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PURPOSE: Diagnosing myocarditis relies on multimodal data including magnetic resonance imaging (MRI), clinical symptoms, and blood values. The correct interpretation and integration of MRI findings requires radiological expertise and knowledge. We aimed to investigate the performance of Generative Pre-trained Transformer 4 (GPT-4), a large language model, for report-based medical decision-making in the context of cardiac MRI for suspected myocarditis. METHODS: This retrospective study includes MRI reports from 396 patients with suspected myocarditis and eight centers, respectively. MRI reports and patient data including blood values, age, and further clinical information were provided to GPT-4 and to radiologists with 1 (Resident 1), 2 (Resident 2), and 4 years (Resident 3) of experience in cardiovascular MRI and knowledge of the 2018 Lake Louise Criteria. The final impression of the report regarding the radiological assessment of whether myocarditis is present or not was not provided. The performance of GPT-4 and of the human readers were compared to a consensus reading (two board-certified radiologists with 8 and 10 years of experience in cardiovascular MRI). Sensitivity, specificity, and accuracy were calculated. RESULTS: GPT-4 yielded an accuracy of 83%, sensitivity of 90%, and specificity of 78%, which was comparable to the physician with 1 year of experience (R1: 86%, 90%, 84%, p=.14) and lower than that of more experienced physicians (R2: 89%, 86%, 91%, p=.007 and R3: 91%, 85%, 96%, p<.001). GPT-4 and human readers showed a higher diagnostic performance when results from T1- and T2-mapping sequences were part of the reports, for Residents 1 and Resident 3 with statistical significance (p=.004 and p=.02, respectively). CONCLUSION: GPT-4 yielded good accuracy for diagnosing myocarditis based on MRI reports in a large dataset from multiple centers and therefore holds the potential to serve as a diagnostic decision supporting tool in this capacity, particularly for less experienced physicians. Further studies are required to explore the full potential and elucidate educational aspects of the integration of large language models in medical decision-making.
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PURPOSE: The prevalent coronavirus disease 2019 (COVID-19) pandemic has spread throughout the world and is considered a serious threat to global health. The prognostic role of thoracic lymphadenopathy in COVID-19 is unclear. The aim of the present meta-analysis was to analyze the prognostic role of thoracic lymphadenopathy for the prediction of 30-day mortality in patients with COVID-19. MATERIALS AND METHODS: The MEDLINE library, Cochrane, and SCOPUS databases were screened for associations between CT-defined features and mortality in COVID-19 patients up to June 2021. In total, 21 studies were included in the present analysis. The quality of the included studies was assessed by the Newcastle-Ottawa Scale. The meta-analysis was performed using RevMan 5.3. Heterogeneity was calculated by means of the inconsistency index I2. DerSimonian and Laird random-effect models with inverse variance weights were performed without any further correction. RESULTS: The included studies comprised 4621 patients. The prevalence of thoracic lymphadenopathy varied between 1â% and 73.4â%. The pooled prevalence was 16.7â%, 95â% CIâ=â(15.6â%; 17.8â%). The hospital mortality was higher in patients with thoracic lymphadenopathy (34.7â%) than in patients without (20.0â%). The pooled odds ratio for the influence of thoracic lymphadenopathy on mortality was 2.13 (95â% CIâ=â[1.80-2.52], pâ<â0.001). CONCLUSION: The prevalence of thoracic lymphadenopathy in COVID-19 is 16.7â%. The presence of thoracic lymphadenopathy is associated with an approximately twofold increase in the risk for hospital mortality in COVID-19. KEY POINTS: · The prevalence of lymphadenopathy in COVID-19 is 16.7â%.. · Patients with lymphadenopathy in COVID-19 have a higher risk of mortality during hospitalization.. · Lymphadenopathy nearly doubles mortality and plays an important prognostic role.. CITATION FORMAT: · Bucher AM, Sieren M, Meinel F etâal. Prevalence and prognostic role of thoracic lymphadenopathy in Covid-19. Fortschr Röntgenstr 2024; DOI: 10.1055/a-2293-8132.
