An accurate 5D potential energy surface for H3O+-H2 interaction.

Modeling of the observational spectra of H3O+ allows for a detailed understanding of the interstellar oxygen chemistry. While its spectroscopy was intensively studied earlier, our knowledge about the collision of H3O+ with the abundant colliders in the interstellar medium is rather limited. In order to treat these collisional excitation processes, it is first necessary to calculate the potential energy surface (PES) of the interacting species. We have computed the five-dimensional rigid-rotor PES of the H3O+-H2 system from the explicitly correlated coupled-cluster theory at the level of singles and doubles with perturbative corrections for triple excitations [CCSD(T)-F12] with the moderate-size augmented correlation-consistent valence triple zeta (aug-cc-pVTZ) basis set. The well depth of the PES is found to be rather large, about 1887.2 cm-1. The ab initio potential was fitted over an angular expansion in order to effectively use it in quantum scattering codes. As a first application, we computed dissociation energies for the different nuclear spin isomers of the H3O+-H2 complex.

Evaluating One Health: the role of team science in multisectoral collaboration.

In a review of the literature surrounding One Health, cross-boundary collaboration, the science of teams, and interdisciplinary health competencies, many individual disciplines, and in some cases multidisciplinary research teams, have looked at the scholarship of collaboration and arrived at remarkably similar conclusions as to which factors and competencies support effective collaboration. However, conclusions on how to effectively evaluate collaboration are consistently lacking across the literature reviewed. Although important advances have been made recently in the area of evaluating One Health operations and outcomes, there is an opportunity to develop process-based performance measures for One Health collaboration and teamwork. Synthesising work on collaborative performance evaluation across multiple disciplinary and sectoral lanes and levels of collaborative analysis, the authors argue that, in addition to outcome-based One Health evaluation, the evaluation of One Health processes needs to be further refined and 'team' effectiveness needs to be evaluated at all levels of the health system: individual, organisational and network.

À l'occasion d'une revue de la littérature scientifique consacrée à Une seule santé, à la collaboration transversale, à la science des équipes et aux compétences interdisciplinaires en matière de santé, plusieurs équipes de chercheurs, pour la plupart spécialisées dans une seule discipline mais aussi, pour certaines, multidisciplinaires, ont étudié la science du travail en collaboration et sont parvenues à des conclusions étonnamment similaires quant aux facteurs et aux compétences qui soutiennent une collaboration efficace. En revanche, il ressort de cet examen de la littérature qu'aucune conclusion n'y apparaît sur la manière d'évaluer efficacement une telle collaboration. Si des avancées importantes ont été enregistrées dans le domaine de l'évaluation des interventions et des résultats Une seule santé, il y a encore matière à développer des méthodes de mesure des performances basées sur les procédures. Cette synthèse des travaux sur l'évaluation collaborative des performances, qui recouvre de multiples voies disciplinaires et sectorielles et différents niveaux d'analyse collaborative permet aux auteurs de soutenir que les évaluations des processus Une seule santé doivent être élaborées plus finement afin de compléter les évaluations basées sur les résultats, et que l'efficacité des « équipe ¼ doit être évaluée à tous les niveaux du système de santé : individus, organisations et réseaux.

Los autores exponen un estudio recapitulativo de la bibliografía relativa a temas como la noción de Una sola salud, la colaboración transfronteriza, la ciencia del trabajo en equipo o las competencias interdisciplinares en temas de salud, señalando a partir de ahí que buen número de disciplinas y, en ciertos casos, equipos pluridisciplinares de investigación, tras examinar cuanto saben los estudiosos en cuestiones de colaboración, llegaron a conclusiones notablemente similares acerca de la suma de factores y competencias que propician una colaboración eficaz. En la bibliografía examinada, sin embargo, brillan por su ausencia las pistas sobre el modo de evaluar eficazmente la colaboración. Aunque últimamente ha habido avances importantes en cuanto a la evaluación de las actividades emprendidas en clave de Una sola salud y sus resultados, existe la posibilidad de establecer parámetros que midan la eficacia de los procesos de colaboración y de trabajo en equipo encuadrados en la filosofía de Una sola salud. Sintetizando los estudios de evaluación de la eficacia de la colaboración que se han realizado desde múltiples ángulos disciplinares y sectoriales y niveles de análisis colectivo, los autores postulan que, además de la evaluación de los resultados, es preciso perfeccionar aún más la evaluación de los procesos de Una sola salud y evaluar asimismo la eficacia de los «equipos¼ en todos los niveles que configuran un sistema de salud: el individual, el institucional y el de las redes de trabajo.

