H U Kauczor

Publications of H U Kauczor

• Dynamic contrast-enhanced MRI for monitoring bisphosphonate therapy in Paget's disease of bone.

  Authors: Martin Libicher, C Kasperk, M Daniels-Wredenhagen, T Heye, H U Kauczor, P Nawroth, S Delorme, W Hosch

  Skeletal radiology. 05/2012;

  PURPOSE: The purpose of this study was to evaluate changes in regional bone perfusion in Paget's disease (PD) following bisphosphonate therapy. We used dynamic contrast-enhanced MRI (DCE-MRI) forPURPOSE: The purpose of this study was to evaluate changes in regional bone perfusion in Paget's disease (PD) following bisphosphonate therapy. We used dynamic contrast-enhanced MRI (DCE-MRI) for assessment of bone perfusion and compared MRI findings with alkaline phosphatase (AP) as a serum marker of bone turnover. MATERIALS AND METHODS: We examined 20 patients (8 women, 12 men, 66 ± 11 years) with symptomatic PD of the axial skeleton. Patients were selected for infusion therapy with the bisphosphonate pamidronate. The most affected bone of lumbar spine or pelvis was examined by DCE-MRI prior to therapy and after a 6-month follow-up. The contrast uptake was evaluated using a two-compartment model with the parameters amplitude A and exchange rate constant K(ep). Color-coded parametric images were generated to visualize bone vascularization. RESULTS: After a 6-month follow-up there was a significant decrease in alkaline phosphatase and in DCE-MRI parameters A and K(ep) (p < 0.0001). Patients without previous bisphosphonate treatment showed a significantly greater decrease in alkaline phosphatase and K(ep) (p < 0.001). CONCLUSION: DCE-MRI shows a significant reduction in regional bone perfusion in PD following parenteral bisphosphonate treatment. Reduction in bone perfusion is greater in bisphosphonate-naïve patients than in those who had been previously treated.

• Permanent muscular sodium overload and persistent muscle edema in Duchenne muscular dystrophy: a possible contributor of progressive muscle degeneration.

  Authors: M-A Weber, A M Nagel, M B Wolf, K Jurkat-Rott, H-U Kauczor, W Semmler, F Lehmann-Horn

  Journal of neurology. 04/2012;

  To assess the presence and persistence of muscular edema and increased myoplasmic sodium (Na(+)) concentration in Duchenne muscular dystrophy (DMD). We examined eight DMD patients (mean age 9.5 ± 5.4To assess the presence and persistence of muscular edema and increased myoplasmic sodium (Na(+)) concentration in Duchenne muscular dystrophy (DMD). We examined eight DMD patients (mean age 9.5 ± 5.4 years) and eight volunteers (mean age 9.5 ± 3.2 years) with 3-tesla proton ((1)H) and (23)Na density-adapted 3D-radial MR sequences. Seven DMD patients were re-examined about 7 months later without change of therapy. The eighth DMD patient was re-examined after 5 and 11 months under medication with eplerenone. We quantified muscle edema on STIR images with background noise as reference and fatty degeneration on T1-weighted images using subcutaneous fat as reference. Na(+) was quantified by a muscular tissue Na(+) concentration (TSC) sequence employing a reference containing 51.3 mM Na(+) with 5 % agarose. With an inversion-recovery (IR) sequence, we determined mainly the myoplasmic Na(+). The normalized muscular (23)Na IR signal intensity was higher in DMD than in volunteers (n = 8, 0.75 ± 0.07 vs. 0.50 ± 0.05, p < 0.001) and persisted at second measurement (n = 7, 1st 0.75 ± 0.07, 2nd 0.73 ± 0.06, p = 0.50). When compared to volunteers (25.6 ± 2.0 mmol/l), TSC was markedly increased in DMD (38.0 ± 5.9 mmol/l, p < 0.001) and remained constant (n = 7, 1st 37.9 ± 6.4 mmol/l, 2nd 37.0 ± 4.0 mmol/l, p = 0.49). Muscular edema (15.6 ± 3.5 vs. 6.9 ± 0.7, p < 0.001) and fat content (0.48 ± 0.08 vs. 0.38 ± 0.01, p = 0.003) were elevated in DMD when compared to volunteers. This could also be confirmed during follow-up (n = 7, p = 0.91, p = 0.12). Eplerenone slightly improved muscle strength and reduced muscular sodium and edema. The permanent muscular Na(+) overload in all DMD patients is likely osmotically relevant and responsible for the persisting, mainly intracellular muscle edema that may contribute to the progressive muscle degeneration.

