International Clinical Protocol on Vestibular Disorders (Dizziness).

26-28 May at 43 Congress of Neurootological and Equilibriometric Society (Budapest, Hungary) International Clinical Protocol on Vestibular Disorders (Dizziness) being discussed and accepted as Consensus Document. Cochrane reports estimates that dizziness has prevalence of 22.9% in the last 12 months and an incidence of 3.1%. Only 1.8% of adults consulted a physician in the last 12 months. Cochrane reviews suggest that the evidence base for dizziness evaluation is weak, thus necessitates the creation of evidence-based document. Protocol is based at the new concept of vestibular system, which involves the vestibular peripheral sensors, space orientation tetrad, vestibular presentations in the brain cortex and vestibular effectory projections in the brain. Labyrinth consists of sensors, for which six modalities are adequate: 1. acceleration, 2. gravitation, 3. low frequency whole-body vibration, 4. Infrasound, 5. magnetic impulse, 6. metabolic changes. Vestibular system from rhomboid fosse gets the inputs from visual, acoustic, somatosensory organs, integrating them and forming space perception and orientation. Interaction with space is realized through sensory, motor, vegetative and limbic projections. So, vestibular disturbances may manifest as paropsia, tinnitus, numbness. Vestibular evoked potentials (not VEMP) and craniocorpography have highest sensitivity (90% and more). As vestibular dysfunction has recurrent character patients need monitoring.

Viability and MR detectability of iron labeled mesenchymal stem cells used for endoscopic injection into the porcine urethral sphincter.

Direct stem cell therapies for functionally impaired tissue require a sufficient number of cells in the target region and a method for verifying the fate of the cells in the subsequent time course. In vivo MRI of iron labeled mesenchymal stem cells has been suggested to comply with these requirements. The study was conducted to evaluate proliferation, migration, differentiation and adhesion effects as well as the obtained iron load of an iron labeling strategy for mesenchymal stem cells. After injection into the porcine urethral sphincter, the labeled cells were monitored for up to six months using MRI. Mesenchymal stem cells were labeled with ferucarbotran (60/100/200 µg/mL) and ferumoxide (200 µg/mL) for the analysis of migration and viability. Phantom MR measurements were made to evaluate effects of iron labeling. For short and long term studies, the iron labeled cells were injected into the porcine urethral sphincter and monitored by MRI. High resolution anatomical images of the porcine urethral sphincter were applied for detection of the iron particles with a turbo-spin-echo sequence and a gradient-echo sequence with multiple TE values. The MR images were then compared with histological staining. The analysis of cell function after iron labeling showed no effects on proliferation or differentiation of the cells. Although the adherence increases with higher iron dose, the ability to migrate decreases as a presumed effect of iron labeling. The iron labeled mesenchymal stem cells were detectable in vivo in MRI and histological staining even six months after injection. Labeling with iron particles and subsequent evaluation with highly resolved three dimensional data acquisition allows sensitive tracking of cells injected into the porcine urethral sphincter for several months without substantial biological effects on mesenchymal stem cells.

Noise-optimized virtual monoenergetic images and iodine maps for the detection of venous thrombosis in second-generation dual-energy CT (DECT): an ex vivo phantom study.

AIMS AND OBJECTIVES: Deep venous thrombosis (DVT) can be difficult to detect using CT due to poor and heterogeneous contrast. Dual-energy CT (DECT) allows iodine contrast optimization using noise-optimized monoenergetic extrapolations (MEIs) and iodine maps (IMs). Our aim was to assess whether MEI and IM could improve the delineation of thrombotic material within iodine-enhanced blood compared to single-energy CT (SECT). MATERIALS AND METHODS: Six vessel phantoms, including human thrombus and contrast media-enhanced blood and one phantom without contrast, were placed in an attenuation phantom and scanned with DECT 100/140 kV and SECT 120 kV. IM, virtual non-contrast images (VNC), mixed images, and MEI were calculated. Attenuation of thrombi and blood were measured. Contrast and contrast-to-noise-ratios (CNRs) were calculated and compared among IM, VNC, mixed images, MEI, and SECT using paired t tests. RESULTS: MEI40keV and IM showed significantly higher contrast and CNR than SE120kV from high to intermediate iodine concentrations (contrast:pMEI40keV < 0.002,pIM < 0.005;CNR:pMEI40keV < 0.002,pIM < 0.004). At low iodine concentrations, MEI190keV and VNC images showed significantly higher contrast and CNR than SE120kV with inverted contrasts (contrast:pMEI190keV < 0.008,pVNC < 0.002;CNR:pMEI190keV < 0.003,pVNC < 0.002). CONCLUSIONS: Noise-optimized MEI and IM provide significantly higher contrast and CNR in the delineation of thrombosis compared to SECT, which may facilitate the detection of DVT in difficult cases. KEY POINTS: • Poor contrast makes it difficult to detect thrombosis in CT. • Dual-energy-CT allows contrast optimization using monoenergetic extrapolations (MEI) and iodine maps (IM). • Noise-optimized-MEI and IM are significantly superior to single-energy-CT in delineation of thrombosis. • Noise-optimized-MEI and IM may facilitate the detection of deep vein thrombosis.