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PURPOSE: Radiological reporting is transitioning to quantitative analysis, requiring large-scale multi-center validation of biomarkers. A major prerequisite and bottleneck for this task is the voxelwise annotation of image data, which is time-consuming for large cohorts. In this study, we propose an iterative training workflow to support and facilitate such segmentation tasks, specifically for high-resolution thoracic CT data. METHODS: Our study included 132 thoracic CT scans from clinical practice, annotated by 13 radiologists. In three iterative training experiments, we aimed to improve and accelerate segmentation of the heart and mediastinum. Each experiment started with manual segmentation of 5-25 CT scans, which served as training data for a nnU-Net. Further iterations incorporated AI pre-segmentation and human correction to improve accuracy, accelerate the annotation process, and reduce human involvement over time. RESULTS: Results showed consistent improvement in AI model quality with each iteration. Resampled datasets improved the Dice similarity coefficients for both the heart (DCS 0.91 [0.88; 0.92]) and the mediastinum (DCS 0.95 [0.94; 0.95]). Our AI models reduced human interaction time by 50 % for heart and 70 % for mediastinum segmentation in the most potent iteration. A model trained on only five datasets achieved satisfactory results (DCS > 0.90). CONCLUSIONS: The iterative training workflow provides an efficient method for training AI-based segmentation models in multi-center studies, improving accuracy over time and simultaneously reducing human intervention. Future work will explore the use of fewer initial datasets and additional pre-processing methods to enhance model quality.
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Tomografía Computarizada por Rayos X , Humanos , Tomografía Computarizada por Rayos X/métodos , Interpretación de Imagen Radiográfica Asistida por Computador/métodos , Radiografía Torácica/métodos , Inteligencia Artificial , Mediastino/diagnóstico por imagen , Corazón/diagnóstico por imagenRESUMEN
Purpose: Magnetic particle imaging (MPI) is an emerging medical imaging modality that is on the verge of clinical use. In recent years, cardiovascular applications have shown huge potential like, e.g., intraprocedural imaging guidance of stent placement through MPI. Due to the lack of signal generation, nano-modifications have been necessary to visualize commercial medical instruments until now. In this work, it is investigated if commercial interventional devices can be tracked with MPI without any nano-modification. Material and Methods: Potential MPI signal generation of nine endovascular metal stents was tested in a commercial MPI scanner. Two of the stents revealed sufficient MPI signal. Because one of the two stents showed relevant heating, the imaging experiments were carried out with a single stent model (Boston Scientific/Wallstent-Uni Endoprothesis, diameter: 16 mm, length: 60 mm). The nitinol stent and its delivery system were investigated in seven different scenarios. Therefore, the samples were placed at 49 defined spatial positions by a robot in a meandering pattern during MPI scans. Image reconstruction was performed, and the mean absolute errors (MAE) between the signals' centers of mass (COM) and ground truth positions were calculated. The stent material was investigated by magnetic particle spectroscopy (MPS) and vibrating sample magnetometry (VSM). To detect metallic components within the delivery system, nondestructive testing via computed tomography was performed. Results: The tracking of the stent and its delivery system was possible without any nano-modification. The MAE of the COM were 1.49 mm for the stent mounted on the delivery system, 3.70 mm for the expanded stent and 1.46 mm for the delivery system without the stent. The results of the MPS and VSM measurements indicate that besides material properties eddy currents seem to be responsible for signal generation. Conclusion: It is possible to image medical instruments with dedicated designs without modifications by means of MPI. This enables a variety of applications without compromising the mechanical and biocompatible properties of the instruments.
