234, = 0.483, = 0.121). prevents HE recurrence compared with (25.0% vs. 64.7%, = 0.007) within 12 months after TIPS, whereas de novo occurrence is unaffected ( = 0.098). The additional administration of to has no benefit (: 25.0%, : 29.7%, = 0.780).

Conclusions: Higher age and previous HE are risk factors post-TIPS HE. In patients with HE prior to TIPS, effective prophylaxis of HE is feasible via combination of lactulose and rifaximin with no additional benefit from .
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http://dx.doi.org/10.3390/jcm10204763DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8537523PMC
October 2021

Lower Ratio of Liver Volume and Body Weight Is a Negative Predictor of Survival after Transjugular Intrahepatic Portosystemic Shunt.

J Pers Med 2021 Sep 9;11(9). Epub 2021 Sep 9.

Clinic for Radiology, University Hospital Muenster, 48149 Muenster, Germany.

Transjugular intrahepatic portosystemic shunt (TIPS) is the most effective measure to treat complications of portal hypertension. However, liver function may deteriorate after TIPS. Predictors of liver function and outcome after TIPS are therefore important for management of TIPS patients. The study aimed to evaluate the impact of liver volume on transplant-free survival (TFS) after TIPS, as well as the evolution of liver volume and its relationship with liver function after TIPS. A retrospective analysis of all consecutive patients who underwent TIPS in a tertiary care university liver center between 2012 and 2017 ( = 216) was performed; = 72 patients with complete prior and follow-up (FU) computed tomography (CT) imaging studies were included in the study. Volumetry of the liver was performed by a semi-automatic 9-lobe image segmentation algorithm at baseline and FU (FU 1: 90-180 d; FU 2: 180-365 d; FU 3: 365-545 d; FU 4: 545-730 d; FU 5: >730 d). Output variables were total liver volume (TLV, cm), left liver volume (LLV, cm), right liver volume (RLV, cm) and TLV/body weight ratio. CT derived liver volumes were correlated with liver function tests, portosystemic pressure gradient (PPG) measurements and survival. To assess predictors of liver volume change over time we fitted linear mixed models. Kaplan-Meier analysis was performed and validated by matched pair analysis followed by Cox regression to determine independent prognostic factors for survival. The median TLV at baseline was 1507.5 cm (773.7-3686.0 cm). Livers with higher baseline liver volumes and larger TLV/weight ratios retained their volume after an initial loss while smaller livers continuously lost volume after TIPS. At the first follow-up period (90-180 d post-TIPS) lower liver volumes and TLV/weight ratios were associated with higher bilirubin levels. Within the final multivariable model containing time (days since TIPS), baseline INR and baseline TLV, the average loss of liver volume was 0.74 mL per day after TIPS. Twelve-month overall transplant-free survival was 89% and median overall TFS was 33 months. The median TFS for a baseline TLV/body weight ratio > 20 was significantly higher compared with ≤20 (40.0 vs. 27.0 months, = 0.010) while there were no differences regarding the indication for TIPS or etiology of liver disease in the matched pair analysis. Lower TLV/weight ratios before TIPS were associated with shorter TFS and should therefore be critically considered when selecting patients for TIPS. In addition, this study provides first evidence of an effect of TIPS on subsequent liver volume change and associated liver function.
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http://dx.doi.org/10.3390/jpm11090903DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8472540PMC
September 2021

F-FDG-PET-MRI for the assessment of acute intestinal graft-versus-host-disease (GvHD).

BMC Cancer 2021 Sep 10;21(1):1015. Epub 2021 Sep 10.

Department of Medicine A, Hematology, Oncology and Pulmonary Medicine, University Hospital Münster, Münster, Germany.

Background: Graft versus host disease (GvHD) is a frequent complication of allogeneic stem cell transplantation (alloSCT), significantly increasing mortality. Previous imaging studies focused on the assessment of intestinal GvHD with contrast-enhanced MRI/CT or F-FDG-PET imaging alone. The objective of this retrospective study was to elucidate the diagnostic value of a combined F-FDG-PET-MRI protocol in patients with acute intestinal GvHD.

Methods: Between 2/2015 and 8/2019, 21 patients with acute intestinal GvHD underwent F-FDG-PET-MRI. PET, MRI and PET-MRI datasets were independently reviewed. Readers assessed the number of affected segments of the lower gastrointestinal tract and the reliability of the diagnosis on a 5-point Likert scale and quantitative PET (SUVmax, SUVpeak, metabolic volume (MV)) and MRI parameter (wall thickness), were correlated to clinical staging of acute intestinal GvHD.