Dual-energy CT: virtual calcium subtraction for assessment of bone marrow involvement of the spine in multiple myeloma.

OBJECTIVE. Dual-energy CT (DECT) enables subtraction of calcium, facilitating the visualization of bone marrow (BM) in the axial skeleton. The purpose of this study was to assess whether DECT BM images have the potential to improve the detection of multifocal and diffuse BM infiltration in multiple myeloma (MM) in comparison with regular CT with MRI as the reference standard. SUBJECTS AND METHODS. This study included 32 consecutive patients who had known MM or presented with monoclonal gammopathy of unknown significance and underwent DECT and MRI of the axial skeleton. The degrees (none, n = 14; moderate, n = 10; and high, n = 8) and patterns (diffuse, n = 10 or multifocal, n = 8) of infiltration were assessed on MR images. Attenuation in BM and CT images in known uninvolved and involved areas was measured. Cutoff values of attenuation in BM images for infiltration in lytic and nonlytic lesions were established by ROC analysis. At least 120 days later, sensitivity and specificity for reading CT images alone and when using additional BM images were evaluated. RESULTS. ROC analysis revealed larger AUC in BM images than in CT images; cutoff values for marrow invasion in BM images were 4 and -3 HU in lytic and nonlytic lesions, respectively. In the blinded reading session, BM images improved the sensitivity for the detection of diffuse infiltration from 0 to as much as 75% for cases with high-grade infiltration. In multifocal patterns, BM images did not significantly change the detection rate. CONCLUSION. BM images have the potential to improve the sensitivity for detection of diffuse BM involvement in comparison with regular CT.

Tendinopathy of the achilles tendon: volume assessed by automated contour detection in submillimeter isotropic 3-dimensional magnetic resonance imaging data sets recorded at a field strength of 3 T.

OBJECTIVE: This prospective study assesses volume changes of the Achilles tendon in case of chronic tendinopathy (TEN), using an automated contour detection algorithm in submillimeter isotropic 3-dimensional magnetic resonance imaging data sets, recorded at 3 T. METHODS: Forty-one subjects (median age, 40 years; range, 19-68 years) were included in this prospective study and underwent nonenhanced magnetic resonance imaging of both Achilles tendons at 3 T, deploying a T2-weighted 3-dimensional Fast-Spin-Echo sequence with submillimeter resolution of 0.8 mm. Of the 41 subjects, 13 were classified as patients with TEN and 28 were healthy volunteers and served as control group. Of the 13 patients, 10 had unilateral TEN and 3 had bilateral TEN. Achilles tendons were automatically segmented in the T2-weighted magnetic resonance data sets for the evaluation of the tendon volume (0-3 cm proximal to the cranial border of the calcaneal bone). The total volume (length, 3 cm) was divided in 3 subvolumes of 1 cm length, named volume (0-1 cm), volume (1-2 cm), and volume (2-3 cm). Minimum and maximum tendon cross-sectional area within the total volume was processed. A standardized pain questionnaire was obtained from all patients. RESULTS: The automated contour detection algorithm worked reliably in all cases. The TEN group showed a significantly increased tendon volume compared to the control group (mean volume, 2.94 vs 2.43 mm; P < 0.05). The difference was most obvious concerning volume (2-3 cm) (P < 0.0001). Evaluation of clinical severity revealed a moderate correlation between VISA-score and tendon volume (2-3 cm) as well as the maximum/minimum tendon area (ρ = -0.44, ρ = -0.48, and ρ = -0.41). In case of unilateral TEN, the symptomatic side showed an increased tendon volume (2-3 cm) and increased minimum area (P < 0.05). CONCLUSIONS: Tendon volume and size are adequate surrogate parameters to differentiate patients with chronic TEN from healthy subjects, and may discriminate symptomatic TEN from asymptomatic "silent" TEN in patients with unilateral symptoms.

