Coronary and carotid atherosclerosis in asymptomatic male marathon runners.

The aim of the study was to evaluate the diagnostic accuracy of carotid ultrasound (CU) to predict coronary atherosclerosis in asymptomatic male marathon runners. A total of 49 male marathon runners older than 45 years (mean age 53.3 ± 7.2 years, range 45-74 years) received CU and cardiac CT angiography (CTA) including calcium scoring (CS). Results of CU and CTA were classified binary: 1. Absence of atherosclerosis and 2. Presence of atherosclerosis. The extent of atherosclerosis was not primary end point of the study. Mean PROCAM score was 2.3% (SD 2.2, range 0.44%-12.34%). One person had to be excluded from analysis (one missing CT-scan). From the remaining 48 marathon runners, 17 (35.4%) had carotid atherosclerosis and 22 (45.8%) coronary atherosclerosis. Atherosclerosis in either exam was diagnosed in 27/48 (56.3%) marathon runners. Diagnostic accuracy of CU to predict coronary atherosclerosis was: sensitivity 54.55% (95% CI 32.2-75.6), specificity 80.8% (CI 60.6-93.4), positive predictive value 70.6 (CI 44.1-89.9), negative predictive value 67.7 (CI 48.6-83.3) with a positive likelihood ratio of 2.84 (CI 1.18-6.82) and a negative likelihood ratio of 0.56 (CI 0.34-0.92). Coronary and/or carotid atherosclerosis can be detected in more than 50% of male marathon runners aged older than 45 years. The diagnostic value of carotid ultrasound to predict coronary atherosclerosis is low but higher than the accuracy of rest- or stress-ECG. As outcome studies in sportsmen are still missing, the routine evaluation of the carotid arteries by ultrasound or even cardiac CT cannot be recommended at present. Furthermore, the incidence of atherosclerosis by our method in normal population is not known.

[Diagnostic accuracy of dual energy CT angiography in patients with diabetes mellitus]. / Diagnostische Genauigkeit der Dual-energy-CT-Angiographie bei Patienten mit Diabetes mellitus.

OBJECTIVES: Peripheral arterial disease (PAD) represents a major and highly prevalent complication in patients with diabetes mellitus. The diagnostic, non-invasive work-up by computed tomography angiography (CTA) is limited in the presence of extensive calcification. The aim of the study was to determine the diagnostic accuracy of dual energy CTA (DE-CTA) for the detection and characterization of PAD in patients with diabetes mellitus. MATERIAL AND METHODS: In this study 30 diabetic patients with suspected or known PAD were retrospectively included in the analysis. All subjects underwent DE-CTA (Somatom Definition Flash, Siemens Healthcare, Erlangen, Germany) prior to invasive angiography, which served as the reference standard. Blinded analysis included assessment of the presence and degree of peripheral stenosis on curved multiplanar reformatting (MPR) and maximum intensity projections (MIP). Conventional measures of diagnostic accuracy were derived. RESULTS: Among the 30 subjects included in the analysis (83% male, mean age 70.0 ± 10.5 years, 83% diabetes type 2), the prevalence of critical stenosis in 331 evaluated vessel segments was high (30%). Dual energy CT identified critical stenoses with a high sensitivity and good specificity using curved MPR (100% and 93.1%, respectively) and MIP images (99% and 91.8%, respectively). In stratified analysis, the diagnostic accuracy was higher for stenosis pertaining to the pelvic and thigh vessels as compared with the lower extremities (curved MPR accuracy 97.1% vs. 99.2 vs. 90.9%; respectively, p < 0.001). CONCLUSION: The use of DE-CTA allows reliable detection and characterization of peripheral arterial stenosis in patients with diabetes mellitus with higher accuracy in vessels in the pelvic and thigh regions compared with the vessels in the lower legs.

Assessment of the nature of residual masses at end of treatment in lymphoma patients using volume perfusion computed tomography.