Results: The detection rate for acute intestinal GvHD was 56.8% for PET, 61.4% for MRI and 100% for PET-MRI. PET-MRI (median Likert-scale value: 5; range: 4-5) offers a significantly higher reliability of the diagnosis compared to PET (median: 4; range: 2-5; p = 0.01) and MRI alone (median: 4; range: 3-5; p = 0.03). The number of affected segments in PET-MRI (r = 0.677; p <  0.001) and the MV (r = 0.703; p <  0.001) correlated significantly with the clinical stage. SUVmax (r = 0.345; p = 0.14), SUVpeak (r = 0.276; p = 0.24) and wall thickening (r = 0.174; p = 0.17) did not show a significant correlation to clinical stage.

Conclusion: F-FDG-PET-MRI allows for highly reliable assessment of acute intestinal GvHD and adds information indicating clinical severity.
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http://dx.doi.org/10.1186/s12885-021-08748-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8434740PMC
September 2021

Evaluation of Ga-PSMA-11 PET-MRI in Patients with Advanced Prostate Cancer Receiving Lu-PSMA-617 Therapy: A Radiomics Analysis.

Cancers (Basel) 2021 Jul 30;13(15). Epub 2021 Jul 30.

Department of Nuclear Medicine, University Hospital Muenster, 48149 Muenster, Germany.

Lutetium PSMA-617 (Lu-PSMA) therapy in patients with metastatic castration resistant prostate cancer (mCRPC) has gained visibility through the ongoing phase III trial. The data on prediction of therapy outcome and survival out of pretherapeutic imaging parameters is still sparse. In this study, the predictive and prognostic value of radiomic features from Ga-PSMA-11 PET-MRI are analyzed. In total, 21 patients with mCRPC underwent Ga-PSMA-11 PET-MRI before Lu-PSMA therapy. The PET-positive tumor volume was defined and transferred to whole-body T2-, T1- and contrast-enhanced T1-weighted MRI-sequences. The radiomic features from PET and MRI sequences were extracted by using a freely available software package. For selecting features that allow differentiation of biochemical response (PSA decrease > 50%), a stepwise dimension reduction was performed. Logistic regression models were fitted, and selected features were tested for their prognostic value (overall survival) in all patients. Eight patients achieved biochemical response after Lu-PSMA therapy. Ten independent radiomic features differentiated well between responders and non-responders. The logistic regression model, including the feature interquartile range from T2-weighted images, revealed the highest accuracy (AUC = 0.83) for the prediction of biochemical response after Lu-PSMA therapy. Within the final model, patients with a biochemical response ( = 0.003) and higher T2 interquartile range values in pre-therapeutic imaging ( = 0.038) survived significantly longer. This proof-of-concept study provides first evidence on a potential predictive and prognostic value of radiomic analysis of pretherapeutic Ga-PSMA-11 PET-MRI before Lu-PSMA therapy.
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http://dx.doi.org/10.3390/cancers13153849DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8345703PMC
July 2021

Combined Transarterial Embolization and Percutaneous Sclerotherapy as Treatment for Refractory and Nonresectable Aneurysmal Bone Cysts.

J Vasc Interv Radiol 2021 10 20;32(10):1425-1434.e2. Epub 2021 Jul 20.

Clinic for Radiology, University Hospital Münster, Münster, Germany; Department of Radiology, University Hospital Ludwig Maximilian University of Munich, Munich, Germany.

Purpose: To evaluate the safety and effectiveness of combined transarterial embolization and percutaneous sclerotherapy in the treatment of refractory and nonresectable aneurysmal bone cysts (ABCs) as assessed by imaging and clinical outcomes.

Materials And Methods: This retrospective, single-center study included 16 consecutive patients (9 women and 7 men; median age, 17 years [range, 6-25 years]) who underwent combined transarterial embolization (using ethylene vinyl alcohol) and percutaneous sclerotherapy (using ethanol gel and polidocanol) for refractory and nonresectable ABCs. The median follow-up was 27.3 months (range, 6.7-47.5 months). Grade of mineralization (5-point Likert scale), grade of fluid-fluid levels (FFLs; 4-point Likert scale), and contrast-enhancing lesion volume were evaluated before and after treatment. The quality of life was determined before and after treatment using the Musculoskeletal Tumor Society (MSTS) score and the 36-Item Short Form Survey (SF-36) health questionnaire.

Results: A mean of 1.6 ± 0.7 transarterial embolizations and 3.2 ± 1.7 percutaneous sclerotherapies were performed. No adverse events were observed. All patients showed either partial or complete response; no patient showed ABC recurrence. The grade of mineralization (3.7 ± 0.7 after therapy vs 1.4 ± 0.5 at baseline; P < .0001) and grade of FFL (3.5 ± 0.8 after therapy vs 1.9 ± 0.6 at baseline; P < .0001) significantly improved after therapy compared with baseline. The mean contrast-enhancing lesion volume significantly decreased after treatment compared with baseline (45.9 mm³ ± 96.1 vs 156.0 mm³ ± 115.3, respectively; P = .0003). The MSTS scores (28.8 ± 1.8 after treatment vs 14.1 ± 8.6 at baseline; P < .0001) and SF-36 findings revealed a significant improvement in the quality of life after treatment compared with baseline, leaving most patients without relevant constraints.

