Henrik J Michaely
Research interests
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Interests3T, mra, functional imaging, MRI
Other
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Scientific MembershipsRSNA, ISMRM, DRG, ESR, ESCR, ESUR
Publications
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0.48Impact points
[Functional magnetic resonance imaging for evaluation of radiation-induced renal damage].
Der Radiologe. 03/2012; 52(3):243-51.
The diagnosis of radiation-induced (especially chronic) renal alterations/damage is difficult and currently relies primarily on clinical evaluation. The importance of renal diagnostic evaluation will increase continuously due to the increasing number of long-term survivors after radiotherapy. This a... [more] The diagnosis of radiation-induced (especially chronic) renal alterations/damage is difficult and currently relies primarily on clinical evaluation. The importance of renal diagnostic evaluation will increase continuously due to the increasing number of long-term survivors after radiotherapy. This article evaluates the potentia diagnostic contribution of magnetic resonance (MR) imaging with a focus on functional MRI. The following functional MRI approaches are briefly presented and evaluated: blood oxygenation level-dependent imaging (BOLD), diffusion-weighted imaging (DWI) or diffusion tensor imaging (DTI), MR perfusion measurements and (23)Na imaging. In summary, only DWI and contrast-enhanced MR perfusion currently seem to be suitable approaches for a broader, clinical implementation. However, up to now valid data from larger patient studies are lacking for both techniques in regard to radiation-induced renal alterations. The BOLD and (23)Na imaging procedures have a huge potential but are currently neither sufficiently evaluated with regard to radiation-induced renal alterations nor technically simple and reliable for implementation into the clinical routine.
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6.19Impact points
Renal BOLD-MRI does not reflect renal function in chronic kidney disease.
Kidney international. 01/2012;
Renal blood oxygen level-dependent magnetic resonance imaging (BOLD-MRI) is a noninvasive fast technique to characterize renal function. Here we evaluated the impact of renal function on the relaxation rate (R2(*)) in the cortex and medulla to provide baseline data for further use of renal BOLD-MRI.... [more] Renal blood oxygen level-dependent magnetic resonance imaging (BOLD-MRI) is a noninvasive fast technique to characterize renal function. Here we evaluated the impact of renal function on the relaxation rate (R2(*)) in the cortex and medulla to provide baseline data for further use of renal BOLD-MRI. This parameter was evaluated in 400 patients scheduled for abdominal imaging who underwent transversal blood oxygen level-dependent measurements with a multi-echo gradient-echo sequence with 12 echo times. The loss of phase coherence (T2(*)) maps were generated in which kidney regions of interest were selected to differentiate the medulla and cortex, and R2(*) was equated to 1/T2(*). Individual R2(*) values were, in turn, correlated to the eGFR (MDRD formula of 280 patients with available serum creatinine measurements), age, and gender each for 1.5 and 3.0 T field-strength scans of 342 patients. At both the field strengths, no significant differences in R2(*) of the cortex and medulla were found between patient gender, age, eGFR, or between different stages of chronic kidney disease determined using the KDOQI system. Thus, BOLD-MRI of a non-specific patient population failed to discriminate between the patients with various stages of chronic kidney disease.Kidney International advance online publication, 11 January 2012; doi:10.1038/ki.2011.455.
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4.41Impact points
Implementation of Dual-Source RF Excitation in 3 T MR-Scanners Allows for Nearly Identical ADC Values Compared to 1.5 T MR Scanners in the Abdomen.
PloS one. 01/2012; 7(2):e32613.
To retrospectively and prospectively compare abdominal apparent diffusion coefficient (ADC) values obtained within in a 1.5 T system and 3 T systems with and without dual-source parallel RF excitation techniques. After IRB approval, diffusion-weighted (DW) images of the abdomen were obtained on thre... [more] To retrospectively and prospectively compare abdominal apparent diffusion coefficient (ADC) values obtained within in a 1.5 T system and 3 T systems with and without dual-source parallel RF excitation techniques. After IRB approval, diffusion-weighted (DW) images of the abdomen were obtained on three different MR systems (1.5 T, a first generation 3 T, and a second generation 3 T which incorporates dual-source parallel RF excitation) on 150 patients retrospectively and 19 volunteers (57 examinations total) prospectively. Seven regions of interest (ROI) were throughout the abdomen were selected to measure the ADC. Statistical analysis included independent two-sided t-tests, Mann-Whitney U tests and correlation analysis. In the DW images of the abdomen, mean ADC values were nearly identical with nonsignificant differences when comparing the 1.5 T and second generation 3 T systems in all seven anatomical regions in the patient population and six of the seven in the volunteer population (p>0.05 in all distributions). The strength of correlation measured in the volunteer population between the two scanners in the kidneys ranged from r = 0.64-0.88 and in the remaining regions (besides the spleen), r>0.85. In the patient population the first generation 3 T scanner had different mean ADC values with significant differences (p<0.05) compared to the other two scanners in each of the seven distributions. In the volunteer population, the kidneys shared similar ADC mean values in comparison to the other two scanners with nonsignificant differences. A second generation 3 T scanner with dual-source parallel RF excitation provides nearly identical ADC values compared with the 1.5 T imaging system in abdominal imaging.