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Stents , Tomografía Computarizada por Rayos X , Procesamiento de Imagen Asistido por Computador/métodos , Magnetismo , Fenómenos MagnéticosRESUMEN
RATIONALE: To provide an overview of the current status of cardiac multimodality imaging practices in Europe and radiologist involvement using data from the European Society of Cardiovascular Radiology (ESCR) MRCT-registry. MATERIALS AND METHODS: Numbers on cardiac CT and MRI examinations were extracted from the MRCT-registry of the ESCR, entered between January 2011 and October 2023 (n = 432,265). Data collection included the total/annual numbers of examinations, indications, complications, and reporting habits. RESULTS: Thirty-two countries contributed to the MRCT-registry, including 29 European countries. Between 2011 and 2022, there was a 4.5-fold increase in annually submitted CT examinations, from 3368 to 15,267, and a 3.8-fold increase in MRI examinations, from 3445 to 13,183. The main indications for cardiac CT were suspected coronary artery disease (CAD) (59%) and transcatheter aortic valve replacement planning (21%). The number of patients with intermediate pretest probability who underwent CT for suspected CAD showed an increase from 61% in 2012 to 82% in 2022. The main MRI indications were suspected myocarditis (26%), CAD (21%), and suspected cardiomyopathy (19%). Adverse event rates were very low for CT (0.3%) and MRI (0.7%) examinations. Reporting of CT and MRI examinations was performed mainly by radiologists (respectively 76% and 71%) and, to a lesser degree, in consensus with non-radiologists (19% and 27%, respectively). The remaining examinations (4.9% CT and 1.7% MRI) were reported by non-radiological specialties or in separate readings of radiologists and non-radiologists. CONCLUSIONS: Real-life data on cardiac imaging in Europe using the largest available MRCT-registry demonstrate a considerable increase in examinations over the past years, the vast majority of which are read by radiologists. These findings indicate that radiologists contribute to meeting the increasing demands of competent and effective care in cardiac imaging to a relevant extent. CLINICAL RELEVANCE STATEMENT: The number of cardiac CT and MRI examinations has risen over the past years, and radiologists read the vast majority of these studies as recorded in the MRCT-registry. KEY POINTS: ⢠The number of cardiac imaging examinations is constantly increasing. ⢠Radiologists play a central role in providing cardiac CT and MR imaging services to a large volume of patients. ⢠Cardiac CT and MR imaging examinations performed and read by radiologists show a good safety profile.
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BACKGROUND: Persistent left superior vena cava (PLSVC) is a rare venous anomaly, affecting 0.3-0.5% of the general population. Cardiac resynchronization therapy (CRT) implantation in patients with PLSVC is challenging due to a complex anatomy. Moreover, data on CRT implantation in this patient population is scarce. Our aim was to report a series of patients with PLSVC and CRT implantation focusing on challenges and pitfalls. METHODS: Electronic medical databases on patients with CRT implantation at the University Heart Centers in Zurich, Switzerland, and Lübeck, Germany, were screened for individuals with a PLSVC. Clinical and demographic characteristics as well as procedural data were reported in all patients. RESULTS: This study presents six cases with a median age of 66 years. CRT implantation was successful in five patients, leading to a reduced QRS duration and improved left ventricular ejection fraction. Atrial fibrillation, ischemic cardiomyopathy, valvular heart disease, and dilated cardiomyopathy were observed in this group as underlying conditions. Specialized tools, such as active fixation left ventricular leads, were utilized. One patient experienced major complications. CONCLUSIONS: This case series shows that although challenging, conventional endovascular CRT implantation is feasible in PLSVC patients. Specialized tools for visualization and fixation may help. Our experiences highlight the importance of preprocedural evaluation of the anatomy and precise intervention planning.
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Multiple myeloma (MM) frequently induces persisting osteolytic manifestations despite hematologic treatment response. This study aimed to establish a biometrically valid study endpoint for bone remineralization through quantitative and qualitative analyses in sequential CT scans. Twenty patients (seven women, 58 ± 8 years) with newly diagnosed MM received standardized induction therapy comprising the anti-SLAMF7 antibody elotuzumab, carfilzomib, lenalidomide, and dexamethasone (E-KRd). All patients underwent whole-body low-dose CT scans before and after six cycles of E-KRd. Two radiologists independently recorded osteolytic lesion sizes, as well as the presence of cortical destruction, pathologic fractures, rim and trabecular sclerosis. Bland-Altman analyses and Krippendorff's α were employed to assess inter-reader reliability, which was high for lesion size measurement (standard error 1.2 mm) and all qualitative criteria assessed (α ≥ 0.74). After six cycles of E-KRd induction, osteolytic lesion size decreased by 22% (p < 0.001). While lesion size response did not correlate with the initial lesion size at baseline imaging (Pearson's r = 0.144), logistic regression analysis revealed that the majority of responding osteolyses exhibited trabecular sclerosis (p < 0.001). The sum of osteolytic lesion sizes on sequential CT scans defines a reliable study endpoint to characterize bone remineralization. Patient level response is strongly associated with the presence of trabecular sclerosis.
