Thomas J Vogl

Publications of Thomas J Vogl

• Ultra-low dose dual-source high-pitch computed tomography of the paranasal sinus: diagnostic sensitivity and radiation dose.

  Authors: Boris Schulz, Stefan Potente, Stefan Zangos, Ingke Friedrichs, Ralf W Bauer, Matthias Kerl, Thomas J Vogl, Martin M Mack

  Acta radiologica (Stockholm, Sweden : 1987). 04/2012;

  BackgroundToday's gold standard for diagnostic imaging of inflammatory diseases of the paranasal sinus is computed tomography (CT).PurposeTo evaluate diagnostic sensitivity and radiation dose of anBackgroundToday's gold standard for diagnostic imaging of inflammatory diseases of the paranasal sinus is computed tomography (CT).PurposeTo evaluate diagnostic sensitivity and radiation dose of an ultra-low dose dual-source CT technique.Material and MethodsParanasal sinuses of 14 cadaveric heads were independently evaluated by two readers using a modern dual-source CT with lowest reasonable dosage in high-pitch mode (100 kV, 10 mAs, collimation 0.6 mm, pitch value 3.0). Additionally the head part of an anthropomorphic Alderson-Rando phantom was equipped with thermoluminiscent detectors to measure radiation exposure to the eye lenses and thyroid gland.ResultsDiagnostic accuracy regarding sinusoidal fluid, nasal septum deviation, and mucosal swelling was 100%. Mastoid fluid was detected in 76% and 92%, respectively. In the phantom study, average measured eye lens dosage was 0.64 mGy; radiation exposure of the thyroid gland was 0.085 mGy.ConclusionRegarding evaluation of inflammatory diseases of the paranasal sinus this study indicates sufficient accuracy of the proposed CT protocol at a very low dosage level.

• Pediatric primary and metastatic neuroblastoma: MRI findings: Pictorial review.

  Authors: Nour-Eldin A Nour-Eldin, Ola Abdelmonem, Ahmed M Tawfik, Nagy N N Naguib, Thomas Klingebiel, Udo Rolle, Dirk Schwabe, Marc Harth, Mohammed M Eltoukhy, Thomas J Vogl

  Magnetic resonance imaging. 04/2012;

  Magnetic resonance imaging (MRI) has become one of the most valuable modalities for initial and follow-up imaging of suspected or known neuroblastoma (NBL) owing to its excellent inherent contrast,Magnetic resonance imaging (MRI) has become one of the most valuable modalities for initial and follow-up imaging of suspected or known neuroblastoma (NBL) owing to its excellent inherent contrast, lack of ionizing radiation and multiplanar imaging capability. Importantly, NBL has a variable appearance on different imaging modalities, and this is particularly pertinent to MRI. MRI is a cornerstone for management of NBL, providing essential information at initial presentation regarding diagnosis, staging, resectability and relation to vital structures. It can also define the extent of residual disease after surgical resection or assess the efficacy of treatment. Follow-up MRI is frequently performed to ensure sustained complete remission or to monitor known residual disease. This pictorial review article aims to provide the reader with a concise, yet comprehensive, collection of MR images of primary and metastatic NBL lesions with relevant correlation with other imaging modalities.

• High-pitch Dual-source Computed Tomography Pulmonary Angiography in Freely Breathing Patients.

  Authors: Ralf W Bauer, Boris Schell, Martin Beeres, Julian L Wichmann, Boris Bodelle, Thomas J Vogl, Josef Matthias Kerl

  Journal of thoracic imaging. 04/2012;

  PURPOSE:: To investigate pulmonary arterial (PA) enhancement, image noise, and artifacts related to breathing and heart motion in patients with suspected pulmonary embolism. MATERIALS AND METHODS::PURPOSE:: To investigate pulmonary arterial (PA) enhancement, image noise, and artifacts related to breathing and heart motion in patients with suspected pulmonary embolism. MATERIALS AND METHODS:: Seventy-six consecutive patients underwent computed tomographic pulmonary angiography (CTPA) in dual-source high-pitch mode (pitch 3.0, 100 kV, 180 mAs, 50 mL contrast material) without breathing commands. PA enhancement, image noise, signal to noise ratio, overall image quality, incidence of total or partial interruption of the contrast column in the PAs, and heart motion-related and breathing-related artifacts of the diaphragm and pulmonary structures were recorded. RESULTS:: Mean central and peripheral PA attenuation was 404±104 and 453±119 HU; mean image noise was 11±2 HU; mean examination time was 0.67±0.09 s; and mean dose-length product was 142±31 mGy cm. There were no motion artifacts of the diaphragm or pulmonary vessels related to breathing or heart motion. There was no case of partial or total interruption of the contrast column in the PA tree. No examination was rated nondiagnostic. CONCLUSIONS:: High-pitch dual-source CTPA in freely breathing patients effectively produces images that are free of artifacts related to breathing and cardiac motion. Hence, Valsalva-related artifacts can be eliminated using this technique.

• MR-based Thermometry of Laser Induced Thermotherapy: Temperature Accuracy and Temporal Resolution In vitro at 0.2 and 1.5 T Magnetic Field Strengths.