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2.65Impact points
Combined large field-of-view MRA and time-resolved MRA of the lower extremities: Impact of acquisition order on image quality.
European journal of radiology. 12/2011;
PURPOSE: Different approaches exist for hybrid MRA of the calf station. So far, the order of the acquisition of the focused calf MRA and the large field-of-view MRA has not been scientifically evaluated. Therefore the aim of this study was to evaluate if the quality of the combined large field-of-vi... [more] PURPOSE: Different approaches exist for hybrid MRA of the calf station. So far, the order of the acquisition of the focused calf MRA and the large field-of-view MRA has not been scientifically evaluated. Therefore the aim of this study was to evaluate if the quality of the combined large field-of-view MRA (CTM MR angiography) and time-resolved MRA with stochastic interleaved trajectories (TWIST MRA) depends on the order of acquisition of the two contrast-enhanced studies. METHODS: In this retrospective study, 40 consecutive patients (mean age 68.1±8.7 years, 29 male/11 female) who had undergone an MR angiographic protocol that consisted of CTM-MRA (TR/TE, 2.4/1.0ms; 21° flip angle; isotropic resolution 1.2mm; gadolinium dose, 0.07mmol/kg) and TWIST-MRA (TR/TE 2.8/1.1; 20° flip angle; isotropic resolution 1.1mm; temporal resolution 5.5s, gadolinium dose, 0.03mmol/kg), were included. In the first group (group 1) TWIST-MRA of the calf station was performed 1-2min after CTM-MRA. In the second group (group 2) CTM-MRA was performed 1-2min after TWIST-MRA of the calf station. The image quality of CTM-MRA and TWIST-MRA were evaluated by 2 two independent radiologists in consensus according to a 4-point Likert-like rating scale assessing overall image quality on a segmental basis. Venous overlay was assessed per examination. RESULTS: In the CTM-MRA, 1360 segments were included in the assessment of image quality. CTM-MRA was diagnostic in 95% (1289/1360) of segments. There was a significant difference (p<0.0001) between both groups with regard to the number of segments rated as excellent and moderate. The image quality was rated as excellent in group 1 in 80% (514/640 segments) and in group 2 in 67% (432/649), respectively (p<0.0001). In contrast, the image quality was rated as moderate in the first group in 5% (33/640) and in the second group in 19% (121/649) respectively (p<0.0001). The venous overlay was disturbing in 10% in group 1 and 20% in group 2 (p=n.s.). CONCLUSION: If a combined hybrid MRA approach with large field-of-view and time-resolved MRA is acquired the large field-of-view MRA should be acquired first in order for optimal image quality.
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2.77Impact points
DCE-MRI of the human kidney using BLADE: A feasibility study in healthy volunteers.
Journal of magnetic resonance imaging : JMRI. 11/2011;
PURPOSE: To evaluate the degree of motion compensation in the kidney using two different sampling methods, each in their optimized settings: A BLADE k-space acquisition technique and a routinely used kidney perfusion acquisition scheme (TurboFLASH). MATERIALS AND METHODS: Dynamic contrast enhanced m... [more] PURPOSE: To evaluate the degree of motion compensation in the kidney using two different sampling methods, each in their optimized settings: A BLADE k-space acquisition technique and a routinely used kidney perfusion acquisition scheme (TurboFLASH). MATERIALS AND METHODS: Dynamic contrast enhanced magnetic resonance examinations were performed in 16 healthy volunteers on a 3 Tesla MR-system with two parameterizations of the BLADE sequence and the standard reference acquisition scheme. Signal intensity enhanced time curves were analyzed with a mathematical model and a widely published separable compartment model on cortex regions to assess robustness versus motion artifacts. RESULTS: BLADE-measurements with a strip-width of 32 lines constituted the smallest mean values for the sum of squared errors (6065 ± 4996) compared with the measurement with a strip-width of 64 lines (13849 ± 14079) or the standard TurboFLASH (11884 ± 8076). Calculations concerning goodness of the fit of the applied compartment model yielded an overall average of the Akaike Fit Error of 732 ± 141 for BLADE (646 ± 149 for a strip-width of 32 lines, 816 ± 53 for 64 lines) and 1626 ± 303 for the TurboFLASH (TFL) sequence. CONCLUSION: We demonstrated that renal dynamic contrast enhanced magnetic resonance imaging using BLADE k-space sampling with a strip-width of 32 is significantly less sensitive to motion than a widely published Turbo-Flash sequence with nearly similar parameters. J. Magn. Reson. Imaging 2011;. © 2011 Wiley Periodicals, Inc.