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PURPOSE: The purpose of this study was to assess the efficacy of transarterial embolization in COVID-19 patients with an arterial bleeding and to investigate differences between various patient groups concerning survival. METHOD: We retrospectively reviewed COVID-19 patients undergoing transarterial embolization due to an arterial bleeding in a multicenter study from April 2020 to July 2022 and analyzed the technical success of embolization and survival rate. 30-day survival between various patient groups was analyzed. The Chi- square test and Fisher's exact test were used for testing association between the categorical variables. RESULTS: 53 COVID-19 patients (age: 57.3 ± 14.3 years, 37 male) received 66 angiographies due to an arterial bleeding. The initial embolization was technically successful in 98.1% (52/53). In 20.8% (11/53) of patients, additional embolization was necessary due to a new arterial bleeding. A majority of 58.5% (31/53) had a severe course of COVID-19 infection necessitating ECMO-therapy and 86.8% (46/53) of patients received anticoagulation. 30-day survival rate in patients with ECMO-therapy was significantly lower than without ECMO-therapy (45.2% vs. 86.4%, p = 0.004). Patients with anticoagulation did not have a lower 30-day survival rate than without anticoagulation (58.7% vs. 85.7%, p = 0.23). COVID-19 patients with ECMO-therapy developed more frequently a re-bleeding after embolization than non-ECMO-patients (32.3% vs. 4.5%, p = 0.02). CONCLUSIONS: Transarterial embolization is a feasible, safe, and effective procedure in COVID-19 patients with arterial bleeding. ECMO-patients have a lower 30-day survival rate than non-ECMO-patients and have an increased risk for re-bleeding. Treatment with anticoagulation could not be identified as a risk factor for higher mortality.
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COVID-19 , Embolización Terapéutica , Adulto , Anciano , Humanos , Masculino , Persona de Mediana Edad , Anticoagulantes/uso terapéutico , COVID-19/complicaciones , COVID-19/terapia , Embolización Terapéutica/métodos , Hemorragia/diagnóstico por imagen , Hemorragia/terapia , Hemorragia/etiología , Estudios Retrospectivos , Resultado del Tratamiento , FemeninoRESUMEN
Background Aneurysmal rupture in the aortoiliac segment is a severe, life-threatening condition. Nowadays, in addition to surgical treatment, the implantation of a covered stent graft constitutes a feasible, minimally invasive treatment option. A novel approach is the add-on of transarterial aneurysm sac embolization with N-butyl-cyanoacrylate (NBCA). Here, we report our experience of performing this add-on embolization procedure after endovascular aneurysm repair for complex ruptured aneurysms of the aortoiliac segment. Material and Methods We describe six patients (mean age of 75.2 years; all male) with ruptured aneurysms in the visceral aortic and aortoiliac segment in whom a high-volume transarterial aneurysm sac embolization was performed as an add-on therapy to the implantation of an aortic prosthesis. The aim of this add-on intervention was to achieve the definite embolization of the aneurysmal rupture site and to ensure the best possible aneurysmal sealing. We report the feasibility, technical success, and considerations of using NBCA as well as clinical and follow-up imaging results, given their availability. Results Technical success was achieved in all cases. Clinical success was achieved in four cases. No periprocedural complications or reinterventions were reported. The mean full procedure time was 107.8 min. The mean radiation dose was 12,966.1 cGy/cm2. A mean amount of 10.7 mL of NBCA mixed with lipiodol in a 1:3 to 1:5 ratio was used for all patients. Available follow-up imaging up to 36 months after the procedure showed no aneurysm progression or endoleaks. In two patients, the NBCA cast had almost fully dissolved over the course of follow-up. Conclusions Our study underscores the notion that aneurysm sac embolization using high volumes of NBCA with ethiodized oil as an embolic agent is a feasible and add-on treatment option for optimizing the exclusion of the aneurysm from patients with ruptured aneurysms in the aortoiliac segment.
