Werner Rudolf Jaschke




  • European Heart Journal 08/2015; DOI:10.1093/eurheartj/ehv361 · 15.20 Impact Factor
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    ABSTRACT: To evaluate the efficacy of ultrasound (US)-guided injections around the lateral femoral cutaneous nerve (LFCN) at different levels in meralgia paraesthetica (MP) patients. The study was approved by the university ethics committee and informed oral and written consent were obtained from all patients. Between June 2008 and August 2013, 20 patients with symptoms of MP, including nine men (mean age, 61.33 years) and 11 women (mean age 61.18 years), were treated with US-guided injection of steroids along the LFCN at three different levels in a mean of 2.25 sessions. A visual analogue scale (VAS) was used to measure symptoms before, immediately after and 12 months after treatment. Complete resolution of symptoms was documented in 15/20 patients (mean VAS decreased from 82 to 0), and partial resolution in the remaining five (mean VAS decreased from 92 to 42), which was confirmed at 12-month follow-up. By using the different levels of injection approach overall significantly better symptom relief was obtained (p < 0.05). The outcome of US-guided injection along the LFCN can be further improved by injections at different levels (p < 0.05), which was confirmed at 12-month long-term follow-up. • Meralgia paraesthetica is an entrapment neuropathy of the lateral femoral cutaneous nerve. • Ultrasound proved effective in diagnosis and in guiding injection therapy. • Injection at the anterior superior iliac spine has been used previously. • Multiple injections along the nerve course were used in this study. • Long-term follow-up (12 months) confirmed the results.
    European Radiology 06/2015; DOI:10.1007/s00330-015-3874-1 · 4.01 Impact Factor
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    ABSTRACT: In this article, we review the recent updates in musculoskeletal ultrasound (MSK US). The progressive development in ultrasound scanners including both hard- and softwares has already been reflected in its ability to diagnose different MSK diseases efficiently. We discuss here the recent applications of conventional US techniques as peripheral nerve imaging and image-guided therapies. The role of color Doppler US and contrast-enhanced US is also discussed with its impact especially in soft tissue tumors and small joint arthropathies. Sonoelastography as a new and promising technique is discussed in detail in this review. It may provide better and more robust diagnosis for many MSK diseases and may replace some of the relatively old routine techniques applied nowadays. In the end, 3D imaging and image fusion are discussed with their impact in image guidance of therapy as well as their teaching applications.
    06/2015; 3(6). DOI:10.1007/s40134-015-0101-4
  • RöFo - Fortschritte auf dem Gebiet der R 04/2015; 187(S 01). DOI:10.1055/s-0035-1550887 · 1.40 Impact Factor
  • D Putzer · M Kuhn · W Jaschke
    RöFo - Fortschritte auf dem Gebiet der R 04/2015; 187(S 01). DOI:10.1055/s-0035-1550830 · 1.40 Impact Factor
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    ABSTRACT: Purpose: We compared the calibration of hepatic iron based on R2* relaxometry and liver biopsy with similar studies that have already been published to investigate the transferability of published calibration curves. Materials and methods: 17 patients with clinically suspected hepatic iron overload (HIO) were enrolled. All patients underwent liver biopsy and MRI of the liver using a multi-echo gradient echo sequence (TR = 200 ms; TE-initial 0.99 ms; Delta-TE 1.41 ms; 12 echos; flip-angle: 20 °). R2* parameter maps were analyzed using manually placed regions of interest and R2* values were correlated with liver iron concentration (LIC) obtained from liver biopsy. In addition, the results of our study were compared with 6 similar, already published studies. Results: A linear relationship between R2* and LIC was found. Regression analysis yielded a correlation coefficient of 0.926, a slope of 0.024 (s mg/g) [95 % CI 0.013 - 0.024] and an intercept of 0.277 (mg/g) [95 % CI -0.328 - 2.49]. We found a significant correlation between the calibration curves obtained from our study in comparison to 3/6 similar studies. The other 3 studies used a different reference standard or sequence parameters which lead to a significant difference for slope, intercept or both in comparison to our data. Conclusion: Calibration curves from published studies that are based on a correlation of liver biopsy and R2* can be used for the estimation of liver iron concentration, although different scanning parameters and post-processing protocols were used. Low initial TEs might be a prerequisite for pooling data for liver iron quantification. Key points: • Calibration curves from different studies can be used for liver iron quantification• For that purpose calibration curves from published studies should be based on liver biopsy• Low initial TEs might be a prerequisite for pooling data for liver iron quantification.