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4.56Impact points
Insights into the location of type I ECG in patients with Brugada syndrome: Correlation of ECG and cardiovascular magnetic resonance imaging.
Heart rhythm : the official journal of the Heart Rhythm Society. 11/2011; 9(3):414-21.
Brugada syndrome is characterized by ST-segment abnormalities in V1-V3. Electrocardiogram (ECG) leads placed in the 3rd and 2nd intercostal spaces (ICSs) increased the sensitivity for the detection of a type I ECG pattern. The anatomic explanation for this finding is pending. The purpose of the stud... [more] Brugada syndrome is characterized by ST-segment abnormalities in V1-V3. Electrocardiogram (ECG) leads placed in the 3rd and 2nd intercostal spaces (ICSs) increased the sensitivity for the detection of a type I ECG pattern. The anatomic explanation for this finding is pending. The purpose of the study was to correlate the location of the Brugada type I ECG with the anatomic location of the right ventricular outflow tract (RVOT). Twenty patients with positive ajmaline challenge and 10 patients with spontaneous Brugada type I ECG performed by using 12 right precordial leads underwent cardiovascular magnetic resonance imaging (CMRI). The craniocaudal and lateral extent of the RVOT and maximal RVOT area were determined. Type I ECG pattern and maximal ST-segment elevation were correlated to extent and maximal RVOT area, respectively. In all patients, Brugada type I pattern was found in the 3rd ICS in sternal and left-parasternal positions. RVOT extent determined by using CMRI included the 3rd ICS in all patients. Maximal RVOT area was found in 3 patients in the 2nd ICS, in 5 patients in the 4th ICS, and in 22 patients in the 3rd ICS. CMRI predicted type I pattern with a sensitivity of 97.2%, specificity of 91.7%, positive predictive value of 88.6%, and negative predictive value of 98.0%. Maximal RVOT area coincided with maximal ST-segment elevation in 29 of 30 patients. RVOT localization determined by using CMRI correlates highly with the type I Brugada pattern. Lead positioning according to RVOT location improves the diagnosis of Brugada syndrome.
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2.28Impact points
Assessment of the kidneys: magnetic resonance angiography, perfusion and diffusion.
Journal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance. 11/2011; 13:70.
Renal magnetic resonance (MR) imaging has undergone major improvements in the past several years. This review focuses on the technical basics and clinical applications of MR angiography (MRA) with the goal of enabling readers to acquire high-resolution, high quality renal artery MRA. The current rol... [more] Renal magnetic resonance (MR) imaging has undergone major improvements in the past several years. This review focuses on the technical basics and clinical applications of MR angiography (MRA) with the goal of enabling readers to acquire high-resolution, high quality renal artery MRA. The current role of contrast agents and their safe use in patients with renal impairment is discussed. In addition, an overview of promising techniques on the horizon for renal MR is provided. The clinical value and specific applications of renal MR are critically discussed.
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2.65Impact points
Attenuation-based characterization of coronary atherosclerotic plaque: comparison of dual source and dual energy CT with single-source CT and histopathology.
European journal of radiology. 10/2011; 80(1):54-9.
To compare different CT acquisition techniques regarding for attenuation-based characterization of coronary atherosclerotic plaques using histopathology as the standard of reference. In a post mortem study 17 human hearts were studied with dual-source CT (DSCT) and dual energy CT (DECT) mode on a DS... [more] To compare different CT acquisition techniques regarding for attenuation-based characterization of coronary atherosclerotic plaques using histopathology as the standard of reference. In a post mortem study 17 human hearts were studied with dual-source CT (DSCT) and dual energy CT (DECT) mode on a DSCT as well as with 16-slice single-source CT (SSCT). At autopsy, atherosclerotic lesions were cut at 5 μm sections. Histopathologic classification of the plaques according to the American Heart Association (AHA) criteria was performed by two pathologists. Attenuation values of all plaques were measured in DSCT, DECT and SSCT studies, respectively and classified based on attenuation according to modified AHA criteria. 58 coronary plaques were identified at autopsy. Regardless of the CT technique only 52/58 plaques were found at CT (sensitivity=89.6%). There was no significant difference between the mean attenuation values of different plaque types between DSCT, DECT, and SSCT: type IV: 11HU/8HU/19HU; type Va: 44HU/45HU/52HU; type Vb: 1088HU/966HU/1079HU). The sensitivity for correct classification varied depending on the plaque type (type II=0%, type III=0%, type IV=43%, type Va=58%, Vb=97%). Independent of the used acquisition technique, SSCT, DSCT and DECT show similar results for attenuation-based characterization of atherosclerotic coronary plaques.