[Surgical treatment of talocalcaneal coalition : Experience with 80 cases of pediatric or adolescent patients]. / Operative Behandlung der Coalitio talocalcanearis : Erfahrungen aus 80 Fällen kindlich-jugendlicher Patienten.

INTRODUCTION: There is still a controversial discussion on the treatment of talocalcaneal coalition with and without planovalgus deformity. From 2002-2014 80 cases of talocalcaneal coalition in children and adolescents under 18 years of age were surgically treated by J. Hamel. The objective of this study is a retrospective analysis, especially of unfavourable results. METHODS: Patients with minimum follow up of 12 months were included (35.7 months on average). In 31 cases treatment consisted of resection and fat-grafting (group 1), in 26 additional cases tarsal osteotomy was added because of planovalgus-deformity (group 2), and in 23 cases primary fusion of the talocalcaneal joint was performed (group 3). RESULTS: In group 1 one patient was lost to follow-up early with a severe peroneal spasticity and unknown further course. Two further patients still had remarkable pain after 15 months, and another patient had to undergo secondary fusion because of persistent pain. In group 2 secondary fusion was undertaken in two cases and offered in four other cases. In group 3 two patients still suffered from moderate tarsal pain, although complete fusion occurred; one of these patients underwent bilateral treatment. All other patients were pain free or nearly pain free on the last follow-up visit, with marked improvement in comparison to the preoperative situation. DISCUSSION: Surgical treatment of talocalcaneal coalition is successful in most cases in the short to medium follow-up, but unfavourable results are not uncommon and may require secondary fusion. Differential indication between resection, additional deformity correction, or primary fusion seems to be most important.

Rotational study of the CH4-CO complex: Millimeter-wave measurements and ab initio calculations.

The rotational spectrum of the van der Waals complex CH4-CO has been measured with the intracavity OROTRON jet spectrometer in the frequency range of 110-145 GHz. Newly observed and assigned transitions belong to the K = 2-1 subband correlating with the rotationless jCH4 = 0 ground state and the K = 2-1 and K = 0-1 subbands correlating with the jCH4 = 2 excited state of free methane. The (approximate) quantum number K is the projection of the total angular momentum J on the intermolecular axis. The new data were analyzed together with the known millimeter-wave and microwave transitions in order to determine the molecular parameters of the CH4-CO complex. Accompanying ab initio calculations of the intermolecular potential energy surface (PES) of CH4-CO have been carried out at the explicitly correlated coupled cluster level of theory with single, double, and perturbative triple excitations [CCSD(T)-F12a] and an augmented correlation-consistent triple zeta (aVTZ) basis set. The global minimum of the five-dimensional PES corresponds to an approximately T-shaped structure with the CH4 face closest to the CO subunit and binding energy De = 177.82 cm(-1). The bound rovibrational levels of the CH4-CO complex were calculated for total angular momentum J = 0-6 on this intermolecular potential surface and compared with the experimental results. The calculated dissociation energies D0 are 91.32, 94.46, and 104.21 cm(-1) for A (jCH4 = 0), F (jCH4 = 1), and E (jCH4 = 2) nuclear spin modifications of CH4-CO, respectively.

Role of diffusion-weighted MRI in differentiation of hepatic abscesses from non-infected fluid collections.

