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ABSTRACT: The purpose of the study was to prospectively evaluate intrahepatic vessel depiction on C-arm CT (CACT) and the influence of the additional combined tissue and three-dimensional vessel visualisation on the positioning of the TACE catheter in comparison to DSA alone. Thirty consecutive patients scheduled for their first transarterial chemoembolisation underwent biphasic CACT and DSA of the liver. After assessing the DSA images for procedure planning, the CACT images were reviewed. The number and origin of the tumour-feeding arteries and the ideal position of the catheter for TACE on both DSA and CACT were assessed and correlated. The number of vessels identified as tumour feeders in each patient was significantly higher using additional CACT than on DSA alone (CACT: 4.0 +/- 1.7; DSA: 3.3 +/- 1.4; P = 0.003, t-test). After considering CACT, in 50% of the patients the catheter position was changed for TACE. Segmental portal vein thrombosis was seen in three patients on CACT, but in only one on DSA. As CACT depicts soft tissue and small vessels with high spatial resolution, tumour vessel allocation is facilitated, and ideal catheter position for TACE can be more accurately identified. The high impact of CACT on the TACE procedure suggests the benefits of its routine use for all patients undergoing their first TACE.
European Radiology 06/2009; 19(9):2302-9. · 3.22 Impact Factor
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ABSTRACT: The staging of anal cancer is extremely important for therapy and prognosis. Transanal endoscopic ultrasound and magnetic resonance imaging are routinely applied. The aim of this prospective comparative study is to evaluate whether tumor staging is concordant between these techniques.
Forty-five anal cancer patients underwent endoscopic ultrasound and magnetic resonance imaging. Histological confirmation was obtained in all patients. The two test methods were compared with the kappa concordance index and sensitivity for the initial method of tumor detection was calculated. For six patients who were operated upon because of tumor progression, the results were evaluated against the histological tumor stage.
High concordance was found in the assessment of tumor size and nodal status (kappa index 0.63 and 0.77). Cancer patients were correctly identified with 100% sensitivity (45/45) by endoscopic ultrasound and with 88.9% (40/45) sensitivity by magnetic resonance imaging. In the six operated patients, T stage was correctly assessed in four of six patients by endoscopic ultrasound and in three of six patients by magnetic resonance imaging.
The results of endoscopic ultrasound strongly coincide with those of magnetic resonance imaging. Endoscopic ultrasound may be superior to magnetic resonance imaging for detection of small superficial tumors. However, magnetic resonance imaging is needed for N staging.
Journal of Gastrointestinal Surgery 05/2009; 13(7):1292-8. · 2.83 Impact Factor
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RöFo - Fortschritte auf dem Gebiet der R 08/2008; 180(7):672-3. · 2.76 Impact Factor
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ABSTRACT: SonoVue is the first ultrasound contrast agent which allows repeated continuous examination of the liver in real time. The aim of this study was to compare low mechanical index (MI) real time contrast enhanced ultrasound of the liver, using the contrast agent SonoVue, with conventional B-mode sonography for the detection of hepatic metastases.
40 patients with known malignancy and at least one liver lesion on conventional B-mode sonography were included. Conventional B-mode sonography was performed followed by contrast enhanced ultrasound (CEUS) of the liver in the arterial (< 30 sec), portal-venous (40-120 sec) and delayed phase (> 120 sec) after injection of SonoVue. CEUS was performed using contrast specific imaging and low MI (< 0.3). Number, location and size of metastases on baseline and CEUS were compared with CT or MRI (blinded reader).
37 patients had 128 metastases on CT or MRI. Baseline US showed 74 metastases confirmed by reference examination (69%), while CEUS yielded 109 metastases (sensitivity 90%) (p < 0.001). On CEUS, 35 additional metastases not seen on baseline but confirmed by reference imaging were detected in 14 patients (36%). In 8 patients, CEUS showed 13 metastases not seen on reference imaging.
Detection of hepatic metastases is substantially improved by low MI real time contrast enhanced ultrasound with SonoVue compared to conventional B-mode sonography.
Ultraschall in der Medizin 08/2005; 26(4):277-84. · 2.40 Impact Factor
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ABSTRACT: Angiodysplasia of the colon has been reported as one of the most common sources of lower gastrointestinal bleeding in the elderly whereas it is very rare in younger patients. Apart from this, portal hypertension may also have effects on the colon. There are, however, only a few reports which have investigated the colon in patients with portal hypertension. We report the case of a 16-year-old woman who presented massive bleeding from angiodysplasia of the colon assembled together with portal hypertension due to portal vein thrombosis caused presumably by neonatal umbilical cord infection. In this regard we discuss diagnosis, therapy and prognosis of this disease.
Zentralblatt für Chirurgie 01/2004; 128(12):1093-6. · 1.02 Impact Factor
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ABSTRACT: Evaluation of clinical relevance of the arterial stimulation procedure with venous sampling (ASVS) in the preoperative localization of insulinoma.
Thirteen patients with endogenous hyperinsulinism underwent preoperative transabdominal ultrasound (US), helical CT (CT), MRI, endoscopic ultrasound (EUS), and angiography (DSA) in conjunction with the ASVS-test for the detection of insulinoma. The results were compared with intraoperative findings, intraoperative ultrasound (IOUS) and histology.
