Publications by authors named "Peter Fries"

63 Publications

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

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

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

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

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

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

Diagnostic Performance of a Lower-dose Contrast-Enhanced 4D Dynamic MR Angiography of the Lower Extremities at 3 T Using Multisegmental Time-Resolved Maximum Intensity Projections.

J Magn Reson Imaging 2021 Apr 7. Epub 2021 Apr 7.

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

Background: For peripheral artery disease (PAD), MR angiography (MRA) is a well-established diagnostic modality providing morphologic and dynamic information comparable to digital subtraction angiography (DSA). However, relatively large amounts of contrast agents are necessary to achieve this.

Purpose: To evaluate the diagnostic accuracy of time-resolved 4D MR-angiography with interleaved stochastic trajectories (TWIST-MRA) by using maximum intensity projections (MIPs) of dynamic images acquired with reduced doses of contrast agent.

Study Type: Retrospective.

Population: Forty adult PAD patients yielding 1088 artery segments.

Field Strength/sequence: A 3.0 T, time-resolved 4D MR-angiography with TWIST-MRA and MIP of dynamic images.

Assessment: DSA was available in 14 patients (256 artery segments) and used as reference standard. Three-segmental MIP reconstructions of TWIST-images after administration of 3 mL of gadolinium-based contrast agent (Gadoteridol/Prohance®, 0.5 M) per anatomical level (pelvis, thighs, and lower legs) yielded 256 artery segments for correlation between MRA and DSA. Three independent observers rated image quality (scale: 1 [nondiagnostic] to 4 [excellent]) and the degree of venous overlay (scale: 0 [none] to 2 [significant]) for all segments. Diagnostic accuracy for the detection of >50% stenosis and artery occlusion was calculated for all observers.

Statistical Tests: Binary classification test (sensitivity, specificity, positive/negative predictive values, diagnostic accuracy). Intraclass correlation coefficients (ICCs), logistic regression analysis with comparison of areas under the receiver-operating-characteristics (ROC) curves (AUCs) with the DeLong method. Bland-Altman-comparison.

Results: High diagnostic performance was achieved for the detection of >50% stenosis (sensitivity 92.9% [84.3-99.9% (95%-CI)] and specificity 98.5% [95.7-99.8% (95%-CI)]) and artery occlusion (sensitivity 93.1% [77.2-99.2% (95%-CI)] and specificity 99.1% [96.9-99.9% (95%-CI)]). Inter-reader agreement was excellent with ICC values ranging from 0.95 to 1.0 for >50% artery stenosis and occlusion. Image quality was good to excellent for both readers (3.41 ± 0.72, 3.33 ± 0.65, and 3.38 ± 0.61 [mean ± SD]) with good correlation between observer ratings (ICC 0.71-0.81). No significant venous overlay was observed (0.06 ± 0.24, 0.23 ± 0.43 and 0.11 ± 0.45 [mean ± SD]).

Data Conclusion: MIPs of dynamic TWIST-MRA offer a promising diagnostic alternative necessitating only reduced amounts (50%) of gadolinium-based contrast agents for the entire runoff vasculature.

Evidence Level: 3 TECHNICAL EFFICACY: Stage 2.
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http://dx.doi.org/10.1002/jmri.27631DOI Listing
April 2021

Safety of Catheter Embolization of Pulmonary Arteriovenous Malformations-Evaluation of Possible Cerebrovascular Embolism after Catheter Embolization of Pulmonary Arteriovenous Malformations in Patients with Hereditary Hemorrhagic Telangiectasia/Osler Disease by Pre- and Post-Interventional DWI.

J Clin Med 2021 Feb 22;10(4). Epub 2021 Feb 22.

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

Background: This paper aimed to prospectively evaluate the safety of embolization therapy of pulmonary arteriovenous malformations (PAVMs) for the detection of cerebral infarctions by pre- and post-interventional MRI. Method One hundred and five patients (male/female = 44/61; mean age 48.6+/-15.8; range 5-86) with pre-diagnosed PAVMs on contrast-enhanced MRA underwent embolization therapy. The number of PAVMs treated in each patient ranged from 1-8 PAVMs. Depending on the size and localization of the feeding arteries, either Nester-Coils or Amplatzer vascular plugs were used for embolization therapy. cMRI was performed immediately before, and at the 4 h and 3-month post-embolization therapy. Detection of peri-interventional cerebral emboli was performed via T2w and DWI sequences using three different b-values, with calculation of ADC maps. Results Embolization did not show any post-/peri-interventional, newly developed ischemic lesions in the brain. Only one patient who underwent re-embolization and was previously treated with tungsten coils that corroded over time showed newly developed, small, diffuse emboli in the post-interventional DWI sequence. This patient already had several episodes of brain emboli before re-treatment due to the corroded coils, and during treatment, when passing the corroded coils, experienced additional small, clinically inconspicuous brain emboli. However, this complication was anticipated but accepted, since the vessel had to be occluded distally. Conclusion Catheter-based embolization of PAVMs is a safe method for treatment and does not result in clinically inconspicuous cerebral ischemia, which was not demonstrated previously.
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http://dx.doi.org/10.3390/jcm10040887DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7926997PMC
February 2021

