Stefan O Schönberg

Publications of Stefan O Schönberg

• First multimodal embolization particles visible on x-ray/computed tomography and magnetic resonance imaging.

  Authors: Soenke H Bartling, Johannes Budjan, Hagit Aviv, Stefan Haneder, Bettina Kraenzlin, Henrik Michaely, Shlomo Margel, Steffen Diehl, Wolfhard Semmler, Norbert Gretz, Stefan O Schönberg, Maliha Sadick

  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 isEmbolization 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.

• Lung MRI at 1.5 and 3 Tesla: observer preference study and lesion contrast using five different pulse sequences.

  Authors: Christian Fink, Michael Puderbach, Juergen Biederer, Michael Fabel, Olaf Dietrich, Hans-Ulrich Kauczor, Maximilian F Reiser, Stefan O Schönberg

  Investigative radiology. 07/2007; 42(6):377-83.

  OBJECTIVES: To compare the image quality and lesion contrast of lung MRI using 5 different pulse sequences at 1.5 T and 3 T. MATERIALS AND METHODS: Lung MRI was performed at 1.5 T and 3 T using 5OBJECTIVES: To compare the image quality and lesion contrast of lung MRI using 5 different pulse sequences at 1.5 T and 3 T. MATERIALS AND METHODS: Lung MRI was performed at 1.5 T and 3 T using 5 pulse sequences which have been previously proposed for lung MRI: 3D volumetric interpolated breath-hold examination (VIBE), true fast imaging with steady-state precession (TrueFISP), half-Fourier single-shot turbo spin-echo (HASTE), short tau inversion recovery (STIR), T2-weighted turbo spin-echo (TSE). In addition to 4 healthy volunteers, 5 porcine lungs were examined in a dedicated chest phantom. Lung pathology (nodules and infiltrates) was simulated in the phantom by intrapulmonary and intrabronchial injections of agarose. CT was performed in the phantom for correlation. Image quality of the sequences was ranked in a side-by-side comparison by 3 blinded radiologists regarding the delineation of pulmonary and mediastinal anatomy, conspicuity of pulmonary nodules and infiltrates, and presence of artifacts. The contrast of nodules and infiltrates (CNODULES and CINFILTRATES) defined by the ratio of the signal intensities of the lesion and adjacent normal lung parenchyma was determined. RESULTS: There were no relevant differences regarding the preference for the individual sequences between both field strengths. TSE was the preferred sequence for the visualization of the mediastinum at both field strengths. For the visualization of lung parenchyma the observers preferred TrueFISP in volunteers and TSE in the phantom studies. At both field strengths VIBE achieved the best rating for the depiction of nodules, whereas HASTE was rated best for the delineation of infiltrates. TrueFISP had the fewest artifacts in volunteers, whereas STIR showed the fewest artifacts in the phantom. For all but the TrueFISP sequence the lesion contrast increased from 1.5 T to 3 T. At both field strengths VIBE showed the highest CNODULES (6.6 and 7.1) and HASTE the highest CINFILTRATES (6.1 and 6.3). CONCLUSION: The imaging characteristics of different pulse sequences used for lung MRI do not substantially differ between 1.5 T and 3 T. A higher lesion contrast can be expected at 3 T.

• Myocardial perfusion imaging with Gadobutrol: a comparison between 3 and 1.5 Tesla with an identical sequence design.

  Authors: Daniel Theisen, Bernd J Wintersperger, Armin Huber, Olaf Dietrich, Maximilian F Reiser, Stefan O Schönberg

  Investigative radiology. 07/2007; 42(7):499-506.