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OBJECTIVES: To evaluate work expectations of radiologists at different career levels, their fulfillment, prevalence of exhaustion, and exhaustion-associated factors. METHODS: A standardized digital questionnaire was distributed internationally to radiologists of all career levels in the hospital and in ambulatory care via radiological societies and sent manually to 4500 radiologists of the largest German hospitals between December 2020 and April 2021. Statistics were based on age- and gender-adjusted regression analyses of respondents working in Germany (510 out of 594 total respondents). RESULTS: The most frequent expectations were "joy at work" (97%) and a "good working atmosphere" (97%), which were considered fulfilled by at least 78%. The expectation of a "structured residency within the regular time interval" (79%) was more frequently judged fulfilled by senior physicians (83%, odds ratio (OR) 4.31 [95% confidence interval (95% CI) 1.95-9.52]), chief physicians (85%, 6.81 [95% CI 1.91-24.29]), and radiologists outside the hospital (88%, 7.59 [95% CI 2.40-24.03]) than by residents (68%). Exhaustion was most common among residents (physical exhaustion: 38%; emotional exhaustion: 36%), in-hospital specialists (29%; 38%), and senior physicians (30%; 29%). In contrast to paid extra hours, unpaid extra hours were associated with physical exhaustion (5-10 extra hours: OR 2.54 [95% CI 1.54-4.19]). Fewer opportunities to shape the work environment were related to a higher probability of physical (2.03 [95% CI 1.32-3.13]) and emotional (2.15 [95% CI 1.39-3.33]) exhaustion. CONCLUSIONS: While most radiologists enjoy their work, residents wish for more training structure. Ensuring payment of extra hours and employee empowerment may help preventing burnout in high-risk groups. KEY POINTS: ⢠Most important work expectations of radiologists who work in Germany are "joy at work," a "good working atmosphere," "support for further qualification," and a "structured residency within the regular time interval," with the latter containing potential for improvement according to residents. ⢠Physical and emotional exhaustion are common at all career levels except for chief physicians and for radiologists who work outside the hospital in ambulatory care. ⢠Exhaustion as a major burnout criterion is associated with unpaid extra hours and reduced opportunities to shape the work environment.
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Agotamiento Profesional , Internado y Residencia , Médicos , Humanos , Motivación , Radiólogos/psicología , Médicos/psicología , Agotamiento Profesional/epidemiología , Agotamiento Profesional/psicología , Encuestas y CuestionariosRESUMEN
BACKGROUND: Different software programs are available for the evaluation of 4D Flow cardiovascular magnetic resonance (CMR). A good agreement of the results between programs is a prerequisite for the acceptance of the method. Therefore, the goal was to compare quantitative results from a cross-over comparison in individuals examined on two scanners of different vendors analyzed with four postprocessing software packages. METHODS: Eight healthy subjects (27 ± 3 years, 3 women) were each examined on two 3T CMR systems (Ingenia, Philips Healthcare; MAGNETOM Skyra, Siemens Healthineers) with a standardized 4D Flow CMR sequence. Six manually placed aortic contours were evaluated with Caas (Pie Medical Imaging, SW-A), cvi42 (Circle Cardiovascular Imaging, SW-B), GTFlow (GyroTools, SW-C), and MevisFlow (Fraunhofer Institute MEVIS, SW-D) to analyze seven clinically used parameters including stroke volume, peak flow, peak velocity, and area as well as typically scientifically used wall shear stress values. Statistical analysis of inter- and intrareader variability, inter-software and inter-scanner comparison