AIM: To evaluate the role of diffusion-weighted magnetic resonance imaging (DW-MRI) in the differentiation of hepatic abscesses from non-infected fluid collections. MATERIALS AND METHODS: In this retrospective study, 22 hepatic abscesses and 27 non-infected hepatic fluid collections were examined in 27 patients who underwent abdominal MRI including DW-MRI. Two independent observers reviewed T2-weighted + DW-MRI and T2-weighted + contrast-enhanced T1-weighted (CET1W) images in two sessions. Detection rates and confidence levels were calculated and compared using McNemar's and Wilcoxon's signed rank tests, respectively. Apparent diffusion coefficient (ADC) values of abscesses and non-infected fluid collections were compared using the t-test. Receiver operating characteristic (ROC) curves were constructed. RESULTS: There was no statistically significant difference in the accuracy of detecting abscesses using T2-weighted + DW-MRI (both observers: 21/22, 95.5%) versus T2-weighted + CET1W images (observer 1: 21/22, 95.5%; observer 2: 22/22, 100%; p < 0.01). Mean ADC values were significantly lower with abscesses versus non-infected fluid collections (0.83 ± 0.24 versus 2.25 ± 0.61 × 10(-3) mm(2)/s; p < 0.001). With ROC analysis there was good discrimination of abscess from non-infected fluid collections at a threshold ADC value of 1.36 × 10(-3) mm(2)/s. CONCLUSION: DW-MRI allows qualitative and quantitative differentiation of abscesses from non-infected fluid collections in the liver.

DW-MRI of liver lesions: can a single ADC-value represent the entire lesion?

AIM: To evaluate whether focal liver lesions (FLLs) exhibit a homogeneous appearance on apparent diffusion coefficient (ADC) maps and whether there is inter-section variation in the calculated ADC values of FLLs (inter-section range). MATERIALS AND METHODS: Eighty-eight patients with 128 FLLs (70 benign, 58 malignant) who underwent abdominal magnetic resonance imaging (MRI) including diffusion-weighted (DW)-MRI were included. Two observers evaluated variation of signal intensity of each FLL within each ADC map image (intra-section) and among different ADC map images through the lesion (inter-section). ADC values of each FLL and neighbouring liver parenchyma were measured on all sections. The inter-section range of FLLs was compared with the neighbouring liver parenchyma. RESULTS: Intra-section inhomogeneity was noted in 39.8% (97/244 sections) and 38.9% (95/244) of benign lesions, and 61% (114/187 sections) and 61.5% (115/187) of malignant lesions, by observer 1 and observer 2, respectively. Inter-section inhomogeneity was noted in 25.7% (18/70) and 27.1% (19/70) of benign lesions, and 51.7% (30/58) and 50% (29/58) of malignant lesions, by observer 1 and observer 2, respectively. The inter-section range for both benign (0.28 × 10(-3) mm(2)/s) and malignant (0.25 × 10(-3) mm(2)/s) FLLs were significantly greater than that of liver parenchyma surrounding benign (0.16 × 10(-3) mm(2)/s, p < 0.001) and malignant (0.14 × 10(-3) mm(2)/s, p = 0.01) FLLs. CONCLUSION: Due to intra-/inter-section variations in ADC values of benign and malignant FLLs, a single ADC value may not reliably represent the entire lesion.

Detection of underlying malignancy in patients with paraneoplastic neurological syndromes: comparison of 18F-FDG PET/CT and contrast-enhanced CT.

PURPOSE: To determine the value of combined (18)F-FDG PET/CT with diagnostic contrast-enhanced CT (CECT) in detecting primary malignancies and metastases in patients with paraneoplastic neurological syndromes (PNS) and to compare this with CECT alone. METHODS: PET/CT scans from 66 patients with PNS were retrospectively evaluated. Two blinded readers initially reviewed the CECT portion of each PET/CT scan. In a second session 3 months later, the readers analysed the combined PET/CT scans. Findings on each study were assessed using a four-point-scale (1 normal/benign; 2 inconclusive, further diagnostic work-up may be necessary; 3 malignant; 4 inflammatory). Sensitivity and specificity for malignant findings were calculated for PET/CT and CECT. Interreader agreement was determined by calculating Cohen's kappa. Pooled data from clinical follow-up (including histopathology and follow-up imaging, median follow-up 20.0 months) served as the reference gold standard. RESULTS: Both readers classified 12 findings in ten patients (15%) as malignant on the PET/CT scans (two patients had two primary tumours). One such imaging finding (suspected thymic cancer) was false-positive (i.e. benign histology). The most common tumours were bronchial carcinoma (n = 3), lymph node metastases of gynaecological tumours (n = 3) and tonsillar carcinoma (n = 2). Three of 12 findings (25%) were not detected by CECT alone (cervical carcinoma, lymph node metastasis and tonsillar carcinoma). In a per-patient analysis, sensitivity and specificity for malignant findings were 100% and 90% for PET/CT and 78% and 88% for CECT. In 24% (reader 1) and 21% (reader 2) of the patients, the PET/CT findings were inconclusive. Of these findings, 57% (reader 1) and 56% (reader 2) were only diagnosed with PET (e.g. focal FDG uptake of the thyroid, gastrointestinal tract and ovaries). On follow-up, none of these findings corresponded to malignancy. Overall agreement between the two readers was excellent with a Cohen's kappa of 0.95 ± 0.04 (p < 0.001) for PET/CT and 0.97 ± 0.03 (p < 0.001) for CECT alone. CONCLUSION: In this cohort of patients with PNS, PET/CT exhibited improved detection of underlying malignancy versus CECT alone. While hybrid imaging produces a greater number of inconclusive findings, sensitivity is increased for the detection of head and neck and gynaecological malignancies as well as metastatic lymph node involvement.