OBJECTIVES: To determine the diagnostic benefit of volume perfusion computed tomography (VPCT) at end of treatment for response assessment in lymphoma patients. METHODS: Seventy-five patients with different lymphoma subtypes were included: 50/75 patients had residual masses at end of treatment, 26/50 patients underwent VPCT at baseline and at end of treatment, and 24/50 patients only had end-of-treatment VPCTs. We evaluated the size of the main lymphoma mass, its blood flow (BF), blood volume (BV) and k-trans, calculated ratios (baseline and end of treatment) as well as sensitivity/specificity/negative (NPV)/positive predictive values (PPV). For VPCT at end of treatment, a cutoff threshold between responders and non-responders was calculated. RESULTS: For patients undergoing VPCT at baseline and end of treatment, reduction in size, BF, BV and k-trans was significant (P < 0.001). Identification of non-response was reached at: <53% reduction in size (sensitivity/specificity/accuracy/PPV/NPV of 88.89%/62.5%/80.77%/84.21%/71.43%), <15% reduction of BF (sensitivity/specificity/accuracy/PPV/NPV of 100%/37.5%/80.77%/0.26%/100%), or <45% reduction of k-trans (sensitivity/specificity/accuracy/PPV/NPV of 88.89%/75%/84.62%/88.89%/75%). In the subgroup undergoing VPCT at end of treatment, BF >18.51 ml/100 ml indicated non-responsiveness (sensitivity 92.86%, specificity 72.73%, accuracy 84%, PPV 81.25%, NPV 88.89%). CONCLUSIONS: VPCT seems adequate for assessment of lymphoma response at end of treatment. The degree of residual lymphoma perfusion at end of treatment helps to identify patients likely to remain in remission 1 year after completion of therapy. KEY POINTS: • Volume perfusion computed tomography (VPCT) offers measurements for assessing tumour response. • Perfusion parameter changes measured by VPCT correlate with antitumour therapy response. • In lymphoma, baseline and end-of-treatment perfusion parameter ratios can predict response. • Perfusion measurements after treatment identify patients likely to remain in remission.

Seminal vesicle invasion: accuracy and analysis of infiltration patterns with high-spatial resolution T2-weighted sequences on endorectal magnetic resonance imaging.

OBJECTIVE: To evaluate the accuracy of high-spatial resolution T2-weighted endorectal magnetic resonance imaging (eMRI) for detection and pattern depiction of seminal vesicle invasion (SVI) in patients with prostate cancer (PCa). METHODS: 376 patients were included who underwent eMRI for staging before radical open prostatectomy at 1.5 T with an endorectal coil. Statistical accuracy for detection of SVI was calculated. MR images of patients with SVI were further evaluated by two radiologists according to the classification by Wheeler and Ohori. RESULTS: In the cohort, 35 patients had SVI after histopathological evaluation of the prostatectomy specimen (stage pT3b). Sensitivity and specificity for detection of SVI were 48.6 and 97.7%, respectively. Negative and positive predictive values and overall accuracy were 94.9, 68.0, and 93.1%, respectively. Infiltration pattern analysis showed that type I invasion was most common with 48.6 followed by type IIa (31.4%) and IIb (20%). Type III was not present. There was no statistical significant difference between the three groups regarding Gleason score, age, and prostate-specific antigen level. CONCLUSIONS: eMRI with high-spatial resolution T2-weighted imaging is accurate for assessment of SVI. Depiction of different infiltration types of SVI is feasible. By adding information about the extent of SVI, diagnostic reporting and risk stratification could be improved.

Computer-based quantification of the Achilles tendon thickness in sequential B-mode ultrasound images: a study of feasibility and reliability.