Robotic Salvage Lymph Node Dissection in Recurrent Prostate Cancer: Lessons Learned from 68 Cases and Implications for Future Clinical Management.

J Urol 2021 Feb 22:101097JU0000000000001697. Epub 2021 Feb 22.

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

Purpose: Salvage lymph node dissection is a rescue treatment for patients with nodal recurrence after radical prostatectomy. Very limited data are available on robotic salvage lymph node dissection. Our purpose was to investigate perioperative and oncological outcomes of robotic salvage lymph node dissection in a large monocentric series.

Materials And Methods: Perioperative data, complications within 30 days after surgery and oncological outcomes as assessed by histology, prostate specific antigen changes, prostate specific antigen nadir after salvage lymph node dissection, and time to further therapy were analyzed. To identify predictive factors for oncological outcome, Kaplan-Meier and Cox-regression analyses were performed. For cases with a mismatch between preoperative positron emission tomography/computed tomography and the number of histologically positive lymph nodes, prostate specific membrane antigen immunohistochemistry was performed on removed lymph nodes.

Results: A total of 68 patients underwent robotic salvage lymph node dissection with a median operation time of 126 minutes, a blood loss of 50 ml, and a length of stay of 4 days. No major complications (>Clavien 3) occurred. Median followup was 12.1 months. Median time to further therapy was 12.4 months, 37% of patients experienced complete biochemical response (prostate specific antigen <0.2 ng/ml) and 11% reached an undetectable prostate specific antigen, which was maintained for >1 year in 3 cases. Lower preoperative prostate specific antigen, longer time between radical prostatectomy and salvage lymph node dissection, preoperative prostate specific membrane antigen positron emission tomography/computed tomography and complete biochemical response after salvage lymph node dissection were significant predictors of longer therapy-free survival (all p <0.005). Prostate specific membrane antigen immunohistochemistry revealed that prostate specific membrane antigen positron emission tomography/computed tomography tends to miss small lymph node metastases <5 mm.

Conclusions: Robotic salvage lymph node dissection is a feasible approach with low perioperative morbidity and delays further systemic therapy in most patients. Prostate specific membrane antigen positron emission tomography/computed tomography detection is mostly limited to tumor foci >5 mm.
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http://dx.doi.org/10.1097/JU.0000000000001697DOI Listing
February 2021

A 71-Year-Old Man With Chest Pain and a Solitary Pulmonary Mass.

Chest 2020 09;158(3):e123-e126

Institute of Medical Microbiology and Hygiene, Saarland University, Homburg/Saar, Germany.

Case Presentation: A 71-year-old man was admitted to our hospital because of diffuse chest pain and a mass on routine chest radiography. He did not report cough, dyspnea, fever, night sweats, or weight loss. His medical history was remarkable for chronic lymphocytic leukemia diagnosed 13 years before presentation, and secondary myelodysplastic syndrome diagnosed 2 years before the onset of the current symptoms. As a curative approach, he had received a matched unrelated stem cell transplantation 16 months earlier, and he had been in complete remission since. He developed chronic graft-vs-host disease, presenting mainly as oral ulceration (grade 1, according to National Institute of Health consensus criteria), which had been treated with oral cyclosporine and extracorporeal photopheresis. The immunosuppression had been tapered 6 months before presentation. Routine medication included co-trimoxazole prophylaxis twice per week. He had no known allergies, and he denied recent travels and sick contacts.
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http://dx.doi.org/10.1016/j.chest.2020.02.083DOI Listing
September 2020

Jejunal obstruction due to rare internal hernia between skeletonized external iliac artery and vein as late complication of laparoscopic hysterectomy with pelvic lymphadenectomy-case report and review of literature.

Arch Gynecol Obstet 2020 11 7;302(5):1075-1080. Epub 2020 Aug 7.

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

Background: Internal herniation of small intestine in the lesser pelvis alongside iliac vasculature is a rare occurrence. Skeletonization of iliac vessels during pelvic lymph node dissection (LND), as part of surgical staging or treatment of patients with uterine, ovarian or urogenital cancer, is a strict prerequisite for orifice formation.