Vacuum-assisted breast biopsy with 7-gauge, 8-gauge, 9-gauge, 10-gauge, and 11-gauge needles: how many specimens are necessary?

BACKGROUND: Published national and international guidelines and consensus meetings on the use of vacuum-assisted biopsy (VAB) give different recommendations regarding the required numbers of tissue specimens depending on needle size and imaging method. PURPOSE: To evaluate the weights of specimens obtained with different VAB needles to facilitate the translation of the required number of specimens between different breast biopsy systems and needle sizes, respectively. MATERIAL AND METHODS: Five different VAB systems and seven different needle sizes were used: Mammotome® (11-gauge (G), 8-G), Vacora® (10-G), ATEC Sapphire™ (9-G), 8-G Mammotome® Revolve™, and EnCor Enspire® (10-G, 7-G). We took 24 (11-G) or 20 (7-10-G) tissue cores from a turkey breast phantom. The mean weight of a single tissue core was calculated for each needle size. A matrix, which allows the translation of the required number of tissue cores for different needle sizes, was generated. Results were compared to the true cumulative tissue weights of consecutively harvested tissue cores. RESULTS: The mean tissue weights obtained with the 11-G / 10-G Vacora® / 10-G Enspire® / 9-G / 8-G Original / 8-G Revolve™ / 7-G needles were 0.084 g / 0.142 g / 0.221 g / 0.121 g / 0.192 g / 0.334 g / 0.363 g, respectively. The calculated required numbers of VAB tissue cores for each needle size build the matrix. For example, the minimum calculated number of required cores according to the current German S3 guideline is 20 / 12 / 8 / 14 / 9 / 5 / 5 for needles of 11-G / 10-G Vacora® / 10-G Enspire® / 9-G / 8-G Original / 8-G Revolve™ / 7-G size. These numbers agree with the true cumulative tissue weights. CONCLUSION: The presented matrix facilitates the translation of the required number of VAB specimens between different needle sizes and thereby eases the implementation of current guidelines and consensus recommendations into clinical practice.

Diffusion-weighted imaging during MR-guided radiofrequency ablation of hepatic malignancies: analysis of immediate pre- and post-ablative diffusion characteristics.

BACKGROUND: Previous studies have shown a benefit of magnetic resonance (MR)-diffusion-weighted imaging (DWI) for follow-up after liver radiofrequency (RF) ablation. However, no data are available concerning acute changes of DWI characteristics immediately after RF ablation. PURPOSE: To analyze and compare the MR-diffusion characteristics of pre-interventional hepatic malignancies and the ablation zone during successful MR-guided RF ablation. MATERIAL AND METHODS: This retrospective study was conducted in accordance with the guidelines of the local institutional review board. Forty-seven patients with 29 HCC (24 patients) and 30 hepatic metastases (23 patients) underwent MR-guided radiofrequency ablation including DWI before and immediately after ablation (b = 0, 400, 800 s/mm(2)). Two reviewers (A and B) analyzed DWI with focus on detectability of the tumor before ablation and characteristics of the coagulative area after treatment. Mean apparent diffusion coefficient (ADC) was compared between liver, untreated tumor, and hyperintense areas in post-ablative DWI (b = 800 s/mm(2)) with the paired Student's t-test. RESULTS: Pre-ablative: the reviewers classified 19/29 (A) and 23/29 (B) HCC and 25/30 (A and B) metastases as detectable in DWI. Post-ablative: a hyperintense rim surrounding the ablation zone was observed in 28/29 treated HCC and 30/30 treated metastases (A and B). A homogenous hypointense central ablation zone was found in 18/29 (A) and 20/29 (B) treated HCC and 17/30 (A & B) treated metastases in DWI. ADC of the rim was significantly lower than ADC of the liver (P < 0.001). CONCLUSION: DWI enables visualization of the target tumor in MR-guided liver radiofrequency ablation in most cases. A common post-ablative DWI finding is a hyperintense rim with decreased ADC surrounding the ablation zone.

Simultaneous whole-body PET/MR imaging in comparison to PET/CT in pediatric oncology: initial results.