INTRODUCTION: Assessment of the Achilles tendon thickness (ATT) using B-mode ultrasound is a common technique for clinical evaluation of chronic mid-part tendinosis. Currently used image-based assessment is limited by relatively high inter- and intra-observer variability. In this study, it was tested whether a new sequence-based automated assessment of ATT provides more reliable and reproducible results than the standard image-based procedure. MATERIALS AND METHODS: A total of 118 non-operated tendons of 59 healthy subjects (44, range 28-50 years) were analysed using an automated image based as well as a newly developed automated sequence-based method. Correlation and agreement of both methods were evaluated. The root mean square deviation (RMSD) and a Bland-Altman analysis were performed to highlight observer (n = 18 tendons) as well as reader (n = 40 tendons) dependent variabilities of both methods. RESULTS: A strong correlation was found between image and sequence-based ATT assessment (p = 0.92). The Bland-Altman analysis showed a good agreement between both methods (mean difference 0.0018, 95 % CI: -0.046; 0.05). In repetitive examinations, sequence-based analysis showed a significant reduction concerning reader- and observer-dependent variability compared to image-based assessment. The RMSD for repetitive sequence-based measurements was approximately 0.3 mm (compared to 0.6 mm for image-based measurement), respectively. CONCLUSIONS: The study shows sequence-based automated assessment of ATT being clearly superior to the standard image-based procedure. The new method provides a clear reduction of reader as well as observer-dependent variability. Due to the decreased scattering of measurement data sequence-based measurement seems especially valuable for quantification of small tendon thickness changes such as exercise-induced hypertrophy.

In vitro stent lumen visualisation of various common and newly developed femoral artery stents using MR angiography at 1.5 and 3 tesla.

OBJECTIVES: To evaluate stent lumen assessment of various commonly used and newly developed stents for the superficial femoral artery (SFA) using MR angiography (MRA) at 1.5 and 3 T. METHODS: Eleven nitinol stents and one cobalt-chromium stent were compared regarding stent lumen visualisation using a common three-dimensional MRA sequence. Maximum visible stent lumen width and contrast ratio were analysed in three representative slices for each stent type. A scoring system for lumen visualisation was applied. RESULTS: Nitinol stents showed significantly better performance than the cobalt chromium stent (P < 0.05) at 1.5 and 3 T. Maximum visible stent lumen ranged between 43.4 and 95.5 %, contrast ratio between 7.2 and 110.6 %. Regarding both field strengths, seven of the nitinol stents were classified as "suitable". Three nitinol stents were "limited", and one nitinol stent and the cobalt chromium stent were "not suitable". CONCLUSIONS: Intraluminal loss of signal and artefacts of most of the SFA stents do not markedly limit assessment of stent lumen by MRA at 1.5 and 3 T. MRA can thus be considered a valid technique for detection of relevant in-stent restenosis. Applied field strength does not strongly influence stent lumen assessment in general, but proper choice of field strength might be helpful.

High-pitch dual-source CT angiography of supra-aortic arteries: assessment of image quality and radiation dose.

INTRODUCTION: High-pitch CT angiography (CTA) is a recent innovation that allows significant shortening of scan time with volume coverage of 43 mm per second. The aim of our study was to assess this technique in CTA of the head and neck. METHODS: CTA of supra-aortic arteries was performed in 50 patients using two acquisition protocols: conventional single-source 64-slice (pitch 1.2) and high-pitch dual-source 128-slice CT (pitch 3.2). Subjective and objective image quality of supra-aortic vessel ostia as well as intra- and extra-cranial segments was retrospectively assessed by blinded readers and radiation dose compared between the two protocols. RESULTS: Conventional and high-pitch CTA achieved comparable signal-to-noise ratios in arterial (54.3 ± 16.5 versus 57.3 ± 14.8; p = 0.50) and venous segments (15.8 ± 6.7 versus 18.9 ± 8.9; p = 0.21). High-pitch scanning was, however, associated with sharper delineation of vessel contours and image quality significantly improved at the level of supra-aortic vessel ostia (p < 0.0001) as well as along the brachiocephalic trunk (p < 0.0001), the subclavian arteries (p < 0.0001), proximal common carotid arteries (p = 0.01), and vertebral V1 segments (p < 0.0001). Using the high-pitch mode, the dose-length product was reduced by about 35% (218.2 ± 30 versus 141.8 ± 20 mGy × cm). CONCLUSIONS: Due to elimination of transmitted cardiac motion, high-pitch CTA of the neck improves image quality in the proximity of the aortic arch while significantly lowering radiation dose. The technique thus qualifies as a promising alternative to conventional spiral CTA and may be particularly useful for identification of ostial stenosis.