  OBJECTIVES: To implement myocardial first-pass perfusion imaging at 3 Tesla and to evaluate the potential benefit with regard to signal parameters in comparison to 1.5 Tesla using identical sequenceOBJECTIVES: To implement myocardial first-pass perfusion imaging at 3 Tesla and to evaluate the potential benefit with regard to signal parameters in comparison to 1.5 Tesla using identical sequence settings and an intraindividual comparison. MATERIALS AND METHODS: In 16 volunteers, myocardial first-pass perfusion imaging was performed at 1.5 Tesla (Magnetom Avanto) and 3 Tesla (Magnetom TIM Trio) after injection of 0.05 mmol/kg body weight Gadobutrol using an accelerated saturation recovery TurboFLASH technique (GRAPPA; R=2) at 1.5 and 3 Tesla. Detailed sequence parameters (TR 2.3 milliseconds, TE 0.93 milliseconds, flip angle 15 degrees , bandwidth 780 Hz/px) as well as spatial resolution were kept identical for both field strengths. Artifacts were assessed quantitatively and qualitatively, signal-to-noise ratio (SNR) and contrast enhancement ratio (CER) were calculated from raw data signal intensity-time curves. A linear fit on the upslope was performed for semiquantitative perfusion analysis. RESULTS: SNR was significantly higher at 3 Tesla than at 1.5 Tesla (35.7+/-11.9 vs. 18.0+/-5.5, P<0.001). CER was significantly greater at 3 Tesla than at 1.5 Tesla (2.2+/-0.9 vs. 1.4+/-0.5, P<0.001). Maximum upslope was significantly higher at 3 Tesla than at 1.5 Tesla (3.3+/-2.4 vs. 2.0+/-1.0, P<0.001). A qualitative examination of all images for artifacts by 2 board-certified radiologists yielded no significant differences between the field strengths. CONCLUSIONS: Three Tesla significantly improves CER and SNR compared with 1.5 Tesla with identical sequence parameters. In addition, the most important semiquantitative perfusion parameter maximum upslope is significantly increased. This may allow for an improvement of spatial resolution and potentially for a better delineation of perfusion defects. However, further studies are necessary to potentially demonstrate a benefit of 3 Tesla perfusion imaging in a clinical setting.

• Myocardial first pass perfusion imaging with gadobutrol: impact of parallel imaging algorithms on image quality and signal behavior.

  Authors: Daniel Theisen, Bernd J Wintersperger, Armin Huber, Olaf Dietrich, Maximilian F Reiser, Stefan O Schönberg

  Investigative radiology. 07/2007; 42(7):522-8.

  OBJECTIVE: To implement parallel imaging algorithms in fast gradient recalled echo sequences for myocardial perfusion imaging and evaluate image quality, signal-to-noise ratio (SNR),OBJECTIVE: To implement parallel imaging algorithms in fast gradient recalled echo sequences for myocardial perfusion imaging and evaluate image quality, signal-to-noise ratio (SNR), contrast-enhancement ratio (CER), and semiquantitative perfusion parameters. MATERIALS AND METHODS: In 20 volunteers, myocardial perfusion imaging with gadobutrol was performed at rest using an accelerated TurboFLASH sequence (TR 2.3 milliseconds, TE 0.93 milliseconds, flip angle [FA] 15 degrees) with GRAPPA, R=2. A nonaccelerated TurboFLASH sequence with similar scan parameters served as standard of reference. Artifacts were assessed qualitatively. SNR, CER, and CNR were calculated and semiquantitative perfusion parameters were determined from fitted SI-time curves. RESULTS: Phantom measurements yielded significant higher SNR for nonaccelerated images (P<0.001). CER was equal; differences in CNR were statistically nonsignificant. The evaluation of semiquantitative perfusion parameters yielded significantly higher peak signal intensities in nonaccelerated images (P<0.001). Differences in maximum upslope were statistically nonsignificant. A qualitative examination of all images for artifacts by 2 board-certified radiologists yielded a significant reduction in dark rim artifacts with GRAPPA, R=2 (P<0.001). CONCLUSIONS: The application of GRAPPA with an acceleration factor of R=2 leads to a significant reduction of dark rim artifacts in fast gradient recalled echo sequences.