• [Compatibility of family and profession : Survey of radiologists and medical technical personnel in clinics with different organizations].

  Authors: B D Bundy, N Bellemann, I Burkholder, T Heye, B A Radeleff, L Grenacher, H U Kauczor, M A Weber

  Der Radiologe. 03/2012; 52(3):267-76.

  The compatibility of family and profession is especially difficult for employees in medical professions because of shift work and overtime. It seems that in the future women are going to representThe compatibility of family and profession is especially difficult for employees in medical professions because of shift work and overtime. It seems that in the future women are going to represent the majority of medical professionals in Germany. Hence, with the forthcoming lack of physicians in Germany social aspects will also play a greater role in the choice of the place of employment. Therefore a statistical survey was made among employees on how they judge the compatibility of family and job and what they would like to improve. From autumn 2009 until spring 2010 a total of 115 questionnaires were distributed to 8 different academic radiology departments. The anonymous questionnaire with partially open, partially graded questions and partially multiple answer questions was designed with the help of an expert for statistics and analytics and included questions about the employment and family situation, plans for the future, requested flexible working hours and childcare models, as well as ideas for improvement. Of the questionnaires 87 were analyzed with a specially designed access database using, for example descriptive statistics and histogram analyses. Of the interviewees 68% were female and 31% were male (1% not significant n.s.), 46% had children and 49% were childless (5% n.s.), 63% were medical doctors, 33% radiographers (3% other) and 82% worked full-time. Of the male respondents with children 42% indicated that their spouse was at home, 18% of female respondents with children indicated that their spouse was at home and only mothers worked part-time. Of the male respondents 73% would like to take parental leave, 44% of all respondents (70% of the male respondents and 34% of the female respondents) agreed that radiology is more compatible with family than other medical disciplines and 87% would like to have a childcare possibility in close proximity to the working place. In most of the families the classic role model prevails, although women are well-educated and men also set a high value on the compatibility of family and profession and would like to take parental leave and work flexible working hours. This is a chance especially for radiology.

• [Moving pleural mass.]

  Authors: M Dadrich, T Schneider, M Puderbach, H U Kauczor, C-P Heußel

  Medizinische Klinik, Intensivmedizin und Notfallmedizin. 02/2012;

  A 74-year-old man with bronchial carcinoma underwent radiofrequency ablation (RFA) due to poor pulmonary function. Therefore non-enhanced computed tomography (CT) of the chest was performed on twoA 74-year-old man with bronchial carcinoma underwent radiofrequency ablation (RFA) due to poor pulmonary function. Therefore non-enhanced computed tomography (CT) of the chest was performed on two subsequent days. Besides the tumor, the CT scans showed a moving calcification in the pleural cavity. This extremely rare condition called thoracolithiasis is usually an incidental finding. Mostly it is asymptomatic and does not require any treatment. It should be considered as a differential diagnosis of a peripheral pulmonary nodule.

• Dynamic contrast-enhanced ultrasound and transient arterial occlusion for quantification of arterial perfusion reserve in peripheral arterial disease.

  Authors: E Amarteifio, S Wormsbecher, M Krix, S Demirel, S Braun, S Delorme, D Böckler, H-U Kauczor, M-A Weber

  European journal of radiology. 01/2012;

  OBJECTIVE: To quantify muscular micro-perfusion and arterial perfusion reserve in peripheral arterial disease (PAD) with dynamic contrast-enhanced ultrasound (CEUS) and transient arterial occlusion.OBJECTIVE: To quantify muscular micro-perfusion and arterial perfusion reserve in peripheral arterial disease (PAD) with dynamic contrast-enhanced ultrasound (CEUS) and transient arterial occlusion. MATERIALS AND METHODS: This study had local institutional review board approval and written informed consent was obtained from all subjects. We examined the dominant lower leg of 40 PAD Fontaine stage IIb patients (mean age, 65 years) and 40 healthy volunteers (mean age, 54 years) with CEUS (7MHz; MI, 0.28) during continuous intravenous infusion of 4.8mL microbubbles. Transient arterial occlusion at mid-thigh level simulated physical exercise. With time-CEUS-intensity curves obtained from regions of interest within calf muscles, we derived the maximum CEUS signal after occlusion (max) and its time (t(max)), slope to maximum (m), vascular response after occlusion (AUC(post)), and analysed accuracy, receiver operating characteristic (ROC) curves, and correlations with ankle-brachial index (ABI) and walking distance. RESULTS: All parameters differed in PAD and volunteers (p<0.014). In PAD, t(max) was delayed (31.2±13.6 vs. 16.7±8.5s, p<0.0001) and negatively correlated with ankle-brachial-index (r=-0.65). m was decreased in PAD (4.3±4.6mL/s vs. 13.1±8.4mL/s, p<0.0001) and had highest diagnostic accuracy (sensitivity/specificity, 75%/93%) for detection of diminished muscular micro-perfusion in PAD (cut-off value, m<5∼mL/s). Discriminant analysis and ROC curves revealed m, and AUC(post) as optimal parameter combination for diagnosing PAD and therefore impaired arterial perfusion reserve. CONCLUSIONS: Dynamic CEUS with transient arterial occlusion quantifies muscular micro-perfusion and arterial perfusion reserve. The technique is accurate to diagnose PAD.

