Heinrich Mertens

HELIOS Klinik Ahrenshoop, Ahrenshöft, Schleswig-Holstein, Germany

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Publications (14)26.79 Total impact

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    ABSTRACT: Several publications have reported that the apparent diffusion coefficient is generally lower in metastatically affected vertebrae. Therefore, metastases are represented in diffusion-weighted images by increased signal intensity in comparison to unaffected vertebrae. However, there were indications that metastases due to prostate cancer may differ from this. Therefore, the contrast behavior of vertebral metastases due to prostate cancer or tumors with another histology are to be systematically studied using diffusion-weighted images. The present study is intended to examine whether the two groups differed and whether possible differences depended on the degree of sclerosis. In a retrospective study the vertebral metastases of patients with prostate cancer (n = 18) were compared to those of patients with tumors of another histology (n = 20). A steady-state free precession sequence was used for the diffusion-weighted imaging. Additionally, a T1 weighted sequence before and after administration of contrast agent as well as a fat suppressed T2 weighted sequence were performed. The contrast behavior of the metastases was evaluated for all four sequences and was compared to that of the unaffected parts of the vertebra. In 18 patients of the tumor group, the vertebral metastases showed positive contrast in the diffusion-weighted images, and 2 had minimally negative contrast up to - 0.04. In the prostate cancer group, the contrast was positive in 9 patients and negative in 9. 6 of the metastases with negative contrast had an osteoblastic metastasization, 1 had an osteolysis, and 1 had a normal finding in the conventional X-ray image. Between the tumor group and the prostate cancer group, the medians of the contrasts were not significantly different (p = 0.054). In general, the metastatically affected vertebrae appear hyperintense in the diffusion-weighted images. This observation is only true for some vertebral metastases due to prostate cancer. The cause for this seems to be the degree of sclerosis of the metastases. Thus, it cannot be generally deduced from the hypointensity in diffusion-weighted images that a lesion is benign.
    RöFo - Fortschritte auf dem Gebiet der R 05/2006; 178(4):416-24. · 1.96 Impact Factor
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    ABSTRACT: We investigated the agreement of multislice computed tomography angiography (CTA) and magnetic resonance angiography (MRA) in the quantitative measurement of carotid artery stenosis. The dependency of the agreement of the chosen postprocessing procedures was also investigated. Fifty consecutive symptomatic patients were included in this study. In all patients, a CTA was performed with a 16-slice CT scanner. Within 30 days, the extracranial vessels were examined using a combined time-of-flight and contrast-enhanced MRA. The CT data sets were used to calculate the degree of stenosis according to the North American Symptomatic Carotid Endarterectomy Trial, European Carotid Surgery Trial, and Common Carotid methods by means of the 1-mm thick, transverse raw data (RD), a sagittal maximum-intensity projection reconstruction, and sagittal multiplanar reconstruction. In addition, a semiautomated analysis was done using a specialized postprocessing software. For all combinations of postprocessing procedures and methods of calculating the degree of stenosis, the correlation coefficient and the agreement based on Bland/Altman plots were calculated. Eleven of the 100 primarily included carotid arteries could not be evaluated. The correlation coefficients for all combinations were comparable and lied in the interval between 0.932 and 0.787. The best correlation was found for the combination of RD/sagittal multiplanar reconstruction and ECST method. The evaluation of the agreement gave a systematic overestimation of CTA between 1.9% and 10.7% with a 95% confidence interval between +/-26.7% and +/-43.3%. With the semiautomated postprocessing software, additional 33 vessels could not be evaluated. The agreement of the calculated degrees of stenoses was worse than that of the planar procedures. CTA and MRA had a feasible agreement in measuring the degree of stenosis of the carotid arteries. The best result could be obtained for the evaluation of the RD and the NASCET method. In this case one has to take into account a systematic overestimation of CTA of 1.9%. The combination with an additional reconstructive postprocessing procedure did not improve the result but might be useful for the radiologist to identify the location of the closest narrowing.
    Journal of Computer Assisted Tomography 05/2006; 30(3):433-42. DOI:10.1097/00004728-200605000-00014 · 1.60 Impact Factor
  • RöFo - Fortschritte auf dem Gebiet der R 02/2006; 178(4):416-424. DOI:10.1055/s-2006-926566 · 1.96 Impact Factor
  • International Congress Series 05/2005; 1281:1388-1388. DOI:10.1016/j.ics.2005.03.012
