Wireless point-of-care ultrasound: First experiences with a new generation handheld device.

AIM: To evaluate the diagnostic reliability of a new generation wireless point-of care ultrasound device for abdominal and thoracic findings. MATERIAL AND METHODS: 40 patients (16 females, 24 males 19 -80 years, on average 56.1 years) were scanned by an experienced examiner using the new wireless Vscan Air device for abdominal and thoracic findings. The probe frequencies were 2-5 MHz (convex probe) and 3-12 MHz for the linear probe. As a reference standard, all patients were also examined using high-end ultrasound (LOGIQ E9/LOGIQ E10). Results were interpreted independently by two examiners in consensus, also with regard to the image quality (0-4, from not assessable = 0, to excellent 4). RESULTS: In all 40 patients (100%) examination with conventional high-end ultrasound and the Vscan Air ultrasound device was feasible. Sensitivity, specificity, positive and negative predictive value for the diagnosis of abdominal and thoracic findings were 63.3%, 100%, 100%, and 40%, respectively. Most main diagnostic findings were detected using the mobile device compared to the high-end ultrasound. Limitations were found regarding characterization and classification of hepatic and renal tumorous lesions.Image quality revealed mostly minor diagnostic limitations for the mobile device, mean 2.9 (SD ± 0.300) and was excellent or with only minor diagnostic limitations for conventional high-end ultrasound, mean 3.25 (SD ± 0.438). CONCLUSION: Due to its easy application and its high diagnostic reliability, point-of-care ultrasound systems of the latest generation represent a valuable imaging method for the primary assessment of abdominal and thoracic findings, especially in patients on intensive care units or in emergency situations.

[Cost and Income Analysis of the 10 Most Frequent Angiography Interventions at a German University Hospital]. / Analyse von Kosten und Erlösen der 10 häufigsten angiografischen Interventionen bei einem Krankenhaus der Maximalversorgung.

Aim: Our aim was to make a detailed evaluation and cost analysis of the 10 most frequent angiography interventions in outpatients and inpatients at a university hospital. Material and Methods: Based on a detailed process-oriented model we calculated the cost and income for port and dialysis catheter implantation, PTA at the upper (UL) and lower leg (LL), TACE, SIRT, stent angioplasty (pelvis, visceral and supra-aortal vessels) and cerebral coil embolisation for the situations mentioned above. Various income models (DRG, GOÄ) were considered. A comprehensive evaluation of the overhead and personnel costs was performed. Results: The calculated data (in €) were as follows (overall, material, personnel costs, DRG income, GOÄ income inpatients, outpatients): port catheter: 375, 266, 59, 328, 260, 612; dialysis catheter: 456, 349, 59, 272, 343, 807; PTA UL: 595, 445, 99, 1 240, 425, 1 077; PTA LL: 732, 552, 129, 1 082, 425, 1 184; stent pelvis: 1 523, 1 338, 135, 1 323, 815, n/a; stent visceral: 2 124, 1 875, 199, 1 326, 912, n/a; stent supra-aortal: 1 901, 1 713, 138, 6 705, 1 138, n/a; TACE: 1 359, 1 120, 188, 2 588, 598, n/a; SIRT: 1 251, 1 054, 147, 2 289, 1 107, n/a; intracranial embolisation: 6 684, 6 367, 266, 6 531, n/a, n/a. Conclusion: Depending on the income model applied, most procedures caused a deficit, especially using GOÄ calculations. Outpatients covered by the private health insurance caused earnings for the procedures applied. Only TACE, SIRT and stent angioplasty of supra-aortal vessels caused profits in inpatients using InEK calculations.

Evaluation of the diagnostic accuracy of CEUS in children with benign and malignant liver lesions and portal vein anomalies.