• Comparison of neuroendocrine tumor detection and characterization using DOTATOC-PET in correlation with contrast enhanced CT and delayed contrast enhanced MRI.

  Authors: F L Giesel, C Kratochwil, A Mehndiratta, S Wulfert, J H Moltz, C M Zechmann, H U Kauczor, U Haberkorn, S Ley

  European journal of radiology. 01/2012;

  PURPOSE: We evaluated the rate of successful characterization of gastroenteropancreatic neuroendocrine tumors (NETs) present with an increased somatostatin receptor, comparing CE-CT with CE-MRI, eachPURPOSE: We evaluated the rate of successful characterization of gastroenteropancreatic neuroendocrine tumors (NETs) present with an increased somatostatin receptor, comparing CE-CT with CE-MRI, each in correlation with DOTATOC-PET. METHODS AND MATERIALS: 8 patients with GEP-NET were imaged using CE-MRI (Gd-EOB-DTPA), CE-CT (Imeron 400) and DOTATOC-PET. Contrast-enhancement of normal liver-tissue and metastasis was quantified with ROI-technique. Tumor delineation was assessed with visual-score in blind-read-analysis by two experienced radiologists. RESULTS: Out of 40 liver metastases in patients with NETs, all were detected by CE-MRI and the lesion extent could be adequately assessed, whereas CT failed to detect 20% of all metastases. The blind-read-score of CT in arterial and portal phase was median -0.65 and -1.4, respectively, and 2.7 for delayed-MRI. The quantitative ROI-analysis presented an improved contrast-enhancement-ratio with a median of 1.2, 1.6 and 3.3 for CE-CT arterial, portal-phase and delayed-MRI respectively. CONCLUSION: Late CE-MRI was superior to CE-CT in providing additionally morphologic characterization and exact lesion extension of hepatic metastases from neuroendocrine tumor detected with DOTATOC-PET. Therefore, late enhanced Gd-EOB-DTPA-MRI seems to be the adequate imaging modality for combination with DOTATOC-PET to provide complementary (macroscopic and molecular) tumor characterization in hepatic metastasized NETs.

• [Transarterial ablation of hepatocellular carcinoma. Status and developments].

  Authors: B A Radeleff, U Stampfl, C M Sommer, N Bellemann, K Hoffmann, T Ganten, R Ehehalt, H U Kauczor

  Der Radiologe. 01/2012; 52(1):44-55.

  Hepatocellular carcinoma (HCC) is the fifth most common cancer worldwide and represents the main cause of death among European patients with liver cirrhosis. Only 30-40% of patients diagnosed withHepatocellular carcinoma (HCC) is the fifth most common cancer worldwide and represents the main cause of death among European patients with liver cirrhosis. Only 30-40% of patients diagnosed with HCC are candidates for curative treatment options (e.g. surgical resection, liver transplantation or ablation). The remaining majority of patients must undergo local regional and palliative therapies. Transvascular ablation of HCC takes advantage of the fact that the hypervascularized HCC receives most of its blood supply from the hepatic artery. In this context transvascular ablation describes different therapy regimens which can be assigned to four groups: cTACE (conventional transarterial chemoembolization), bland embolization (transarterial embolization TAE), DEB-TACE (TACE with drug-eluting beads, DEB) and SIRT (selective internal radiation therapy, radioembolization). Conventional TACE is the most common type of transvascular ablation and represents a combination of intra-arterial chemotherapy and embolization with occlusion of the arterial blood supply. However, there is no standardized regimen with respect to the chemotherapeutic drug, the embolic agent, the usage of lipiodol and the interval between the TACE procedures. Even the exact course of a cTACE procedure (order of chemotherapy or embolization) is not standardized. It remains unclear whether or not intra-arterial chemotherapy is definitely required as bland embolization using very small, tightly calibrated spherical particles (without intra-arterial administration of a chemotherapeutic drug) shows tumor necrosis comparable to cTACE. For DEB-TACE microparticles loaded with a chemotherapeutic drug combine the advantages of cTACE and bland embolization. Thereby, a continuing chemotherapeutic effect within the tumor might cause a further increase in intratumoral cytotoxicity and at the same time a decrease in systemic toxicity.