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    ABSTRACT: Today, the exchange of medical images and clinical information is well defined by the digital imaging and communications in medicine (DICOM) and Health Level Seven (ie, HL7) standards. The interoperability among information systems is specified by the integration profiles of IHE (Integrating the Healthcare Enterprise). However, older imaging modalities frequently do not correctly support these interfaces and integration profiles, and some use cases are not yet specified by IHE. Therefore, corrections of DICOM objects are necessary to establish conformity. The aim of this project was to develop a toolbox that can automatically perform these recurrent corrections of the DICOM objects. The toolbox is composed of three main components: 1) a receiver to receive DICOM objects, 2) a processing pipeline to correct each object, and 3) one or more senders to forward each corrected object to predefined addressees. The toolbox is implemented under Java as an open source project. The processing pipeline is realized by means of plug ins. One of the plug ins can be programmed by the user via an external eXtensible Stylesheet Language (ie, XSL) file. Using this plug in, DICOM objects can also be converted into eXtensible Markup Language (ie, XML) documents or other data formats. DICOM storage services, DICOM CD-ROMs, and the local file system are defined as input and output channel. The toolbox is used clinically for different application areas. These are the automatic correction of DICOM objects from non-IHE-conforming modalities, the import of DICOM CD-ROMs into the picture archiving and communication system and the pseudo naming of DICOM images. The toolbox has been accepted by users in a clinical setting. Because of the open programming interfaces, the functionality can easily be adapted to future applications.
    Academic Radiology 04/2005; 12(3):385-92. · 2.08 Impact Factor
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    ABSTRACT: Within a hospital, the radiology department has taken over the role of a cost center. Cost accounting can be applied to analyze the costs for the performance of services. By assigning the expenditures of resources to the service, the cash value can directly be distributed to the costs of equipment, material and rooms. Time-oriented catalogs of services are predefined to calculate the number of the employees for a radiology department. Using our own survey of time data, we examined whether such catalogs correctly represent the time consumed in a radiology department. Only services relevant for the turnover were compared. For 96 primary radiological services defined by the score-oriented German fee catalog for physicians (Gebuhrenordnung fur Arzte), a ranking list was made for the annual procedures in descending frequency order. According to the Pareto principle, the 11 services with the highest frequency were chosen and the time consumed for the technical and medical services was collected over a period of 2 months. This survey was compared with the time-oriented catalogs TARMED and EBM 2000plus. The included 11 relevant radiological services represented 80.3 % of the annual procedures of our radiology department. When comparing the technical services between the time-oriented catalogs and our own survey, TARMED gives a better description of the time consumed in 7 of the 11 services and EMB 2000plus in 3 services. When comparing the medical services, TARMED gives a better description of the time consumed in 6 of the 11 services and EBM 2000plus in 4 services. When averaging all the radiological services, TARMED overestimates the current number of physicians necessary for primary reading by a factor of 10.0 % and EBM 2000plus by a factor of 2.6 %. As to the time spent on performing the relevant radiological services, TARMED is slightly superior to describe the radiology department of a hospital than EBM 2000plus. For calculating the number of physicians necessary for primary reading, EBM 2000plus is superior to TARMED.
    RöFo - Fortschritte auf dem Gebiet der R 04/2005; 177(3):420-8. · 1.96 Impact Factor
  • RöFo - Fortschritte auf dem Gebiet der R 03/2005; 177(03):420-428. DOI:10.1055/s-2004-813932 · 1.96 Impact Factor
  • Academic Radiology 03/2005; 12(3):385-392. DOI:10.1016/j.acra.2004.11.015 · 2.08 Impact Factor
  • Thomas Hackländer, Heinrich Mertens
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    ABSTRACT: The aim of this project was to simulate the features and functions of a clinical or real-world MR scanner on a personal computer by means of a computer program. The users should be able to change all relevant settings of the virtual scanner and adapt them to the expected pathology. The algorithms of the simulation are based on parameter images of the three physical basic properties T1, T2, and proton density. From this, the synthetic images are calculated pixel by pixel on the basis of the well-known formulas of the pulse sequences chosen and modified by the user. The graphical user interface is oriented to a real-world MR scanner. The software is programmed in pure Java and is freely available under the GPL license. Besides spin echo pulse sequence, 6 other pulse sequence classes are implemented. Parameters like repetition time and echo time can be adjusted. The choice of parameters like matrix size, slice-thickness, and number of acquisitions has an impact on the signal-to-noise ratio of the images. In a first step, the simulation calculates the signal intensity in k-space. Wraparound and motion artifacts are simulated by modifying the data of k-space. In a last step, a 2D-Fourier transform of k-space data is performed. As the image calculation takes only a few seconds, an interactive manner of working is possible. The simulation has been used in the education of medical students and interns for more than 1 year and has gained widespread acceptance.