OBJECTIVE: Comparison of the diagnostic findings of MRI, CT and CEUS in children with benign and malignant and portal venous anomalies of the liver. MATERIALS/METHODS: Retrospective analysis of the diagnostic findings of CEUS, MRI and CT scans in 56 children (age 0-17 years) with a total of 60 benign and malignant liver lesions and anomalies of the portal vein/perfusion. All patients underwent CEUS using sulphur hexafluoride microbubbles and a multi-frequency probe (1-5 MHz, 6-9 MHz). Cine-loops were stored up to 3 minutes. MRI was performed in 38 lesions. CT was performed in 8 lesions. RESULTS: Out of the 56 patients 49 liver lesions (48 benign, 1 malignant), 9 anomalies of the portal vein/perfusion and 2 of the biliary system were detected. 16/49 lesions were analyzed histopathologically. Using CEUS, the characterization of the lesions was possible in 45 out of 49 cases. In 32 cases, CEUS provided the exact diagnosis. Only two benign lesions were falsely categorized as malignant.Findings of MRI and CEUS were concordant in 84% of cases (n = 32/38). CEUS considered 1 benign lesion to be malignant. 2 lesions were not detectable and in 3 lesions no definite diagnosis was established using MRI.Findings of CT and CEUS were concordant in 5 of 8 cases. In 21 lesions CEUS as the only imaging modality was found to be sufficient for diagnostics. CONCLUSION: Despite the restricted indications for using CEUS in children, it offers a high diagnostic detection rate (93%) for characterization of liver lesions and portal vein anomalies.

Monitoring during hepatic radiofrequency ablation (RFA): comparison of real-time ultrasound elastography (RTE) and contrast-enhanced ultrasound (CEUS): first clinical results of 25 patients.

PURPOSE: To evaluate the reliability of ultrasound elastography for delineating thermal ablation defects post-radiofrequency ablation (RFA) by comparing lesion dimensions determined by real-time elastography (RTE) with the findings of contrast-enhanced ultrasound (CEUS). MATERIALS AND METHODS: A total of 21 malignant liver tumors were percutaneously ablated using RFA. Color-coded elastography and CEUS were performed by one experienced examiner, using a 1 - 5 MHz multi-frequency convex transducer (LOGIQ E9, GE). Lesions were examined using CEUS and real-time elastography (RTE) to assess ablation defects. Measurements of lesions (long axis, short axis, and area) representing the same image plane used for elastography were taken during CEUS examination and compared to the measurements obtained from the elastograms. All measurements were performed by two independent observers. RESULTS: A statistically significant correlation in vivo between RTE and CEUS measurements with respect to the lesion's principal axis and area (r = 0.876 long axis, r = 0.842 short axis and r = 0.889 area) was found. Inter-rater reliability assessed with the concordance correlation coefficient was substantial for all measurements (ρc ≥ 0.96) Overall, elastography slightly underestimated the lesion size, as judged by the CEUS images. CONCLUSION: These results support that RTE could potentially be used for the routine assessment of thermal ablation therapies.

Impact of liver cirrhosis on liver enhancement at Gd-EOB-DTPA enhanced MRI at 3 Tesla.

PURPOSE: The purpose of this study was to assess differences in enhancement effects of liver parenchyma between normal and cirrhotic livers on dynamic, Gd-EOB-DTPA enhanced MRI at 3T. MATERIALS AND METHODS: 93 patients with normal (n=54) and cirrhotic liver (n=39; Child-Pugh class A, n=18; B, n=16; C, n=5) underwent contrast-enhanced MRI with liver specific contrast media at 3T. T1-weighted volume interpolated breath hold examination (VIBE) sequences with fat suppression were acquired before contrast injection, in the arterial phase (AP), in the late arterial phase (LAP), in the portal venous phase (PVP), and in the hepatobiliary phase (HBP) after 20 min. The relative enhancement (RE) of the signal intensity of the liver parenchyma was calculated for all phases. RESULTS: Mean RE was significantly different among all evaluated groups in the hepatobiliary phase and with increasing severity of liver cirrhosis, a decreasing, but still significant reduction of RE could be shown. Phase depending changes of RE for each group were observed. In case of non-cirrhotic liver or Child-Pugh Score A cirrhosis mean RE showed a significant increase between AP, LAP, PVP and HBP. For Child-Pugh B+C cirrhosis RE increased until PVP, however, there was no change in case of B cirrhosis (p=0.501) and significantly reduced in case of C cirrhosis (p=0.043) during HBP. CONCLUSION: RE of liver parenchyma is negatively affected by increased severity of liver cirrhosis, therefore diagnostic value of HBP could be limited in case of Child Pugh B+C cirrhosis.

A rare case of supraclinoid internal carotid artery (ICA) fenestration in combination with duplication of the middle cerebral artery (MCA) originating from the ICA fenestration and an associated aneurysm.