• Investigation of renal lesions by diffusion-weighted magnetic resonance imaging applying intravoxel incoherent motion-derived parameters-Initial experience.

  Authors: S Rheinheimer, B Stieltjes, F Schneider, D Simon, S Pahernik, H U Kauczor, P Hallscheidt

  European journal of radiology. 11/2011; 81(3):e310-6.

  Usefulness of biexponentially fitted signal attenuation at different b-values for differentiating the histological characteristics of renal tumors. A total of 26 patients with 28 renal massesUsefulness of biexponentially fitted signal attenuation at different b-values for differentiating the histological characteristics of renal tumors. A total of 26 patients with 28 renal masses (histologically proven: 20 clear cell renal cell carcinomas [ccRCC], three transitional cell carcinomas, two oncocytomas, and one papillary RCC) and 30 volunteers with healthy kidneys were examined at 1.5Tesla using an echo-planar DWI sequence. Using the IVIM model, we calculated the perfusion fraction f and the diffusion coefficient D. Furthermore, the ADC was obtained. These tumor parameters were compared to healthy renal tissue nonparametrically, and a receiver operating characteristic (ROC) analysis was performed. Healthy renal parenchyma showed higher ADC and D values (p<0.001) than ccRCC (ADC 1.95±0.10 [SD]μm(2)/ms, f 18.32±2.52%, and D 1.88±0.11μm(2)/ms versus ADC 1.45±0.38μm(2)/ms, f 18.59±6.16%, and D 1.34±0.38μm(2)/ms). When detecting malignancies the area under the curve for D was higher than for ADC. The f values for ccRCC were higher (p<0.001) than for non-ccRCC (ADC 1.52±0.47μm(2)/ms, f 8.44±1.24%, and D 1.30±0.18μm(2)/ms). Both f and D correlated with ccRCC grading. IVIM imaging is able to provide reliable diffusion values in the human kidney and may enhance the accuracy of tumor diagnosis. The D value was the best parameter to distinguish renal tumors from healthy renal tissue. The f value is promising for determining the histological subgroups.

• [Imaging in the emergency room].

  Authors: J K Kloth, H-U Kauczor, W Hosch

  Medizinische Klinik (Munich, Germany : 1983). 10/2011; 106(2):82-8.

  In order to reduce mortality in severely injured patients, a rapid radiologic diagnosis is essential. Sonography plays a role only as a focused assessment with sonography for trauma (FAST) to clarifyIn order to reduce mortality in severely injured patients, a rapid radiologic diagnosis is essential. Sonography plays a role only as a focused assessment with sonography for trauma (FAST) to clarify free intraperitoneal fluid immediately on admittance. Today, whole-body multislice helical computed tomography (CT) has become increasingly important as a diagnostic tool. Based on the results of the CT scan, patients can be referred for laparotomy or safely classified for "wait and see" treatment. Although the reduction in injury-related mortality would outweigh the risk of radiation dose, the indiscriminate use of CT for patients with minor injuries is not justified and must be avoided.

• [Prevention, diagnosis, therapy, and follow-up of lung cancer. Interdisciplinary guideline of the German Respiratory Society and the German Cancer Society--abridged version].

  Authors: G Goeckenjan, H Sitter, M Thomas, D Branscheid, M Flentje, F Griesinger, N Niederle, M Stuschke, T Blum, K-M Deppermann [......] E Stoelben, L Swoboda, H Teschler, H W Tessen, M Weber, A Werner, H-E Wichmann, E Irlinger Wimmer, C Witt, H Worth

  Pneumologie (Stuttgart, Germany). 08/2011; 65(8):e51-75.

• MRI in lung cancer: a pictorial essay.

  Authors: B Hochhegger, E Marchiori, O Sedlaczek, K Irion, C P Heussel, S Ley, J Ley-Zaporozhan, A Soares Souza, H-U Kauczor

  The British journal of radiology. 07/2011; 84(1003):661-8.

  Imaging studies play a critical role in the diagnosis and staging of lung cancer. CT and 18-fluorodeoxyglucose positron emission tomography CT (PET/CT) are widely and routinely used for staging andImaging studies play a critical role in the diagnosis and staging of lung cancer. CT and 18-fluorodeoxyglucose positron emission tomography CT (PET/CT) are widely and routinely used for staging and assessment of treatment response. Many radiologists still use MRI only for the assessment of superior sulcus tumours, and in cases where invasion of the spinal cord canal is suspected. MRI can detect and stage lung cancer, and this method could be an excellent alternative to CT or PET/CT in the investigation of lung malignancies and other diseases. This pictorial essay discusses the use of MRI in the investigation of lung cancer.