PURPOSE: To compare positron emission tomography (PET)/magnetic resonance (MR) imaging and PET/computed tomography (CT) for lesion detection and interpretation, quantification of fluorine 18 ((18)F) fluorodeoxyglucose (FDG) uptake, and accuracy of MR-based PET attenuation correction in pediatric patients with solid tumors. Materials and Methods This prospective study had local ethics committee and German Federal Institute for Drugs and Medical Devices approval. Written informed consent was obtained from all patients and legal guardians. Twenty whole-body (18)F-FDG PET/CT and (18)F-FDG PET/MR examinations were performed in 18 pediatric patients (median age, 14 years; range, 11-17 years). (18)F-FDG PET/CT and (18)F-FDG PET/MR data were acquired sequentially on the same day for all patients. PET standardized uptake values (SUVs) were quantified with volume of interest measurements in lesions and healthy tissues. MR-based PET attenuation correction was compared with CT-derived attenuation maps (µ-maps). Lesion detection was assessed with separate reading of PET/CT and PET/MR data. Estimates of radiation dose were derived from the applied doses of (18)F-FDG and CT protocol parameters. Descriptive statistical analyses were performed to report correlation coefficients and relative deviations for comparison of SUVs, rates of lesion detection, and percentage reductions in radiation dose. RESULTS: PET SUVs showed strong correlations between PET of PET/CT (PETCT) and PET of PET/MR (PETMR) (r > 0.85 for most tissues). Apart from drawbacks of MR-based PET attenuation correction in osseous structures and lungs, similar SUVs were found on PET images corrected with CT-based µ-maps (13.1% deviation of SUVs for bone marrow and <5% deviation for other tissues). Lesion detection rate with PET/MR imaging was equivalent to that with PET/CT (61 areas of focal uptake on PETMR images vs 62 areas on PETCT images). Advantages of PET/MR were observed especially in soft-tissue regions. Furthermore, PET/MR offered significant dose reduction (73%) compared with PET/CT. CONCLUSION: Pediatric oncologic PET/MR is technically feasible, showing satisfactory performance for PET quantification with SUVs similar to those of PET/CT. Compared with PET/CT, PET/MR demonstrates equivalent lesion detection rates while offering markedly reduced radiation exposure. Thus, PET/MR is a promising modality for the clinical work-up of pediatric malignancies. Online supplemental material is available for this article.

Quick water-selective excitation of fast relaxing tissues with 3D UTE sequences.

PURPOSE: The aim of this study was to implement a time effective 1-1 double pulse water-selective excitation (WE) into a three-dimensional ultrashort echo time (UTE) sequence (WE-UTE) for visualization of short-T2 tissues with positive contrast and sufficient suppression of surrounding fat. METHODS: First, an analytical description of magnetization components in the steady state applying WE-UTE was derived and results were compared with numerical simulations based on Bloch's equations. Parameters were optimized for best positive contrast between short-T2 tissues and fat under consideration of variable relaxation properties over a broad range. Maximal signal yield and signal efficiency of on-resonant protons were compared with UTE sequences with and without off-resonance fat saturation (FatSat). WE-UTE was exemplarily applied for in-vivo musculoskeletal imaging on a 3T whole-body MR unit. RESULTS: Steady state magnetization of WE-UTE could be described analytically and showed excellent accordance with numerical simulations. Even for tissues with T2 = 1 ms WE-UTE resulted in 79% of maximal signal yield of UTE without FatSat and was more efficient regarding signal yield if compared with UTE with FatSat. Using WE-UTE in-vivo tendons and ligaments could be well delineated with positive contrast to surrounding fat. CONCLUSION: WE-UTE provides a quick method for visualizing short-T2 tissues with positive contrast.

Liver lesion conspicuity during real-time MR-guided radiofrequency applicator placement using spoiled gradient echo and balanced steady-state free precession imaging.

PURPOSE: To retrospectively evaluate the conspicuity of liver lesions in a fluoroscopic spoiled gradient echo (GRE) and a balanced steady-state free precession (SSFP) magnetic resonance imaging (MRI) sequence. MATERIALS AND METHODS: In all, 103 patients with hepatocellular carcinomas (HCC) (41) or liver metastases (67) were treated using MR-guided radiofrequency ablation in a wide-bore 1.5 T scanner. A multislice real-time spoiled GRE sequence allowing for a T1 weighting (T1W) and a balanced SSFP sequence allowing for a T2/T1W contrast were used for MR guidance. The contrast-to-noise-ratio (CNR) of the lesions was calculated and lesion conspicuity was assessed retrospectively (easily detectable / difficult to detect / not detectable). RESULTS: HCC was easily detectable in 33/52% (GRE/SSFP), difficult to detect in 30/18%, and not detectable in 37/30% of the cases. Mean CNR varied widely (9.1 for GRE vs. 16.4 for SSFP). Liver metastases were easily detectable in 58/41% (GRE/SSFP), difficult to detect in 14/21%, and not detectable in 28/38% of the cases. Mean CNR for liver metastases was 11.5 (GRE) vs. 12.7 (SSFP). Twenty percent of all lesions could not be detected with either of the MR fluoroscopy sequences. CONCLUSION: MR fluoroscopy using GRE and SSFP contrast enabled real-time detectability of 80% of the liver lesions.