Case Presentation: A 68-year-old woman presented at the emergency department with complaints of constipation for the last 3 days and acute-onset abdominal pain, nausea and vomiting since few hours. She had a history of laparoscopic hysterectomy, bilateral salpingo-oophorectomy and para-aortic and pelvic LND 7 years ago. A distended abdomen with diffuse tenderness on palpation was noted. A CT scan demonstrated bowel obstruction secondary to an incarcerated hernia underneath an elongated right external iliac artery. During an emergency exploratory laparotomy, the incarcerated bowel was reduced and the hernial orifice closed with a running suture. The patient had an uneventful postoperative period and was discharged on the fifth postoperative day.

Discussion: This rare internal hernia can manifest with non-specific symptoms of small bowel obstruction at any given point after index surgery, sometimes even after several years free of complaints. Contrast-enhanced computed tomography is the method of choice for fast and reliable diagnosis and helps in planning the necessary emergency laparotomy.

Conclusion: This life-threatening complication adds to the current controversy of pelvic and para-aortic lymphadenectomy in patients with endometrial cancer. Primary closure of peritoneal defects should be considered to potentially prevent internal hernias, especially when elongated iliac vessels are present.
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http://dx.doi.org/10.1007/s00404-020-05724-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7524845PMC
November 2020

From infancy to adulthood-Developmental changes in pulmonary quantitative computed tomography parameters.

PLoS One 2020 29;15(5):e0233622. Epub 2020 May 29.

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

Purpose: Quantified computed tomography (qCT) is known for correlations with airflow obstruction and fibrotic changes of the lung. However, as qCT studies often focus on diseased and elderly subjects, current literature lacks physiological qCT values during body development. We evaluated chest CT examinations of a healthy cohort, reaching from infancy to adulthood, to determine physiological qCT values and changes during body development.

Method: Dose-optimized chest CT examinations performed over the last 3 years using a dual-source CT were retrospectively analysed. Exclusion criteria were age >30 years and any known or newly diagnosed lung pathology. Lung volume, mean lung density, full-width-at-half-maximum and low attenuated volume (LAV) were semi-automated quantified in 151 patients. qCT values between different age groups as well as unenhanced (Group 1) and contrast-enhanced (Group 2) protocols were compared. Models for projection of age-dependant changes in qCT values were fitted.

Results: Significant differences in qCT parameters were found between the age groups from 0 to 15 years (p < 0.05). All parameters except LAV merge into a plateau level above this age as shown by polynomial models (r2 between 0.85 and 0.67). In group 2, this plateau phase is shifted back around five years. Except for the volume, significant differences in all qCT values were found between group 1 and 2 (p < 0.01).

Conclusion: qCT parameters underly a specific age-dependant dynamic. Except for LAV, qCT parameters reach a plateau around adolescence. Contrast-enhanced protocols seem to shift this plateau backwards.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0233622PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7259551PMC
August 2020

Radiation dose of chaperones during common pediatric computed tomography examinations.

Pediatr Radiol 2020 07 15;50(8):1078-1082. Epub 2020 May 15.

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

Background: One main challenge in pediatric imaging is to reduce motion artifacts by calming young patients. To that end, the Radiological Society of North America (RSNA) as early as 1997 stated the necessity of adults accompanying their child during the child's examination. Nonetheless, current research lacks data regarding radiation dose to these chaperones.

Objective: The aim of this study was to measure the radiation dose of accompanying adults during state-of-the-art pediatric CT protocols.

Materials And Methods: In addition to a 100-kV non-contrast-enhanced chest CT (Protocol 1), we performed a 70-kV contrast-enhanced chest protocol (Protocol 2) using a third-generation dual-source CT. We acquired data on the radiation dose around the scanner using digital dosimetry placed right at the gantry, 1 m away, as well as beside the gantry. We acquired the CT-surrounding radiation dose during scanning of a pediatric phantom as well as 12 pediatric patients.

Results: After conducting 10 consecutive phantom scans using Protocol 1, we found the location with the highest cumulative dose acquired was right next to the gantry opening, at 3 μSv. Protocol 2 showed highest cumulative dose of 2 μSv at the same location. For Protocol 1, the location with the highest radiation doses during pediatric scans was right next to the gantry opening, with doses of 0.75±0.70 μSv. For Protocol 2, the highest radiation was measured 1 m away at 0.50±0.60 μSv. No radiation dose was measured at any time beside the gantry.