  Authors: Thomas J Vogl, Frank Huebner, Nagy N N Naguib, Ralf W Bauer, Martin G Mack, Nour-Eldin A Nour-Eldin, Dirk Meister

  Lasers in surgery and medicine. 03/2012; 44(3):257-65.

  To evaluate MR-thermometry using fast MR sequences for laser induced interstitial thermotherapy (LITT) at 0.2 and 1.5 T systems. In-vitro experiments were performed using Agarose gel mixture andTo evaluate MR-thermometry using fast MR sequences for laser induced interstitial thermotherapy (LITT) at 0.2 and 1.5 T systems. In-vitro experiments were performed using Agarose gel mixture and lobes of porcine liver. MR-thermometry was performed by means of longitudinal relaxation time (T1) and proton resonance frequency shift (PRF) methods under acquisition of amplitude and phase shift images. Four different sequences were used for T1 thermometry: A gradient-echo (GRE), a True Fast Imaging with Steady Precession (TRUFI), a Saturation Recovery Turbo-FLASH (SRTF), and an Inversion Recovery Turbo-FLASH (IRTF) sequence (FLASH-Fast Low Angle Shot). PRF was measured with four sequences: Two fast-spoiled GRE sequences (one as WIP sequence), a Turbo-FLASH (TFL) sequence (WIP sequence), and a multiecho-TrueFISP sequence. Temperature was controlled and verified using a fiber-optic Luxtron device. The temperature was correlated with the MR measurement. All sequences showed a good linear correlation R(2)  = 0.97-0.99 between the measured temperature and the MR-thermometry measurements. The only exception was the TRUFI sequence in the Agarose phantom that showed a non-linear calibration curve R(2)  = 0.39-0.67. At 1.5 T, the Agarose experiments revealed similar temperature accuracies of 4-6°C for all sequences excluding TRUFI. During experiments with the liver, the PRF sequences showed better performance than the T1, with accuracies of 5-12°C, contrary to the T1 sequences at 14-18°C. The accuracy of the Siemens PRF-FLASH sequence was 5.1°C. At 0.2 T, the Agarose experiments provided the highest accuracy of 3.3°C for PRF measurement. At the liver experiments the T1 sequences SRTF and FLASH revealed the best accuracies at 6.4 and 7.0°C. The accuracy and speed of MR temperature measurements are sufficient for controlling the temperature-based tumor destruction. For 0.2 T systems SRTF and FLASH sequences are recommended. For 1.5 T systems SRTF and FLASH are the most accurate. Lasers Surg. Med. 44:257-265, 2012. © 2012 Wiley Periodicals, Inc.

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• Late peripheral stent thrombosis due to stent fracture, vigorous exercise and hyporesponsiveness to clopidogrel.

  Authors: Birgit Linnemann, Axel Thalhammer, Zsuzsanna Wolf, Vanessa Tirneci, Thomas J Vogl, And Edelgard Lindhoff-Last

  VASA. Zeitschrift für Gefässkrankheiten. Journal for vascular diseases. 03/2012; 41(2):136-44.

  Late peripheral arterial stent thrombosis usually occurs due to haemodynamically relevant in-stent restenosis. However, late stent thrombosis may be multicausal. We report here the well-documentedLate peripheral arterial stent thrombosis usually occurs due to haemodynamically relevant in-stent restenosis. However, late stent thrombosis may be multicausal. We report here the well-documented case of a 69-year-old man with acute thrombosis of the stented superficial femoral artery after a long-distance bicycle tour. Catheter-directed thrombolysis revealed a residual stenosis located at a stent fracture site. In addition, platelet function tests revealed an inadequate platelet response to clopidogrel. In conclusion, stent fracture, strenuous exercise and hyporesponsiveness to clopidogrel may have contributed to the development of late peripheral stent thrombosis.

• Correlation of left ventricular wall thickness, heart mass, serological parameters and late gadolinium enhancement in cardiovascular magnetic resonance imaging of myocardial inflammation in an experimental animal model of autoimmune myocarditis.

  Authors: Wolfgang Kromen, Huedayi Korkusuz, Yuecel Korkusuz, Philip Esters, Ralf W Bauer, Frank Huebner, Sebastian Lindemayr, Thomas J Vogl

  The international journal of cardiovascular imaging. 02/2012;

  For a definitive diagnosis of myocarditis, different strategies like analysis of late gadolinium enhancement (LGE) in cardiovascular magnetic resonance imaging (CMR) up to invasive endomyocardialFor a definitive diagnosis of myocarditis, different strategies like analysis of late gadolinium enhancement (LGE) in cardiovascular magnetic resonance imaging (CMR) up to invasive endomyocardial biopsy have been applied. The objective of the study was to investigate inflammatory changes like left ventricular wall thickening and increase of ventricular mass and to quantitatively analyse their correlation with extent and localisation of myocardial damage in CMR and with subsequent changes of serological markers in an animal model of an experimental autoimmune myocarditis (EAM). In the current study, an EAM was induced in 10 male Lewis rats, 10 rats served as control. On day 21, animals were examined with four CMR protocols to assess the extent of LGE in a 12 segment model of the rat heart. Left myocardial wall thickness and mass and histological grade of inflammation were measured to determine localisation and severity of the induced myocarditis. Depending on the CMR sequence, LGE was mostly found in the left anterior (9.6%) and left lateral (8.7%) myocardial wall segments. Wall thickness correlated with the LGE area in CMR imaging and the histopathological severity of myocarditis for the left lateral myocardial wall segment. In a similar way, the heart mass correlated to the extent of LGE for the left lateral segment. We conclude that in our animal model left ventricular wall thickness and mass reflect the severity of myocardial changes in myocarditis and that the EAM rat model is well suited for further investigations of myocarditis.