Fenestrations and duplications of the cervical and intracranial arteries are rare anatomic variants, reported to be associated with aneurysms or other vascular anomalies. We here present a patient with a supraclinoid ICA fenestration in combination with a duplication of the MCA originating from the ICA fenestration and an associated aneurysm.

Diagnosis of pericardial effusion with a new generation hand-carried ultrasound device in cardiothoracic intensive care unit patients.

BACKGROUND: Technological advances introduced hand-carried ultrasound (HCU) imagers in daily clinical workflow providing several benefits such as fast bedside availability and prompt diagnosis. PURPOSE: To evaluate the diagnostic yield of a latest generation HCU imager compared to contrast-enhanced multidetector computed tomography (MDCT) for the detection of pericardial effusion (PE) in cardiothoracic intensive care unit (ICU) patients. MATERIAL AND METHODS: Thirty-six patients from a cardiothoracic ICU were enrolled to this study irrespective of their underlying disease. All patients were examined with a new generation HCU for the presence of PE. Definite diagnosis of PE was based on findings of MDCT as standard of reference. Statistical analysis was performed using PASW 18. RESULTS: PE was identified in 20 patients by MDCT (prevalence 56%). The HCU examination was carried out technically successfully in all patients. Sensitivity, specificity, positive and negative predictive value of HCU for the diagnosis of PE were 75%, 88%, 88%, and 74%, respectively. CONCLUSION: HCU provides rapid, practical, reliable, and cost-effective diagnosis of PE in patients on cardiothoracic ICU.

[As time goes by--is it worth intensifying patient care during the waiting period for radiological examinations?]. / Wie die Zeit vergeht--Lohnt sich die Intensivierung der Wartezeitbetreung in der Radiologie?

PURPOSE: Service characteristics in hospital care in general have a high influence on patients' contentment. One of the key features of good service is waiting time. The aim of this study was to analyze the influence of ambience and individual care while waiting for a radiological examination on patient satisfaction. MATERIALS AND METHODS: The study was conducted prospectively and included and total of 100 patients at a tertiary care center. All patients waiting for contrast-enhanced computed tomography (CT) and were randomly divided into two groups. 50 patients waited under regular circumstances, i.e. the normal waiting ara of our radiological department, whilst the remaining 50 patients spent their waiting time in a separate small waiting area with intensified care and service. Both subjective and objective waiting time and the patients' contentment were raised with a standardized questionnaire. Quality criteria mentioned by the patients were then ranked according to their importance. RESULTS: Of all included patients 76 % were ambulant with an average age of 60 years (range 22 - 83 years) and 69 % female. These characteristics were identical in both groups. With a mean waiting time of 90 minutes (Group intensified care 100 minutes, group regular care 81 minutes) most patients evaluated the overall service during waiting time as "good" to "ideal", only 2 % as of "low quality". No significant differences between the two study arms concerning the patient satisfaction could be detected. Patients with intensified care estimated their delay time significantly shorter by an average of 24 minutes (p < 0.02). For 40 % a detailed consent discussion was the main quality criterion, while a short waiting time only for 24 %. CONCLUSION: An optimized, i.e. intensified care during the waiting time for a radiological examination results in a significant reduction of the subjective waiting time, but does not lead to a significantly higher patient contentment. The subjective judgement of examination quality seems to influence the acceptance of prolonged latency to a high degree.

Endovascular treatment of acute arterial hemorrhage in trauma patients using ethylene vinyl alcohol copolymer (Onyx).

PURPOSE: This study was designed to determine the feasibility and efficacy of endovascular embolization with liquid embolic agent ethylene vinyl alcohol copolymer (Onyx) in patients with acute traumatic arterial bleeding. METHODS: This is a retrospective review of 13 patients (9 men and 4 women; mean age 45 years) with severe trauma who underwent embolotherapy using Onyx from November 2003 to February 2009. Bleeding was located in the pelvis (5 patients), kidney (3 patients), mesenteric region (2 patients), retroperitoneal space (2 patients), neck (1 patient), and thigh (1 patient). In three cases (23.1%), Onyx was used in conjunction with coils. We evaluate the technical and clinical success, procedural and embolization time, occurrence of rebleeding, and embolotherapy-related complications, such as necrosis or migration of Onyx into nontarget vessels. RESULTS: In all patients, embolotherapy was technically and clinically successful on the first attempt. Control of bleeding could be reached with a mean time of 19 (range, 4-63) min after correct placement of the microcatheter in the feeding artery. No recurrent bleeding was detected. No unintended necrosis or migration of Onyx into a nontarget region was observed. During the follow-up period, three patients (23.1%) died due to severe intracranial hemorrhage, cardiac arrest, and sepsis. CONCLUSIONS: Transcatheter embolization with new liquid embolic agent Onyx is technically feasible and effective in trauma patients with acute arterial hemorrhage.