• Dual-energy CT-cholangiography in potential donors for living-related liver transplantation: Improved biliary visualization by intravenous morphine co-medication.

  Authors: C M Sommer, C B Schwarzwaelder, W Stiller, S T Schindera, T Heye, U Stampfl, N Bellemann, M Holzschuh, J Schmidt, J Weitz, L Grenacher, H U Kauczor, B A Radeleff

  European journal of radiology. 06/2011;

  PURPOSE: To prospectively evaluate whether intravenous morphine co-medication improves bile duct visualization of dual-energy CT-cholangiography. MATERIALS AND METHODS: Forty potential donors forPURPOSE: To prospectively evaluate whether intravenous morphine co-medication improves bile duct visualization of dual-energy CT-cholangiography. MATERIALS AND METHODS: Forty potential donors for living-related liver transplantation underwent CT-cholangiography with infusion of a hepatobiliary contrast agent over 40min. Twenty minutes after the beginning of the contrast agent infusion, either normal saline (n=20 patients; control group [CG]) or morphine sulfate (n=20 patients; morphine group [MG]) was injected. Forty-five minutes after initiation of the contrast agent, a dual-energy CT acquisition of the liver was performed. Applying dual-energy post-processing, pure iodine images were generated. Primary study goals were determination of bile duct diameters and visualization scores (on a scale of 0 to 3: 0-not visualized; 3-excellent visualization). RESULTS: Bile duct visualization scores for second-order and third-order branch ducts were significantly higher in the MG compared to the CG (2.9±0.1 versus 2.6±0.2 [P<0.001] and 2.7±0.3 versus 2.1±0.6 [P<0.01], respectively). Bile duct diameters for the common duct and main ducts were significantly higher in the MG compared to the CG (5.9±1.3mm versus 4.9±1.3mm [P<0.05] and 3.7±1.3mm versus 2.6±0.5mm [P<0.01], respectively). CONCLUSION: Intravenous morphine co-medication significantly improved biliary visualization on dual-energy CT-cholangiography in potential donors for living-related liver transplantation.

• [Extrapulmonary tuberculosis: radiological imaging of an almost forgotten transformation artist].

  Authors: T Heye, M Stoijkovic, H-U Kauczor, T Junghanss, W Hosch

  RöFo : Fortschritte auf dem Gebiete der Röntgenstrahlen und der Nuklearmedizin. 06/2011; 183(11):1019-29.

  Tuberculosis (TB) continues to be one of the infectious diseases with the world's highest rates of avoidable morbidity and mortality. A continuing downward trend has only been observed in highlyTuberculosis (TB) continues to be one of the infectious diseases with the world's highest rates of avoidable morbidity and mortality. A continuing downward trend has only been observed in highly industrialized countries, including Germany with 4,400 cases in the year 2009 representing an incidence of 5.5 per 100,000 persons. At the same time, the exposure to this patient group and the clinical experience are decreasing. Tuberculosis may affect any organ. The lung was the manifestation site in 80% of cases, and extrapulmonary manifestations were recorded in 20% of cases in Germany in the year 2008. Lymph node involvement is most common with a rate of approximately 50% of all extrapulmonary cases followed by the pleura in 18% of cases, genitourinary tract in 13% of cases, bones and joints in 6% of cases, gastrointestinal tract in 6% of cases, the central nervous system in 3% of cases and the spine in 3% of cases. Symptoms like fever, night sweats and weight loss are non-specific and may be absent. The aim of the review is to raise awareness of this disease, which is increasingly falling into oblivion, with its various radiological manifestations and to point out clinical-epidemiological and demographic factors that raise suspicion of tuberculosis.

• Microwave Ablation of Porcine Kidneys in vivo: Effect of two Different Ablation Modes ("Temperature Control" and "Power Control") on Procedural Outcome.