Dual-energy CT for the characterization of urinary calculi: In vitro and in vivo evaluation of a low-dose scanning protocol.

The efficiency and radiation dose of a low-dose dual-energy (DE) CT protocol for the evaluation of urinary calculus disease were evaluated. A low-dose dual-source DE-CT renal calculi protocol (140 kV, 46 mAs; 80 kV, 210 mAs) was derived from the single-energy (SE) CT protocol used in our institution for the detection of renal calculi (120 kV, 75 mAs). An Alderson-Rando phantom was equipped with thermoluminescence dosimeters and examined by CT with both protocols. The effective doses were calculated. Fifty-one patients with suspected or known urinary calculus disease underwent DE-CT. DE analysis was performed if calculi were detected using a dedicated software tool. Results were compared to chemical analysis after invasive calculus extraction. An effective dose of 3.43 mSv (male) and 5.30 mSv (female) was measured in the phantom for the DE protocol (vs. 3.17/4.57 mSv for the SE protocol). Urinary calculi were found in 34 patients; in 28 patients, calculi were removed and analyzed (23 patients with calcified calculi, three with uric acid calculi, one with 2,8-dihyxdroxyadenine-calculi, one patient with a mixed struvite calculus). DE analysis was able to distinguish between calcified and non-calcified calculi in all cases. In conclusion, dual-energy urinary calculus analysis is effective also with a low-dose protocol. The protocol tested in this study reliably identified calcified urinary calculi in vivo.

Virtual reality in preoperative imaging in maxillofacial surgery: implementation of "the next level"?

Not only are current imaging techniques - cone-beam computed tomography (CT), CT, and magnetic resonance imaging (MRI) - becoming more precise in capturing data, but the illustration and interpretation of the acquired images is no longer limited to conventional display screens or projectors. The so-called "virtual reality" (VR) glasses have the potential to engage the viewer in a 3-dimensional space, and ultimately to enable evaluation of the reconstructed anatomical structures from a new perspective. For the first time in the field of oral and maxillofacial surgery (OMFS), a 3-dimensional imaging dataset (cone-beam CT, CT, and MRI) can be evaluated by using VR glasses. A medical student, an OMFS resident, and an OMFS consultant rated the preoperative usability of VR glasses to improve the operative understanding of three cases: a deeply impacted wisdom tooth, a fracture of the lower jaw, and an oncological resection. VR glasses seem to help to simplify operations and give the surgeon a good preoperative overview of the intraoperative findings, particularly in the evaluation of impacted teeth and hard tissue structures. In addition, VR glasses seem to be a promising innovation to help in the training of surgical residents and to teach students. However, the more experienced the surgeon, the smaller is the additional value of VR glasses. Preoperative examination using VR glasses can aid better understanding and planning of the surgical site in the future, and is an innovative piece of advanced technology for displaying CT, cone-beam CT, and MRI anatomical data.

[MR-imaging of aggressive fibromatosis]. / MR-Bildgebung der Aggressiven Fibromatose.

Aggressive fibromatosis is a rare mesenchymal benign tumor characterized histologically by proliferation of fibroblasts and myofibroblasts with marked production of intercellular collagen. Predominant low signal intensity on all pulse sequences is said to be characteristic of, but not specific for, aggressive fibromatosis. The principal role of imaging in the management of aggressive fibromatosis is preoperative planning an the detection of recurrence or disease progression in nonsurgically managed patients.

[Detection of bone metastasis of prostate cancer - comparison of whole-body MRI and bone scintigraphy]. / Nachweis ossärer Metastasen des Prostatakarzinoms - Vergleich der Leistungsfähigkeit der Ganzkörper-MRT und der Skelettszintigrafie.