• Retrospective Study on the Use of Different Protocols for Repeated Transarterial Chemoembolization in the Treatment of Patients with Hepatocellular Carcinoma.

  Authors: Thomas J Vogl, Nagy N N Naguib, Nour-Eldin A Nour-Eldin, Parviz Farshid, Thomas Lehnert, Tatjana Gruber-Rouh, Katharina Sophia Engels

  Academic radiology. 01/2012;

  PURPOSE: To evaluate local tumor control and survival rate after repeated transarterial chemoembolization using two different protocols in hepatocellular carcinoma (HCC) patients. MATERIALS ANDPURPOSE: To evaluate local tumor control and survival rate after repeated transarterial chemoembolization using two different protocols in hepatocellular carcinoma (HCC) patients. MATERIALS AND METHODS: A total of 190 patients (mean, 68 years) with HCC were repeatedly treated with transarterial chemoembolization in 4-week intervals. The chemotherapy protocol consisted of mitomycin C alone (n = 111) and mitomycin C with gemcitabine (n = 79). Embolization was performed with lipiodol and microspheres. Tumor response was evaluated by magnetic resonance imaging using Response Evaluation Criteria In Solid Tumors (RECIST) criteria. Survival rates were calculated using Kaplan-Meier method. RESULTS: In the mitomycin C-only group, we observed partial response in 38.8% (43/111), stable disease in 27% (30/111), and progressive disease in 34.2% (38/111). In the mitomycin C/gemcitabine group (n = 79), partial response was observed in 43% (34/79), stable disease in 16.5% (13/79) and progressive disease in 40.5% (32/79). The overall 1- and 2-year survival rates were 56% and 28%, respectively. The overall median survival time from the start of transarterial chemoembolization treatment was 15 months. The median survival of patients treated with mitomycin C was 16.5 months and it was 12 months for patients treated with a combination of mitomycin C and gemcitabine. No statistically significant difference between the two groups was observed (P = .7). CONCLUSION: Chemoembolization is an effective minimally invasive therapy option for palliative treatment of HCC patients. Mitomycin C only proves to be effective, the addition of gemcitabine was not advantageous.

• Different signal intensity at Gd-EOB-DTPA compared with Gd-DTPA-enhanced MRI in hepatocellular carcinoma transgenic mouse model in delayed phase hepatobiliary imaging.

  Authors: Huedayi Korkusuz, Lea L Knau, Wolfgang Kromen, Verena Bihrer, Daniel Keese, Albrecht Piiper, Thomas J Vogl

  Journal of magnetic resonance imaging : JMRI. 01/2012;

  PURPOSE: To evaluate hyperintense Gd-DTPA- compared with hyper- and hypointense Gd-EOB-DTPA-enhanced magnet resonance imaging (MRI) in c-myc/TGFα transgenic mice for detecting hepatocellularPURPOSE: To evaluate hyperintense Gd-DTPA- compared with hyper- and hypointense Gd-EOB-DTPA-enhanced magnet resonance imaging (MRI) in c-myc/TGFα transgenic mice for detecting hepatocellular carcinoma (HCC). MATERIALS AND METHODS: Twenty HCC-bearing transgenic mice with overexpression of the protooncogene c-myc and transforming growth factor-alpha (TGF-α) were analyzed. MRI was performed using a 3-T MRI scanner and an MRI coil. The imaging protocol included Gd-DTPA- and Gd-EOB-DTPA-enhanced T1-weighted images. The statistically evaluated parameters are signal intensity (SI), signal intensity ratio (SIR), contrast-to-noise ratio (CNR), percentage enhancement (PE), and signal-to-noise ratio (SNR). RESULTS: On Gd-DTPA-enhanced MRI compared with Gd-EOB-DTPA-enhanced MRI, the SI of liver was 265.02 to 573.02 and of HCC 350.84 to either hyperintense with 757.1 or hypointense with 372.55 enhancement. Evaluated parameters were SNR of HCC 50.1 to 56.5/111.5 and SNR of liver parenchyma 37.8 to 85.8, SIR 1.32 to 1.31/0.64, CNR 12.2 to 26.1/-30.08 and PE 42.08% to 80.5/-98.2%, (P < 0.05). CONCLUSION: Gd-EOB-DTPA is superior to Gd-DTPA for detecting HCC in contrast agent-enhanced MRI in the c-myc/TGFα transgenic mouse model and there was no difference between the hyperintense or hypointense appearance of HCC. Either way, HCCs can easily be distinguished from liver parenchyma in mice. J. Magn. Reson. Imaging 2012;. © 2012 Wiley Periodicals, Inc.