[Importance of PET/CT for imaging of colorectal cancer]. / Stellenwert der PET/CT zur Bildgebung des kolorektalen Karzinoms.

CLINICAL/METHODICAL ISSUE: Fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) has emerged as a very useful imaging modality in the management of colorectal carcinoma. Data from the literature regarding the role of PET/CT in the initial diagnosis, staging, radiotherapy planning, response monitoring and surveillance of colorectal carcinoma is presented. Future directions and economic aspects are discussed. STANDARD RADIOLOGICAL METHODS: Computed tomography (CT), magnetic resonance imaging (MRI) and FDG-PET for colorectal cancer and endorectal ultrasound for rectal cancer. METHODICAL INNOVATIONS: Combined FDG-PET/CT. PERFORMANCE: While other imaging modalities allow superior visualization of the extent and invasion depth of the primary tumor, PET/CT is most sensitive for the detection of distant metastases of colorectal cancer. ACHIEVEMENTS: We recommend a targeted use of PET/CT in cases of unclear M staging, prior to metastasectomy and in suspected cases of residual or recurrent colorectal carcinoma with equivocal conventional imaging. The role of PET/CT in radiotherapy planning and response monitoring needs to be determined. Currently there is no evidence to support the routine use of PET/CT for colorectal screening, staging or surveillance. PRACTICAL RECOMMENDATIONS: To optimally exploit the synergy between morphologic and functional information, FDG-PET should generally be performed as an integrated FDG-PET/CT with a contrast-enhanced CT component in colorectal carcinoma.

[Whole-body MRI and FDG-PET/CT imaging diagnostics in oncology]. / Ganzkörper-MRT und FDG-PET/CT in der bildgebenden onkologischen Diagnostik.

The advent of whole-body MRI (WB-MRI) has introduced a systemic approach to oncologic imaging compared to established sequential, multi-modal diagnostic algorithms. Hardware innovations, such as whole-body scanners at 1.5 Tesla and also recently 3 Tesla, combined with acquisition acceleration techniques, have made WB-MRI clinically feasible. With this method dedicated assessment of individual organs with various soft tissue contrast, high spatial resolution and contrast media dynamics can be combined with whole-body anatomic coverage.PET/CT has established itself as a powerful modality in the staging of patients suffering from malignant tumors. In addition to the morphologic information provided by the CT component of this hybrid modality, the PET component contributes invaluable metabolic information, which greatly enhances accuracy in the assessment of lymphatic spread and viability of tumor tissue. Whole-body MR diffusion imaging is a novel and promising technique which may contribute to superior sensitivity in the detection of tumor manifestations. In the assessment of distant metastatic spread WB-MRI is highly sensitive and has advantages over PET/CT, especially in those tumors frequently spreading to the liver, bone or brain. WB-MRI is also very attractive as a radiation-free alternative for imaging of pediatric tumor patients in whom multiple follow-up examinations may be required.WB-MRI allows for precise assessment of the bone marrow and has been proven to be highly accurate for the staging of hematologic diseases, such as multiple myeloma. In this article recent developments and applications of WB-MRI in oncologic imaging are addressed and compared to the results of PET/CT.

[Combined functional and morphological imaging of sarcomas: significance for diagnostics and therapy monitoring]. / Kombinierte funktionelle und morphologische Bildgebung bei Sarkomen : Stellenwert für Diagnostik und Therapiemonitoring.