PURPOSE: Prostate cancer continues to be the third leading cancer-related mortality of western men. Early diagnosis of bone metastasis is important for the therapy regime and for assessing the prognosis. The standard method is bone scintigraphy. Whole-body MRI proved to be more sensitive for early detection of skeletal metastasis. However, studies of homogenous tumor entities are not available. The aim of the study was to compare bone scintigraphy and whole-body MRI regarding the detection of bone metastasis of prostate cancer. MATERIALS AND METHODS: 14 patients with histologically confirmed prostate cancer and a bone scintigraphy as well as whole-body MRI within one month were included. The mean age was 68 years. Scintigraphy was performed using the planar whole-body technique (ventral and dorsal projections). Suspect areas were enlarged. Whole-body MRI was conducted using native T 1w and STIR sequences in the coronary plane of the whole body, sagittal imaging of spine and breath-hold STIR and T 1w-Flash-2D sequences of ribs and chest. Bone scintigraphy and whole-body MRI were evaluated retrospectively by experienced radiologists in a consensus reading on a lesion-based level. RESULTS: Whole-body MRI detected significantly more bone metastasis (p = 0.024). 96.4 % of the demonstrated skeletal metastases in bone scintigraphy were founded in whole-body MRI while only 58.6 % of the depicted metastases in MRI were able to be located in scintigraphy. There was no significant difference regarding bone metastasis greater than one centimeter (p = 0.082) in contrast to metastasis less than one centimeter (p = 0.035). Small osteoblastic metastases showed a considerably higher contrast in T 1w sequences than in STIR imaging. Further advantages of whole-body MRI were additional information about extra-osseous tumor infiltration and their complications, for example stenosis of spinal canal or vertebral body fractures, found in 42.9 % of patients. CONCLUSION: Whole-body MRI using native STIR and T 1w sequences is superior to bone scintigraphy for the detection of small bone metastasis of prostate cancer. Simultaneous clarification of associated complications demonstrates further advantages.

[Orthorad--the online reference database of skeletal plain film radiography]. / Orthorad--die Referenzdatenbank zur Skelettradiographie im Internet.

PURPOSE: It is evident that there is a growing need for Internet-based reference databases for reasons of practicability and due to the increasing use of reporting on digital workstations. The main advantages of online databases are expected with respect to plain film radiography and cross-sectional imaging. A reference database of skeletal plain film radiography was to be created using the Orthorad program. MATERIALS AND METHODS: The most important standard settings and special images of young and healthy adults in plain film radiography were collected over one year. All samples were approved for the Orthorad database by a board qualified radiologist. Based on the workflows of radiographers and radiologists, the records were organized by body part ( http://www.idr.med.uni-erlangen.de/orthorad/orthorad.htm ). This logical data structure will ensure that the tool serves as a source of information in two ways: On the one hand, the radiographer can access information on positioning, tube voltage and cassette format. On the other hand, the radiologist receives important knowledge regarding X-ray anatomy, reference data regarding the human skeleton, and information about the correct reporting for an image. RESULTS AND CONCLUSION: Orthorad is used as an online reference database for traumatologic plain film radiography to support radiographers and radiologists in their daily working routines. To date, user feedback has been positive.

Bronchial Artery Embolization in Hemoptysis: 10-Year Survival and Recurrence-Free Survival in Benign and Malignant Etiologies - A Retrospective Study.