Conclusion: Our results provide proof that chaperones receive low radiation doses during state-of-the-art CT examinations. Given knowledge of these values as well as the optimal spots with the lowest radiation doses, parents as well as patients might be more relaxed during the examination.
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http://dx.doi.org/10.1007/s00247-020-04681-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7329757PMC
July 2020

Single Angio-Seal vascular closure device for transfemoral access exceeding 8F.

J Cardiol 2020 08 10;76(2):211-216. Epub 2020 May 10.

Diagnostic and Interventional Radiology, Saarland University Medical Center, Homburg/Saar, Germany. Electronic address:

Background: This was a retrospective single-center evaluation for off-label use of a single Angio-Seal-VIP 8F vascular closure device (VCD) (Terumo Interventional Systems, Somerset, NJ, USA) for retrograde transfemoral arterial access exceeding 8F.

Methods: Between 2010 and 2018, in 32 consecutive patients (3 females; mean age 67±9; range 46-86 years) retrograde femoral access was performed in 48 groins for aortoiliac stent or stent graft implantations using 9-14F sheaths. For vascular closure, one single Angio-Seal™-VIP 8F was used. Procedural success, closure-related complications, and risk factors were retrospectively evaluated using patient characteristics, duplex-ultrasound, and contrast-enhanced computed tomography angiography (CTA). Receiver-operating-characteristics were used for statistical analysis.

Results: Technical success for deployment of VCD was 100%. Visual inspection and duplex-ultrasound confirmed immediate hemostasis in 100%. Postinterventional CTA depicted major vascular access site complications in 6.3% (3/48 groins) requiring surgical treatment. A subgroup of 13 patients underwent surgical cut-down one day after VCD deployment as part of a two-staged complex endovascular aortic aneurysm repair procedure, allowing for visual assessment of prior used undersized Angio-Seal. Patient's height (p=0.028) and severe access site calcifications (p=0.028) proved as predictors for one vessel occlusion and two pseudoaneurysms. Low body-mass-index (BMI) showed a non-significant trend. Sheath-size, common femoral artery depth, or body weight were not indicative for occurrence of complications.

Conclusions: In selected cases, without availability of appropriate VCDs, a single Angio-Seal-VIP 8F served as a feasible option to achieve sufficient hemostasis of transfemoral access exceeding 8F without relevant bleeding complications. Very low BMI, tall body-height, and severe atherosclerosis were identified to predispose to access site complications.
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http://dx.doi.org/10.1016/j.jjcc.2020.02.024DOI Listing
August 2020

Life-threatening arterioureteral fistula treatment by endovascular complete anatomic iliac artery bifurcation reconstruction.

J Vasc Surg Cases Innov Tech 2020 Jun 14;6(2):199-204. Epub 2020 Apr 14.

Clinic for General, Abdominal and Vascular Surgery, Saarland University Medical Center, Homburg/Saar, Germany.

We present an endovascular approach for anatomic reconstruction of the iliac bifurcation in life-threatening arterioureteral fistula without sacrificing the pelvic arterial vascular supply. Five consecutive patients suffering from acute onset of significant gross hematuria caused by iliac-ureteral fistula resulting from previous oncologic surgery and radiation therapy were treated by transfemoral stent graft implantation in a double-barrel technique. Iliac-ureteral pseudoaneurysm coverage succeeded in an iliac neobifurcation with preservation of pelvic perfusion. Follow-up ranging from 9 to 37 months confirmed cessation of hematuria. One patient experienced stent graft thrombosis of the external iliac artery as a result of large cervical cancer invasion treated by crossover bypass. In all other patients, stent grafts were patent.
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http://dx.doi.org/10.1016/j.jvscit.2020.01.012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7160530PMC
June 2020

Benefit of including CT urography in 68Ga-PSMA-11 PET/CT with low-dose CT: first results from a larger prostate cancer cohort analysis.

Q J Nucl Med Mol Imaging 2020 Jan 24. Epub 2020 Jan 24.

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

Background: Accuracy of 68Ga-PSMA-11 PET/CT may be hampered by ureter accumulation, mimicking lymph node metastases depending on localization and configuration. The benefit of CT urography for differentiation of lymph node metastasis from urinary tract activity was evaluated in a "PET/CT with low-dose CT" setting.

Methods: Retrospective analysis of PET/CT for primary staging, biochemical recurrence or local treatment planning in patients with prostate cancer. For CT urography (CTU), iodinated contrast agent was administered 10 minutes prior to image acquisition. All potential pathologic (peri)ureteral tracer uptake were assigned to excretory ureteral accumulation or pathological lesion. To assess additional provided benefit of CTU all foci were rated with an introduced scoring system (ranging from 0 pts: CTU not needed, up to 3 pts: no differentiation possible without CTU). Success of ureter contrasting was assessed by measurement of Hounsfield units. Besides benefit for reading urography-enhanced PET/CT, the possible impact on subsequent patient treatment was evaluated.