(18)F-fluorodeoxyglucose positron-emission tomography (FDG-PET) and especially hybrid FDG-PET/CT is becoming more and more accepted for the clinical management of adult and pediatric patients with sarcomas. By integrating the CT component the specificity in particular but also the sensitivity of the modality are improved further. With PET/CT a complete staging including the detection of lung metastases is feasible in a single examination. For patients with primary bone and soft tissue sarcomas FDG-PET/CT is utilized for diagnosis, staging and restaging, metabolic tumor grading, guidance of biopsies, detection of tumor recurrence and therapy monitoring. Furthermore, it has been demonstrated that FDG uptake of the tumor prior to treatment and changes of FDG uptake after therapy significantly correlate with histopathologic response and survival of patients. Therefore, PET and PET/CT have a prognostic value. In the future new perspectives of hybrid PET/CT imaging will arise by introducing novel radiotracers and combined functional imaging of tumor metabolism and perfusion. High resolution MRI is essential for local evaluation of the primary tumor and preoperative planning with assessment of possible infiltration of vascular or neural structures. Contrast-enhanced MRI remains a key tool in the diagnosis of recurrent disease, especially in tumors which are not hypermetabolic. Dynamic contrast-enhanced MR sequences can significantly contribute to therapy monitoring. More research is necessary to prospectively compare dynamic contrast-enhanced MRI and FDG-PET/CT for evaluation of local and recurrent diseases.

[Cardiac SPECT/CT: correlation between atherosclerosis, significant coronary artery stenoses and myocardial perfusion parameters in patients with known coronary artery disease]. / Kardiale SPECT/CT : Korrelation zwischen atherosklerotischen Veränderungen, signifikanten Koronarstenosen und myokardialen Perfusionsparametern bei Patienten mit bekannter koronarer Herzerkrankung.

Invasive coronary angiography (ICA) and CT angiography (CTA) both enable significant coronary artery stenoses to be detected, but they are not suitable for assessing their hemodynamic relevance. This can be accomplished using myocardial perfusion scintigraphy (MPS) which, however, has limited specificity and spatial resolution. Regarding patients with known coronary artery disease (CAD) it is furthermore important to stratify patient's individual risk for severe cardiac events to guide therapy management.The results of our investigations in 158 patients with CAD indicate that global and regional calcium scores (CAC) do not correlate with the presence of myocardial perfusion defects and significant coronary artery stenoses, respectively. However, published literature has reported CAC as being an independent predictor of long-time survival.For clinical purposes it seems that non-invasive diagnostics with CTA, MPS and CAC screening can be useful even in patients with known CAD. CAC and global scar burden enable long-term risk-stratification, whereas fusion of CTA and MPS is useful to detect the culprit lesion of relevant perfusion defects and to select options for revascularization.

[PET/CT imaging of atherosclerotic blood vessel alterations]. / Bildgebung atherosklerotischer Gefässwandveränderungen mit der PET/CT.

Atherosclerosis is a chronic inflammatory disease of middle sized and large vessels with sequelae comprising the most frequent causes of death in the Western world. Modern imaging modalities are being introduced for the study of atherosclerosis with emphasis on the detection of vulnerable plaques. The hybrid imaging method PET/CT presents advantages for the localization of vulnerable plaques based on the uptake of various molecular imaging agents indicative of inflammatory processes. Using semiquantitative image analysis fluorodeoxyglucose (FDG) uptake in large peripheral vessels has been identified in a series of 21 patients, who were scanned first with the previous generation of PET/CT scanner and subsequently with a new generation apparatus, after a mean interval of 6.5 months. The mean ratio of FDG uptake in the walls of eight large vessels to the blood-pool activity (TBR) was nearly identical in the two PET/CT sessions (TBR(1) 1.26 versus TBR(2) 1.28; p=n.s.), indicating independence of the TBR endpoint from the particular instrumentation.

[Quantification of immunohistochemical expression of somatostatin receptors in neuroendocrine tumors using 68Ga-DOTATATE PET/CT]. / Quantifizierung der Somatostatinrezeptorexpression neuroendokriner Tumoren mit der (68)Ga-DOTATATE-PET/CT.