Purpose: The aim of the study was to evaluate safety, effectiveness, recurrence rate and 10-year survival after bronchial artery embolization (BAE) in benign and malignant etiologies. Methods: The retrospective study includes 100 BAE procedures in 88 patients. Underlying disease was classified as benign (n = 67) and malignant (n = 21) etiologies. Immediate bleeding control and procedure safety were evaluated in all patients. In 51 (58 %) patients, follow-up data with a median follow-up time of 1015 days (range, 494 to 3727 days) were acquired to assess overall survival, time-to-recurrence of bleeding and recurrence-free survival, using Kaplan-Maier estimates to compare differences between both subgroups. Results: Immediate bleeding control was achieved after 96/100 procedures (96 %), with a minor complication rate of 5.0 %. No major complications occurred. The overall survival was 74 % after 1 year and 59 % after 5 years and 10 years. There was a significant difference in survival between the malignant and benign groups (p < 0.0001). Survival was 90 %, 80 % and 76 % at 1 year, 3 years and 10 years, respectively, in the benign group and 18 % and 0 % at 1 year and 3 years, respectively in the malignant group. The median time to recurrence of bleeding and recurrence-free survival were 239 days and 94 % after 1 year and 87 % after 10 years in the benign group, compared to 66 days and 34 % after 1 year and 0 % after 3 years in the malignant group (p = 0.0107). Conclusion: BAE is a safe and highly effective treatment option in hemoptysis. However, the recurrence rate and survival are highly dependent on the underlying disease. Key Points: • BAE is a safe and highly effective treatment option in hemoptysis.• Recurrence rate and survival are strongly dependent on the underlying disease with significantly impaired results in patients with malignant diseases. • Coil embolization is an effective BAE treatment method. Nevertheless, it should be mentioned, that reinterventions can be impeded, if embolization is performed in the proximal part of bronchial arteries. Citation Format: • Syha R, Benz T, Hetzel J et al. Bronchial Artery Embolization in Hemoptysis: 10-Year Survival and Recurrence-Free Survival in Benign and Malignant Etiologies - A Retrospective Study. Fortschr Röntgenstr 2016; 188: 1061 - 1066.

Assessment of the parenchymal blood volume by C-arm computed tomography for radioembolization dosimetry.

PURPOSE: Aim of the study was to evaluate the impact of parenchymal blood volume (PBV) C-arm CT in transarterial radioembolization (TARE) planning procedure regarding the appropriateness of segmental blood supply from selective catheter positions defined by angiographic images compared to PBV mapsto determine the influence of changed target volumes on dose calculation. MATERIAL AND METHODS: A total of 22 consecutive patients (median age, 62 years) underwent a TARE planning procedure were included in this retrospective study. Selective angiograms and selective PBV C-arm CT (right and left liver lobe) were evaluated in a blinded fashion, regarding segmental hepatic artery variants. Volumetry of target volume and dosimetry of glass and resin microspheres were performed. RESULTS: Classification of segment IV and segment I to the corresponding target vascular bed supply was correct in 91.0% (20/22) and 86.4% (19/22) for angiography and C-arm CT, respectively. Except one case, all other liver segments were classified properly to the left and right hepatic arterial supply. Based on the mismatch of the angiographic and the C-arm CT approach, changes of target volume were evident in 27.3% of patients, resulting in a mean mismatch volume of 90±54ml (range, 51-198ml) and a percentage of dose differences of 14.2±11.8% and 12.6±10.6% for the right and 12.5±8.5% and 11.1±7.8% for the left liver lobe in glass and resin microspheres, respectively. CONCLUSION: The C-arm CT approach is superior to the angiographic determination of vascular supply of specific liver segments for dosimetry before radioembolization. Especially for unexperienced interventional radiologists or for a complex anatomy, C-arm CT improves individualized dosimetry concepts.

Volume perfusion computed tomography (VPCT)-based evaluation of response to TACE using two different sized drug eluting beads in patients with nonresectable hepatocellular carcinoma: Impact on tumor and liver parenchymal vascularisation.