Results: A number of n=247 patients were included in this study. By CT urography, it was possible to identify each ureter on low-dose CT, with its major part contrasted. In 120/247 (48.6%) patients, urography increased the diagnostic confidence while providing substantial support for interpretation in 60 (24.3%) cases. In 42 (17.0%) patients, urography was clinically relevant (up-/downstaging) with potential impact on subsequent patient care. In 30 of these 42 cases (12.1% of all), discrepant treatment would have resulted from a misdiagnosed tracer accumulation without urography.

Conclusions: CT urography benefits the interpretation of 68Ga-PSMA-11 PET/CT with low-dose CT and leads to discrepant patient treatment in a small but significant subset of patients (12% in our cohort). The implementation of CT urography into standard protocols of 68Ga-PSMA-11 PET/CT with low-dose CT is recommended.
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http://dx.doi.org/10.23736/S1824-4785.20.03224-0DOI Listing
January 2020

"Simple mechanical devices did not improve pelvis positioning in AP pelvis radiographs for reliable assessment of the acetabular orientation".

J Exp Orthop 2019 May 23;6(1):20. Epub 2019 May 23.

Department of Orthopaedics and Orthopaedic Surgery, Saarland University Medical Center, Kirrberger Straße, Bdg. 37, 66421, Homburg/Saar, Germany.

Background: The aim of this study was to develop two simple positioning devices for anteroposterior pelvis radiographs and to evaluate their effect on accuracy of the radiographs for assessment of the acetabular orientation compared with non-instrumented positioning.

Methods: The superior anterior iliac spines and the pubic symphysis were used as anatomical landmarks to obtain a horizontal orientation of the pelvis according to the anterior pelvic plane. Anteroposterior pelvis radiographs were taken of 11 human cadaveric pelvic bones with each of the positioning devices and without any device. Defined measurements were carried out to objectify the tilt and rotation of the pelvis and to assess the cross-over sign as well as the presence of the ischial spine sign. Computed tomography scans were performed as a standard of reference. Bland-Altman-Plots were used to compare the continuous measurement values and Cohen's Kappa was applied for the categorical data. Intra- and inter-observer reliability was determined by the intraclass correlation coefficient and Cohen's Kappa.

Results: The mean values of the measurements showed a high variability. A low correlation of the measurement values was found between the radiographs of the different positioning methods and the computed tomography scans. The intra- and inter-observer reliability was good (Cohen's Kappa 0.78 and 0.69; intraclass correlation coefficient 0.99 and 0.98).

Conclusion: The use of positioning devices did not lead to more accurate anteroposterior pelvis radiographs compared to non-instrumented positioning. Simple positioning devices do not provide standardized anteroposterior pelvis radiographs for reliable assessment of the acetabular orientation.
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http://dx.doi.org/10.1186/s40634-019-0191-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6533352PMC
May 2019

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

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

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

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

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

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

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

Fleckenstein's hypothesis revisited: excessive myocardial calcification after prolonged high dose catecholamine treatment: a case report.

Eur Heart J Case Rep 2018 Dec 14;2(4):yty126. Epub 2018 Nov 14.

Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Universität des Saarlandes, Kirrberger Str., Geb. 41.1, Homburg/Saar, Germany.

Background: Myocardial calcification after prolonged highly dosed catecholamine treatment has been described experimentally. Here, we demonstrate myocardial calcifications by high-dose catecholamine treatment leading to chronic heart failure in patients.

Case Summary: A 62-year-old Caucasian woman presented with central pulmonary embolism, developing acute heart failure, and cardiogenic shock. Twenty-six days of high-dose norepinephrine treatment had to be administered to maintain circulation. After 74 days of intensive care treatment, the patient fortunately recovered but was readmitted to emergency ward because of dyspnoea and congestion. Computed tomography pulmonary angiography ruled out recurrence of pulmonary embolism, but depicted massive intramural cardiac calcifications, which were not present before treatment. Coronary angiography showed normal coronary arteries, and myocardial biopsy excluded infectious myocarditis. There was no evidence for sarcoidosis, thyroid disease, tuberculosis, or hyperparathyroidism. Oral heart failure treatment was initiated and at the 7 week follow-up the patient remained symptomatic with New York Heart Association functional Class III, while right and left ventricular function had recovered.