Measurement of apparent diffusion coefficient with simultaneous MR/positron emission tomography in patients with peritoneal carcinomatosis: comparison with 18F-FDG-PET.

PURPOSE: To characterize peritoneal carcinomatosis (PC) of different histologically proven primary tumors based on diffusion-weighted imaging (DWI) and (18) F-FDG positron emission tomography (PET). MATERIALS AND METHODS: Forty-one patients underwent simultaneous MR/PET after clinically indicated (18) F-FDG-PET/CT. For all patients, histology of the primary tumor was obtained. MR protocol comprised anatomical imaging and axial DWI. Apparent diffusion coefficient (ADC) maps and FDG-PET were co-registered for evaluation of ADC and standard uptake value (SUV) of peritoneal lesions. Both lesion- and patient-based analysis was performed. Up to four peritoneal lesions were evaluated per patient. Mean and maximum standard uptake value (SUVmean , SUVmax ), mean and minimum ADC (ADCmean , ADCmin ) of each lesion were assessed. Spearman rank correlation (rs ) of ADC and SUV were calculated. SUV and ADC of ovarian and colorectal cancer lesions were compared using Wilcoxon test. RESULTS: Measurable lesions (n = 52) were found in 20 of 41 PC patients. Moderate, but significant correlation existed between ADC and SUV in the lesion-based as well as the patient-based analysis (lesion-based: SUVmean versus ADCmean rs = -0.58; SUVmax versus ADCmin rs = -0.56, all P < 0.0001; patient-based: SUVmean versus ADCmean rs = -0.64, P = 0.002; SUVmax versus ADCmin rs = -0.60, P = 0.005). ADC and SUV differed significantly between ovarian and colorectal cancer lesions (ADCmin : P < 0.0001; ADCmean : P < 0.0001; SUVmax : P = 0.002; SUVmean : P = 0.005). Overall, mucinous tumor entities showed a tendency to higher ADC and lower SUV. CONCLUSION: PC lesions showed significant differences in glucose uptake and diffusion characteristics depending on primary tumor histology. These differences should be considered when interpreting FDG-PET and DWI in PC patients.

Short-term exercise-induced changes in hydration state of healthy Achilles tendons can be visualized by effects of off-resonant radiofrequency saturation in a three-dimensional ultrashort echo time MRI sequence applied at 3 Tesla.

PURPOSE: Off-resonant RF saturation influences signal intensity dependent on free and bound water fractions as well as the macromolecular content. The extent of interaction between these compartments can be evaluated by using the off-resonance saturation ratio (OSR). Combined with UTE sequences quantification of OSR even in tendinous tissues with extremely fast signal decay is possible. The aim of this prospective study was to investigate short-term exercise-induced effects of hydration state of the Achilles tendon by means of OSR and tendon volume. MATERIALS AND METHODS: Measurements of OSR and tendon volume before and after ankle-straining activity were performed in seven healthy male volunteers (median age 29 years) using a 3D UTE sequence with implemented off-resonance saturation pulse at 3T (off-resonance frequency 2/3 kHz) and by an automated contour detection in isotropic T2-weighted MR images with sub-millimeter resolution, respectively. Different tendon regions were evaluated. Reproducibility of OSR was measured in subsequent imaging sets. Root-mean-square-deviation (RMSD) and coefficient of variations (CV) were determined. RESULTS: RMSD of OSR in resting position were between 0.006 and 0.01 for different tendon regions and off-resonance frequencies (CV 2 to 3%). A significant increase (P < 0.05) of OSR after exercise was seen in all tendon regions except at the insertion (off-resonance frequency 3 kHz). Tendon volume was decreased significantly after ankle-straining activity (P = 0.003). CONCLUSION: The observed decreased tendon volume and increased OSR directly after exercise indicates a short-term change in tendinous proton compartments, most likely a loss of free water molecules within the tendon.

Midtreatment evaluation of lymphoma response to chemotherapy by volume perfusion computed tomography.