OBJECTIVE: Response monitoring of transarterial chemoembolization (TACE) with the help of volume perfusion computed tomography (VPCT) at day one post-TACE and analysis of TACE-impact on tumor and uninvolved liver parenchymal perfusion by using different particles sizes and epirubicin dose. MATERIALS AND METHODS: Institutional review board approved this prospective study. VPCT was performed in the baseline, post-interventional (FU1; 24 h post-TACE) and at follow-up (FU2; median, 81 days) in 45 consecutive patients. 100-300 µm (n=17) and 300-500 µm (n=28) drug eluting beads (DEB) using an epirubicin dose of (<=25 vs. >25) were administered. VPCT was performed for 40-s using 80 kV, 100/120 mAs, 64×0.6 mm collimation, 26 consecutive measurements, IV injection (50 ml iodinated contrast), flow rate (5 ml/s). Blood flow (BF), blood volume (BV) and k-trans were registered as average and max values in the tumor. Arterial liver perfusion (ALP), portal-venous perfusion (PVP) and the hepatic perfusion index (HPI) were registered both in tumor and non-involved liver parenchyma. Response to TACE was classified by VPCT as complete (CR), partial (PR) or no response (NR). RESULTS: A significant reduction of viable tumor tissue was found in all patients between baseline and FU1 (p<0.001) being independent on particle size and epirubicin dose (p>0.05). PPV/NPV/sensitivity/specificity of post-interventional VPCT (FU1) results for prediction of the mid-term tumor course (FU2) were 100%/70%/76%/100%. There was generally a significant increase of the ALP between baseline and FU1 in the liver parenchyma coupled by a significant subsequent decrease (normalization) of ALP and HPI between FU1 and FU2. CONCLUSION: VPCT accurately measures impact of TACE on liver tumor and hepatic parenchymal perfusion. The former proved not to be significantly dependent on particle size and epirubicin dose. There was no persistent perfusion deficit in the liver after TACE.

Prevalence of Subclinical Coronary Artery Disease in Middle-Aged, Male Marathon Runners Detected by Cardiac CT.

PURPOSE: To evaluate the prevalence of coronary artery disease (CAD) in middle-aged, male marathon runners using coronary dual source CT angiography (DSCTA). MATERIALS AND METHODS: 50 male marathon runners older than 45 years (mean age: 52.7, standard deviation: 5.9 years, range: 45 to 67 years) received DSCTA including calcium scoring (CS) in addition to standard pre-participation screening. Based on standard risk factors, the risk for coronary events was calculated using the PROCAM score. Coronary status was defined using the following system: 1. absence of CAD (CS zero, no coronary plaques) 2. mild coronary atherosclerosis (CS > 0, coronary plaques with luminal narrowing < 50 %), 3. moderate coronary atherosclerosis (CS > 0, luminal narrowing > 50 %), 4. significant CAD (CS > 0, luminal narrowing > 75 %). RESULTS: The mean PROCAM score was 1.85 % (standard deviation = 1.56, range 0.39 to 8.47 %). 26/50 marathon runners had no atherosclerosis. 1 of the remaining 24 participants had significant CAD, 3 had moderate coronary atherosclerosis and 20 had mild coronary atherosclerosis. Treadmill exercise testing was unremarkable in terms of myocardial ischemia in all participants. Age, systolic blood pressure, personal minimum time, family history of cardiovascular disease and PROCAM score were factors associated with an increased risk for coronary atherosclerosis. CONCLUSION: Coronary atherosclerosis can be detected in almost 50 % of male marathon runners aged older than 45 years. In 24 % of the participants plaques were located in the proximal coronary system. However, only a minority of these persons have obstructive CAD. As expected, treadmill exercise testing failed to detect these persons that possibly have a higher risk for coronary events. KEY POINTS: • Coronary atherosclerosis can be detected in ~50 % of male marathon runners > 45 years. • Only a minority of these persons have obstructive CAD. • Treadmill exercise testing failed to detect these persons. • Cardiac CT might help to identify athletes with elevated risk for coronary events, especially in persons with a family history of coronary artery.

Opiate binding sites in the cellular immune system: expression and regulation.

The direct actions of opiates on the mammalian immune system depend on the existence of ligand binding sites either on the surface of the affected cell or in the interior of the cell. With the cloning of various opiate receptors from neuronal tissue, numerous researchers have screened leukocyte cDNA libraries for the expression of these receptors with some positive results. However, the pattern of expression of neuronal opiate receptors in the cellular immune system does not completely explain the biological action of opiates there. Several possibilities could account for this non-congruence including differential expression of the receptors as determined by such factors as cell population or prior history of the cells; the existence of sequence modified versions of the neuronal receptors such that the amplification methods miss their presence; or the opiates act by a different, non-receptor mechanism in the cellular immune system.