Discussion: Prolonged activation of the heart by catecholamines leading to myocardial calcifications has first been examined experimentally by Fleckenstein . Herein, we are able to show, that this can occur in clinical situations. Careful dosing of catecholamines and early use of non-catecholamine-based haemodynamic support is recommended to avoid consecutive impairment of heart function and heart failure.
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http://dx.doi.org/10.1093/ehjcr/yty126DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6426089PMC
December 2018

The first post-cardiac injury syndrome reported following transcatheter aortic valve implantation: a case report.

Eur Heart J Case Rep 2018 Dec 28;2(4):yty107. Epub 2018 Sep 28.

Department for Internal Medicine III, Cardiology, Angiology and Intensive Care Medicine, Saarland University Medical Center, Homburg, Germany.

Background: Post-cardiac injury syndrome is a form of secondary pericarditis with or without pericardial effusion, which typically occurs weeks to months following an injury to the heart or pericardium. Disease activity can be followed with serial testing of inflammatory markers e.g. C-reactive protein (CRP) and/or sedimentation rate, electrocardiogram, and echocardiography.

Case Summary: A 79-year-old woman was admitted with chest pain, dyspnoea at rest, cough, and low degree fever. The patient had undergone transcatheter aortic valve implantation (TAVI) 6 months before admission. Inflammatory markers were increased and a chest X-ray and computed tomography (CT) showed a minimal left pleural effusion. An empirical antibiotic treatment and ibuprofen to control chest pain were started on the presumption of an acute bronchitis. Despite 15 days of different antibiotic protocols the markers of inflammation remained increased. A positron emission tomography with computed tomography and cardiac magnetic resonance imaging showed signs of an aseptic pericarditis. After having excluded any infectious, metabolic, drug-induced or neoplastic genesis we considered the diagnosis of late onset autoimmune-mediated pericarditis. Subsequently, treatment was promptly initiated with colchicine and prednisone. The patient reported clinical improvement in the following days and the CRP value continuously decreased.

Discussion: To the best of our knowledge, this is the first reported case of post-cardiac injury syndrome after TAVI. It should be considered in those patients who have persistent chest pain, fever, fatigue, and elevated inflammatory markers after a TAVI procedure, even though it may occur weeks or months after the intervention. A triple therapy with colchicine, ibuprofen, and low-dosage steroids may be used for persistent symptoms.
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http://dx.doi.org/10.1093/ehjcr/yty107DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6426006PMC
December 2018

Spontaneous mitral annular rupture.

Eur Heart J Case Rep 2018 Sep 4;2(3):yty097. Epub 2018 Sep 4.

Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Kirrberger Str., Geb. 40, Homburg, Saar, Germany.

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http://dx.doi.org/10.1093/ehjcr/yty097DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6177081PMC
September 2018

Percutaneous endovascular tissue sampling of endoluminal tumors using directional atherectomy.

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

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

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

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

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

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

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

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

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

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

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

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

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

A 5-year-old boy with a chronic cough caused by Echinococcus granulosus.

Lancet 2019 01;393(10166):74

Hospital for General Paediatrics and Neonatology, Saarland University, Homburg, Germany.

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http://dx.doi.org/10.1016/S0140-6736(18)32852-6DOI Listing
January 2019

Verlagerung der Vena azygos aus ihrem akzessorischen Lappenspalt nach Resektion eines pulmonalen Rundherdes.

Rofo 2019 Feb 17;191(2):141-143. Epub 2018 Dec 17.

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

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http://dx.doi.org/10.1055/a-0657-4033DOI Listing
February 2019

AGuIX from bench to bedside-Transfer of an ultrasmall theranostic gadolinium-based nanoparticle to clinical medicine.

Br J Radiol 2019 Jan 18;92(1093):20180365. Epub 2018 Sep 18.

Radiotherapy department, CHU de Grenoble, Grenoble cedex 9, France.

AGuIX are sub-5 nm nanoparticles made of a polysiloxane matrix and gadolinium chelates. This nanoparticle has been recently accepted in clinical trials in association with radiotherapy. This review will summarize the principal preclinical results that have led to first in man administration. No evidence of toxicity has been observed during regulatory toxicity tests on two animal species (rodents and monkeys). Biodistributions on different animal models have shown passive uptake in tumours due to enhanced permeability and retention effect combined with renal elimination of the nanoparticles after intravenous administration. High radiosensitizing effect has been observed with different types of irradiations and on a large number of cancer types (brain, lung, melanoma, head and neck…). The review concludes with the second generation of AGuIX nanoparticles and the first preliminary results on human.
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http://dx.doi.org/10.1259/bjr.20180365DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6435081PMC
January 2019

Endovascular Aortic Repair with the Use of Low-Profile Altura and Covera Stent Graft for Accessory Renal Artery Chimney.