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2.65Impact points
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6.34Impact points
Quantitative and qualitative (23)Na MR imaging of the human kidneys at 3 T: before and after a water load.
Radiology. 09/2011; 260(3):857-65.
To qualitatively and quantitatively assess the corticomedullary sodium 23 ((23)Na) concentration in human kidneys before and after oral administration of a water load by using 3-T magnetic resonance (MR) imaging. Fourteen healthy volunteers (mean age, 28 years; range, 24-34 years) were included in t... [more] To qualitatively and quantitatively assess the corticomedullary sodium 23 ((23)Na) concentration in human kidneys before and after oral administration of a water load by using 3-T magnetic resonance (MR) imaging. Fourteen healthy volunteers (mean age, 28 years; range, 24-34 years) were included in this institutional review board-approved study between July and December 2009. For (23)Na MR imaging, a density-adapted three-dimensional radial gradient echo sequence (echo time, 0.55 msec; repetition time, 120 msec; spatial resolution, 5 × 5 × 5 mm) was used with a dedicated (23)Na-tuned coil. Beforehand, the coil profile was assessed by using phantom measurements, and the volunteer images were mathematically corrected accordingly. Images of the volunteers were obtained before and 30 minutes after oral ingestion of 1 L of water. As internal reference, (23)Na concentration of the cerebrospinal fluid (CSF) was calculated. Well-defined corticomedullary complexes in each kidney were assessed, with (23)Na concentrations in the cortex and medulla assessed at various standardized points. From these values, quantitative (23)Na concentrations were derived, and the slopes of the linear portion of the concentration gradient were calculated. Paired t tests were performed. Mean calculated (23)Na concentrations of CSF before (135.2 mmol/L ± 10.4) and after water load (135.5 mmol/L ± 11.0) fell within physiologic ranges (P = .95). An increase in average (23)Na concentration from 63.5 mmol/L ± 9.3 in the cortex to 108.0 mmol/L ± 10.9 in the medulla was identified. After the water load, this gradient was preserved, although (23)Na concentrations decreased significantly (P < .0001) to 48.6 mmol/L ± 5.3 in the cortex and 81.9 mmol/L ± 10.1 in the medulla-declines of 23.4% and 24.7%, respectively. This study demonstrates the physiologic evaluation of human kidneys with 3-T (23)Na MR imaging. The (23)Na imaging technique used allows the quantification of the corticomedullary (23)Na concentration and the assessment of its change with differing physiologic conditions.
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4.85Impact points
Gadofosveset: parameter optimization for steady-state imaging of the thoracic and abdominal vasculature.
Investigative radiology. 06/2011; 46(11):678-85.
Comparison of 3 optimized pulse sequences for thoracoabdominal contrast-enhanced magnetic-resonance angiography by signal-to-noise measurements and time-dependent T1 mapping in the steady state after injection of 0.03 mmol/kg BW gadofosveset. After institutional review board approval, 15 healthy vol... [more] Comparison of 3 optimized pulse sequences for thoracoabdominal contrast-enhanced magnetic-resonance angiography by signal-to-noise measurements and time-dependent T1 mapping in the steady state after injection of 0.03 mmol/kg BW gadofosveset. After institutional review board approval, 15 healthy volunteers (19-46 years, mean age: 31.5 years) were included in this prospective, intraindividual comparison study. All examinations were performed at 1.5 T. Three pulse sequences: volume interpolated breath-hold examination (VIBE) sequences as VIBESEMI (echo time [TE]: 1.64 milliseconds, repetition time [TR]: 3.77 milliseconds, FA: 15 degrees, voxel size: 1.2 × 1.2 × 1.2 mm) with short TR, VIBEOPT (TE: 2.2 milliseconds, TR: 5.2, FA: 15 degree, voxel size: 1.2 × 1.2 × 1.2 mm) with long TR, and a typical 3-dimensional fast low angle shot (FLASH) sequence (TE: 1.39 milliseconds, TR: 3.77 milliseconds, FA: 25 degree, voxel size: 1.0 × 0.8 × 1.0 mm) were repeated 10, 20, 30, and 40 minutes after the injection of 0.03 mmol/kg BW gadofosveset (mean dose: 9.7 mL). Mean signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were computed for the aorta and the inferior vena cava (IVC). Three-dimensional gradient echo sequences with variable flip angles were performed for T1 mapping 0 to 50 minutes postinjection (p.i.). Additional phantom measurements were performed to compare the sequences. Significantly higher SNR values of the FLASH were found at every point compared with VIBEOPT (P = 0.002-P = 0.004), but only 10, respectively, 20 minutes p.i. to VIBESEMI. No significant differences of SNR were obtained between VIBESEMI and VIBEOPT. In the aorta, the maximal percentage gain of SNR was 29.2% for 3D-FLASH compared with VIBESEMI. Similar, but mostly