Conclusions: Combined transarterial embolization and percutaneous sclerotherapy is a minimally invasive, safe, and effective treatment option for refractory and nonresectable ABCs. Treatment fostered bone mineralization and significantly improved patients' quality of life.
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http://dx.doi.org/10.1016/j.jvir.2021.07.008DOI Listing
October 2021

Percutaneous Sclerotherapy of Venous Malformations of the Hand: A Multicenter Analysis.

Cardiovasc Intervent Radiol 2021 Oct 20;44(10):1543-1550. Epub 2021 Jul 20.

Department of Radiology, University Hospital, LMU Munich, Marchioninistr 15, 81377, München, Germany.

Purpose: To evaluate the safety and outcome of percutaneous sclerotherapy for treating venous malformations (VMs) of the hand.

Materials And Methods: A retrospective multicenter trial of 29 patients with VMs primarily affecting the hand, including wrist, carpus, and/or fingers, treated by 81 percutaneous image-guided sclerotherapies using ethanol gel and/or polidocanol was performed. Clinical and imaging findings were assessed to evaluate clinical response, lesion size reduction, and complication rates. Substratification analysis was performed with respect to the Puig's classification, the sclerosing agent, the injected volume of the sclerosant, and to previously performed treatments.

Results: The mean number of procedures per patient was 2.8 (± 2.2). Last follow-up (mean = 9.2 months) revealed a partial relief of symptoms in 78.9% (15/19), while three patients (15.8%) presented symptom-free and one patient (5.3%) with no improvement. Post-treatment imaging revealed an overall objective response rate of 88.9%. Early post-procedural complications occurred after 5/81 sclerotherapies (6.2%) and were entirely resolved by conservative means. Type of VM (Puig's classification) as well as sclerosing agent had no impact on clinical response (p = 0.85, p = 0.11) or complication rates (p = 0.66, p = 0.69). The complication rates were not associated with the sclerosant volume injected (p = 0.76). In addition, no significant differences in clinical success (p = 0.11) or complication rates (p = 0.89) were detected when comparing patients with history of previous treatments compared to therapy-naive patients.

Conclusion: Percutaneous sclerotherapy is both safe and effective for treating VMs of the hand. Even patients with history of previous treatments benefit from further sclerotherapy showing similar low complication rates to therapy-naive patients.

Level Of Evidence: Level 4, Retrospective study.
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http://dx.doi.org/10.1007/s00270-021-02926-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8478723PMC
October 2021

Multispectral optoacoustic tomography of peripheral arterial disease based on muscle hemoglobin gradients-a pilot clinical study.

Ann Transl Med 2021 Jan;9(1):36

Department for Clinical Radiology, University Hospital Münster, Münster, Germany.

Background: Current imaging assessment of peripheral artery disease (PAD) relies on anatomical cross-sectional visualizations of the affected arteries. Multispectral optoacoustic tomography (MSOT) is a novel molecular imaging technique that provides direct and label-free visualizations of soft tissue perfusion and oxygenation.

Methods: MSOT was prospectively assessed in a pilot trial in healthy volunteers (group n=4, mean age 31, 50% male and group n=4, mean age 37.3, 75% male) and patients with intermittent claudication (group n=4, mean age 72, 75% male, PAD stage IIb). We conducted cuff-induced ischemia (group n) and resting state measurements (groups n and n) over the calf region. Spatially resolved mapping of oxygenated (HbO), deoxygenated (Hb) and total (THb) hemoglobin, as well as oxygen saturation (SO), were measured via hand-held hybrid MSOT-Ultrasound based purely on hemoglobin contrast.

Results: Calf measurements in healthy volunteers revealed distinct dynamics for HbO, Hb, THb and SO under cuff-induced ischemia. HbO, THb and SO levels were significantly impaired in PAD patients compared to healthy volunteers (P<0.05 for all parameters). Revascularization led to significant improvements in HbO of the affected limb.

Conclusions: Clinical MSOT allows for non-invasive, label-free and real-time imaging of muscle oxygenation in health and disease with implications for diagnostics and therapy assessment in PAD.
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http://dx.doi.org/10.21037/atm-20-3321DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7859778PMC
January 2021

Invasive diagnostic and therapeutic measures are unnecessary in patients with symptomatic van Neck-Odelberg disease (ischiopubic synchondrosis): a retrospective single-center study of 21 patients with median follow-up of 5 years.

Acta Orthop 2021 06 4;92(3):347-351. Epub 2021 Feb 4.

Department of Orthopedics and Tumor Orthopedics; University Hospital of Münster, Münster.