J Vasc Interv Radiol 2018 09;29(9):1285-1288

Department of Diagnostic and Interventional Radiology, Saarland University Medical Center, Kirrberger Straße, Geb. 50.1, 66421 Homburg, Germany.

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http://dx.doi.org/10.1016/j.jvir.2018.02.015DOI Listing
September 2018

Multiple treatment approaches following incomplete endovascular closure of abdominal aneurysm rupture-related aortocaval fistula.

EuroIntervention 2018 Sep;14(7):836-837

Department of Diagnostic and Interventional Radiology, Saarland University Medical Center, 66421 Homburg, Germany.

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http://dx.doi.org/10.4244/EIJ-D-18-00165DOI Listing
September 2018

Cardiac Computed Tomography as an Imaging Modality in Coronary Anomalies.

Ann Thorac Surg 2018 Jan;105(1):e15-e17

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

Coronary artery fistulae and coronary aneurysms are rare anomalies. When they become symptomatic, they require precise anatomic information to allow for planning of the therapeutic procedure. We report a case in which both fistulae and aneurysm were present. The required information could only be obtained by electrocardiogram-gated computed tomography with reformation. This imaging modality should be considered in every case of fistula or coronary aneurysm.
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http://dx.doi.org/10.1016/j.athoracsur.2017.08.035DOI Listing
January 2018

Magnetic Resonance Lymphography at 9.4 T Using a Gadolinium-Based Nanoparticle in Rats: Investigations in Healthy Animals and in a Hindlimb Lymphedema Model.

Invest Radiol 2017 12;52(12):725-733

From the *Clinic of Diagnostic and Interventional Radiology, Saarland University Medical Center, Homburg/Saar, Germany; †Institute for Clinical and Experimental Surgery, Saarland University, Homburg/Saar, Germany; ‡Institut Lumière Matière, Université Claude Bernard Lyon 1, CNRS, Lyon, France; §Department of Radiotherapy and Radiation Oncology, Saarland University Medical Center, Homburg/Saar, Germany; and ∥Division of Plastic Surgery and Hand Surgery, University Hospital Zürich, University of Zürich, Zürich, Switzerland.

Objectives: Magnetic resonance lymphography (MRL) in small animals is a promising but challenging tool in preclinical lymphatic research. In this study, we compared the gadolinium (Gd)-based nanoparticle AGuIX with Gd-DOTA for interstitial MRL in healthy rats and in a chronic rat hindlimb lymphedema model.

Materials And Methods: A comparative study with AGuIX and Gd-DOTA for interstitial MRL was performed in healthy Lewis rats (n = 6). For this purpose, 75 μL of 3 mM AGuIX (containing 30 mM Gd-DOTA side residues) and 75 μL 30 mM Gd-DOTA were injected simultaneously in the right and left hindlimbs. Repetitive high-resolution, 3-dimensional time-of-flight gradient recalled echo MRL sequences were acquired over a period of 90 minutes using a 9.4 T animal scanner. Gadofosveset-enhanced MR angiography and surgical dissection after methylene blue injection served as supportive imaging techniques. In a subsequent proof-of-principle study, AGuIX-based MRL was investigated in a hindlimb model of chronic lymphedema (n = 4). Lymphedema of the right hindlimbs was induced by means of popliteal and inguinal lymphadenectomy and irradiation with 20 Gy. The nonoperated left hindlimbs served as intraindividual controls. Six, 10, and 14 weeks after lymphadenectomy, MRL investigations were performed to objectify lymphatic reorganization. Finally, skin samples of the lymphedematous and the contralateral control hindlimbs were analyzed by means of histology and immunohistochemistry.

Results: AGuIX-based MRL resulted in high-resolution anatomical depiction of the rodent hindlimb lymphatic system. Signal-to-noise ratio and contrast-to-noise ratio of the popliteal lymph node were increased directly after injection and remained significantly elevated for up to 90 minutes after application. AGuIX provided significantly higher and prolonged signal intensity enhancement as compared with Gd-DOTA. Furthermore, AGuIX-based MRL demonstrated lymphatic regeneration in the histopathologically verified chronic lymphedema model. Collateral lymphatic vessels were detectable 6 weeks after lymphadenectomy.