    RöFo - Fortschritte auf dem Gebiet der R 04/2015; 187(06). DOI:10.1055/s-0034-1399318 · 1.40 Impact Factor
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    ABSTRACT: To evaluate the accuracy of two different sonographic median nerve measurement calculations in predicting carpal tunnel syndrome (CTS) severity in a study population with clinically and electrophysiologically confirmed CTS. 643 wrists of 427 patients (325 females and 102 males, age range: 17-90 years, mean ± SD: 57.9 ± 14.7) were included with CTS diagnosis based on clinical and nerve conduction studies (NCS). Cross-sectional area (CSA) measurement of the median nerve was performed at the carpal tunnel level (CSAc) and at the pronator quadratus muscle level (CSAp). Two parameters were calculated: delta (∆-CSA), which is the difference between proximal and distal measurements, and ratio (R-CSA), calculated by dividing distal over proximal measurements. Patients were classified into mild, moderate and severe CTS based upon NCS. The mean ∆-CSA (4.2 ± 2.6, 6.95 ± 2.2 and 10.7 ± 4.9 mm(2)) and mean R-CSA (1.5 ± 0.4, 1.95 ± 0.4 and 2.4 ± 0.7) values were significantly different between all groups (p < 0.001). Optimal cut-off values for ∆-CSA and R-CSA were 6 mm(2) and 1.7, respectively, to distinguish mild from moderate disease, and 9 mm(2) and 2.2, respectively, to distinguish moderate from severe disease. Threshold values for the calculated sonographic parameters ∆-CSA and R-CSA are useful in predicting CTS severity compared to NCS. • Two proposed parameters were calculated (∆-CSA, R-CSA) and compared to NCS. • A defined sonoanatomical proximal landmark was used for the calculation. • Both parameters showed ability to detect CTS severity comparable to NCS. • Cut-off values could be determined for both parameters.
    European Radiology 04/2015; 25(8). DOI:10.1007/s00330-015-3649-8 · 4.01 Impact Factor
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    ABSTRACT: Purpose: To evaluate the feasibility and effectiveness of US-guided sacroiliac joint injection in the treatment of sacroiliitis in children. Materials and Methods: This study was approved by the institutional review board and informed oral and written consent was obtained from the patients and their parents. In 13 patients (7 females and 6 males), 9 - 16 years (mean +/- std 11.39 +/-1.98), 18 sacroiliac joint (SI joint) injections were performed under US guidance. All patients suffered from severe sacroiliitis. US scanning was performed using a linear-array transducer operating at 5 - 18 MHz. Rating of the patients pain using a 0 - 10 dolorimetry scale on a visual analog score (VAS) was recorded before, immediately after and 3 months after injection to monitor severity and therapeutic response. Results: Injection could be performed in all patients without complication and showed good response immediately and 3 months after the injection with a decrease of the VAS (from mean +/- std 9.44 +/- 1.097 to 3.89 +/- 3.82, p < 0.001 and to 0.56 +/- 1.097, p < 0.05, respectively). Conclusion: US-guided SI joint injection was feasible in all children, relatively quick and easy to perform and appeared effective in the treatment of children with sacroiliitis. © Georg Thieme Verlag KG Stuttgart · New York.
    Ultraschall in der Medizin 03/2015; DOI:10.1055/s-0034-1399145 · 4.92 Impact Factor
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    ABSTRACT: Dual-energy contrast-enhanced mammography is one of the latest developments in breast care. Imaging with contrast agents in breast cancer was already known from previous magnetic resonance imaging and computed tomography studies. However, high costs, limited availability-or high radiation dose-led to the development of contrast-enhanced spectral mammography (CESM). We reviewed the current literature, present our experience, discuss the advantages and drawbacks of CESM and look at the future of this innovative technique.