PURPOSE: The immunohistochemical expression of somatostatin receptor (SSTR) subtype 2 was compared to quantitative (68)Ga-DOTATATE PET in neuroendocrine tumors (NET). MATERIAL AND METHODS: In 27 patients suffering from metastatic NET the expression of somatostatin receptors (SSTR, score 0-3) and the Ki-67 index were assessed. The immunohistochemical findings were compared with the (68)Ga-DOTATATE PET uptake in these tumors using the SUV(max) (standardized uptake value). Both values were compared with the Ki-67 proliferation index. RESULTS: The SUV(max) in NET without SSTR expression was significantly lower compared to those with SSTR expression (p <0.05), even though 3 out of 5 NETs with a score of 0 showed a high uptake of (68)Ga-DOTATATE. The SUV(max) correlated significantly (r=0.40, p <0.05) with the score of immunohistochemical SSTR expression (negative, score 0, moderate, score 1 and high, scores 2 and 3). The Ki-67 index correlated inversely with the SSTR expression score (r=-0.42, p <0.05), but not significantly with the SUV(max) (r=-0.33, p=0.11). CONCLUSION: (68)Ga-DOTATATE uptake was moderately correlated with the results of immunohistochemical SSTR analyses. However, SSTR negative NET may show high uptake of (68)Ga-DOTATATE.

[Assessment of aortic stenosis after aortic valve replacement: comparative evaluation of dual-source CT and echocardiography]. / Quantitative Evaluation der Aortenklappenöffnungsfläche mit der Dual-Source-CT und Korrelation mit der 2D-Echokardiografie: Initiale Ergebnisse.

PURPOSE: To prospectively evaluate whether planimetric measurements of aortic valve area (AVA) with dual-source computed tomography (DSCT) correlate with measurements obtained by echocardiography and to correlate the amount of calcification of the aortic valve with AVA in a group of patients after aortic valve replacement. MATERIALS AND METHOD: 23 patients underwent dual-source computed tomography (DSCT) of the heart (Somatom Definition, Siemens Medical Solutions, Forchheim, Germany), without heart rate control (heart rate 52-113 beats/minute). All patients had undergone aortic valve replacement (homografts, mean time after surgery: 7+/-3 years). The AVA of the transplanted aortic valve graft was measured planimetrically by means of DSCT and compared with echocardiography as a standard of reference, to exclude post-surgical restenosis of the valve. Maximum AVA in systole planimetrically measured with CT was compared with calculated AVA values determined with the continuity equation, using transvalvular pressure gradients. The amount of calcification of the aortic valve was quantified and correlated (Spearman's R) with the AVA. To assess intra- and inter-reader reproducibility, the DCST data was re-analyzed by two readers 4 weeks after the initial review. RESULTS: All DSCT datasets were of diagnostic image quality concerning valve depiction. The mean AVA as measured by DSCT was 2.7+/-0.9 cm (2) compared to 1.8+/-0.5 cm (2) by echocardiography (p<0.05). The planimetric evaluation of the CT data as compared to results of echocardiography showed a significant correlation of the results (Pearson's correlation coefficient R=0.78, p<0.001). Intra- and inter-reader reproducibility was good with intra-class correlation coefficients of 0.86 and 0.81, respectively (p<0.001). There was a significant negative correlation between the amount of aortic valve calcification and AVA as measured by echocardiography (R= -0.42; p<0.05) and as measured by DSCT (R= -0.67; p=0.001). CONCLUSION: First experience indicates that DSCT is able to assess aortic valve opening area with high image quality and good intra- and inter-reader reproducibility in subjects after aortic valve replacement. The negative correlation between AVA and the amount of aortic valve calcification suggests that calcification is a possible risk factor for restenosis in subjects with aortic valve replacement.

C-reactive protein in the arterial intima: role of C-reactive protein receptor-dependent monocyte recruitment in atherogenesis.

Infiltration of monocytes into the arterial wall is an early cellular event in atherogenesis. Recent evidence shows that C-reactive protein (CRP) is deposited in the arterial intima at sites of atherogenesis. In this study, we demonstrate that CRP deposition precedes the appearance of monocytes in early atherosclerotic lesions. CRP is chemotactic for freshly isolated human blood monocytes. A specific CRP receptor is demonstrated on monocytes in vitro as well as in vivo, and blockage of the receptor by use of a monoclonal anti-receptor antibody completely abolishes CRP-induced chemotaxis. CRP may play a major role in the recruitment of monocytes during atherogenesis.