OBJECTIVE: The aim of this study was to search for chemotherapy-induced perfusion changes of diffuse large B-cell lymphoma, follicular lymphoma, and Hodgkin lymphoma at midtreatment versus baseline volume perfusion computed tomography (VPCT). METHODS: Forty-five consecutive patients with untreated diffuse large B-cell lymphoma, follicular lymphoma, and Hodgkin lymphoma received VPCT examinations of the tumor bulk at baseline and during chemotherapy (midtreatment). Blood flow (BF), blood volume (BV), and transit constant (K-trans) were determined. Treatment response was categorized according to the Cheson criteria into complete or partial remission and stable or relapsed/progressive disease. RESULTS: Midtreatment follow-up showed a reduction in BF, BV, and K-trans in all lymphoma subtypes compared with baseline. The reduction in BV was less pronounced in larger tumors. Notably, BF, BV, and K-trans decreased in the responders (complete remission/partial remission) when compared with the nonresponders (stable or relapsed/progressive disease). Less than 10% reduction in BF was shown to be the best VPCT criterion for the identification of nonresponse. CONCLUSIONS: Chemotherapy-induced perfusion changes in responders are recognizable at midtreatment VPCT.

BI-RADS® 3 lesions at contrast-enhanced breast MRI: is an initial short-interval follow-up necessary?

BACKGROUND: Magnetic resonance imaging (MRI) BI-RADS® 3 lesions should have a very high probability of being benign. To prove benignity most institutions do follow-up MRI. PURPOSE: To evaluate the necessity of initial short-interval follow-up after 6 months as it is suggested for mammographic BI-RADS®3 lesions. MATERIAL AND METHODS: We analyzed 163 consecutive MRI-BI-RADS® 3 lesions on follow-up MRI: 75 masses (46%), 67 foci (41.1%), and 21 (12.9%) non-mass-like enhancing lesions (NMLE). RESULTS: During MRI follow-up (mean time, 563 days) 20% of the lesions disappeared, 23% decreased, 52% did not change, and 4.9% showed increase. All increasing lesions were biopsied (5 benign, 2 ductal carcinoma in situ, 1 invasive carcinoma). The rate of malignancy was 1.8%. All malignant lesions (1 mass, 1 focus, 1 NMLE) showed increase at initial follow-up after a mean interval of 190 days. CONCLUSION: In this study the malignancy rate of MRI-BI-RADS® 3 lesions corresponded to mammographic BI-RADS® 3 lesions. Initial short-interval MRI should be suggested to identify malignant MRI-BI-RADS® 3 lesions.

Comparison of four microwave ablation devices: an experimental study in ex vivo bovine liver.

PURPOSE: To compare volume, sphericity, and short-axis diameter of the coagulation zone of four commercially available microwave ablation systems with three technical concepts in an ex vivo setting and to formulate mathematical models to predict these quantities. MATERIALS AND METHODS: Two high-power systems (systems A and B), a system that enables simultaneous use of three antennas (system C), and a non-perfusion-cooled system that automatically adapts power and frequency (system D) were tested in ex vivo bovine livers (108 ablations). Coagulation volume, sphericity, and mean short-axis diameter were assessed, and mathematical functions were fitted for each system and assessed with the coefficient of determination (R(2)). Analysis of variance and Tukey post hoc tests were used for interdevice comparison after 5 and 10 minutes and after maximum recommended ablation time. RESULTS: Volume and short-axis diameter were determined by using a mathematical model for every system, with coefficients of determination of 0.75-0.98 and 0.70-0.97, respectively. Correlation for determination of sphericity was lower (R(2) = 0.01-0.68). Mean results with ablation performed according to manufacturer recommendations were as follows: Volume, sphericity, and short-axis diameter were 57.5 cm(3), 0.75, and 43.4 mm, respectively, for system A; 72.3 cm(3), 0.68, and 45.5 mm, respectively, for system B; 17.1 cm(3), 0.58, and 26.8 mm, respectively, for system C (one antenna); 76.5 cm(3), 0.89, and 50.6 mm, respectively, for system C (three antennas); and 56.0 cm(3), 0.64, and 40.9 mm, respectively, for system D. Systems A (mean volume, 52.4 cm(3) ± 4.5 [standard deviation]) and B (39.4 cm(3) ± 1.7) reach large ablation zones with 5-minute ablation. CONCLUSION: The largest ablation zone is obtained with systems B and C (three antennas) under maximum recommended ablation duration and with system A under short ablation time. The most spherical zone is obtained with system C (three antennas).