not significant, results were obtained regarding the SNR in the IVC with the 3D-FLASH sequence yielding higher SNR versus both comparators (P = 0.007-P = 0.466). Except 10 minutes p.i., CNR analysis yielded higher values for the VIBESEMI versus both comparators in the aorta as well as in the IVC. No statistical significant difference was found for the VIBESEMI versus the 3D-FLASH sequence in all comparisons. Regarding the phantom measurements, statistically significant higher SNR was found for the VIBESEMI versus the 3D-FLASH. The T1 time in the aorta decreased p.i. from 1227 ± 383 milliseconds to 141 ± 27 milliseconds and showed over the time a slow reincrease to 175 ± 29 milliseconds at 50 minutes p.i. Ten to 30 minutes after injection of gadofosveset, a relatively constant longitudinal relaxation is given. In this steady state, no additional improvements were obtained by theoretically optimized sequence parameters in the VIBEOPT with a longer TR.
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4.85Impact points
First multimodal embolization particles visible on x-ray/computed tomography and magnetic resonance imaging.
Investigative radiology. 03/2011; 46(3):178-86.
Embolization therapy is gaining importance in the treatment of malignant lesions, and even more in benign lesions. Current embolization materials are not visible in imaging modalities. However, it is assumed that directly visible embolization material may provide several advantages over current embo... [more] Embolization therapy is gaining importance in the treatment of malignant lesions, and even more in benign lesions. Current embolization materials are not visible in imaging modalities. However, it is assumed that directly visible embolization material may provide several advantages over current embolization agents, ranging from particle shunt and reflux prevention to improved therapy control and follow-up assessment. X-ray- as well as magnetic resonance imaging (MRI)-visible embolization materials have been demonstrated in experiments. In this study, we present an embolization material with the property of being visible in more than one imaging modality, namely MRI and x-ray/computed tomography (CT). Characterization and testing of the substance in animal models was performed. To reduce the chance of adverse reactions and to facilitate clinical approval, materials have been applied that are similar to those that are approved and being used on a routine basis in diagnostic imaging. Therefore, x-ray-visible Iodine was combined with MRI-visible Iron (Fe3O4) in a macroparticle (diameter, 40-200 μm). Its core, consisting of a copolymerized monomer MAOETIB (2-methacryloyloxyethyl [2,3,5-triiodobenzoate]), was coated with ultra-small paramagnetic iron oxide nanoparticles (150 nm). After in vitro testing, including signal to noise measurements in CT and MRI (n = 5), its ability to embolize tissue was tested in an established tumor embolization model in rabbits (n = 6). Digital subtraction angiography (DSA) (Integris, Philips), CT (Definition, Siemens Healthcare Section, Forchheim, Germany), and MRI (3 Tesla Magnetom Tim Trio MRI, Siemens Healthcare Section, Forchheim, Germany) were performed before, during, and after embolization. Imaging signal changes that could be attributed to embolization particles were assessed by visual inspection and rated on an ordinal scale by 3 radiologists, from 1 to 3. Histologic analysis of organs was performed. Particles provided a sufficient image contrast on DSA, CT (signal to noise [SNR], 13 ± 2.5), and MRI (SNR, 35 ± 1) in in vitro scans. Successful embolization of renal tissue was confirmed by catheter angiography, revealing at least partial perfusion stop in all kidneys. Signal changes that were attributed to particles residing within the kidney were found in all cases in all the 3 imaging modalities. Localization distribution of particles corresponded well in all imaging modalities. Dynamic imaging during embolization provided real-time monitoring of the inflow of embolization particles within DSA, CT, and MRI. Histologic visualization of the residing particles as well as associated thrombosis in renal arteries could be performed. Visual assessment of the likelihood of embolization particle presence received full rating scores (153/153) after embolization. Multimodal-visible embolization particles have been developed, characterized, and tested in vivo in an animal model. Their implementation in clinical radiology may provide optimization of embolization procedures with regard to prevention of particle misplacement and direct intraprocedural visualization, at the same time improving follow-up examinations by utilizing the complementary characteristics of CT and MRI. Radiation dose savings can also be considered. All these advantages could contribute to future refinements and improvements in embolization therapy. Additionally, new approaches in embolization research may open up.