Dual-Source computed tomography of the chest in the surgical planning of repeated cardiac surgery.

AIM: When reoperative cardiac surgery is indicated, detailed, three-dimensional imaging of the thorax permits accurate depiction of cardiac anatomy and vascular structures potentially increasing the safety of the surgical procedure. We sought to evaluate the contribution of dual-source multidetector-row computed tomography (DSCT) of the heart and thorax in planning repeated open heart surgery. METHODS: Twenty-eight patients (mean age, 68 years) scheduled for repeated cardiac surgery who had undergone previous coronary artery bypass grafting (n=19) or cardiac valve replacement (8) or combined valvular and bypass surgery (1) underwent contrast-enhanced ECG-gated DSCT (Somatom Definition, Siemens Medical Solutions) of the whole thorax with a temporal resolution of 82 ms and a spatial resolution of 0.4 mm³. The indication for repeated surgery was bypass surgery (N.=6), valve replacement (16), combined bypass and valvular surgery (5) or other reasons (1). Assessment of surgical risk based on DSCT data were performed in terms of the relation of the ascending aorta and cardiac structures to the expected median sternotomy line, graft patency and anatomic course, and the degree of calcification of the ascending aorta and coronary arteries. RESULTS: DSCT findings led to a change of surgical approach for 9/28 (32.1%) patients (non-midline incision, N.=3; surgery performed under circulatory arrest, N.=5; peripheral arterial cannulation before sternotomy, N.=1) and cancellation of surgery for 4/28 (14.3%) patients (heavy aortic and coronary calcifications impeding bypass surgery, N.=2; right heart or aortic aneurysm in close proximity to the sternum in high risk patients, N.=2). The planned surgical approach remained unchanged after DSCT for the remaining15/28 (53.6%) patients. Of 54 bypass graft conduits (20 arterial, 34 venous) visualized on DSCT in 20 patients after previous bypass grafting, 16 arterial and 24 venous grafts were patent, while 4 arterial and 10 venous grafts were occluded. CONCLUSION: DSCT of the heart and thorax is an effective, non-invasive tool for the preoperative planning of repeated cardiac surgery. The technique provides significant information to modify the surgical approach and may increase the safety of the procedure.

FDG-PET-CT and whole-body MRI for triage in patients planned for radioembolisation therapy.

PURPOSE: The purpose was to evaluate the potential of FDG-PET-CT and whole-body MRI (WB-MRI) as diagnostic triage methods for patients planned for radioembolisation of metastatic liver disease. MATERIALS AND METHODS: 135 patients with multifocal liver metastases were evaluated for potential palliative therapy with radioembolisation using 90-Yttrium microspheres. All patients were examined consecutively with FDG-PET-CT and WB-MRI for exclusion of relevant extra-hepatic tumor manifestations. All patients underwent 99mTc-albumine angiography followed by scintigraphy to exclude significant hepato-pulmonary shunting. RESULTS: Out of the 135 patients included into the pre-therapeutic diagnostic algorithm, 56% were eligible and received radioembolisation, while 44% could not be treated. In 91% the exclusion criteria was diagnosis of significant extra-hepatic metastatic disease. In 85% exclusion diagnosis was made concordantly by both FDG-PET-CT and WB-MRI, in 9% diagnosis was provided by PET-CT, in 6% by WB-MRI alone. Patient-based sensitivity for detection of extra-hepatic disease was 94% for PET-CT and 91% for WB-MRI. False-positive diagnosis of extrahepatic disease leading to exclusion for radioembolisation therapy was made in 2% of patients, in one patient by PET-CT and in one patient by WB-MRI alone. Overall, specificity for inclusion of radioembolisation therapy by combining both modalities was 99%. In 9% of patients angiographic diagnosis made radioembolisation impossible, in 7% solely the angiographic findings were decisive. CONCLUSION: Both FDG-PET-CT and WB-MRI are efficient diagnostic triage methods for patients planned for radioembolisation of liver metastases. Overall, FDG-PET-CT shows a trend to higher diagnostic accuracy compared to WB-MRI and may be used as imaging method of choice as a standalone examination. In combination, both modalities exhibited high sensitivity for the diagnosis of extra-hepatic tumor manifestations and result in high specificity.