Background and purpose - Van Neck-Odelberg disease (VND) is a self-limiting skeletal phenomenon characterized by a symptomatic or asymptomatic uni- or bilateral overgrowth of the pre-pubescent ischiopubic synchondrosis. It is frequently misinterpreted as a neoplastic, traumatic, or infectious process, often resulting in excessive diagnostic and therapeutic measures. This study assessed the demographic, clinical, and radiographic features of the condition and analyzed diagnostic and therapeutic pathways in a large single-center cohort.Patients and methods - We retrospectively analyzed 21 consecutive patients (13 male) with a median age of 10 years (IQR 8-13) and a median follow-up of 5 years (IQR 42-94 months), who were diagnosed at our department between 1995 and 2019.Results - VND was unilateral in 17 cases and bilateral in 4 cases. Initial referral diagnoses included suspected primary bone tumor (n = 9), fracture (n = 3), osteomyelitis (n = 2), and metastasis (n = 1). The referral diagnosis was more likely to be VND in asymptomatic than symptomatic patients (4/6 vs. 2/15). More MRI scans were performed in unilateral than bilateral VND (median 2 vs. 0). All 15 symptomatic patients underwent nonoperative treatment and reported a resolution of symptoms and return to physical activity after a median time of 5 months (IQR 0-6).Interpretation - By understanding the physiological course of VND during skeletal maturation, unnecessary diagnostic and therapeutic measures can be avoided and uncertainty and anxiety amongst affected patients, their families, and treating physicians can be minimized.
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http://dx.doi.org/10.1080/17453674.2021.1882237DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8231411PMC
June 2021

Intraosseous contrast administration for emergency stroke CT.

Neuroradiology 2021 Jun 18;63(6):967-970. Epub 2021 Jan 18.

Clinic for Radiology, University Hospital Muenster, Muenster, Germany.

Computed tomography (CT) imaging in acute stroke is an established and fairly widespread approach, but there is no data on applicability of intraosseous (IO) contrast administration in the case of failed intravenous (IV) cannula placement. Here, we present the first case of IO contrast administration for CT imaging in suspected acute stroke providing a dedicated CT examination protocol and analysis of achieved image quality as well as a review of available literature.
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http://dx.doi.org/10.1007/s00234-021-02642-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8128809PMC
June 2021

Portal and hepatic vein embolization prior to major hepatectomy.

Z Gastroenterol 2021 Jan 11;59(1):35-42. Epub 2021 Jan 11.

Department for General, Visceral and Transplantation Surgery, University Hospital Muenster, Muenster, Germany.

Purpose:  To analyze safety and effectiveness of simultaneous portal and hepatic vein embolization (PHVE) or sequential hepatic vein embolization (HVE) compared to portal vein embolization (PVE) for future remnant liver (FRL) hypertrophy prior to major hepatic surgery.

Methods:  Patients undergoing PVE, PHVE or HVE at our tertiary care center between 2018 and 2020 were retrospectively included. FRLV, standardized FRLV (sFRLV) and sFRLV growth rate per day were assessed via volumetry, as well as laboratory parameters.

Results:  36 patients (f = 15, m = 21; median 64.5 y) were included, 16 patients received PHVE and 20 patients PVE, of which 4 received sequential HVE. Significant increase of FRLV was achieved with both PVE and PHVE compared to baseline (p < 0.0001). sFRLV growth rate did not significantly differ following PHVE (2.2 ± 1.2 %/d) or PVE (2.2 ± 1.7 %/d, p = 0.94). Left portal vein thrombosis (LPVT) was observed after PHVE in 6 patients and in 1 patient after PVE. Sequential HVE showed a considerably high growth rate of 1.42 ± 0.45 %/d after PVE.

Conclusion:  PHVE effectively induces FRL hypertrophy but yields comparable sFRLV to PVE. Sequential HVE further induces hypertrophy after insufficient growth due to PVE. Considering a potentially higher rate of LPVT after PHVE, PVE might be preferred in patients with moderate baseline sFRLV, with optional sequential HVE in non-sufficient responders.
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http://dx.doi.org/10.1055/a-1330-9450DOI Listing
January 2021

S100A9-Imaging Enables Estimation of Early Therapy-Mediated Changes in the Inflammatory Tumor Microenvironment.

Biomedicines 2021 Jan 3;9(1). Epub 2021 Jan 3.

University Clinic of Radiology, Medical Faculty, University of Muenster and University Hospital Muenster, D-48149 Muenster, Germany.

(1) Background: The prognosis of cancer is dependent on immune cells in the tumor microenvironment (TME). The protein S100A9 is an essential regulator of the TME, associated with poor prognosis. In this study, we evaluated early therapy effects on the TME in syngeneic murine breast cancer via S100A9-specific in vivo imaging. (2) Methods: Murine 4T1 cells were implanted orthotopically in female BALB/c mice ( = 59). Tumor size-adapted fluorescence imaging was performed before and 5 days after chemo- (Doxorubicin, = 20), anti-angiogenic therapy (Bevacizumab, = 20), or placebo (NaCl, = 19). Imaging results were validated ex vivo (immunohistochemistry, flow cytometry). (3) Results: While tumor growth revealed no differences ( = 0.48), fluorescence intensities (FI) for S100A9 in Bevacizumab-treated tumors were significantly lower as compared to Doxorubicin (2.60 vs. 15.65 AU, < 0.0001). FI for Doxorubicin were significantly higher compared to placebo (8.95 AU, = 0.01). Flow cytometry revealed shifts in monocytic and T-cell cell infiltrates under therapy, correlating with imaging. (4) Conclusions: S100A9-specific imaging enables early detection of therapy effects visualizing immune cell activity in the TME, even before clinically detectable changes in tumor size. Therefore, it may serve as a non-invasive imaging biomarker for early therapy effects.
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http://dx.doi.org/10.3390/biomedicines9010029DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7823872PMC
January 2021