Comparison of time-intensity-curve- (TIC-) analysis of contrast-enhanced ultrasound (CEUS) and dynamic contrast-enhanced (DCE) MRI for postoperative control of microcirculation in free flaps - first results and critical comments.

Postoperative monitoring of transplanted free flaps is an essential tool to reveal possible complications. The aim of this study was to compare the value of time-intensity-curve- (TIC-) analysis based on grey scale data of contrast-enhanced ultrasound (CEUS) and dynamic contrast-enhanced (DCE-) magnetic resonance imaging (MRI). Postoperative imaging was performed in 11 patients following free flap transplantation and TIC analysis was obtained in identical regions of interest (ROI) of CEUS and DCE MRI data. Microcirculation was assessed in superficial (0-1 cm), middle (1-2 cm), and deep (2-3 cm) ROIs in one or two different positions within the flap resulting in a total of 46 ROIs evaluated (in very thin flaps only superficial and middle ROIs were assessed). For both imaging methods, mean signal increase was found to be significantly higher in ROIs of normally perfused flaps (n = 40) compared to ROIs with compromised microcirculation (n = 6). Although TIC analysis allows quantification of microcirculation in different regions of the flap, in this preliminary study no distinct threshold could be defined to differentiate flaps with normal and compromised microcirculation.

[Detection of intraorbital foreign material using MDCT]. / Nachweismöglichkeit intraorbitaler Fremdkörper durch MDCT.

AIM: To judge the possibilities of detection of orbital foreign bodies in multidetector CT (MDCT) with a focus on glass slivers. MATERIALS AND METHODS: Experimental systematic measuring of Hounsfield Units (HU) of 20 different materials, containing 16 different types of glass with 4 different types of ophthalmic lenses among them. The measurements were performed using a standardized protocol with an orbita phantom being scanned with 16-slice MDCT. Using the resulting density values, the smallest detectable volume was calculated. Using this data we produced slivers of 5 different glass types in the sub-millimeter range and calculated their volume. Those micro-slivers underwent another CT scan using the same protocol as mentioned above to experimentally discern and confirm the detection limit for micro-slivers made of different materials. RESULTS: Glass has comparatively high density values of at least 2000 HU. The density of glasses with strong refraction is significantly higher and reaches up to 12 400 HU. We calculated a minimum detectable volume of 0.07 mm (3) for glass with a density of 2000 HU. Only glass slivers with a density higher than 8300 HU were experimentally detectable in the sub-millimeter range up to a volume as small as 0.01 mm (3). Less dense glass slivers could not be seen, even though their volume was above the theoretically calculated threshold for detection. CONCLUSION: Due to its high density of at least 2000 HU, glass is usually easily recognizable as an orbital foreign body. The detection threshold depends on the object's density and size and can be as low as 0.01 mm (3) in the case of glass with strong refraction and thus high density. The detection of glass as an orbital foreign body seems to be secure for slivers with a volume of at least 0.2 mm (3) for all types of glass.

Multidetector computed tomography mesentericography for the diagnosis of obscure gastrointestinal bleeding.

