Kurt Huck

Publications of Kurt Huck

• Venous thromboembolism: additional diagnostic value and radiation dose of pelvic CT venography in patients with suspected pulmonary embolism.

  Authors: Miriam Reichert, Thomas Henzler, Radko Krissak, Paul Apfaltrer, Kurt Huck, Karen Buesing, Tim Sueselbeck, Stefan O Schoenberg, Christian Fink

  European journal of radiology. 04/2011; 80(1):50-3.

  To assess the additional diagnostic value of indirect CT venography (CTV) of the pelvis and upper thighs performed after pulmonary CT angiography (CTA) for the diagnosis of venous thromboembolismTo assess the additional diagnostic value of indirect CT venography (CTV) of the pelvis and upper thighs performed after pulmonary CT angiography (CTA) for the diagnosis of venous thromboembolism (VTE). In a retrospective analysis, the radiology information system entries between January 2003 and December 2007 were searched for patients who received pulmonary CTA and additional CTV of the pelvis and upper thighs. Of those patients, the radiology reports were reviewed for the diagnosis of pulmonary embolism (PE) and deep venous thrombosis (DVT) in the pelvic veins and veins of the upper thighs. In cases with an isolated pelvic thrombosis at CTV (i.e. which only had a thrombosis in the pelvic veins but not in the veins of the upper thigh) ultrasound reports were reviewed for the presence of DVT of the legs. The estimated radiation dose was calculated for pulmonary CTA and for CTV of the pelvis. In the defined period 3670 patients were referred to our institution for exclusion of PE. Of those, 642 patients (353 men, 289 women; mean age, 65±15 years, age range 18-98 years) underwent combined pulmonary CTA and CTV. Among them, PE was found in 227 patients (35.4%). In patients without PE CTV was negative in all cases. In patients with PE, CTV demonstrated pelvic thrombosis in 24 patients (3.7%) and thrombosis of the upper thighs in 43 patients (6.6%). Of those patients 14 (2.1%) had DVT in the pelvis and upper thighs. In 10 patients (1.5%) CTV showed an isolated pelvic thrombosis. Of those patients ultrasound reports were available in 7 patients, which revealed DVT of the leg veins in 5 cases (1%). Thus, the estimated prevalence of isolated pelvic thrombosis detected only by pelvic CTV ranges between 1-5/642 patients (0.1-0.7%). Radiation dose ranges between 4.8 and 9.7 mSv for additional CTV of the pelvis. CTV of the pelvis performed after pulmonary CTA is of neglectable additional diagnostic value for the detection of VTE, because the additional radiation dose is high and isolated pelvic DVT is very rare. Venous imaging of the legs (preferably by radiation-free ultrasound) is sufficient for the diagnosis of underlying DVT in patients with suspected PE.

• Peripheral Magnetic Resonance Angiography With Continuous Table Movement in Combination With High Spatial and Temporal Resolution Time-Resolved MRA With a Total Single Dose (0.1 mmol/kg) of Gadobutrol at 3.0 T.

  Authors: Matthias Voth, Stefan Haneder, Kurt Huck, Alexandra Gutfleisch, Stefan Schoenberg, Henrik Michaely

  Investigative radiology. 08/2009;

  PURPOSE:: To prove the concept of peripheral continuous table movement (CTM) MR-angiography (MRA) in combination with high spatial and temporal resolution time-resolved TWIST-MRA in a singlePURPOSE:: To prove the concept of peripheral continuous table movement (CTM) MR-angiography (MRA) in combination with high spatial and temporal resolution time-resolved TWIST-MRA in a single MR-examination at 3.0 T with a single dose (0.1 mmol/kg) of gadobutrol in total. MATERIALS AND METHODS:: We included 22 consecutive patients (15 m/7 f, mean age: 64 years) referred for peripheral MRA with clinical symptoms of peripheral arterial occlusive disease Fontaine stages II-IV. All of them underwent both CTM-MRA (TR: 2.4 ms/TE: 1.0 ms/flip angle: 21 degree) of the entire run-off vessels and TWIST-MRA (TR: 2.8 ms/TE: 1.1 ms/flip angle: 20 degree) of the calf station during a single MR-examination. All examinations were performed on a 3.0 T MR system (Tim Trio). Spatial resolution of the CTM-MRA datasets was technically limited to an acquired resolution of 1.2 x 1.2 x 1.96 mm reconstructed to 1.2 mm isotropic. The TWIST-MRA was acquired with 1.1 x 1.1 x 1.35 mm and reconstructed to 1.1 mm isotropic with a temporal resolution of 5.5 seconds in the calf station. A total of 0.1 mmol/kg BW gadobutrol diluted 1:1 with saline was injected at a flow rate of 1.5 mL/s of which 0.07 mmol/kg was administered for the CTM-MRA and 0.03 mmol/kg for the TWIST-MRA.CTM-MRA run off datasets were qualitatively assessed using a 4 point scale (4 = excellent, 1 = nondiagnostic) followed by TWIST-MRA datasets for the calf using the same scale. Additional relevant findings only visible in the TWIST-MRA were documented. RESULTS:: All datasets could be evaluated with a total of 397 assessable segments. CTM-MRA was diagnostic in 99% (393/397 segments) with image quality judged as excellent in 54% (213/397 segments), good in 42% (14/397), and moderate in 4% (14/397) of analyzed segments respectively. Nondiagnostic image quality was seen in 1% (4/397 segments). Venous overlay in the calf station was found in 27% (6/22 patients). TWIST-MRA was diagnostic in 100% (115/115 segments), throughout with good or excellent image quality. In 14 of 22 patients additional relevant findings were detected by TWIST-MRA. CONCLUSION:: Single-dose gadobutrol CTM-MRA in combination with a high spatial and temporal resolution TWIST-MRA at 3.0 T is a reliable technique with good image quality. Despite the use of single dose contrast agent large field of view coverage and dynamic images can be acquired. Because of its robustness, this imaging approach of the vasculature has great potential for a broad clinical use.