Fraction of unsaturated fatty acids in visceral adipose tissue (VAT) is lower in subjects with high total VAT volume - a combined 1 H MRS and volumetric MRI study in male subjects.

Visceral adipose tissue (VAT) is thought to play an important role in the pathogenesis of obesity and insulin resistance. However, little is known about the composition of VAT with regard to the amount of mono- (MUFAs) and polyunsaturated fatty acids (PUFAs) in triglycerides. Volume-selective MRS was performed in addition to MRI for the quantification of VAT. Analysis comprised proton signals from the vinyl-H group (H-C=C-H), including protons from MUFA+PUFA, and diallylic-H, i.e. methylene-interrupted PUFAs. The methyl (-CH(3) ) resonance, which is the only peak with a defined number of protons/triglyceride (n=9), served as reference. Twenty male subjects participated in this prospective study and underwent MRS of VAT on a 3-T whole-body unit. Spectra were recorded by a single-voxel stimulated echo acquisition mode (STEAM) technique (TE/TM/TR=20/10/4000 ms; volume of interest between 20 × 25 × 20 and 30 × 30 × 20 mm(3); 48-80 acquisitions depending on the size of the volume of interest; bandwidth, 1200 Hz). Post-processing was performed by a Java-based magnetic resonance user interface (jMRUI; AMARES). The volume of VAT was quantified in a separate session on a 1.5-T imager a few days prior to the MRS session by T(1) -weighted imaging. The relative amount of VAT was calculated as a percentage of body weight (%VAT). Ratios of vinyl-H to -CH(3) and diallylic-H to -CH(3) were calculated. All spectra recorded from VAT were of high quality, enabling reliable quantification of the mentioned resonances. %VAT and vinyl-H/CH(3) varied over a broad range (2.8-8.3% and 0.45-0.64, respectively). A strong negative correlation between %VAT and vinyl-H/CH(3) was found (r= -0.92), whereas diallylic-H/CH(3) alone was clearly less well correlated with %VAT (r= -0.21). The composition of VAT shows strong interindividual variations. The greater the total amount of VAT, the less unsaturated the fatty acids. This is a preliminary result in mainly obese male subjects, and it remains to be determined whether this correlation holds for other cohorts of different age, gender and body mass index. Furthermore, changes in VAT composition during weight loss or different forms of diet have yet to be examined.

Correlation between [¹8F]FDG PET/CT and volume perfusion CT in primary tumours and mediastinal lymph nodes of non-small-cell lung cancer.

PURPOSE: The aim of this study was to investigate correlations between glucose metabolism as determined by [(18)F]FDG PET/CT and tumour perfusion as quantified by volume perfusion CT in primary tumours and mediastinal lymph nodes (MLN) of patients with non-small-cell lung cancer (NSCLC). METHODS: Enrolled in the study were 17 patients with NSCLC. [(18)F]FDG uptake was quantified in terms of SUVmax and SUVavg. Blood flow (BF), blood volume (BV) and flow extraction product (K(trans)) were determined as perfusion parameters. The correlations between the perfusion parameters and [(18)F]FDG uptake values were subsequently evaluated. RESULTS: For the primary tumours, no correlations were found between perfusion parameters and [(18)F]FDG uptake. In MLN, there were negative correlations between BF and SUVavg (r = -0.383), BV and SUVavg (r = -0.406), and BV and SUVmax (r = -0.377), but not between BF and SUVmax, K(trans) and SUVavg, or K(trans) and SUVmax. Additionally, in MLN with SUVmax >2.5 there were negative correlations between BF and SUVavg (r = -0.510), BV and SUVavg (r = -0.390), BF and SUVmax (r = -0.536), as well as BV and SUVmax (r = -0.346). CONCLUSION: Perfusion and glucose metabolism seemed to be uncoupled in large primary tumours, but an inverse correlation was observed in MLN. This information may help improve therapy planning and response evaluation.

Accuracy of preoperative endorectal MRI in predicting extracapsular extension and influence on neurovascular bundle sparing in radical prostatectomy.