• Gadoxetate acid-enhanced MRI of hepatocellular carcinoma in a c-myc/TGFα transgenic mouse model including signal intensity and fat content: initial experience.

  Authors: Huedayi Korkusuz, Lea Knau, Wolfgang Kromen, Frank Huebner, Renate Hammerstingl, Sebastian Lindemayr, Verena Bihrer, Albrecht Piiper, Thomas J Vogl

  Cancer imaging : the official publication of the International Cancer Imaging Society. 01/2012; 12:72-8.

  Genetically engineered mouse models, such as double transgenic c-myc/TGFα mice, with specific pathway abnormalities might be more successful at predicting the clinical response of hepatocellularGenetically engineered mouse models, such as double transgenic c-myc/TGFα mice, with specific pathway abnormalities might be more successful at predicting the clinical response of hepatocellular carcinoma (HCC) treatment. But a major drawback of the tumour models is the difficulty of visualizing endogenously formed tumours. The optimal imaging procedure should be brief and minimally invasive. Magnetic resonance imaging (MRI) satisfies these criteria and gadoxetate acid-enhanced MRI improves the detection of HCC. Fat content is stated to be an additional tool to help assess tumour responses, for example, in cases of radiofrequency ablation. Therefore the aim of this study was to investigate if gadoxetate acid-enhanced MRI could be used to detect HCC in c-myc/TGFα transgenic mice by determining the relation between the signal intensity of HCC and normal liver parenchyma and the corresponding fat content as a diagnostic marker of HCC. In our study, 20 HCC in c-myc/TGFα transgenic male mice aged 20-34 weeks were analyzed. On gadoxetate acid-enhanced MRI, the signal intensity was 752.4 for liver parenchyma and 924.5 for HCC. The contrast to noise ratio was 20.4, the percentage enhancement was 267.1% for normal liver parenchyma and 353.9% for HCC. The fat content was 11.2% for liver parenchyma and 16.2% for HCC. There was a correlation between fat content and signal intensity with r = 0.7791. All parameters were statistically significant with P < 0.05. Our data indicate that gadoxetate acid contrast enhancement allows sensitive detection of HCC in c-myc/TGFα transgenic mice and determination of the fat content seems to be an additional useful parameter for HCC.

• Uterine Artery Embolization for Uterine Leiomyoma: Role of Uterine Artery Doppler in the Pre-Interventional, Interventional and Post-interventional Patient Workup.

  Authors: Nagy N N Naguib, Nour-Eldin A Nour-Eldin, Fouad Serag Eldin, Yasser Z Mazloum, Abdel Fatah Agameya, Shadia Abou Seif, Ashraf N Etaby, Thomas Lehnert, Tatjana Gruber-Roh, Stefan Zangos, Hanns Ackermann, Thomas J Vogl

  Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology. 12/2011;

  AIM: To study Doppler changes in the uterine artery immediately and 3 months after uterine artery embolization (UAE) and to test the feasibility of using uterine artery Doppler as a predictor of theAIM: To study Doppler changes in the uterine artery immediately and 3 months after uterine artery embolization (UAE) and to test the feasibility of using uterine artery Doppler as a predictor of the predominant side of arterial supply to leiomyomas, amount of embolizing material needed and leiomyoma tumor volume at follow-up. MATERIALS AND METHODS: The study was performed on 38 patients to whom UAE was performed. Uterine artery Doppler was performed trans-abdominally before, within 6 hours and 3 months after UAE to determine the peak systolic (PSV) and end diastolic (EDV) velocities and resistive index (RI). Leiomyoma volume was measured using contrast enhanced MRI before and 3 months after UAE. The predominant side of arterial supply to leiomyoma was confirmed on angiography using the uterine artery diameter and tumor blush after contrast injection. For the volume correlations the average PSV, EDV and RI of both sides was used. For prediction of the predominant side of supply and for correlation with the amount of embolizing material separate measurements from each side were used. RESULTS: Immediately following UAE the uterine artery PSV and EDV were significantly reduced (p <0.05) while the RI was significantly elevated (p <0.05) relative to the pre-embolization value. For detection of the predominant side of supply, the lowest RI showed the highest accuracy (82%) for prediction. No significant correlation was noted between the pre-embolization PSV, EDV and RI (p>0.05) and the utilized amount of embolizing material. For the leiomyoma volume, immediate post-embolization EDV and RI values showed statistically significant (p= 0.0400 and 0.0002, rho = 0.34 and -0.58 respectively) correlation with the 3 month follow-up leiomyoma volume with the RI showing the highest correlation value. The leiomyoma volume was predicted to be reduced by 38%-61% after 3 months if the immediate post-embolization average RI value was between 0.82 and 0.88 CONCLUSION: Pre-interventional Doppler assessment can be used to predict the predominant side of supply to the leiomyomas but not the amount of embolizing material needed. Post-interventional Doppler assessment can predict the leiomyoma volume after UAE. Copyright © 2011 ISUOG. Published by John Wiley & Sons, Ltd.

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• CT perfusion measurements of head and neck carcinoma from single section with largest tumor dimensions or average of multiple sections: Agreement between the two methods and effect on intra- and inter-observer agreement.