  Authors: C M Sommer, F Arnegger, V Koch, B Pap, M Holzschuh, N Bellemann, T Gehrig, J Senft, F Nickel, C Mogler, S Zelzer, H P Meinzer, U Stampfl, H U Kauczor, B A Radeleff

  Cardiovascular and interventional radiology. 05/2011;

  PURPOSE: This study was designed to analyze the effect of two different ablation modes ("temperature control" and "power control") of a microwave system on procedural outcome in porcine kidneys inPURPOSE: This study was designed to analyze the effect of two different ablation modes ("temperature control" and "power control") of a microwave system on procedural outcome in porcine kidneys in vivo. METHODS: A commercially available microwave system (Avecure Microwave Generator; MedWaves, San Diego, CA) was used. The system offers the possibility to ablate with two different ablation modes: temperature control and power control. Thirty-two microwave ablations were performed in 16 kidneys of 8 pigs. In each animal, one kidney was ablated twice by applying temperature control (ablation duration set point at 60 s, ablation temperature set point at 96°C, automatic power set point; group I). The other kidney was ablated twice by applying power control (ablation duration set point at 60 s, ablation temperature set point at 96°C, ablation power set point at 24 W; group II). Procedural outcome was analyzed: (1) technical success (e.g., system failures, duration of the ablation cycle), and (2) ablation geometry (e.g., long axis diameter, short axis diameter, and circularity). RESULTS: System failures occurred in 0% in group I and 13% in group II. Duration of the ablation cycle was 60 ± 0 s in group I and 102 ± 21 s in group II. Long axis diameter was 20.3 ± 4.6 mm in group I and 19.8 ± 3.5 mm in group II (not significant (NS)). Short axis diameter was 10.3 ± 2 mm in group I and 10.5 ± 2.4 mm in group II (NS). Circularity was 0.5 ± 0.1 in group I and 0.5 ± 0.1 in group II (NS). CONCLUSIONS: Microwave ablations performed with temperature control showed fewer system failures and were finished faster. Both ablation modes demonstrated no significant differences with respect to ablation geometry.

• Reliability of semiautomatic centerline analysis versus manual aortic measurement techniques for TEVAR among non-experts.

  Authors: F Rengier, T F Weber, S Partovi, M Müller-Eschner, D Böckler, H-U Kauczor, H von Tengg-Kobligk

  European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery. 05/2011; 42(3):324-31.

  The study aimed to test whether reliability and inter-observer variability of preoperative measurements for thoracic endovascular aortic repair (TEVAR) among non-experts are improved by semiautomaticThe study aimed to test whether reliability and inter-observer variability of preoperative measurements for thoracic endovascular aortic repair (TEVAR) among non-experts are improved by semiautomatic centerline analysis compared with manual assessment. Preoperative computed tomography (CT) angiographies of 30 patients with thoracic aortic disease (mean age 66.8 ± 11.6 years, 23 men) were retrospectively analysed in randomised order by one blinded vascular expert (reference standard) and three blinded non-expert readers. Aortic diameters were measured at four positions relevant to TEVAR using three measurement techniques (manual axial slices, manual multiplanar reformations (MPRs) and semiautomatic centerline analysis). Length measurements were performed using centerline analysis. Reliability was calculated as absolute measurement deviation (AMD) from reference standard and inter-observer variability as coefficient of variance (CV) among non-expert readers. For axial, MPR and centerline techniques, mean AMD was 7.3 ± 7.7%, 6.7 ± 4.5% and 4.7 ± 4.8% and mean CV was 5.2 ± 4.2%, 5.8 ± 4.8% and 3.9 ± 5.4%. Both AMD and CV were significantly lower for centerline analysis compared with axial technique (p = 0.001/0.042) and MPR (p = 0.009/0.003). AMD and CV for length measurements by centerline analysis were 3.2 ± 2.8% and 2.6 ± 2.4%, respectively. Centerline analysis was significantly faster than MPR (p < 0.001). Semiautomatic centerline analysis provides the most reliable and least variable diameter and length measurements among non-experts in candidates for TEVAR.

• Successful thrombolysis and spasmolysis of acute leg ischemia after accidental intra-arterial injection of dissolved flunitrazepam tablets.

  Authors: B Radeleff, U Stampfl, C-M Sommer, N Bellemann, A Hyhlik-Duerr, M-A Weber, D Boeckler, H-U Kauczor

  Cardiovascular and interventional radiology. 05/2011; 34(5):1085-9.

  A 37-year-old man with known intravenous drug abuse presented in the surgical ambulatory care unit with acute leg ischemia after accidental intra-arterial injection of dissolved flunitrazepam tabletsA 37-year-old man with known intravenous drug abuse presented in the surgical ambulatory care unit with acute leg ischemia after accidental intra-arterial injection of dissolved flunitrazepam tablets into the right femoral artery. A combination of anticoagulation, vasodilatation, and local selective and superselective thrombolysis with urokinase was performed to salvage the leg. As a result of the severe ischemia-induced pain, the patient had to be monitored over the complete therapy period on the intensive care unit with permanent administration of intravenous fluid and analgetics. We describe the presenting symptoms and the interventional technique, and we discuss the recent literature regarding the management of accidental intra-arterial injection of dissolved flunitrazepam tablets.