PURPOSE: To evaluate the accuracy of presurgical endorectal MRI (eMRI) for local staging before radical prostatectomy (RP) and its influence on neurovascular bundle (NVB) resection during radical prostatectomy. PATIENTS AND METHODS: A total of 385 patients with histologically proven prostate cancer (PCa) have been included in this retrospective study between 2004 and 2008. All patients underwent preoperative eMRI at 1.5 T before open RP. Staging results by eMRI were compared with the histopathological findings. The presence of positive surgical margins and extent of nerve-sparing procedure were evaluated. Subgroup analysis of low-risk group and intermediate to high-risk group based on D'Amico criteria was conducted. RESULTS: In 294 (76.4%) patients, pathological stage was correctly predicted, 69 patients (17.9%) were understaged and 22 (5.7%) overstaged. Overall sensitivity, specificity, negative and positive predictive value for predicting extracapsular extension (ECE) were 41.5, 91.8, 78.0 and 69.0%, respectively. One hundred and fifty-two (48.4%) of the patients classified as stage cT2 by eMRI underwent bilateral NVB sparing, whereas 14 (19.7%) patients with reported ECE underwent bilateral NVB sparing (P < 0.01). Overall positive surgical margin rate was 14.8%. Sensitivity of predicting ECE and positive predictive value were lower in the low-risk group than in the intermediate and high-risk group. CONCLUSIONS: eMRI is effective in predicting extracapsular extension in an intermediate to high-risk group. Preoperative eMRI in patients with low-risk criteria is not recommended as a routine assessment modality. eMRI findings did appear to influence surgical strategy as patients with imaging findings suggesting >cT2 disease were less likely to undergo NVB sparing.

Twelve-month results of a randomized trial comparing mono with dual antiplatelet therapy in endovascularly treated patients with peripheral artery disease.

PURPOSE: To present the 12-month results of a trial investigating the effects of dual antiplatelet therapy on target lesion revascularization (TLR) after balloon angioplasty ± stenting in the femoropopliteal segment. METHODS: A prospective, randomized, single-center, double-blinded and placebo-controlled clinical trial randomly assigned 40 patients to receive pre- and postinterventional therapy with aspirin and clopidogrel. Another 40 patients received the same doses of aspirin and placebo instead of clopidogrel. Clopidogrel and placebo were stopped after 6 months, and patients remained on aspirin only. At 12 months after the intervention, 36 clopidogrel patients and 37 placebo patients were reevaluated. RESULTS: At 6 months, clopidogrel patients had significantly lower rates of TLR compared to placebo patients [2 (5%) vs. 8 (20%), p=0.04]. After stopping clopidogrel/placebo after 6 months, there was no significant difference in TLR at 12 months after treatment [9 (25%) clopidogrel vs. 12 (32.4%) placebo, p=0.35]. Mortality was 0 vs. 1 in the placebo group at 6 months (p=0.32) and 0 vs. 3 at 12 months (p=0.08). CONCLUSION: In contrast to the first report of a reduction in the TLR at 6 months, this advantage of dual antiplatelet therapy does not persist after stopping clopidogrel. Prolonged dual therapy (>6 months) should be considered in patients who are at high risk for restenosis.

High-grade, non-flow-limiting dissections do not negatively impact long-term outcome after paclitaxel-coated balloon angioplasty: an additional analysis from the THUNDER study.

PURPOSE: To investigate the impact of using paclitaxel-coated balloons (PCB) on outcome after post-angioplasty dissection in femoropopliteal arteries. METHODS: The angiograms obtained in the THUNDER study (ClinicalTrials.gov identifier NCT00156624) were analyzed to compare degrees of dissection and angiographic parameters between the control (uncoated balloons, n=43) and treatment (PCBs, n=43) groups before and after the intervention and at 6-month follow-up. Furthermore, target lesion revascularizations (TLR) were documented up to 2 years. RESULTS: In each group, 24 (56%) patients had a dissection after the intervention. At the 6-month follow-up, patients with dissection of any grade after treatment with PCBs had significantly less late lumen loss (0.4 mm) than patients with dissection after treatment with uncoated balloons (1.9 mm, p=0.001) and a lower degree of stenosis (20% vs. 51%, respectively; p=0.003). Patients with severe dissection (grades C, D, or E) especially seemed to benefit from the PCBs, with late lumen loss of 0.4 mm vs. 2.4 mm for controls (p=0.05). The binary restenosis rate was also markedly lower in the PCB group (20%) than in the uncoated group (55%, p=0.02). In the 2-year follow-up, TLR was performed in 56% of patients in the control group compared to 10% of patients in the PCB group (p=0.002). CONCLUSION: The results of this subgroup analysis suggest that patients with dissection following treatment with a paclitaxel-coated balloon have a very acceptable outcome and stent implantation is not necessary as long as the dissection does not result in acute flow limitation.