PURPOSE: To evaluate the diagnostic yield of 16-row multidetector computed tomography (CT) mesentericography in patients with obscure gastrointestinal bleeding. MATERIALS AND METHODS: The radiological information system database was used to retrospectively identify all patients in whom CT mesentericography (CTM) was performed for the diagnosis of obscure gastrointestinal bleeding between July 2002 and September 2006. A subsequent prospective study was conducted between October 2006 and September 2009 to evaluate CTM in patients with major obscure gastrointestinal bleeding. The retrospectively identified patients (six patients) as well as the prospectively evaluated patients (seven patients) constitute the study population. Following mesenteric DSA the catheter was left in the superior mesenteric artery, the patient was transferred to the CT suite and CTM was carried out by scanning the abdomen after contrast material injection via the catheter. Active bleeding was suspected if a focal area of high attenuation consistent with contrast material extravasation was found within the bowel lumen. RESULTS: CTM detected the site of active bleeding in three of 13 patients (23 %). In the subpopulation of patients who were prospectively evaluated, CT mesentericography identified the site of active bleeding in one of seven patients (14 %). Depiction of active bleeding by CTM prompted surgical intervention in each case and surgery confirmed the findings of CT mesentericography. CONCLUSION: Due to the relatively low rate of positive findings and inherent drawbacks, we feel that CTM cannot be recommended in general. However, in selected patients who are continuously bleeding at a low rate and in whom iv-CT was negative, CT mesentericography might be helpful.

Image fusion of contrast enhanced ultrasound (CEUS) with computed tomography (CT) or magnetic resonance imaging (MRI) using volume navigation for detection, characterization and planning of therapeutic interventions of liver tumors.

AIM: To evaluate, whether image fusion of contrast enhanced ultrasound (CEUS) with CT or MRI affects the diagnosis and characterization of liver lesions or the therapeutic strategy of surgical or interventional procedures compared to the preliminary diagnosis. MATERIAL AND METHODS: In a retrospective study the image fusion scans of CEUS with contrast enhanced CT or MRI of 100 patients (71 male, mean age 59 years, 0.3-85 years) with benign or malignant liver lesions were evaluated. Fundamental B-scan, color Doppler imaging and CEUS were performed in all patients by an experienced examiner using a multifrequency convex transducer (1-5 MHz, LOGIQ 9/GE) and volume navigation (Vnav). After a bolus injections of up to 2.4 ml SonoVue® (BRACCO, Italy) digital raw data was stored as cine-loops up to 5 min. In 74 patients, CEUS was fused with a pre-existing ceCT, in 26 patients a ceMRI was used. RESULTS: In all 100 patients (100%) the image quality in all modalities (ceCT, ceMRI and CEUS) was excellent or with only minor diagnostic limitations. Regarding the number of lesions revealed in image fusion of CEUS/ceCT/ceMRI and the preceding diagnostic method, concordant results were found in 84 patients. In 12 patients, additional lesions were found using fusion imaging causing subsequently a change of the therapeutical strategy. In 15 out of 21 patients with either concordant or discordant results regarding the number of lesions, image fusion allowed a definite diagnosis due to a continuous documentation of the microcirculation of the tumor and its contrast enhancement. A significant coherency (p < 0.05) among image fusion with either ceCT or ceMRI and CEUS and a subsequent change of therapeutic strategy was found. CONCLUSION: Image fusion with volume navigation (VNav) of CEUS with ceCT or ceMRI frequently allows a definite localization and diagnosis of hepatic lesions in patients with primary hepatic carcinoma or metastatic diseases. This might cause a change of the therapeutic strategy in many patients with hepatic lesions.

Characterization of microvascularization of liver tumor lesions with high resolution linear ultrasound and contrast enhanced ultrasound (CEUS) during surgery: First results.

AIM: Evaluation of high resolution linear ultrasound and intra-operative linear contrast enhanced ultrasound (CEUS) and its benefit for the detection and characterization of tumor lesions. MATERIAL AND METHODS: Twenty patients were investigated preoperatively regarding tumor detection using CT (n = 8) or MRI (n = 12) and image fusion (VNav) (n = 3). All patients had surgery for their hepatic tumor (hepatocellular carcinoma (HCC), cholangiocellular carcinoma (CCC), metastasis, and adenoma). Ultrasound was performed intra-operatively first with B-scan using a convex probe. Than multifrequency linear transmitters (6-9 MHz, 6-15 MHz, LOGIQ E9, GE) were applied for B-scan, coulor coded Doppler sonography (CCDS) and Power Doppler followed by dynamic CEUS with Contrast Harmonic Imaging (CHI) after bolus injection of a maximum of 15 mL SonoVue®. RESULTS: In 9 cases with the use of intra-operative CEUS additional tumor lesions (diameter 4-15 mm) could be detected and were histologically confirmed after surgical resection (7 cases) or intra-operative biopsy (2 cases). Using intraoperative CEUS 64 tumor lesions could be detected compared to 51 tumor lesions detected by preoperative CT or MRI (p < 0.05). Using the 6-15 MHz multifrequency linear transducer with CHI, arterial perfusion of adenomas, neuroendocrine metastases and HCC lesions was detectable. In 3 cases a resection was not achievable. Two of these cases were treated with radio frequency ablation (RFA). The other case had no curable option due to multifocal tumor manifestation. CONCLUSION: The intra-operative use of high-resolution linear transducer techniques with CEUS offers new diagnostic perspectives for an effective liver surgery.