    Archives of Gynecology 03/2015; 292(4). DOI:10.1007/s00404-015-3693-2 · 1.36 Impact Factor
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    ABSTRACT: Purpose: The objectives of this study were to compare sonoelastographic color findings of the perineural area between carpal tunnel syndrome patients and healthy volunteers, and to analyze elastographic findings in that area before and immediately after intracarpal tunnel injection in carpal tunnel syndrome patients. Materials and Methods: We studied both hands of 15 healthy volunteers (7 men, 8 women; mean age: 60.1 years, range: 41 - 88 years) and 72 hands from 70 patients with symptomatic carpal tunnel syndrome (24 men, 46 women; mean age: 54.2 years, range: 24 - 83 years). Sonoelastographic color distribution was assessed in the perineural area between the median nerve and adjacent flexor tendons. The color elastograms were graded using the following system: Grade 1 as red (softest), grade 2 as yellow (soft), grade 3 as green (hard), grade 4 as blue (hardest). The patients were treated with corticosteroid injection and were reassessed with sonoelastography immediately after the injection. Results: The median color grading in the perineural area of carpal tunnel syndrome patients was grade 3 (3.1 ± 0.3, mean ± 95 % Cl), which was stiffer than that of healthy volunteers (grade 1, 1.9 ± 0.4) (p < 0.0001). Immediately after injection, the diffusion of the injected fluid was observed as having a softer appearance (grade 1, 1.4 ± 0.2) (p < 0.0001). Conclusion: The perineural area surrounding the median nerve in carpal tunnel syndrome patients was stiffer than that in healthy volunteers. Diffusion of the injected fluid in the carpal tunnel was seen as a softer finding after injection in real time using sonoelastography. © Georg Thieme Verlag KG Stuttgart · New York.
    Ultraschall in der Medizin 03/2015; DOI:10.1055/s-0034-1385836 · 4.92 Impact Factor
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    ABSTRACT: Purpose: To evaluate multiparametric magnetic resonance imaging/transrectal ultrasound (mpMRI/TRUS) fusion targeted biopsy (TB) of the prostate for prostate cancer (PCa) diagnosis. Patients and methods: From April 2013 to January 2014, 53 men were included in this prospective single-centre study. The degree of PCa suspicion from mpMRI findings was classified according to the PI-RADS scoring system. Of these, 50 patients underwent both an mpMRI/TRUS fusion TB and a 10-core systematic biopsy (SB) of the prostate and were eligible for analysis. Results: 225 targeted and 500 systematic cores were included in this study. PCa was histologically confirmed in 52.0% of patients (26/50), whereas TB revealed PCa in 46.0% (23/50) and SB in 36.0% (18/50). TB identified PCa in 16.0% of all patients (8/50) that were missed by SB. All told, the targeted core was 2.8 times more likely to be PCa-positive than the systematic core (29.3 vs. 10.4%). Conclusions: mpMRI/TRUS fusion TB of the prostate is safe, practicable and may improve PCa diagnosis using fewer biopsy cores compared to SB.
    Urologia Internationalis 01/2015; 94(3). DOI:10.1159/000365489 · 1.43 Impact Factor
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    Daniel Putzer · Werner Jaschke
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    ABSTRACT: The early and accurate characterization of pancreatic masses remains a challenge in diagnostic radiology, while the continuously evolving diagnostic possibilities give rise to an ever-increasing number of incidentally found pancreatic masses. This article discusses the relevance and role of ultrasound, endoscopic ultrasound, computed tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET) in the diagnosis of pancreatic lesions. Specific protocols such as MR cholangiopancreatography and multiphase CT allow for a close characterization. While CT and MRI deliver information to further evaluate pancreatic disease, PET/CT has shown potential for staging purposes and in the clinical follow-up of pancreatic cancer patients. Common differential diagnoses regarding pancreatic cancer are discussed, and typical imaging features of anatomical variations, cystic lesions and pancreatitis are illustrated, together with clinical signs of pancreatic disease. The use of cross-sectional imaging in correlation with clinical features allows for an accurate and early detection of pancreatic masses and assists in differentiating benign from malignant disease. © 2014 S. Karger AG, Basel.
    Digestive Diseases 01/2015; 33(1):91-8. DOI:10.1159/000366045 · 2.18 Impact Factor
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    ABSTRACT: Objectives To evaluate the automated two-point Dixon screening sequence for the detection and estimated quantification of hepatic iron and fat compared with standard sequences as a reference. Methods One hundred and two patients with suspected diffuse liver disease were included in this prospective study. The following MRI protocol was used: 3D-T1-weighted opposed- and in-phase gradient echo with two-point Dixon reconstruction and dual-ratio signal discrimination algorithm (“screening” sequence); fat-saturated, multi-gradient-echo sequence with 12 echoes; gradient-echo T1 FLASH opposed- and in-phase. Bland–Altman plots were generated and correlation coefficients were calculated to compare the sequences. Results The screening sequence diagnosed fat in 33, iron in 35 and a combination of both in 4 patients. Correlation between R2* values of the screening sequence and the standard relaxometry was excellent (r = 0.988). A slightly lower correlation (r = 0.978) was found between the fat fraction of the screening sequence and the standard sequence. Bland–Altman revealed systematically lower R2* values obtained from the screening sequence and higher fat fraction values obtained with the standard sequence with a rather high variability in agreement. Conclusions The screening sequence is a promising method with fast diagnosis of the predominant liver disease. It is capable of estimating the amount of hepatic fat and iron comparable to standard methods. Key points • MRI plays a major role in the clarification of diffuse liver disease. • The screening sequence was introduced for the assessment of diffuse liver disease. • It is a fast and automated algorithm for the evaluation of hepatic iron and fat. • It is capable of estimating the amount of hepatic fat and iron.