Analysis of failed therapy evaluations in radioembolization of primary and secondary liver cancers.

J Cancer Res Clin Oncol 2021 May 6;147(5):1537-1545. Epub 2020 Nov 6.

Institute of Clinical Radiology, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149, Munster, Germany.

Purpose: To analyze patients' characteristics and reasons for not performing planned transarterial radioembolization (TARE) in liver cancer after Tc-labeled macroaggregated albumin (Tc-MAA) evaluation.

Methods: In this retrospective single-center cohort, all patients undergoing Tc-MAA evaluation prior to planned TARE for primary or secondary liver cancer between 2009 and 2018 were analyzed. Patients were assigned to either "TARE" or "no TARE" group. Patients' characteristics, arising reasons for not performing the planned TARE treatment as well as predictive factors for occurrence of these causes were analyzed.

Results: 436 patients [male = 248, female = 188, median age 62 (23-88) years] with Tc-MAA evaluation prior to planned TARE of primary or secondary liver cancer were included in this study. 148 patients (33.9%) did not receive planned TARE. Patients with a hepatic tumor burden > 50%, no liver cirrhosis, no previous therapies and a higher bilirubin were significantly more frequent in "no TARE" compared to "TARE" group. Main reasons for not performing TARE were extrahepatic tracer accumulation (n = 70, 40.5%), non-target accumulation of Tc-MAA (n = 27, 15.6%) or a hepatopulmonary shunt fraction of more than 20% (n = 23, 13.3%). Independent preprocedural parameters for not performing planned TARE were elevated bilirubin (p = 0.021) and creatinine (p = 0.018) and lower MELD score (p = 0.031).

Conclusion: A substantial number of patients are precluded from TARE following Tc-MAA evaluation, which is, therefore, implicitly needed to determine contraindications to TARE and should not be refrained from in pretreatment process. However, a preceding careful patient selection is needed especially in patients with high hepatic tumor burden and alteration in lab parameters.
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http://dx.doi.org/10.1007/s00432-020-03443-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8021531PMC
May 2021

Repeated radioembolization in advanced liver cancer.

Ann Transl Med 2020 Sep;8(17):1055

Institute of Clinical Radiology, University Hospital Muenster, Muenster, Germany.

Background: To evaluate safety and clinical outcome of repeated transarterial Y (yttrium) radioembolization (TARE) in primary and metastatic liver cancer.

Methods: Between 2009 and 2018, n=288 patients underwent TARE for treatment of malignant liver disease in a tertiary care hospital. This retrospective single center study analyzed the safety and outcome of patients (n=11/288) undergoing repeated resin microsphere TARE. Included patients suffered from hepatocellular carcinoma (n=3), colorectal cancer (n=2), breast cancer (n=2), intrahepatic cholangiocarcinoma (n=3), and neuroendocrine carcinoma (n=1). All patients had shown either partial response (n=9) or stable disease (n=2) after first TARE. Lab parameters, response assessed by the Response Evaluation Criteria in Solid Tumors (mRECIST/RECIST) at 3 months and overall survival was analyzed. Additionally, patients with repeated TARE were compared to a matched control group (n=56) with single TARE therapy. Kaplan Meier analysis was performed to analyze survival.

Results: Patients after repeated TARE showed similar increase in lab parameters as compared to their first TARE. No case of radioembolization induced liver disease was observed. While n=5/11 patients showed a partial response and n=4/11 patients a stable disease after repeated TARE, only n=2/11 patients suffered from progressive disease. Median overall survival was 20.9±11.9 months for the repeated TARE group while it was 5.9±16.2 months for the control group.

Conclusions: Repeated Y TARE is safe and can be of benefit for patients yielding a comparable degree of local disease control compared to patients with singular TARE.
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http://dx.doi.org/10.21037/atm-20-2658DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7575953PMC
September 2020

Efficacy of 90Y-Radioembolization in Metastatic Colorectal Cancer Depending on the Primary Tumor Side.

Dig Dis 2021 3;39(4):351-357. Epub 2020 Nov 3.

Institute of Clinical Radiology, University Hospital Münster, Münster, Germany.