  Authors: Ahmed M Tawfik, Nour-Eldin A Nour-Eldin, Nagy N Naguib, Ahmed Abdel Razek, Adel T Denewer, Sotirios Bisdas, Thomas J Vogl

  European journal of radiology. 12/2011;

  PURPOSE: To evaluate the agreement between quantitative CT perfusion measurements of head and neck squamous cell carcinoma (SCC) obtained from single section with maximal tumor dimension and fromPURPOSE: To evaluate the agreement between quantitative CT perfusion measurements of head and neck squamous cell carcinoma (SCC) obtained from single section with maximal tumor dimension and from average values of multiple sections, and to compare intra- and inter-observer agreement of the two methods. METHODS: Perfusion was measured for 28 SCC cases using a region of interest (ROI) inserted in the single dynamic CT section showing maximal tumor dimension, then using average values of multiple ROIs inserted in all tumor-containing sections. Agreement between values of blood flow (BF), blood volume (BV), mean transit time (MTT) and permeability surface area product (PS) calculated by the two methods was assessed. Intra-observer agreement was assessed by comparing repeated calculations done by the same radiologist using both methods after 2 months blinding period. Perfusion measurements were done by another radiologist independently to assess inter-observer agreement of both methods. RESULTS: No significant differences were observed between the means of the 4 perfusion parameters calculated by both methods, all p values >0.05 The 95% limits of agreement between the two methods were (-33.9 to 43)ml/min/100g for BF, (-2.5 to 2.8)ml/100g for BV, (-4.9 to 3.9)s for MTT and (-17.5 to 18.6)ml/min/100g for PS. Narrower limits of agreement were obtained using average of multiple sections than with single section denoting improved intra- and inter-observer agreement. CONCLUSION: Agreement between both methods is acceptable. Taking the average of multiple sections slightly improves intra- and inter-observer agreement.

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• Image-quality perception as a function of dose in digital radiography.

  Authors: Thomas Lehnert, Nagy N N Naguib, Huedayi Korkusuz, Ralf W Bauer, J Matthias Kerl, Martin G Mack, Thomas J Vogl

  AJR. American journal of roentgenology. 12/2011; 197(6):1399-403.

  The purpose of this article is to determine the degree to which the skin entrance dose could be lowered, by adjusting exposure parameters and filtration, and the subsequent effect on readers'The purpose of this article is to determine the degree to which the skin entrance dose could be lowered, by adjusting exposure parameters and filtration, and the subsequent effect on readers' confidence levels of digital radiographs. The study was prospectively performed on a cadaver. Digital radiographs of bones were evaluated and scored on a 9-point scale separately by four radiologists who were blinded to the types of filtration and doses used. The study entailed three phases: phase 1, random dose and filter; phase 2, fixed filter and varying radiation doses (100%, 75%, 50%, and 25% of the standard recommended dose); and phase 3, fixed dose and varying filtration (no filtration, aluminum filter, and aluminum-copper filter). Skin entrance dose was measured using a dosimeter placed on the skin. Differences in scores were tested using a Friedman test. The mean scores given to images with 100%, 75%, 50%, and 25% of the recommended standard dose were 6.18, 6.1, 5.11, and 4.07, respectively. No significant difference was noted between 100%- and 75%-dose images (p = 0.1). A significant difference (p < 0.0001) was noted when we compared the 100%- and 75%-dose images with the 50%- and 25%-dose images. The mean scores given for no filtration, aluminum filtration, and aluminum-copper filtration were 5.67, 5.43, and 5.18, respectively. No significant difference between no filtration and aluminum filtration (p = 0.411) was noted. A significant difference was detected between no filtration and aluminum-copper filtration (p = 0.012). The combination of an aluminum filter and a 75% standard dose achieved a 31.1% reduction in skin entrance dose. It is possible to achieve a 31.1% reduction in skin entrance dose for imaging bony structures by using 75% of the standard dose and aluminum filtration without significantly affecting image quality.

• Initial experience with repetitive transarterial chemoembolization (TACE) as a third line treatment of ovarian cancer metastasis to the liver: indications, outcomes and role in patient's management.

  Authors: Thomas J Vogl, Nagy N N Naguib, Thomas Lehnert, Nour-Eldin A Nour-Eldin, Katrin Eichler, Stephan Zangos, Tatjana Gruber-Rouh

  Gynecologic oncology. 11/2011; 124(2):225-9.