    European Radiology 12/2014; 25(5). DOI:10.1007/s00330-014-3528-8 · 4.01 Impact Factor
  • Radiology 09/2014; 272(3):622-633. · 6.87 Impact Factor
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    ABSTRACT: All participants for image samplings provided written informed consent. Conventional B-mode ultrasonography (US) has been widely utilized for musculoskeletal problems as a first-line approach because of the advantages of real-time access and the relatively low cost. The biomechanical properties of soft tissues reflect to some degree the pathophysiology of the musculoskeletal disorder. Sonoelastography is an in situ method that can be used to assess the mechanical properties of soft tissue qualitatively and quantitatively through US imaging techniques. Sonoelastography has demonstrated feasibility in the diagnosis of cancers of the breast and liver, and in some preliminary work, in several musculoskeletal disorders. The main types of sonoelastography are compression elastography, shear-wave elastography, and transient elastography. In this article, the current knowledge of sonoelastographic techniques and their use in musculoskeletal imaging will be reviewed. © RSNA, 2014.
    Radiology 09/2014; 272(3):622-633. DOI:10.1148/radiol.14121765 · 6.87 Impact Factor
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    ABSTRACT: Objective To prospectively assess the value of coronary CT angiography (CTA) in asymptomatic patients with high ‘a priori’ risk of coronary artery disease (CAD). Methods 711 consecutive asymptomatic patients (61.8 years; 40.1% female) with high ‘a priori’ risk of CAD were prospectively examined with a coronary calcium score (CCS) and CTA. Coronary arteries were evaluated for atherosclerotic plaque (non-calcified and calcified) and stenosis (mild <50%, intermediate 50–70% or high-grade >70%). Coronary Segment Involvement Score (SIS, total number of segments with plaque) and nc (non-calcified) SIS were calculated. Primary end points were major adverse cardiac events (ST-elevation MI, non-ST-elevation MI and cardiac death); secondary end points were coronary revascularisation and >50% stenosis by invasive angiography. Results Of 711 patients, 28.3% were negative for CAD and 71.7% positive (CAD+) by CTA (15.6% had plaques without stenosis, 23.9% mild, 10.7% intermediate and 21.5% high-grade stenosis). CCS zero prevalence was 306 (43%), out of those 100 (32.7%) had non-calcified plaque only. Mean follow-up period was 2.65 years. MACE rate was 0% in CAD negative and higher (1.2%) in CAD positive by CTA. Coronary revascularisation rate was 5.5%. Patients with SIS ≥5 had an HR of 6.5 (95% CI 1.6 to 25.8, p<0.013) for MACE, patients with ncSIS ≥1 had an HR of 2.4 (95% CI 1.2 to 4.6, p<0.01) for secondary end point. The sensitivity of CTA for stenosis >50% compared with invasive angiography was 92.9% (95% CI 83.0% to 98.1%). Negative predictive value of CTA was 99.4% (95% CI 98.3% to 99.8%) for combined end points. Conclusions CAD prevalence by CTA in asymptomatic high-risk patients is high. CCS zero does not exclude CAD. CTA is highly accurate to exclude CAD. Total coronary plaque burden and nc plaques, even if only one segment is involved, are associated with an increased risk of adverse outcome.