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2.65Impact points
Peripheral MRA with continuous table movement: imaging speed and robustness compared to a conventional stepping table technique.
European journal of radiology. 02/2011; 80(2):537-42.
To investigate the potential of continuous table movement (CTM)-MRA for reduction of acquisition time and to evaluate the image quality in comparison to conventional stepping table (CST) MRA. The data of 82 patients were included in this retrospective, IRB-approved study. All patients underwent peri... [more] To investigate the potential of continuous table movement (CTM)-MRA for reduction of acquisition time and to evaluate the image quality in comparison to conventional stepping table (CST) MRA. The data of 82 patients were included in this retrospective, IRB-approved study. All patients underwent peripheral MRA at our institution. 41 consecutive patients were examined with a CST-MRA at a 1.5 T MR system. 41 different consecutive patients were examined with a CTM-MRA at 3.0 T MR system. Image quality was assessed by two independent radiologists in consensus on a 4-point Likert-type scale. Descriptive statistics and t-tests were used to compare image acquisition time of CST-MRA to that of CTM-MRA with and without additional time-resolved imaging of the feet using the TWIST technique. Additionally, acquisition time was compared in a subgroup of the fastest 50%. The mean imaging time for the CTM-MRA was 34% less than with the CST-MRA (18.2 min vs. 27.5 min; p<0.0001). Even with inclusion of the TWIST sequence the combined CTM-/TWIST-MRA protocol was 26% faster (20.3 min vs. 27.5 min; p<0.0001). The image quality was slightly better with CTM-MRA (CTM-MRA mean score 3.3±0.5, mean score CST-MRA 2.9±0.6). Venous overlay was significantly lower using the CTM-MRA approach (CTM-MRA mean score 2.8±0.4; CST-MRA mean score 2.2±0.7; p<0.0001). CTM-MRA is on average 30% faster than a comparable CST-MRA protocol with equal image quality. Even when adding an additional time-resolved-MRA of the calf station the CTM-MRA protocol is still 26% faster. In conclusion, this study proves that CTM-MRA further improves MRA by reducing user interference and image acquisition times and hence allowing to increase the clinical throughput.
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2.65Impact points
Imaging of non-atherosclerotic aneurysmal disease.
European journal of radiology. 02/2011; 80(1):41-9.
Atherosclerotic aneurysms account for about 95% of all aneurysms. This overview concentrates on the 5% leftover, which however represents a heterogenic group of aneurysms with a wide range of different pathogenesis. Thus, therapy is not exclusively restricted to the exclusion of the aneurysm. In non... [more] Atherosclerotic aneurysms account for about 95% of all aneurysms. This overview concentrates on the 5% leftover, which however represents a heterogenic group of aneurysms with a wide range of different pathogenesis. Thus, therapy is not exclusively restricted to the exclusion of the aneurysm. In non-atherosclerotic aneurysmal disease various additional therapeutic strategies are included such as chemotherapy, anti-inflammatory therapy and embolisation procedures. Diagnosis, therapeutic decision making and even therapy itself to a growing extent depends on adequate (pretherapeutic) imaging and therefore radiologic expertise. This review describes the most common forms of non-atherosclerotic aneurysms and focuses on their pathogenesis, potential diagnostic approaches and therapy options.
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3.59Impact points
Contrast-enhanced magnetic resonance angiography (MRA): evaluation of three different contrast agents at two different doses (0.05 and 0.1 mmol/kg) in pigs at 1.5 Tesla.
European radiology. 02/2011; 21(2):337-44.