• In vivo monitoring of cystic fibrosis-like lung disease in mice by volumetric computed tomography.

  Authors: M O Wielpütz, M Eichinger, Z Zhou, K Leotta, S Hirtz, S H Bartling, W Semmler, H-U Kauczor, M Puderbach, M A Mall

  The European respiratory journal : official journal of the European Society for Clinical Respiratory Physiology. 04/2011; 38(5):1060-70.

  The onset and spontaneous development of cystic fibrosis (CF) lung disease remain poorly understood. In the present study, we used volumetric computed tomography (VCT) as a new method forThe onset and spontaneous development of cystic fibrosis (CF) lung disease remain poorly understood. In the present study, we used volumetric computed tomography (VCT) as a new method for longitudinal in vivo monitoring of early lesions and disease progression in CF-like lung disease in β-epithelial Na(+) channel (ENaC)-transgenic (TG) mice. Using a VCT scanner prototype (80 kV, 50 mA·s, scan time 19 s and spatial resolution 200 μm), βENaC-TG mice and wild-type (WT) littermates were examined longitudinally at 10 time-points from neonatal to adult ages, and VCT images were assessed by qualitative and quantitative morphological parameters. We demonstrate that VCT detected early-onset airway mucus obstruction, diffuse infiltrates, atelectasis and air trapping as characteristic abnormalities in βENaC-TG mice. Furthermore, we show that early tracheal mucus obstruction predicted mortality in βENaC-TG mice and that the density of lung parenchyma was significantly reduced at all time-points in βENaC-TG compared with WT mice (median ± sem -558 ± 8 HU in WT versus -686 ± 16 HU in βENaC-TG at 6 weeks of age; p < 0.005). Our study demonstrates that VCT is a sensitive, noninvasive technique for early detection and longitudinal monitoring of morphological abnormalities of CF-like lung disease in mice, and may thus provide a useful tool for pre-clinical in vivo evaluation of novel treatment strategies for CF.

• Dual-energy, standard and low-kVp contrast-enhanced CT-cholangiography: A comparative analysis of image quality and radiation exposure.

  Authors: W Stiller, C B Schwarzwaelder, C M Sommer, S Veloza, B A Radeleff, H U Kauczor

  European journal of radiology. 04/2011;

  OBJECTIVE: Quantitative image quality assessment in terms of image noise (IN), contrast-to-noise ratio (CNR), and signal-to-noise ratio (SNR) in relation to required radiation dose (RD) forOBJECTIVE: Quantitative image quality assessment in terms of image noise (IN), contrast-to-noise ratio (CNR), and signal-to-noise ratio (SNR) in relation to required radiation dose (RD) for dual-energy (DE), standard and low-kVp contrast-enhanced computed-tomography (CT) cholangiography. MATERIALS AND METHODS: For each of 22 DECT-cholangiography examinations, 3 image datasets were analyzed as independent single-source CT-acquisitions at different tube potential, i.e. 80kVp, 120kVp-equivalent (linear blended dataset M0.3: 30% 80kVp, 70% 140kVp), and 140kVp. Analysis comprised determination of IN, CNR and SNR in regions of interest (ROI) placed in liver parenchyma and contrasted bile ducts. IN was evaluated as mean standard deviation of 3 ROI placed within liver parenchyma (segments 6/7, 5/8, 2/3); CNR was assessed as bile duct-to-liver parenchyma ratio, and SNR as bile duct-to-image noise ratio. RD in terms of CT dose index (CTDI(vol)), dose-length product (DLP) and effective dose (ED) has been determined for each of the datasets, and compared to console prediction and scan summary values. Using phantom measurements of CTDI(vol), a method for separating comprehensive RD values of DE-acquisitions into the original RD contribution of each tube (80kVp/140kVp) has been developed, enabling comparison of all 3 datasets as if independently acquired using single-source "single-energy" technique. RESULTS: Highest IN was detected for 80kVp- (38.6±5.1HU), lowest for 120kVp-equivalent linear blended M0.3-datasets (23.1±3.4HU) with significant differences between all datasets (P<0.001). Highest SNR and CNR were measured for M0.3- (SNR: 14.8±4.1; CNR: 11.6±3.8) and 80kVp-datasets (SNR: 13.8±4.8; CNR: 11.2±4.5); lowest for 140kVp-datasets (SNR: 9.5±2.5; CNR: 7.1±2.3) with significant differences between M0.3- and 140kVp-datasets as well as between 80kVp- and 140kVp-datasets (both P<0.001 for both CNR, SNR). CTDI(vol), DLP and ED were reduced by 50% for low-kilovoltage acquisitions (CTDI(vol): 5.5±1.4mGy; DLP: 127.8±40.1mGycm; ED: 1.9±0.6mSv) compared to comprehensive DE-acquisitions (CTDI(vol): 11.0±2.3mGy; DLP: 253.8±67.5mGycm; ED: 3.8±1.0mSv, tube contribution: 80kVp: 44.5%; 140kVp: 55.5%), and by 20% compared to conventional acquisitions at 120kVp (CTDI(vol): 6.71mGy; DLP: 153.5±16.9mGycm; ED: 2.3±0.3mSv). CONCLUSIONS: Despite higher IN, low-kilovoltage CT-cholangiography reveals no significant difference with respect to CNR and SNR when compared to linear blended images yielded by DECT. Compared to DECT or conventional CT at 120kVp, contrast-enhanced low-kVp CT cholangiography potentially allows reduction of patient dose by up to 50% or 20%, respectively. Therefore, CT-cholangiography at 80kVp should be considered as an alternative to DECT-cholangiography whenever DECT is unavailable, or if increased image quality of DECT regarding quantitative bile duct evaluation is not needed for diagnosis.