    08/2014; 1(1):e000096. DOI:10.1136/openhrt-2014-000096
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    ABSTRACT: Purpose: Evaluation of the Prostate Imaging Reporting and Data System (PI-RADS) scoring system for classifying multi-parametric magnetic resonance imaging findings of the prostate using whole-mount step-section slides as reference standard. Materials and methods: Prospective inclusion of 50 consecutive patients with biopsy-proven prostate cancer (PCa). All patients received a multi-parametric MRI of the prostate, consisting of T2-weighted, diffusion-weighted, and dynamic contrast-enhanced MRI. After prostatectomy, all prostates were prepared as whole-mount step-section slides. For each patient, six lesions were predefined on whole-mount step-sections according to a distinct scheme and the corresponding regions were identified on MRI. Each lesion then was scored on MRI according to PI-RADS by an experienced blinded uro-radiologist and compared with histopathological findings. Results: PCa received significant (p < 0.01) higher overall PI-RADS scores (4.10 ± 0.75) compared with benign changes (2.00 ± 0.74). In the peripheral zone, each single modality score showed good diagnostic accuracy for PCa detection (area under the curve [AUC] > 0.90). When combining all single modality scores, an even higher discriminative ability of PCa detection (AUC = 0.97, 95 % CI 0.95-0.99) could be achieved. In contrast, in the transitional zone, dynamic contrast-enhanced MRI (DCE) showed very low diagnostic accuracy (AUC = 0.60). Regarding tumor malignancy, no high-grade PCa (Gleason >7a) was present at PI-RADS scores <4 and no Gleason 6 PCa at a PI-RADS score of 5. Conclusion: The PI-RADS scoring system showed good diagnostic accuracy: Only PI-RADS 4 and 5 showed high-grade PCa. However, it seems necessary to revise the PI-RADS scoring system concerning DCE in the transitional zone.
    World Journal of Urology 08/2014; 33(7). DOI:10.1007/s00345-014-1370-x · 2.67 Impact Factor
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    ABSTRACT: Palpation of organs is one of the oldest clinical examination techniques, for instance, if you think of the palpation of the breast or the digital rectal examination of the prostate, where hard palpable regions are suspicious for cancer. This is the basic principle of real-time elastography, an ultrasound technique, which is able to visualise tissue elasticity. Since prostate cancer features an increased stiffness due to the higher cell and vessel density than the normal surrounding tissue, real-time elastography has been used for several years for prostate cancer detection. This review introduces the different techniques of ultrasound elastography and furthermore summarises its limitations and potentials.
    BioMed Research International 05/2014; 2014:180804. DOI:10.1155/2014/180804 · 3.17 Impact Factor
  • B Henninger · H Zoller · S Rauch · M Schocke · W Jaschke · C Kremser
    RöFo - Fortschritte auf dem Gebiet der R 04/2014; 186(S 01). DOI:10.1055/s-0034-1373572 · 1.40 Impact Factor
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    ABSTRACT: The objective of this study was to report on the incidence of left arm ischemia, left arm function, and quality of life after thoracic endovascular aortic repair (TEVAR) by stent grafting with and without coverage of the left subclavian artery (LSA). All patients who underwent TEVAR since 1996 in our institution were included. Basic demographic parameters, underlying disease, details of TEVAR, long-term left arm function (Disabilities of the Arm, Shoulder, and Hand [DASH] questionnaire), and quality of life (12-Item Short Form Health Survey) were analyzed. End points were left arm ischemia, need for LSA revascularization (before or after TEVAR), long-term functional impairment, and quality of life. A total of 138 patients underwent TEVAR for degenerative aneurysm (n = 64), traumatic aortic injury (TAI; n = 38), or Stanford type B dissection (n = 36). Seventy-three patients (52.9%) had LSA coverage, which led to partial or complete LSA occlusion in 49 (35.5%). Selectively, nine patients (6.5%) had primary LSA revascularization. After TEVAR, left arm ischemia was observed in only one patient, who consecutively needed a left carotid to subclavian bypass. During a mean follow-up period of 4.1 ± 3.7 years, no additional patient needed secondary LSA revascularization. In comparing patients with occluded vs patent LSA, the Physical Component Summary (PCS) and Mental Component Summary (MCS) health scores (12-Item Short Form Health Survey) as well as DASH scores were similar. However, subgroup analysis showed better PCS scores for TAI patients with patent LSA, whereas MCS and DASH scores were similar in TAI patients, and scores were indifferent within thoracic aortic aneurysm and Stanford type B dissection subgroups. In comparing different subgroups, TAI patients had significantly better PCS, MCS, and DASH scores. TEVAR is associated with a low risk of peri-interventional left arm ischemia. During long-term follow-up, secondary LSA revascularization is uncommon. Coverage of the LSA has no impact on left arm function and quality of life, probably with the exception of physical health scores in patients with TAI.
    Journal of vascular surgery: official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter 03/2014; 60(1). DOI:10.1016/j.jvs.2014.01.060 · 3.02 Impact Factor

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