included calculation of absolute and relative error (ER), intraclass correlation coefficient (ICC), Bland-Altman analysis, and equivalence testing based on the assumption that inter-software differences needed to be within 80% of the range of intrareader differences. RESULTS: SW-A and SW-C were the only software programs showing agreement for stroke volume (ICC = 0.96; ER = 3 ± 8%), peak flow (ICC: 0.97; ER = -1 ± 7%), and area (ICC = 0.81; ER = 2 ± 22%). Results from SW-A/D and SW-C/D were equivalent only for area and peak flow. Other software pairs did not yield equivalent results for routinely used clinical parameters. Especially peak maximum velocity yielded poor agreement (ICC ≤ 0.4) between all software packages except SW-A/D that showed good agreement (ICC = 0.80). Inter- and intrareader consistency for clinically used parameters was best for SW-A and SW-D (ICC = 0.56-97) and worst for SW-B (ICC = -0.01-0.71). Of note, inter-scanner differences per individual tended to be smaller than inter-software differences. CONCLUSIONS: Of all tested software programs, only SW-A and SW-C can be used equivalently for determination of stroke volume, peak flow, and vessel area. Irrespective of the applied software and scanner, high intra- and interreader variability for all parameters have to be taken into account before introducing 4D Flow CMR in clinical routine. Especially in multicenter clinical trials a single image evaluation software should be applied.
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Imagen por Resonancia Magnética , Programas Informáticos , Humanos , Femenino , Reproducibilidad de los Resultados , Valor Predictivo de las Pruebas , AortaRESUMEN
Medical ultrasound (US) is a commonly used modality for image-guided procedures. Recent research systems providing an in situ visualization of 2D US images via an augmented reality (AR) head-mounted display (HMD) were shown to be advantageous over conventional imaging through reduced task completion times and improved accuracy. In this work, we continue in the direction of recent developments by describing the first AR HMD application visualizing real-time volumetric (3D) US in situ for guiding vascular punctures. We evaluated the application on a technical level as well as in a mixed-methods user study with a qualitative prestudy and a quantitative main study, simulating a vascular puncture. Participants completed the puncture task significantly faster when using 3D US AR mode compared to 2D US AR, with a decrease of 28.4% in time. However, no significant differences were observed regarding the success rate of vascular puncture (2D US AR-50% vs. 3D US AR-72%). On the technical side, the system offers a low latency of 49.90 ± 12.92 ms and a satisfactory frame rate of 60 Hz. Our work shows the feasibility of a system that visualizes real-time 3D US data via an AR HMD, and our experiments show, furthermore, that this may offer additional benefits in US-guided tasks (i.e., reduced task completion time) over 2D US images viewed in AR by offering a vividly volumetric visualization.
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Realidad Aumentada , Gafas Inteligentes , Humanos , Punciones , UltrasonografíaRESUMEN
This position paper is a joint statement of the German Radiological Society (DRG) and the Professional Association of German Radiologists (BDR), which reflects the current state of knowledge about coronary computed tomography. It is based on preclinical and clinical studies that have investigated the clinical relevance as well as the technical requirements and fundamentals of cardiac computed tomography. CITATION FORMAT: · Langenbach MC, Sandstede J, Sieren M etâal. DRG and BDR Position Paper on Coronary CT: Clinical Evidence and Quality of Patient Care in Chronic Coronary Syndrome. Fortschr Röntgenstr 2023; 195: 115â-â133.