Image fusion with volume navigation of contrast enhanced ultrasound (CEUS) with computed tomography (CT) or magnetic resonance imaging (MRI) for post-interventional follow-up after transcatheter arterial chemoembolization (TACE) of hepatocellular carcinomas (HCC): Preliminary results.

AIM: The assessment of the immediate post-interventional microcirculation and perfusion following transcatheter arterial chemoembolization (TACE) with new real time imaging fusion technique (VNav) of computed tomography (CT) or magnetic resonance imaging (MRI) with contrast enhanced ultrasound (CEUS) compared to follow-up. MATERIAL: Following TACE an image fusion of CEUS with CT or MRI of the liver was performed in 20 patients (18 men, 2 women; age 29-75 years) with confirmed hepatocelluar carcinoma (HCC) to evaluate the post-interventional tumor vascularization and perfusion of HCC tumor lesions. Image fusion with CEUS performed immediately was compared with the result at the end of TACE (DSA), with post TACE CT (non-enhanced CT within 24 hours) and with follow up CT (enhanced CT after 6 weeks) after embolization. Ultrasound was performed using a 1-5 MHz multifrequency SonoVue transducer (LOGIQ 9/GE) after a bolus injection of 2-4ml SonoVue® with contrast harmonic imaging (CHI). Thirteen examinations were fused with a contrast enhanced CT, 7 with a MRI performed before TACE. RESULTS: The post-interventional volume navigation image fusion of CT or MRI with CEUS showed differences regarding the residual tumor perfusion compared to other modalities. The correlation (Spearman-test) between the perfusion result at the end of TACE, non-enhanced CT after TACE and image fusion with CEUS was 0.42 and 0.50. The difference between the result at the end of TACE and the fusion with CEUS was significant (p < 0.05, Wilcoxon-test). The correlation between fusion of CEUS with CT/MRI and follow-up CT (after 6 weeks) was 0.64, the difference was not significant (p > 0.05). The differences between native CT within 24 hours after TACE and follow up CT after 6 weeks or fusion of CEUS and CT/MRI were significant (p < 0.05). The inter-observer variability was 0.61 at the end of TACE, 0.58 at non-enhanced CT (within 24 hours), 0.87 at fusion CEUS with CT/MRI and 0.74 at follow up CT after 6 weeks (Cohens Kappa test). CONCLUSION: Image fusion with volume navigation (VNav) of CEUS with CT or MRI allows an accurate localisation of foci in patients with HCC. This exact mapping permits an easier control and evaluation of the results after TACE. The fusion of CEUS and CT or MRI allows a better evaluation of the microcirculation and the residual tumor perfusion at an earlier point of time than usual modalities of therapy control like non-enhanced CT. This might lead to a more differentiated monitoring of therapy.

[Cost analysis of contrast-enhanced cranial MRI at a German university hospital]. / Kostenanalyse einer kontrastgestützten MRT des Schädels an einem Universitätsklinikum.

PURPOSE: Detailed evaluation and cost analysis of a cranial contrast-enhanced MRI (c-ceMRI) in outpatients, inpatients, patients in an intensive care unit and children under anesthesia. MATERIALS AND METHODS: Based on a detailed process-oriented model, we calculated the cost of a cranial MRI for the four situations mentioned above. A comprehensive evaluation of the overhead and personnel costs was performed. RESULTS: We performed 5108 MRI examinations on 2 scanners in the year 2008. 2150 examinations (42 %) were identified as c-ceMRI. For inpatients we calculated a total cost of € 242.46 per examination with a personnel cost of € 81.71 for the radiological department. In outpatients we calculated total costs of € 181.97 with radiological personnel costs of € 68.67. Patients coming from an intensive care unit were treated by an intensive care team, which resulted in total costs of € 416.58 with € 283 in costs for radiological personnel (32.8 %). MRI examinations of children under anesthesia resulted in costs of € 616.79 for the hospital, of which € 285.78 were radiological personnel costs (34.5 %). CONCLUSION: In this study we evaluated for the first time different radiological scenarios of a c-ceMRI at a university hospital. Considering the present reimbursement situation, all outpatients covered by statutory health insurance resulted in a deficit for the hospital. Particularly high costs for patients in intensive care units as well as for children under anesthesia have to be taken into account and are currently not adequately covered by care providers.