  To evaluate local tumor control and survival data after transarterial chemoembolization (TACE) with different drug combinations in the palliative third-line treatment of patients with ovarian cancerTo evaluate local tumor control and survival data after transarterial chemoembolization (TACE) with different drug combinations in the palliative third-line treatment of patients with ovarian cancer liver metastases. Sixty-five patients (mean age: 51.5 year) with unresectable hematogenous hepatic metastases of ovarian cancer who did not respond to systemic chemotherapy were repeatedly treated with TACE in 4-week intervals. The local chemotherapy protocol consisted of Mitomycin (group 1) (n=14; 21.5%), Mitomycin with Gemcitabine (group 2) (n=26; 40%), or Mitomycin with Gemcitabine and Cisplatin (group 3) (n=25; 38.5%). Embolization was performed with Lipiodol and starch microspheres. Local tumor response was evaluated by MRI according to RECIST criteria. Survival data were calculated according to the Kaplan-Meier method. The local tumor control was: partial response (PR) in 16.9% (n=11), stable disease (SD) in 58.5% (n=38) and progressive disease (PD) in 24.6% (n=16) of patients. In group 1, we observed SD in 78.6% (11/14), and PD in 21.4% (3/14) of patients. In group 2, PR in 7.7% (2/26), SD in 57.7% (15/26), and PD in 34.6% (9/26) of patients. In group 3, PR in 36% (9/25), SD in 48% (12/25), and PD in 16% (4/25) of patients. Survival rate from the start of TACE was 58% after 1-year, 19% after 2-years, and 13% after 3-years. The median and mean survival times were 14 and 18.5 months without statistically significant difference for the 3 groups of patients (p=0.502). Transarterial chemoembolization is effective palliative treatment in achieving local control in selected patients with liver metastases from ovarian cancer.

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• Liver metastases of pancreatic cancer: role of repetitive transarterial chemoembolization (TACE) on tumor response and survival.

  Authors: Alireza Azizi, Nagy N N Naguib, Emmanuel Mbalisike, Parviz Farshid, Alborz Hedayati Emami, Thomas J Vogl

  Pancreas. 11/2011; 40(8):1271-5.

  To evaluate the effect of chemoembolization on pancreatic cancer liver metastases. Thirty-two patients with pancreatic cancer liver metastases retrospectively underwent chemoembolization (4- toTo evaluate the effect of chemoembolization on pancreatic cancer liver metastases. Thirty-two patients with pancreatic cancer liver metastases retrospectively underwent chemoembolization (4- to 8-week intervals). Size-based evaluation (response evaluation criteria in solid tumors [RECIST]) and survival indexes were assessed overall and for sex and number of lesions. Of the patients, 71.87% showed stable disease, 9.37% partial response (PR) and 18.75% progressive disease (PD). Survival rate for 1, 3, and 5 years from first TACE was 60%, 25%, and 11%, respectively. Median survival time was 16 months and for stable disease group was 20 months. Progression-free survival for 6 months and 1, 3, and 5 years was 84%, 57.3%, 20%, and 10%, respectively. There was significant difference between men and women in response. Survival rates for 1 and 5 years for the men were 80% and 14% and for the women were 47% and 0%. There was no significant difference between oligonodular liver lesion (n < 5) and multinodular (n > 5) groups. Survival rates for 1 and 5 years for oligonodular were 84% and 14%, and for multinodular was 50% and 0%. Repetitive TACE resulted in a relevant response for the control of liver metastases of pancreatic cancer with respectable median survival time. Interestingly, the number of lesions, statistically, was not an effective factor.

• Microwave ablation therapy: clinical utility in treatment of pulmonary metastases.

  Authors: Thomas J Vogl, Nagy N N Naguib, Tatjana Gruber-Rouh, Karen Koitka, Thomas Lehnert, Nour-Eldin A Nour-Eldin

  Radiology. 11/2011; 261(2):643-51.

  To prospectively evaluate the safety and efficacy of microwave ablation therapy of unresectable pulmonary metastases. All patients provided informed consent for this prospective institutional reviewTo prospectively evaluate the safety and efficacy of microwave ablation therapy of unresectable pulmonary metastases. All patients provided informed consent for this prospective institutional review board-approved study. Eighty patients (30 men, 50 women; mean age, 59.7 years ± 6.4; range, 48-68 years) underwent computed tomography-guided percutaneous microwave ablation of pulmonary metastatic lesions in 130 sessions. The tumors represented metastases from colorectal carcinoma, breast carcinoma, hepatocellular carcinoma, renal cell carcinoma, and bronchogenic carcinoma; there was no evidence of extrapulmonary metastasis for any tumor. Logistic regression analysis was used for evaluation of the statistical significance of factors affecting the end result of microwave ablation therapy. The Kaplan-Meier method was used for estimation of survival rates. Complete, successful ablation was achieved in 95 (73.1%) of 130 lesions. Successful tumor ablation was significantly more frequent for lesions with a maximal axial diameter of 3 cm or smaller (90 of 110) than for lesions greater than 3 cm in maximal axial diameter (five of 20) (P < .0001) and for peripheral lesions (80 [80%] of 100) than for centrally located lesions (15 [50%] of 30) (P = .002). The histopathologic type of the metastasis did not significantly correlate with the ablation result (P > .3). The 12- and 24-month survival rates were 91.3% and 75%, respectively. There was no intraprocedural death, and the overall 60-day mortality rate after ablation was 0%. Higher survival rates were observed in patients with tumor-free states after successful ablation than in patients with failed ablation (P = .001). The incidence of pneumothorax was 8.5% (11 of 130). An intercostal chest tube was applied in one (0.8%) of the 11 sessions. Pulmonary hemorrhage developed in eight (6.2%) of 130 sessions. Microwave ablation therapy may be safely and effectively used as a therapeutic tool for treatment of pulmonary metastases. The efficacy of the treatment is primarily determined by preablation tumor size and location in relation to the hilum.