To compare the image quality of contrast-enhanced magnetic resonance angiography (CE-MRA) of the supra-aortic vessels at 0.05 mmol/kg bw and 0.1 mmol/kg bw, between gadobutrol, Gd-DTPA and Gd-BOPTA quantitatively and qualitatively a total of eight pigs were evaluated intraindividually at 1.5 T. Each... [more] To compare the image quality of contrast-enhanced magnetic resonance angiography (CE-MRA) of the supra-aortic vessels at 0.05 mmol/kg bw and 0.1 mmol/kg bw, between gadobutrol, Gd-DTPA and Gd-BOPTA quantitatively and qualitatively a total of eight pigs were evaluated intraindividually at 1.5 T. Each pig was examined using 0.1 mmol/kg gadobutrol, Gd-DTPA and Gd-BOPTA on day one and 0.05 mmol/kg on day two. MRA datasets for the carotid artery and the infraorbital artery were qualitatively assessed regarding overall image quality on an ordinal four-point scale (4-excellent, 1-non-diagnostic). The signal-to noise-ratio (SNR) was measured. The qualitative assessment of the carotid artery showed a higher median image quality for the 0.1 mmol dose than for the 0.05 mmol dose for all three compounds. No difference was found for the infraorbital artery. Mean SNR of Gd-BOPTA, Gd-DTPA, gadobutrol at 0.05 mmol/kg were 36.0 ± 13.4/37.9 ± 16.3/43.7 ± 0.4 and at 0.1 mmol/kg they were 50.1 ± 12.4/46.6 ± 6.5 / 54.6 ± 10.2. Gd-BOPTA 0.05 revealed a significantly lower SNR than all other agents at normal dose. Full-dose gadolinium MRA results in higher image quality and significantly higher SNR compared with the half dose. Gadobutrol and Gd-BOPTA have similar enhancement properties at full dose but at half dose, gadobutrol appears superior.
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0.67Impact points
Value of multiparametric prostate MRI of the peripheral zone.
Zeitschrift für medizinische Physik. 01/2011; 21(3):198-205.
MRI of the prostate offers the possibility to localize and stage prostate cancer and may improve detection of disease. Currently, T2-weighted images and spectroscopy are the most commonly used MRI techniques. To assess the value of prostate MRI and its different modalities in the process of diagnosi... [more] MRI of the prostate offers the possibility to localize and stage prostate cancer and may improve detection of disease. Currently, T2-weighted images and spectroscopy are the most commonly used MRI techniques. To assess the value of prostate MRI and its different modalities in the process of diagnosis, the currently available MRI techniques were compared. 16 patients were examined on a 1.5 T MR system. All patients underwent the same MR protocol using an endorectal coil: T2-weighted triplanar turbo-spin-echo (TSE), axial echo-planar diffusion-weighted imaging (DWI), 3D chemical-shift imaging MR spectroscopy (MRS) and axial dynamic-contrast-enhanced TurboFLASH (DCE). Parametric maps of the choline+creatine/citrate ratio (CC-CR), apparent diffusion coefficient (ADC) and plasma flow/mean transit time (PF/MTT) were calculated. Additionally, average time for reading and scanning were evaluated. As reference, biopsy results were used. Sensitivity/specificity were 50.0-85.7%/44.4-72.2% for the T2 weighted images, 78.6-100.0%/38.9-55.6% for the ADC maps, 71.4-85.7%/44.4-55.6% for the PF/MTT maps and 64.3-78.6%/50.0-77.8% for the CC-CR. Average scan and reading time were 8:46/1:54 min for T2, 1:28/3:17 min for DWI, 8:41/2:12 min for DCE and 11:36/3:47 for spectroscopy. We found no significant differences in accuracy between the modalities. We observed DWI to be advantageous in examination and reading compared to DCE and MRS, therefore it might be the preferred modality when a shortened protocol is needed.
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3.59Impact points
Magnetic resonance angiography (MRA) of the calf station at 3.0 T: intraindividual comparison of non-enhanced ECG-gated flow-dependent MRA, continuous table movement MRA and time-resolved MRA.
European radiology. 01/2011; 21(7):1452-61.
To compare 3D non-enhanced ECG-gated inflow-dependent MRA (NE-MRA) vs. continuous table movement (CTM) MR-angiography and time-resolved TWIST-MRA in the calf station at 3.0 T in a clinical patient collective. 36 patients (27 male/9 female, 66.1 ± 14.4 years) with PAOD (stage II-IV) underwent during ... [more] To compare 3D non-enhanced ECG-gated inflow-dependent MRA (NE-MRA) vs. continuous table movement (CTM) MR-angiography and time-resolved TWIST-MRA in the calf station at 3.0 T in a clinical patient collective. 36 patients (27 male/9 female, 66.1 ± 14.4 years) with PAOD (stage II-IV) underwent during a single MRI: NE-MRA, contrast-enhanced CTM-MRA and TWIST-MRA with a single dose of a gadolinium-based contrast agent. The image quality (IQ) and the degree of stenoses were rated on a four-point scale. Positive (PPV) and negative predictive values (NPV), sensitivity (SS) and specificity (SP) for stenoses detection were calculated for NE-MRA vs. CTM-MRA and vs. TWIST-MRA. Values were obtained for overall graduation of wall changes and for severe stenoses (>70%). With NE-MRA 122/288 segments were not assessable. Compared with CTM-MRA and TWIST-MRA the IQ was significantly inferior (p < 0.0001 to p = 0.0426). CTM-MRA/TWIST-MRA detected stenoses in 44.9%/46.1% of the segments, NE-MRA in 53.5%. SS/NPV of the NE-MRA ranged from 97.8 to 100%. The SP and PPV ranged from 72.7 to 85.5% and 66.7 to 78.2%. Contrast-enhanced MRA techniques are superior to NE-MRA regarding IQ and correct identification of stenoses. If technically successful, NE-MRA is characterised by high NPV and overestimation of the degree of stenoses.