• Magnetic resonance imaging findings in acute pulmonary embolism.

  Authors: B Hochhegger, J Ley-Zaporozhan, E Marchiori, K Irion, A Soares Souza, J Moreira, H U Kauczor, S Ley

  The British journal of radiology. 03/2011; 84(999):282-7.

  Pulmonary embolism (PE) is the third most common acute cardiovascular disease after myocardial infarction and stroke, and results in thousands of deaths each year. Improvements in MRI accuracy arePulmonary embolism (PE) is the third most common acute cardiovascular disease after myocardial infarction and stroke, and results in thousands of deaths each year. Improvements in MRI accuracy are ongoing with the use of parallel imaging for angiography techniques and pulmonary perfusion. This, associated with other potential advantages of MRI (e.g. a radiation free method and better safety profile of MR contrast media), reinforces its use. The aim of this paper is to perform a pictorial review of the principal findings of MRI in acute PE. Acute PE can manifest itself as complete arterial occlusion and the affected artery may be enlarged. We report the main vascular and parenchymal signs, and an overview of current literature regarding accuracy, limitations and technical aspects is provided.

• Super-micro-bland particle embolization combined with RF-ablation: Angiographic, macroscopic and microscopic features in porcine kidneys.

  Authors: C M Sommer, N Kortes, C Mogler, N Bellemann, M Holzschuh, F Arnegger, F Nickel, T Gehrig, S Zelzer, H P Meinzer, T Longerich, U Stampfl, H U Kauczor, B A Radeleff

  European journal of radiology. 03/2011;

  PURPOSE: To describe angiographic, macroscopic and microscopic features of super-micro-bland particle embolization in combination with RF-ablation in kidneys. Thereby, a special focus was given onPURPOSE: To describe angiographic, macroscopic and microscopic features of super-micro-bland particle embolization in combination with RF-ablation in kidneys. Thereby, a special focus was given on the impact of the sequence of the different procedural steps. MATERIALS AND METHODS: In ten pigs, super-micro-bland particle embolization combined with RF-ablation was carried out. Super-micro-bland embolization was performed with spherical particles of very small size and tight calibration (40±10μm). In the left kidneys, RF-ablations were performed before embolization (I). In the right kidneys, RF-ablations were performed after embolization (II). The animals were killed three hours after the procedures. Angiographic (e.g. vessel architecture), macroscopic (e.g. long and short axes of the RF-ablations) and microscopic (e.g. particle distribution) study goals were defined. RESULTS: Angiography detected almost no vessels in the center of the RF-ablations in I. In II, angiography could not define the RF-ablations. Macroscopy detected significantly larger long and short axes of the RF-ablations in II compared to I (52.2±3.2mm vs. 45.3±6.9mm [P<0.05] and 25.1±3.5mm vs. 20.0±1.9mm [P<0.01], respectively). Microscopy detected irregular particle distribution at the rim of the RF-ablations in I. In II, microscopy detected homogeneous particle distribution at the rim of the RF-ablations. Microscopy detected no particles in the center of the RF-ablations in I and II. CONCLUSION: The sequence of the different procedural steps of super-micro-bland particle embolization combined with RF-ablation impacts angiographic, macroscopic and microscopic features in kidneys in the acute setting.