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• Intravenous contrast material administration at high-pitch dual-source CT pulmonary angiography: Test bolus versus bolus-tracking technique.

  Authors: J Matthias Kerl, Thomas Lehnert, Boris Schell, Boris Bodelle, Martin Beeres, Volkmar Jacobi, Thomas J Vogl, Ralf W Bauer

  European journal of radiology. 10/2011;

  PURPOSE: To compare test bolus and bolus tracking for the determination of scan delay of high-pitch dual-source CT pulmonary angiography in patients with suspected pulmonary embolism using 50ml ofPURPOSE: To compare test bolus and bolus tracking for the determination of scan delay of high-pitch dual-source CT pulmonary angiography in patients with suspected pulmonary embolism using 50ml of contrast material. MATERIALS AND METHODS: Data of 80 consecutive patients referred for CT pulmonary angiography were evaluated. All scans were performed on a 128-channel dual-source CT scanner with a high-pitch protocol (pitch 3.0, 100kV, 180mAs). Contrast enhancement was achieved by injecting 50ml of iomeprol followed by a saline chaser of 50ml injected at a rate of 4ml/s. The scan delay was determined using either the test bolus (n=40) or bolus tracking (n=40) technique. Test bolus required another 15ml CM to determine time to peak enhancement of the contrast bolus within the pulmonary trunk. Attenuation profiles in the pulmonary trunk and on segmental level as well as in the ascending aorta were measured to evaluate the timing techniques. Additionally, overall image quality was evaluated. RESULTS: In all patients an adequate and homogeneous contrast enhancement of more than 250HU was achieved in the pulmonary arteries. No statistically significant difference between test bolus and bolus tracking was found regarding attenuation of the pulmonary arteries or overall image quality. However, using bolus tracking 15ml CM less was injected. CONCLUSION: A homogeneous opacification of the pulmonary arteries and sufficient image quality can be achieved with both the bolus tracking and test bolus techniques with significant lower contrast doses compared to conventional contrast material injection protocols.

• Transcatheter Treatment of Hepatocellular Carcinoma with Doxorubicin-loaded DC Bead (DEBDOX): Technical Recommendations.

  Authors: Riccardo Lencioni, Thierry de Baere, Marta Burrel, James G Caridi, Johannes Lammer, Katerina Malagari, Robert C G Martin, Elizabeth O'Grady, Maria Isabel Real, Thomas J Vogl, Anthony Watkinson, Jean-Francois H Geschwind

  Cardiovascular and interventional radiology. 10/2011;

  Tranarterial chemoembolization (TACE) has been established by a meta-analysis of randomized controlled trials as the standard of care for nonsurgical patients with large or multinodular noninvasiveTranarterial chemoembolization (TACE) has been established by a meta-analysis of randomized controlled trials as the standard of care for nonsurgical patients with large or multinodular noninvasive hepatocellular carcinoma (HCC) isolated to the liver and with preserved liver function. Although conventional TACE with administration of an anticancer-in-oil emulsion followed by embolic agents has been the most popular technique, the introduction of embolic drug-eluting beads has provided an alternative to lipiodol-based regimens. Experimental studies have shown that TACE with drug-eluting beads has a safe pharmacokinetic profile and results in effective tumor killing in animal models. Early clinical experiences have confirmed that drug-eluting beads provide a combined ischemic and cytotoxic effect locally with low systemic toxic exposure. Recently, the clinical value of a TACE protocol performed by using the embolic microsphere DC Bead loaded with doxorubicin (DEBDOX; drug-eluting bead doxorubicin) has been shown by randomized controlled trials. An important limitation of conventional TACE has been the inconsistency in the technique and the treatment schedules. This limitation has hampered the acceptance of TACE as a standard oncology treatment. Doxorubicin-loaded DC Bead provides levels of consistency and repeatability not available with conventional TACE and offers the opportunity to implement a standardized approach to HCC treatment. With this in mind, a panel of physicians took part in a consensus meeting held during the European Conference on Interventional Oncology in Florence, Italy, to develop a set of technical recommendations for the use of DEBDOX in HCC treatment. The conclusions of the expert panel are summarized.

• Liver, gastrointestinal, and cardiac toxicity in intermediate hepatocellular carcinoma treated with PRECISION TACE with drug-eluting beads: results from the PRECISION V randomized trial.

  Authors: Thomas J Vogl, Johannes Lammer, Riccardo Lencioni, Katerina Malagari, Anthony Watkinson, Frank Pilleul, Alban Denys, Clara Lee

  AJR. American journal of roentgenology. 10/2011; 197(4):W562-70.