Background: Metastatic colorectal cancer (mCRC) is associated with different molecular biology, clinical characteristics, and outcome depending on the primary tumor localization. We aimed to evaluate the effectiveness of 90Y-radioembolization (RE) for therapy of colorectal liver metastases depending on the primary tumor side.

Methods: We performed a retrospective analysis of n = 73 patients with mCRC and RE in our university liver center between 2009 and 2018. Patients were stratified according to the primary tumor side (left vs. right hemicolon), treatment response was assessed by the Response Evaluation Criteria in Solid Tumors (RECIST) at follow-up after 3 months. Kaplan-Meier analysis was performed to analyze survival followed by Cox regression to determine independent prognostic factors for survival.

Results: Prior to RE, all patients had received systemic therapy, with either stable or progressive disease, but no partial or complete response. In n = 22/73 (30.1%) patients, the primary tumor side was in the right colon; in n = 51/73 (69.9%) patients, in the left colon. Hepatic tumor burden was ≤25% in n = 36/73 (49.3%) patients and >25% in n = 37/73 (50.7%) patients. At 3 months, n = 21 (33.8%) patients showed treatment response (n = 2 [3.2%]; complete response, n = 19 [30.6%]; partial response), n = 13 (21.0%) stable disease, and n = 28 (45.2%) progressive disease after RE. The median survival in case of primary tumor side in the left colon was significantly higher than for primary tumors in the right colon (8.7 vs. 6.0 months, p = 0.033). The median survival for a hepatic tumor burden ≤25% was significantly higher than that of >25% (13.9 vs. 4.3 months, p < 0.001). The median overall survival was 6.1 months.

Conclusion: The median survival after RE in hepatic-mCRC depends on the primary tumor side and the preprocedural hepatic tumor burden.
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http://dx.doi.org/10.1159/000512744DOI Listing
July 2021

Value Improvement by Assessing IR Care via Time-Driven Activity-Based Costing.

J Vasc Interv Radiol 2021 02 31;32(2):262-269. Epub 2020 Oct 31.

Institute of Clinical Radiology, University Hospital Muenster, Muenster, Germany; Klinik und Poliklinik für Radiologie, Klinikum der Universität München, Munich, Germany.

Purpose: To evaluate time-driven activity-based costing (TDABC) in interventional radiology for image-guided vascular malformation treatment as an example.

Materials And Methods: Retrospective analysis was performed on consecutive vascular malformation treatment cycles [67 venous malformations (VMs) and 11 arteriovenous malformations (AVMs)] in a university hospital in 2018. All activities were integrated with a process map, and spent resources were assigned accordingly. TDABC uses 2 parameters: (i) practical capacity cost rate, calculated as 80% of theoretical capacity, and (ii) time consumption of each resource determined by interviews (23 items). Thereby, the total costs were calculated. Treatment cycles were modified according to identified resource waste and TDABC-guided negotiations with health insurance.

Results: Total personnel time required was higher for AVM (1,191 min) than for VM (637 min) treatment. The interventional procedure comprised the major part (46%) of personnel time required in AVM, whereas it comprised 19% in VM treatment. Materials represented the major cost type in AVM (75%) and VM (45%) treatments. TDABC-based treatment process modification led to a decrease in personnel time need of 16% and 30% and a cost reduction of 5.5% and 15.7% for AVM and VM treatments, respectively. TDABC-guided cost reduction and TDABC-informed negotiations improved profit from -56% to +40% and from +41% to +69% for AVM and VM treatments, respectively.

Conclusions: TDABC facilitated the precise costing of interventional radiologic treatment cycles and optimized internal processes, cost reduction, and revenues. Hence, TDABC is a promising tool to determine the denominator of interventional radiology's value.
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http://dx.doi.org/10.1016/j.jvir.2020.09.017DOI Listing
February 2021

CT-Guided Percutaneous Drainage of Pneumoperitoneum Presenting as Acute Abdomen.

J Vasc Interv Radiol 2021 02 28;32(2):271-276. Epub 2020 Oct 28.

Institute of Clinical Radiology, University Hospital Muenster, Muenster, Germany.

Purpose: To evaluate the feasibility and effectiveness of computed tomography (CT)-guided percutaneous drainage (PD) in patients with iatrogenic pneumoperitoneum presenting as acute abdomen.

Materials And Methods: In this retrospective, single-center cohort study, 16 consecutive patients (9 males, 7 females; median age, 67.5 [51-85] years) undergoing PD for managing acute abdomen caused by iatrogenic pneumoperitoneum between 2013 and 2019 were analyzed. Inclusion criteria were clinical signs of acute abdomen that was unresponsive to conservative management and pneumoperitoneum due to an iatrogenic cause after PD, observed using CT imaging. Volumetry of pneumoperitoneum was performed using computer-aided image segmentation. To evaluate the clinical outcome, the paired t-test was performed to analyze the course of pain intensity on the numerical pain rating scale (NPRS, 0-10). Patient records were reviewed to determine PD-related adverse events and median drain duration.