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Radiología , Tomografía Computarizada por Rayos X , Humanos , Tomografía Computarizada por Rayos X/métodos , Corazón , Radiólogos , Atención al PacienteRESUMEN
PURPOSE: Magnetic particle imaging (MPI) is a tomographic imaging modality with the potential for cardiovascular applications. In this context, the extent to which stents are heated should be estimated from safety perspective. Furthermore, the influence of the measurement parameters and stent distance to the isocenter of the MPI scanner on stent heating were evaluated. MATERIALS AND METHODS: Nine different endovascular stents and stent grafts were tested in polyvinyl-chloride tubes. The stents had diameters from 10 to 31 mm, lengths between 25 and 100 mm and were made from stainless steel, nitinol or cobalt-chromium. The temperature differences were recorded with fiber-optic thermometers. All measurements were performed in a preclinical commercial MPI scanner. The measurement parameters were varied (drive field strengths: 3, 6, 9, 12 mT and selection field gradients: 0, 1.25 and 2.5 T/m). Furthermore, measurements with different distances to the scanner's isocenter were performed (100 to 0 mm). RESULTS: All stents showed heating (maximum 53.1 K, minimum 4.6 K). The stent diameter directly correlated with the temperature increase. The drive field strength influenced the heating of the stents, whereas the selection field gradient had no detectable impact. The heating of the stents decreased with increasing distance from the scanner's isocenter and thus correlated with the loss of the scanner's magnetic field. CONCLUSION: Stents can cause potentially harmful heating in MPI. In addition to the stent diameter and design, the drive field strength and the distance to the MPI scanner's isocenter must be kept in mind as influencing parameters.
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Procedimientos Endovasculares , Calefacción , Stents , Tomografía , Humanos , Fenómenos Magnéticos , Reparación Endovascular de AneurismasRESUMEN
In the guideline updates of the European Society of Cardiology (ESC), noninvasive radiological cross-sectional imaging is taking an increasingly prominent role, while at the same time invasive diagnostic approaches are becoming less important. Especially for the diagnosis and treatment of chronic and acute coronary syndromes, there are fundamental changes in clinical routine. In addition, cross-sectional imaging also offers an alternative to diagnostic algorithms for other cardiac pathologies, especially echocardiography, which is increasingly used in the differential diagnosis of cardiac diseases. The radiologist should be aware of the recommendations of the current guidelines and encourage their establishment in clinical practice. This paper summarizes the indications of cross-sectional cardiac imaging with focus on new recommendations in the ESC guidelines and addresses specific strengths and weaknesses of each modality.
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Enfermedad de la Arteria Coronaria , Corazón , Imagen por Resonancia Magnética , Tomografía Computarizada por Rayos X , Humanos , Cardiología/métodos , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Corazón/diagnóstico por imagen , Imagen por Resonancia Magnética/métodos , Tomografía Computarizada por Rayos X/métodos , Angiografía CoronariaRESUMEN
OBJECTIVE: Thrombectomy of the aortoiliac segment remains a challenge for surgical and endovascular revision. This study aimed to evaluate the concept of percutaneous thrombectomy in patients with aortoiliac segment occlusions. MATERIALS & METHODS: Eighteen patients with aortoiliac occlusion who underwent percutaneous thrombectomy were retrospectively identified using the local picture archive and divided into the stent-graft (N = 10) and native vessels (N = 8) groups. The procedure was performed by placing a 12-24 French sheath adjacent to the distal end of the occluded vessel segment. The occlusion was passed with a balloon catheter which was retracted after inflation, to deliver the thrombus into the sheath. Technical success (reperfusion of the vessel and no residual thrombus/stenosis < 30%), complications and primary arterial patency were assessed. Follow-up included computed tomography angiography and evaluation of the clinical situation via telephone. RESULTS: Technical success was achieved in 38% (7/18) of patients after percutaneous thrombectomy alone and in 100% after additional procedures. The most common complication was peripheral embolism (44%, 8/18), which was treated successfully in all cases and was linked to a mismatch between the sheath and target vessel of ≥ 1 mm (P < .01). There were no significant differences in the incidence of complications between the two groups. Primary patency was 72% (13/18) with no significant difference between groups (P = .94). Follow-up CT scans were available for 13/18 patients (72%), with a mean follow-up time of 270 ± 146 days. All patients were contacted via phone (follow-up time, 653 ± 264 days). CONCLUSION: Percutaneous thrombectomy appears to be effective for revascularization of the aortoiliac segment, both in stent-grafts and in native vessels. The most common complication is peripheral embolism; however, the risk may be reduced by choosing an adequate sheath size.