  The purpose of our study was to evaluate hepatic, gastrointestinal, and cardiac toxicity after PRECISION transarterial chemoembolization (TACE) with drug-eluting beads (DEB) versus conventional TACEThe purpose of our study was to evaluate hepatic, gastrointestinal, and cardiac toxicity after PRECISION transarterial chemoembolization (TACE) with drug-eluting beads (DEB) versus conventional TACE with doxorubicin in the treatment of intermediate-stage hepatocellular carcinoma (HCC). Two hundred twelve patients (185 men and 27 women; mean age, 67 years) were randomized to TACE with DEB or conventional TACE. The majority of patients (67% in both groups) presented in a more advanced stage. Safety was measured by rate of adverse events (Southwest Oncology Group criteria) and changes in laboratory parameters. Cardiotoxicity was assessed with left ventricular ejection fraction (LVEF) mainly on MRI or echocardiography. The mean maximum postchemoembolization alanine transaminase increase in the DEB group was 50% less than in the conventional TACE group (p < 0.001) and 41% less in respect to aspartate transaminase (p < 0.001). End-of-study values returned to approximately baseline levels but with greater variability in conventional TACE patients. Treatment-emergent adverse events in the hepatobiliary system organ class occurred in 16.1% of DEB group patients compared with 25% of conventional TACE patients. There were fewer liver toxicity events in the DEB group. There was a small but statistically significant difference in mean change from baseline in LVEF between the two groups of 4 percentage points for the conventional TACE group (95% CI, 0.71-7.3; p = 0.018). PRECISION TACE with DEB loaded with doxorubicin offers a safe therapy option for intermediate-stage HCC, even in patients with more advanced liver disease.

• High-pitch dual-source CT angiography of the whole aorta without ECG synchronisation: initial experience.

  Authors: Martin Beeres, Boris Schell, Aristidis Mastragelopoulos, Eva Herrmann, Josef Matthias Kerl, Tatjana Gruber-Rouh, Clara Lee, Petra Siebenhandl, Boris Bodelle, Stephan Zangos, Thomas J Vogl, Volkmar Jacobi, Ralf W Bauer

  European radiology. 09/2011; 22(1):129-37.

  To investigate the feasibility, image quality and radiation dose for high-pitch dual-source CT angiography (CTA) of the whole aorta without ECG synchronisation. Each group of 40 patients underwentTo investigate the feasibility, image quality and radiation dose for high-pitch dual-source CT angiography (CTA) of the whole aorta without ECG synchronisation. Each group of 40 patients underwent CTA either on a 16-slice (group 1) or dual-source CT device with conventional single-source (group 2) or high-pitch mode with a pitch of 3.0 (group 3). The presence of motion or stair-step artefacts of the thoracic aorta was independently assessed by two readers. Subjective and objective scoring of motion and artefacts were significantly reduced in the high-pitch examination protocol (p < 0.05). The imaging length was not significantly different, but the imaging time was significantly (p < 0.001) shorter in the high-pitch group (12.2 vs. 7.4 vs. 1.7 s for groups 1, 2 and 3). The ascending aorta and the coronary ostia were reliably evaluable in all patients of group 3 without motion artefacts as well. High-pitch dual-source CT angiography of the whole aorta is feasible in unselected patients. As a significant advantage over regular pitch protocols, motion-free imaging of the aorta is possible without ECG synchronisation. Thus, this CT mode bears potential to become a standard CT protocol before trans-catheter aortic valve implantation (TAVI).

• Outcomes of an algorithmic approach to management of pneumothorax complicating thermal ablation of pulmonary neoplasms.

  Authors: Nour-Eldin Nour-Eldin, Nagy N N Naguib, Ahmed M Tawfik, Karen Koitka, Ahmed S Saeed, Thomas J Vogl

  Journal of vascular and interventional radiology : JVIR. 09/2011; 22(9):1279-86.

  To investigate the outcomes of an algorithm for treatment of pneumothorax in association with radiofrequency (RF) and microwave (MW) ablation of pulmonary neoplasms. This retrospective study includedTo investigate the outcomes of an algorithm for treatment of pneumothorax in association with radiofrequency (RF) and microwave (MW) ablation of pulmonary neoplasms. This retrospective study included data from 248 ablation sessions for lung tumors in 164 patients (92 men; mean age, 59.7 y ± 9.8): 200 RF ablations (80.6%) and 48 MW ablations (19.4%). Pneumothorax was classified as mild, moderate, or severe. Twelve patients developed mild pneumothorax and were observed for further complications, and 33 developed moderate or severe pneumothorax and were managed with percutaneous aspiration of the pneumothorax. The decision to abort or continue ablation was determined based on clinical response to percutaneous aspiration, clinical distress, and feasibility of applying the applicator within the lesion. Incidence of pneumothorax was 18.1% (45 of 248 sessions), with four (8.9%) occurrences during MW ablation and 41 (91.1%) during RF ablation. Pneumothoraces were mild in 12 sessions (26.7%), moderate in 27 (60%), and severe in six (13.3%). Complete evacuation of the pneumothorax was achieved in 25 of 33 sessions (75.8%). Intercostal tube drainage was indicated in eight sessions (24.2%), including six severe and two moderate pneumothoraces. Pneumothorax evolved immediately after thoracic puncture in 10 patients. Ablation therapy was aborted in two sessions in which severe pneumothorax occurred, and an intercostal chest tube was inserted. Mild pneumothorax can be managed by close observation without interruption of ablation therapy. Manual evacuation was an effective strategy for management of moderate pneumothorax and allowed for adequate positioning of the electrode, but did not suffice for severe and progressive pneumothorax, which required placement of an intercostal chest tube.

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