Sensitivity was as follows: US 8%, MRI 27%, CT 46%, EUS 50%,DSA 69%,and ASVS 92%. Intraoperative palpation and IOUS yielded a sensitivity of 77%. In 3 patients the tumors were neither palpable nor detectable by IOUS, the mode of resection was based on preoperative diagnostics. The ASVS procedure as a functional test was superior to all other modalities for the preoperative tumor detection.
The ASVS was the most sensitive diagnostic modality. It should especially be considered in terms of health economical aspects when CT or MRI do not yield conclusive results.
Der Radiologe 05/2003; 43(4):301-5. · 0.61 Impact Factor
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ABSTRACT: Zielsetzung. Bestimmung des Stellenwertes des arteriellen Stimulationstests mit venöser Blutentnahme (ASVS) zur präoperativen Lokalisation
von Insulinomen.
Methodik. Dreizehn Patienten mit endogenem Hyperinsulinismus wurden bei nichtkonklusiver externer Vordiagnostik präoperativ mittels
transabdominellem Ultraschall (US), Spiral-CT (CT),MRT, endoskopischem Ultraschall (EUS), digitaler Subtraktionsangiographie
(DSA) in Verbindung mit dem ASVS-Test untersucht. Die Resultate wurden mit intraoperativen Befunden und den histologischen
Ergebnissen korreliert.
Ergebnisse. Die Sensitivitäten betrugen für US 8%,MRT 27%, CT 46%, EUS 50%,DAS 69% und ASVS 92%.Die intraoperative Palpation und Ultraschall
(IOUS) erzielten eine Sensitvität von 77%.Bei 3 Patienten war das Insulinom intraoperativ weder palpabel noch durch IOUS lokalisierbar,
die Resektion erfolgte anhand der präoperativen Diagnostik. Der ASVS-Test als funktionelles Verfahren war in der Detektion
den präoperativen bildgebenden Verfahren überlegen.
Schlussfolgerungen. Der ASVS-Test erwies sich als das zuverlässigste Verfahren für die Lokalisationsdiagnostik.Vor dem Hintergrund gesundheitsökonomischer
Überlegungen sollte er bei negativer Schnittbilddiagnostik frühzeitig eingesetzt werden.
Purpose. Evaluation of clinical relevance of the arterial stimulation procedure with venous sampling (ASVS) in the preoperative localization
of insulinoma.
Methods. Thirteen patients with endogenous hyperinsulinism underwent preoperative transabdominal ultrasound (US), helical CT (CT),
MRI, endoscopic ultrasound (EUS), and angiography (DSA) in conjunction with the ASVS-test for the detection of insulinoma.
The results were compared with intraoperative findings, intraoperative ultrasound (IOUS) and histology.
Results. Sensitivity was as follows: US 8%, MRI 27%, CT 46%, EUS 50%,DSA 69%,and ASVS 92%.Intraoperative palpation and IOUS yielded
a sensitivity of 77%. In 3 patients the tumors were neither palpable nor detectable by IOUS, the mode of resection was based
on preoperative diagnostics.The ASVS procedure as a functional test was superior to all other modalities for the preoperative
tumor detection.
Conclusion. The ASVS was the most sensitive diagnostic modality. It should especially be considered in terms of health economical aspects
when CT or MRI do not yield conclusive results.
Der Radiologe 01/2003; 43(4):301-305. · 0.61 Impact Factor
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ABSTRACT: The development of new imaging techniques and the refinement of established methods in uroradiological imaging is proceeding rapidly. In the last few years several important developments have been implemented in the routine diagnostic evaluation of urological patients.A milestone is the recent advent of multidetector helical computed tomography (CT), enabling the radiologist to provide the clinician with high-quality three-dimensional (3-D) reconstructions of the urological organs. Powerful workstations are an indispensable tool in the post-processing of CT and magnetic resonance imaging (MRI)data. Significant advances in imaging were obtained in the fields of oncological imaging (e.g. prostate MRI and spectroscopic imaging), paediatric uroradiology(e.g. MR urography) and the evaluation of stone disease by unenhanced helical CT.
BJU International 04/2002; 89(5):477-87; Quiz i-iii. · 2.84 Impact Factor
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ABSTRACT: In unresectable hepatocellular carcinoma (HCC), liver transplantation (LTX) represents a chance for potential cure. Early
experiences with unselected patient populations revealed a high mortality due to recurrent disease (Mor et al. 1998). Subgroups of patients with promising long-term results are patients with UICC (International Union Against
Cancer) stage I and II disease and those with the rare fibrolamellar subtype. In most cases, immediate transplantation is
not possible, particularly because patients with HCC are not given priority on the waiting list. Several strategies to control
tumor growth during the waiting period, such as transcatheter arterial chemoembolization, percutaneous ethanol injection,
radiofrequency ablation, and laser-induced thermotherapy, have been introduced.
12/2001: pages 127-132;
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RöFo - Fortschritte auf dem Gebiet der R 09/2001; 173(8):767-8. · 2.76 Impact Factor