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Embolia , Trombosis , Humanos , Estudios Retrospectivos , Resultado del Tratamiento , Trombectomía/métodos , StentsRESUMEN
With the increasing need for minimally invasive procedures based on lower complication rates, higher patient acceptance, and technical developments, there is a growing focus on the sound interventional training of young radiologists. This survey aimed to analyze the current situation in interventional radiology (IR) training in Germany to detect shortcomings and identify areas for improvement.From November 1-30, 2020, an online questionnaire was distributed to representative radiological associations and societies with the request to forward it to radiology residents and radiologists <â40 years. The 44 questions covered six distinct areas from personal working conditions to the characterization of the IR department, training conditions, role of women in IR, and attendance at congresses/external training.A total of 330 participants completed the questionnaire. 77â% of participants expressed a high interest in IR, and 47â% could even imagine subspecializing in interventional radiology. Most institutions provided the necessary learning conditions and infrastructure. The rate of overall satisfaction with IR training conditions was 45â% (vs. a dissatisfaction rate of 39â%). However, females showed a lower satisfaction rate with their training environment than male participants (28â% vs. 51â%; Pâ=â0.06). Positive correlations with work satisfaction were found for the presence and duration of the IR rotation, the number of partly independently/mentored performed interventions, and structured feedback. Moreover, the need for a structured training curriculum was expressed by 67â% of participants.Radiological residents and young radiologists expressed a high interest in interventional radiology, and they rate the infrastructure of German hospitals regarding IR as sufficient. However, they expressed the need for consistent IR rotations and better-structured resident and postgraduate education (curricula & interviews).Interest in interventional radiology among radiological residents and young radiologists in Germany is high, but satisfaction with interventional radiology training leaves room for improvement. The most frequently mentioned aspects that can improve IR training were · organized rotations of at least 6 months. · structured curriculums with face-to-face feedback. · structured guidance by senior interventionists during procedures. CITATION FORMAT: · Sieren M, Katoh M, Mahnken AH etâal. Work and Training Conditions of German Residents and Young Radiologists in Interventional Radiology - A Nationwide Survey. Fortschr Röntgenstr 2022; 194: 1346â-â1357.
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Radiólogos , Radiología Intervencionista , Masculino , Femenino , Humanos , Radiología Intervencionista/educación , Alemania , Encuestas y Cuestionarios , CurriculumRESUMEN
The purpose of this work was to develop instrument markers that are visible in both magnetic particle imaging (MPI) and magnetic resonance imaging (MRI). The instrument markers were based on two different magnetic nanoparticle types (synthesized in-house KLB and commercial Bayoxide E8706). Coatings containing one of both particle types were fabricated and measured with a magnetic particle spectrometer (MPS) to estimate their MPI performance. Coatings based on both particle types were then applied on a segment of a nonmetallic guidewire. Imaging experiments were conducted using a commercial, preclinical MPI scanner and a preclinical 1 tesla MRI system. MPI image reconstruction was performed based on system matrices measured with dried KLB and Bayoxide E8706 coatings. The bimodal markers were clearly visible in both methods. They caused circular signal voids in MRI and areas of high signal intensity in MPI. Both the signal voids as well as the areas of high signal intensity were larger than the real marker size. Images that were reconstructed with a Bayoxide E8706 system matrix did not show sufficient MPI signal. Instrument markers with bimodal visibility are essential for the perspective of monitoring cardiovascular interventions with MPI/MRI hybrid systems.
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Osteosarcomas are the most common primary malignant bone tumors and are classified by the WHO into several intramedullary and surface subtypes. One of these is the rare parosteal osteosarcoma. Liposarcomas are the second most common soft tissue sarcoma and are classified into several types ranging from intermediate to high grade tumors. In one of our recent patients we found an unusual combination of a parosteal osteosarcoma and a large fatty component, which fluorescence-in-situ-hybridization revealed as liposarcoma. Radiologists, pathologists, and surgeons should consider the possibility of bone and soft tissue malignancies consisting of different components, as this may be of paramount importance for oncologically complete resection.