The morphine-binding site on human activated T-cells is not related to the mu opioid receptor.

Mitogen activation of human T-lymphocytes induces a morphine-binding site. Morphine binding is displaceable by beta-endorphin (1--31) and (--)-naloxone but not DAMGO. This site is not stereoselective for (--)-morphine. T-lymphocytes, expressing this binding site, were assayed by reverse-transcription polymerase chain reaction (RT-PCR) for expression of hMOR-1 mRNA. Several primer sets were used and each assay compared with cells known to express human or mouse MOR-1 mRNA. Neither hMOR-1 nor any homologous receptor was detected in human T-lymphocytes. Therefore, the morphine-binding site on mitogen-activated T-lymphocytes is unlikely to be closely related to hMOR-1.

The effects of teacher intrusion on social play interactions between children with autism and their nonhandicapped peers.

This study investigated the effects of two levels of teacher intrusion upon the behavior of elementary age children with autism and nonhandicapped peers during dyadic play interactions occurring in two special education classrooms. High versus low levels of teacher intrusion were contrasted in a mixed between- and within-subjects design counterbalanced for order across the two conditions. There were few differences in behavior across the two conditions, though the low-intrusion condition was associated with higher levels of toy contact, appropriate and inappropriate play, and lower levels of spontaneous verbalizations by the students with autism. There was no difference in the occurrence of excess behavior by condition. Results are discussed with respect to future investigations of effective teacher mediation to prepare children for positive peer interactions.

High-pitch computed tomography of the lung in pediatric patients: an intraindividual comparison of image quality and radiation dose to conventional 64-MDCT.

PURPOSE: The aim of this study was to investigate frequencies of typical artifacts in low-dose pediatric lung examinations using high-pitch computed tomography (HPCT) compared to MDCT, and to estimate the effective radiation dose (Eeff). MATERIALS AND METHODS: Institutional review board approval for this retrospective study was obtained. 35 patients (17 boys, 18 girls; mean age 112 ±â€Š69 months) were included and underwent MDCT and follow-up scan by HPCT or vice versa (mean follow-up time 87 days), using the same tube voltage and current. The total artifact score (0 - 8) was defined as the sum of artifacts arising from movement, breathing or pulsation of the heart or pulmonary vessels (0 - no; 1 - moderate; 2 - severe artifacts). Eeff was estimated according to the European Guidelines on Quality Criteria for Multislice Computed Tomography. The Mann-Whitney U test was used to analyze differences between the patient groups. The Spearman's rank correlation coefficient was used for correlation of ordinal variables. RESULTS: The scan time was significantly lower for HPCT compared to MDCT (0.72 ±â€Š0.13 s vs. 3.65 ±â€Š0.81s; p < 0.0001). In 28 of 35 (80 %) HPCT examinations no artifacts were visible, whereas in MDCT artifacts occurred in all examinations. The frequency of pulsation artifacts and breathing artifacts was higher in MDCT compared to HPCT (100 % vs. 17 % and 31 % vs. 6 %). The total artifact score significantly correlated with the patient's age in MDCT (r = - 0.42; p = 0.01), but not in HPCT (r = - 0.32; p = 0.07). The estimated Eeff was significantly lower in HPCT than in MDCT (1.29 ±â€Š0.31 vs. 1.47 ±â€Š0.37 mSv; p < 0.0001). CONCLUSION: Our study indicates that the use of HPCT has advantages for pediatric lung imaging with a reduction of breathing and pulsation artifacts. Moreover, the estimated Eeff was lower. In addition, examinations can be performed without sedation or breath-hold without losing image quality. KEY POINTS: • Fewer artifacts in pediatric lung imaging with HPCT• Reduced Eeff in HPCT• HPCT without sedation or breath-hold without loss of image quality.