Results: The median pneumoperitoneum volume was 891.1 (127.7-3,677.0) mL. All PD procedures were successfully performed, with symptom relief and immediate abdominal decompression (mean segmental volume reduction, 79.8% ± 13.5). Acute abdomen symptoms were resolved, with significant improvement in pain intensity between the day of the PD procedure and the first day after the procdure (mean NPRS scores, 3.3 ± 1.9 vs 0.8 ± 1.0; P < .001). The median drain duration was 2 (1-3) days. No PD-associated adverse events were observed. After PD, 14 patients required only conservative management, whereas 2 patients with anastomotic leakage required additional surgery as they showed signs of persisting sepsis and generalized peritonitis.

Conclusions: PD is a safe and suitable procedure for the management of symptoms in patients with iatrogenic pneumoperitoneum presenting as acute abdomen.
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http://dx.doi.org/10.1016/j.jvir.2020.09.018DOI Listing
February 2021

Evaluation of 311 contemporary cases of stereotactic biopsies in patients with neoplastic and non-neoplastic lesions-diagnostic yield and management of non-diagnostic cases.

Neurosurg Rev 2021 Oct 20;44(5):2597-2609. Epub 2020 Sep 20.

Department of Neurosurgery, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany.

Stereotactic biopsies are an established tool for obtaining diagnosis of unclear brain lesions. However, non-diagnostic biopsies still occur. We aimed to analyze the contemporary diagnostic yield of stereotactic biopsies, predictors for non-diagnostic biopsies, outcome, and follow-up strategy after non-diagnostic biopsy. We conducted a single-center retrospective study of 311 adult patients undergoing stereotactic biopsies due to a newly diagnosed lesion at our department between 2012 and 2018. Patient data regarding comorbidities, presenting symptoms, imaging features, and non-invasive diagnostic procedures were obtained. The overall diagnostic yield was 86.2% and differed significantly between the various suspected diagnosis groups and was the highest when suspecting primary brain tumor compared with non-neoplastic lesions (91.2% vs. 73.3%, p > 0.001). Predicators for non-diagnostic biopsies were small lesion size, lack of contrast-enhancement, presence of sepsis, or underlying hemato-oncological disease. In case of non-diagnostic biopsy, a re-biopsy was performed in 12 cases, revealing a final diagnosis in 75%. In 16 cases, empiric therapy was started based on the suspected underlying disease. Close follow-up was performed in the remaining 15 cases. We showed that stereotactic biopsy is a safe procedure with reasonable diagnostic yield even for non-neoplastic lesions, when non-invasive diagnostic was inconclusive. In addition, we developed treatment recommendations for cases of non-diagnostic biopsies.
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http://dx.doi.org/10.1007/s10143-020-01394-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8490258PMC
October 2021

Tracking of Tumor Cell-Derived Extracellular Vesicles In Vivo Reveals a Specific Distribution Pattern with Consecutive Biological Effects on Target Sites of Metastasis.

Mol Imaging Biol 2020 12 31;22(6):1501-1510. Epub 2020 Jul 31.

Institute of Clinical Radiology, University Hospital Münster, Münster, Germany.

Purpose: Extracellular vesicles, small vesicles carrying inter alia proteins, miRNA and RNA, are important mediators of intercellular communication. The purpose of this study was to assess the distribution of extracellular vesicles from highly malignant breast cancer and their subsequent effect on the immune cell infiltrate in target organs of metastasis.

Procedures: Extracellular vesicles were isolated from the tissue culture supernatant of highly malignant 4T1 breast cancer cells or the serum of healthy BALB/c mice. The purity of the isolate was verified by electron microscopy and western blotting. Extracellular vesicles were additionally subjected to proteome analysis. After labeling with the fluorescent dye DiR, extracellular vesicles were injected into healthy BALB/c mice and their in vivo distribution was assessed using fluorescence reflectance imaging (FRI). Following ex vivo imaging of the organs, lung tissue samples were analyzed for extracellular vesicle-mediated changes of myeloid cells and T cell numbers, using flow cytometry. Proteome analysis revealed major differences in the cargo of tumor cell-derived versus extracellular vesicles from healthy serum.

Results: In contrast to control extracellular vesicles, DiR-labeled extracellular vesicles from tumor cells preferentially accumulated in lung, liver, and spine. Subsequent flow cytometry of the immune cell composition of lung tissue samples revealed an increase of cytotoxic CD8+ T cells and a decrease of CD4+ T-helper cells as well as an increase in mature macrophages in response to tumor cell EV.

Conclusions: In conclusion, distribution of tumor cell-derived extracellular vesicles follows a specific pattern and can be monitored, using dedicated imaging. Extracellular vesicles alter the immune cell composition in target organs of metastasis, using a specific proteome cargo.
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http://dx.doi.org/10.1007/s11307-020-01521-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7666295PMC
December 2020

Soft ultrasound priors in optoacoustic reconstruction: Improving clinical vascular imaging.