• Dual-Energy CT Angiography in Peripheral Arterial Occlusive Disease.

  Authors: Carolin Brockmann, Susanne Jochum, Maliha Sadick, Kurt Huck, Peter Ziegler, Christian Fink, Stefan Schoenberg, Steffen Diehl

  Cardiovascular and interventional radiology. 02/2009;

  We sought to study the accuracy of dual-energy computed tomographic angiography (DE-CTA) for the assessment of symptomatic peripheral arterial occlusive disease of the lower extremity by using theWe sought to study the accuracy of dual-energy computed tomographic angiography (DE-CTA) for the assessment of symptomatic peripheral arterial occlusive disease of the lower extremity by using the dual-energy bone removal technique compared with a commercially available conventional bone removal tool. Twenty patients underwent selective digital subtraction angiography and DE-CTA of the pelvis and lower extremities. CTA data were postprocessed with two different applications: conventional bone removal and dual-energy bone removal. All data were reconstructed and evaluated as 3D maximum-intensity projections. Time requirements for reconstruction were documented. Sensitivity, specificity, accuracy, and concordance of DE-CTA regarding degree of stenosis and vessel wall calcification were calculated. A total of 359 vascular segments were analyzed. Compared with digital subtraction angiography, sensitivity, specificity, and accuracy, respectively, of CTA was 97.2%, 94.1%, and 94.7% by the dual-energy bone removal technique. The conventional bone removal tool delivered a sensitivity of 77.1%, a specificity of 70.7%, and an accuracy of 72.0%. Best results for both postprocessing methods were achieved in the vascular segments of the upper leg. In severely calcified segments, sensitivity, specificity, and accuracy stayed above 90% by the dual-energy bone removal technique, whereas the conventional bone removal technique showed a substantial decrease of sensitivity, specificity, and accuracy. DE-CTA is a feasible and accurate diagnostic method in the assessment of symptomatic peripheral arterial occlusive disease. Results obtained by DE-CTA are superior to the conventional bone removal technique and less dependent on vessel wall calcifications.

• Treatment of hemodynamic insufficiency in chronic CCA occlusion using a short saphenous vein interposition graft: diagnostic and technical considerations. An illustrative case report.

  Authors: Gerrit Alexander Schubert, Stephan Rewerk, Thomas Riester, Kurt Huck, Peter Vajkoczy

  Neurosurgical review. 02/2008; 31(1):123-6, discussion 126.

  Extracranial-intracranial bypass surgery has been shown to reverse hemodynamic insufficiency on the basis of steno-occlusive disease of the internal carotid artery (ICA) or middle cerebral artery. InExtracranial-intracranial bypass surgery has been shown to reverse hemodynamic insufficiency on the basis of steno-occlusive disease of the internal carotid artery (ICA) or middle cerebral artery. In contrast, chronic occlusion of the common carotid artery (CCA) without extracranial donor vessels affords alternative revascularization procedures as well as a more elaborate preoperative workup. This case is intended to illustrate the specific diagnostic approach and considerations as well as a beneficial treatment modality in the setting of pronounced hemodynamic insufficiency as a consequence of a CCA occlusion, in conjunction with contralateral CCA and ICA stenoses. A 61-year-old man complaining of new onset aphasia underwent vascular imaging that revealed a proximal occlusion of the left CCA with a concomitant patent proximal ICA on ultrasound. Functional cerebral blood flow measurement including Xenon-enhanced computer tomography showed corresponding chronic hemodynamic insufficiency of the left hemisphere. The patient received a modified revascularization procedure, where a saphenous vein was used as interposition graft between the subclavian artery and the left proximal ICA. Postoperatively, both clinical and morphological improvement were noted. Successful treatment of hemodynamic insufficiency because of chronic CCA occlusion necessitates a thorough preoperative workup and application of alternative revascularization strategies.