Conclusions: This study demonstrates that AGuIX is a suitable contrast agent for preclinical interstitial MRL in rodents. AGuIX yields anatomical imaging of lymphatic vessels with diameters greater than 200 μm. Moreover, it resides in the lymphatic system for a prolonged time. AGuIX may therefore facilitate high-resolution MRL-based analyses of the lymphatic system in rodents.
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http://dx.doi.org/10.1097/RLI.0000000000000398DOI Listing
December 2017

Three-dimensional ultrashort echo time MRI and Short T images generated from subtraction for determination of tumor burden in lung cancer: Preclinical investigation in transgenic mice.

Magn Reson Med 2018 02 11;79(2):1052-1060. Epub 2017 May 11.

Department of Internal Medicine V-Pulmonology, Allergology, and Respiratory Critical Care Medicine, Saarland University Hospital, Homburg, Germany.

Purpose: To investigate the potential of 3D ultrashort echo time MRI and short T images generated by subtraction for determination of total tumor burden in lung cancer.

Methods: As an animal model of spontaneously developing non-small cell lung cancer, the K-rasLA1 transgenic mouse was used. Three-dimensional MR imaging was performed with radial k-space acquisition and echo times of 20 µs and 1 ms. For investigation of the short T component in the recorded signal, subtraction images were generated from these data sets and used for consensus identification of tumors. Next, manual segmentation was performed on all MR images by two independent investigators. MRI data were compared with the results from histologic investigations and among the investigators.

Results: Tumor number and total tumor burden from imaging experiments correlated strongly with the results of histologic investigations. Intra- and interuser comparison showed highest correlations between the individual measurements for ultra-short TE MRI.

Conclusions: Three-dimensional MRI protocols facilitate accurate tumor identification in mice harboring lung tumors. Ultrashort TE MRI is the superior imaging strategy when investigating lung tumors of miscellaneous size with 3D MR imaging strategies. Magn Reson Med 79:1052-1060, 2018. © 2017 International Society for Magnetic Resonance in Medicine.
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http://dx.doi.org/10.1002/mrm.26741DOI Listing
February 2018

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

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

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

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

Automated oscillometric blood pressure and pulse-wave acquisition for evaluation of vascular stiffness in atherosclerosis.

Clin Res Cardiol 2017 Jul 6;106(7):514-524. Epub 2017 Feb 6.

Clinic of Diagnostic and Interventional Radiology, Saarland University Medical Center, Kirrberger Straße, Geb. 50.1, 66421, Homburg/saar, Germany.

Objective: Evaluation of diagnostic accuracy of an oscillometry-based device (VascAssist) combining fully automated ankle-brachial index (ABI) and pulse-wave velocity (PWV) assessment for detection of peripheral arterial disease (PAD).

Subjects And Methods: 110 consecutive subjects including symptomatic PAD patients (n = 41) and healthy PAD-free participants (n = 69) were recruited. All subjects underwent standard manual Doppler-based ABI (sABI) and oscillometry-based automated ABI (aABI) measurements (VascAssist). Oscillometry by the VascAssist included central and peripheral PWV assessment. Additionally, arterial stiffness (AS) was evaluated by flow-mediated vasodilation (FMD) of the brachial artery in all patients. All symptomatic PAD patients underwent catheter angiography for endovascular intervention and post-interventional acquisition of sABI, aABI, PWV and FMD.

Results: Sensitivity, specificity, PPV and NPV of aABI for detecting PAD was 73%, 100%, 100%, and 86% as compared to 80%, 96%, 92%, and 89% for sABI. Pearson-correlation for diabetics was r = 0.81; (P < .001) and for non-diabetics r = 0.77; (P < .001). Bland-Altman-analysis revealed a difference (95% CI) for diabetics of 0.09 (-0.22-0.4] and non-diabetics 0.022 [-0.25-0.295]. Weak correlation exists for FMD/AS analysis (pre-interventional R = 0.386, P = .043; post-interventional R = -0.06; P = .76) and significant increase of pre-/post-interventional PWV analysis (P < .001).

Conclusion: Combined automatic ABI and PWV acquisition with the VascAssist device showed excellent diagnostic accuracy for detection of PAD. Compared to FMD, AS analysis may serve as an investigator-independent (screening) tool for determination of functional vascular damage in atherosclerosis.
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http://dx.doi.org/10.1007/s00392-017-1080-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5486635PMC
July 2017

Thrombosis of TAVI prosthesis-cause for concern or innocent bystander? A comment and review of currently available data.

Clin Res Cardiol 2017 02 19;106(2):79-84. Epub 2016 Dec 19.

Klinik für Innere Medizin III (KardiologieAngiologieInternistische Intensivmedizin), Universitätsklinikum des Saarlandes, 66421, Homburg/Saar, Germany.

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http://dx.doi.org/10.1007/s00392-016-1061-2DOI Listing
February 2017