Photoacoustics 2020 Sep 10;19:100172. Epub 2020 Mar 10.

Institute of Biological and Medical Imaging (IBMI), Helmholtz Zentrum München, Ingolstädter Landstr. 1, D-85764, Neuherberg, Germany.

Using the same ultrasound detector, hybrid optoacoustic-ultrasound (OPUS) imaging provides concurrent scans of tissue slices or volumes and visualizes complementary sound- and light-based contrast at similar resolutions. In addition to the benefit of hybrid contrast, spatial co-registration enables images from one modality to be employed as prior information for improving an aspect of the performance of the other modality. We consider herein a handheld OPUS system and utilize structural information from ultrasound images to guide regional Laplacian regularization-based reconstruction of optoacoustic images. Using phantoms and data from OPUS scans of human radial and carotid arteries, we show that ultrasound-driven optoacoustic inversion reduces limited-view artefacts and improves image contrast. In phantoms, prior-integrated reconstruction leads to a 50 % higher contrast-to-noise ratio (CNR) of the image than standard reconstruction, and a 17 % higher structural similarity (SSIM) index. In clinical data, prior-integrated reconstruction detects deep-seated radial arteries with higher CNR than the standard method at three different depths. In this way, the prior-integrated method offers unique insights into atherosclerotic carotid plaques in humans (with p<0.01 between patients and healthy volunteers), potentially paving the way for new abilities in vascular imaging and more generally in optoacoustic imaging.
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http://dx.doi.org/10.1016/j.pacs.2020.100172DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7139114PMC
September 2020

TIPS Modification in the Management of Shunt-Induced Hepatic Encephalopathy: Analysis of Predictive Factors and Outcome with Shunt Modification.

J Clin Med 2020 Feb 19;9(2). Epub 2020 Feb 19.

Institute of Clinical Radiology, University Hospital Muenster, D-48149 Muenster, Germany.

Purpose: To evaluate predictive parameters for the development of Hepatic Encephalopathy (HE) after Transjugular Intrahepatic Portosystemic Shunt (TIPS) placement and for success of shunt modification in the management of shunt-induced HE.

Methods: A retrospective analysis of all patients with TIPS ( = 344) has been performed since 2011 in our university liver center. = 45 patients with HE after TIPS were compared to = 48 patients without HE after TIPS (case-control-matching). Of = 45 patients with TIPS-induced HE, = 20 patients received a reduction stent ( = 18) or TIPS occlusion ( = 2) and were differentiated into responders (improvement by at least one HE grade according to the West Haven classification) and non-responders (no improvement).

Results: Older patient age, increased serum creatinine and elevated International Normalized Ratio (INR) immediately after TIPS placement were independent predictors for the development of HE. In 11/20 patients (responders, 55%) undergoing shunt modification, the HE grade was improved compared with nine non-responders (45%), with no relevant recurrence of refractory ascites or variceal bleeding. A high HE grade after TIPS insertion was the only positive predictor of treatment response ( = 0.019). A total of 10/11 responders (91%) survived the 6 months follow-up after modification but only 6/9 non-responders (67%) survived.

Discussion: Older patient age as well as an increased serum creatinine and INR after TIPS are potential predictors for the development of HE. TIPS reduction for the treatment of TIPS-induced HE is safe, with particular benefit for patients with pronounced HE.
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http://dx.doi.org/10.3390/jcm9020567DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7073830PMC
February 2020

[Generation Y in surgery-the competition battle for talent in times of talent shortage].

Chirurg 2020 Nov;91(11):955-961

WWU Weiterbildung, Universität Münster, Münster, Deutschland.

Background: Surgical disciplines are fighting with a critical and escalating shortage of recruits. Potential young professionals belong to the Generation Y, a generation that is constantly challenging senior consultants and human resources departments. The aim of this study was the analysis of various measures of personnel acquisition with respect to motivating factors of young medical students.

Material And Methods: A survey was carried out among students of the first and ninth semesters of a medical faculty on individual motivating factors, aspiration for medical specialist training and professional experience gained in surgery.

Results: Results from 179 out of 269 medical students were available for analysis (66.5% response rate). The interest in a specialist training in surgery was high in the first semester of medical school (21%) but dropped noticeably up to the ninth semester (13%, p = 0.23). Medical students in the ninth semester, who favored professional advancement and appreciation over flexible working hours showed a significantly higher interest in a specialist training in surgery (p = 0.022). Surgical experience gained was valued with an average grade of 2+ (1 = best, 6 = worst).

Conclusion: The high fundamental interest in a surgical residency during the beginning of medical studies is a competitive advantage of surgical disciplines; however, the diverse recruiting efforts are mainly aimed at later stages of studies. Timely hands-on courses in the core working area of surgery, the operating theatre, have proven to be particularly successful for the long-term acquisition and retention of junior doctors.
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http://dx.doi.org/10.1007/s00104-020-01138-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7581597PMC
November 2020
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