Detection and characterization of endoleaks following endovascular treatment of abdominal aortic aneurysms using contrast harmonic imaging (CHI) with quantitative perfusion analysis (TIC) compared to CT angiography (CTA).

PURPOSE: To show the feasibility of the detection of endoleaks following endovascular treatment of aortic aneurysms using contrast harmonic imaging (CHI) in comparison to computed tomography angiography (CTA). MATERIALS AND METHODS: 51 patients with suspected endoleaks, who underwent previous endovascular treatment for abdominal aortic aneurysm, were examined using CTA and vascular ultrasound. Biphasic CTA in all cases and digital subtraction angiography (DSA) in 8 patients were evaluated by two radiologists in consensus and served as the standard of reference. Ultrasound was performed by an experienced examiner with a multi-frequency linear transducer (2 - 4 MHz) using CHI following bolus injection of 2.4 ml of SonoVue® IV (maximum 5 ml). All images were evaluated by two observers in consensus regarding the reperfusion of the abdominal aneurysm using time intensity curve (TIC) analysis. RESULTS: In 30 of 51 patients, endoleaks were detected concordantly in CHI and CTA. In 20 of 51 patients, no endoleak was found in CHI and CTA/DSA. In one patient, a type II endoleak could initially only be detected in CHI and was later confirmed in follow-up examinations by CTA (sens. 99%, spec. 93%, NPV 99 %, PPV 95%). TIC analysis allowed evaluation of the perfusion dynamics of endoleaks in all patients. Significant differences were found (p < 0.05, Mann Whitney U Test) regarding the perfusion within the aneurysm when an endoleak was present (10.39 ± 4.29 dB) or not present (6.42 ± 2.86 dB). CONCLUSION: CHI with perfusion analysis allows definite detection of endoleaks, especially if contraindications for CTA are present. CHI presents an alternative for follow-up monitoring.

[Evaluation of a liquid embolization agent (Onyx) for transcatheter embolization for renal vascular lesions]. / Endovaskuläre Behandlung akuter Nierenblutungen mit einem neuen Flüssigembolisat (Onyx): erste klinische Ergebnisse.

PURPOSE: To evaluate the therapeutic outcome after endovascular treatment of renal vascular lesions using the liquid embolization agent, Onyx. MATERIALS AND METHODS: Between 2004 and 2008 nine patients with renal vascular lesions were treated with transcatheter arterial embolization using Onyx. The renal vascular lesions consisted of 4 AV-fistulas, a pseudoaneurysm, bleeding from a single subsegmental artery, diffuse parenchymal bleeding after trauma, septic embolizations and multiple aneurysms in endocarditis. All patients underwent selective angiography of the renal artery. A dimethyl sulfoxide (DMSO)-compatible microcatheter was used and Onyx was injected. The technical and clinical success rate, examination time and procedure-related complications were documented. RESULTS: The overall technical and clinical success rate was 100 %. One patient had to be treated twice due to recurrent bleeding after an accidental puncture with a drainage catheter. No loss of viable renal tissue occurred in 4 cases. In 4 patients mild to moderate parenchyma loss was noted. In one patient having diffuse renal bleeding, occlusion of the main renal artery was performed. No procedure-related complications were noted. The mean examination time was 16.17 min when treating with Onyx alone and 60 min when using a combination of Onyx and coils. Within an average follow-up period of 21 months, no recurrent renal bleeding or recurrent AV-fistulas occurred. CONCLUSION: Onyx is an effective embolization agent for the treatment of renal vascular lesions. It allows controlled and quick application with low complication rates and a short examination time as a standalone agent or in combination with coils.