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3.59Impact points
Comparison of a new whole-body continuous-table-movement protocol versus a standard whole-body MR protocol for the assessment of multiple myeloma.
European radiology. 12/2010; 20(12):2907-16.
To evaluate a whole body (WB) continuous-table-movement (CTM) MR protocol for the assessment of multiple myeloma (MM) in comparison to a step-by-step WB protocol. Eighteen patients with MM were examined at 1.5T using a WB CTM protocol (axial T2-w fs BLADE, T1-w GRE sequence) and a step-by-step WB pr... [more] To evaluate a whole body (WB) continuous-table-movement (CTM) MR protocol for the assessment of multiple myeloma (MM) in comparison to a step-by-step WB protocol. Eighteen patients with MM were examined at 1.5T using a WB CTM protocol (axial T2-w fs BLADE, T1-w GRE sequence) and a step-by-step WB protocol including coronal/sagittal T1-w SE and STIR sequences as reference. Protocol time was assessed. Image quality, artefacts, liver/spleen assessability, and the ability to depict bone marrow lesions less than or greater than 1 cm as well as diffuse infiltration and soft tissue lesions were rated. Potential changes in the Durie and Salmon Plus stage and the detectability of complications were assessed. Mean protocol time was 6:38 min (CTM) compared to 24:32 min (standard). Image quality was comparable. Artefacts were more prominent using the CTM protocol (P = 0.0039). Organ assessability was better using the CTM protocol (P < 0.001). Depiction of bone marrow and soft tissue lesions was identical without a staging shift. Vertebral fractures were not detected using the CTM protocol. The new protocol allows a higher patient throughput and facilitates the depiction of extramedullary lesions. However, as long as vertebral fractures are not detectable, the protocol cannot be safely used for clinical routine without the acquisition of an additional sagittal sequence.
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1.27Impact points
Retrospective respiratory triggering renal perfusion MRI.
Acta radiologica (Stockholm, Sweden : 1987). 12/2010; 51(10):1163-71.
artifacts of respiratory motion are one of the well-known limitations of dynamic contrast-enhanced MRI (DCE-MRI) of the kidney. to propose and evaluate a retrospective triggering approach to minimize the effect of respiratory motion in DCE-MRI of the kidney. nine consecutive patients underwent renal... [more] artifacts of respiratory motion are one of the well-known limitations of dynamic contrast-enhanced MRI (DCE-MRI) of the kidney. to propose and evaluate a retrospective triggering approach to minimize the effect of respiratory motion in DCE-MRI of the kidney. nine consecutive patients underwent renal perfusion measurements. Data were acquired with a 2D saturation-recovery TurboFLASH sequence. In order to test the dependence of the results on size and location of the manually drawn triggering regions of interest (ROIs), three widely differing triggering regions were defined by one observer. Mean value, standard deviation, and variability of the renal function parameters plasma flow (F(P)), plasma volume (V(P)), plasma transit time (T(P)), tubular flow (F(T)), tubular volume (V(T)), and tubular transit time (T(T)) were calculated on a per-patient basis. the results show that triggered data have adequate temporal resolution to measure blood flow. The overall average values of the function parameters were: 152.77 (F(P)), 15.18 (V(P)), 6,73 (T(P)), 18.50 (F(T)), 35.36 (V(T)), and 117.67 (T(T)). The variability (calculated in % SD from the mean value) for three different respiratory triggering regions defined on a per-patient basis was between 0.81% and 9.87% for F(P), 1.45% and 8.19% for V(P), 0% and 9.63% for T(P), 2.15% and 12.23% for T(F), 0.8% and 17.28% for V(T), and 1.97% and 12.87% for T(T). triggering reduces the oscillations in the signal curves and produces sharper parametric maps. In contrast to numerically challenging approaches like registration and segmentation it can be applied in clinical routine, but a (semi)-automatic approach to select the triggering ROI is desirable to reduce user dependence.
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0.50Impact points
Following (16)
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Hagen Rehbein
Charité Universitätsmedizin Berlin -
Soenke Bartling
German Cancer Research Center / UMC Mannheim -
Lutz Lüdemann
Universität Duisburg-Essen -
Florian Lietzmann
Universität Heidelberg -
Christina Doesch
UMM Universitätsmedizin Mannheim