    Academic Radiology 02/2005; 12(1):85-96. DOI:10.1016/j.acra.2004.09.011 · 2.08 Impact Factor
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    ABSTRACT: The main objective of this study was to evaluate a clinically suspected renovascular hypertension (RVH) by means of MRI. It was to find out if functional MRI (fMRI) is able to provide adequate results with regard to MAG3 captopril scintigraphy and if contrast-enhanced MR angiography (MRA) is able to provide adequate results in the stenosis grading compared with the nonselective digital subtraction angiography (DSA). This open, monocentric, prospective, phase 3 study included patients with a clinically suspected RVH. For fMRI a dynamic TurboFLASH sequence and for MRA a single-shot breath-hold flash 3D sequence was performed. Gadodiamide was injected as contrast medium. Sixty patients were included in the study. The correlation between fMRI and scintigraphy had an accuracy, a sensitivity, and a specificity of 69%, 5%, and 92%, respectively, and correlations between MRA and DSA of 95%, 92%, and 96%. The noninvasive MRA can replace DSA in the diagnosis of renal artery stenosis. However, fMRI can not replace renal scintigraphy.
    Journal of Computer Assisted Tomography 11/2004; 28(6):823-31. DOI:10.1097/00004728-200411000-00016 · 1.60 Impact Factor
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    ABSTRACT: The idea for this project was born by the necessity to offer medical students an easy approach to the theoretical basics of magnetic resonance imaging. The aim was to simulate the features and functions of such a scanner on a commercially available computer by means of a computer program. The simulation was programmed in pure Java under the GNU General Public License and is freely available for a commercially available computer with Windows, Macintosh or Linux operating system. The graphic user interface is oriented to a real scanner. In an external program parameter, images for the proton density and the relaxation times T1 and T2 are calculated on the basis of clinical examinations. From this, the image calculation is carried out in the simulation program pixel by pixel on the basis of a pulse sequence chosen and modified by the user. The images can be stored and printed. In addition, it is possible to display and modify k-space images. Seven classes of pulse sequences are implemented and up to 14 relevant sequence parameters, such as repetition time and echo time, can be altered. Aliasing and motion artifacts can be simulated. As the image calculation only takes a few seconds, interactive working is possible. The simulation has been used in the university education for more than 1 year, successfully illustrating the dependence of the MR images on the measuring parameters. This should facititate the approach of students to the understanding MR imaging in the future.
    RöFo - Fortschritte auf dem Gebiet der R 09/2004; 176(8):1151-6. DOI:10.1055/s-2004.813215 · 1.96 Impact Factor
  • RöFo - Fortschritte auf dem Gebiet der R 08/2004; 176(08):1151-1156. DOI:10.1055/s-2004-813215 · 1.96 Impact Factor
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    ABSTRACT: The aim of the study was to investigate the application of the contrast-enhanced magnetic resonance angiography (CE-MRA) for the visualization of left internal mammary artery (LIMA) bypass. A total of 30 patients with LIMA bypass (22 men, 8 women, 35 to 77 years) received a CE-MRA 4 to 20 days after surgery. The non-ECG-triggered CE-MRA was performed during expiration using a body array coil at a 1.5 Tesla scanner (Magnetom-Vision). A three-dimensional gradient-echo sequence with slice interpolation technique was applied. For the three-dimensional visualization, single coronal slices were postprocessed with maximal intensity projection. Of 30 patients 22 agreed to a comparative coronary angiography. Five bypasses were identified up to the end-to-side anastomosis. A total of 80% of the bypass course was detectable in 13 patients and 60% in 11 patients. In two LIMA bypasses only 30% of the proximal part could be viewed; one was found by conventional coronary angiography to be occluded. The other conventional coronary angiography showed the LIMA bypass to be patent. The complete course of the LIMA bypass to the left anterior descending coronary artery can be visualized by the MRA technique. The most reliable imaging of the distal anastomosis can be realized by reducing the negative influence of the beating heart.
    The Annals of Thoracic Surgery 05/2001; 71(4):1229-32. DOI:10.1016/S0003-4975(01)02435-3 · 3.63 Impact Factor
  • RöFo - Fortschritte auf dem Gebiet der R 07/1999; 170(6):598-600. DOI:10.1055/s-2007-1011099 · 1.96 Impact Factor

Publication Stats

70 Citations
26.79 Total Impact Points


  • 2004–2005
    • HELIOS Klinik Ahrenshoop
      Ahrenshöft, Schleswig-Holstein, Germany
    • HELIOS Klinikum Emil von Behring
      Berlin Steglitz Zehlendorf, Berlin, Germany
  • 1999–2005
    • Universität Witten/Herdecke
      Witten, North Rhine-Westphalia, Germany