C J Herold

Medical University of Vienna, Wien, Vienna, Austria

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Publications (149)352.33 Total impact

  • Der Radiologe 05/2014; 54(5):425-6. · 0.47 Impact Factor
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    ABSTRACT: Purpose To determine whether gadoxetic acid-enhanced magnetic resonance (MR) imaging can be used to distinguish between simple steatosis and nonalcoholic steatohepatitis (NASH) in patients with nonalcoholic fatty liver disease (NAFLD), defined according to the steatosis activity and fibrosis (SAF) scoring system, which is based on the semiquantitative scoring of steatosis activity and liver fibrosis. Materials and Methods The local institutional review committee approved this study and waived written informed consent. This was a retrospective study of gadoxetic acid-enhanced 3-T MR imaging performed in 81 patients with NAFLD (45 men [56%]; mean age, 56 years; range, 25-78 years). The MR images were analyzed by using the relative enhancement (the ratio of signal intensities of the liver parenchyma before and 20 minutes after intravenous administration of gadoxetic acid). Univariate and multiple regression analyses were applied to identify variables associated with relative enhancement measurements. The ability of relative enhancement to allow differentiation between simple steatosis and NASH was assessed by using area under the receiver operating characteristic (ROC) curve analysis. Results Relative enhancement negatively correlated with the degree of lobular inflammation (r = -0.59, P < .0001), ballooning (r = -0.44, P < .0001), and fibrosis (r = -0.59, P ≤.0001), but not with steatosis (r = -0.16, P = .15). Patients with NASH had a significantly lower relative liver enhancement (0.82 ± 0.22) than those with simple steatosis (1.39 ± 0.52) (P < .001). Relative enhancement measurements performed well in the differentiation between simple steatosis and NASH, with an area under the ROC curve of 0.85 (95% confidence interval: 0.75, 0.91) (cutoff = 1.24, sensitivity = 97%, specificity = 63%). Conclusion Gadoxetic acid relative enhancement was significantly lower in patients with NASH than in patients with simple steatosis, but further prospective studies are warranted. © RSNA, 2014.
    Radiology 02/2014; · 6.34 Impact Factor
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    ABSTRACT: A recent paradigm shift in radiology has focused on the globalization of so-called P4 radiology. P4 radiology represents delivery of imaging results that are predictive, personalized, pre-emptive and participatory. The combination of the P4 approach and biomarkers is particularly pertinent to MRI, especially with technological advances such as diffusion-weighted imaging. The development of new liver-specific MRI contrast media, particularly gadoxetic acid, demonstrate specific pharmacokinetic properties, which provide combined morphologic and functional information in the same setting. The evaluation of hepatobiliary pathology beyond morphology gives rise to the possibilty of using gadoxetic acid-enhanced MRI as an imaging biomarker of hepatobiliary diseases. The integration of functional imaging with an understanding of complex disease mechanisms forms the basis for P4 radiology, which may ultimately lead to individualized, cost-effective, targeted therapy for patients. This will enable radiologists to determine the prognosis of the disease and estimate early response to treatment, with the participation of all the required medical disciplines.
    Expert review of gastroenterology & hepatology 02/2014; 8(2):147-60.
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    ABSTRACT: Purpose To retrospectively assess the use of a combination of cancellous bone reconstructions (CBR) and multiplanar reconstructions (MPRs) for the detection of bone metastases at thoracoabdominal computed tomography (CT) compared with the use of MPRs alone. Materials and Methods The study was approved by the local institutional review board. Included were 156 consecutive patients with confirmed cancer who underwent a whole-body positron emission tomography (PET)/CT examination for clinical purposes (93 male and 63 female patients; mean age ± standard deviation, 59.8 years ± 14.9; range, 11-85 years). Only the CT images were processed with the CBR algorithm, which segments the bones and removes the cortical layer from the images. The PET images served as part of the reference standard. Images from 15 patients were used as a training set. Four radiologists independently evaluated images of half of the remaining 141 patients by using CBRs and MPRs together, and the other half by using MPRs only. Radiologists were blinded to patient names, and patient order was randomized. Results for detection rates and reporting time were recorded and compared with a standard of reference for each patient that was created by one senior radiologist and one nuclear medicine specialist by using all available CT and PET data, CBRs, and follow-up examinations. General estimation equations were used for statistical analysis. Results There were 349 lesions found in 103 patients, with 203 classified as malignant. Each patient was assessed by two readers per method, leading to a total of 698 lesions. The detection rate for all bone lesions was 35% (247 of 698) for MPRs and 74% (520 of 698) when CBRs and MPRs were used together, which was significantly higher (P < .001). The average reading time decreased from 85 to 43 seconds (P < .001) when both reconstructions were used. Conclusion Advanced visualization of cancellous bone significantly increased the detection of bone metastases and reduced the time for interpretation. © RSNA, 2013 Online supplemental material is available for this article.
    Radiology 12/2013; · 6.34 Impact Factor
  • M E Mayerhoefer, C J Herold
    Der Radiologe 08/2013; 53(8):667-8. · 0.47 Impact Factor
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    ABSTRACT: OBJECTIVE. The purpose of this study was to use second-generation dual-source CT to assess the influence of size, degree of stenosis, luminal contrast attenuation, and plaque geometry on stenosis quantification in a coronary artery phantom. MATERIALS AND METHODS. Six vessel phantoms with three outer diameters (2, 3, and 4 mm), each containing three radiolucent plaques (72.2 HU) that simulated eccentric and concentric 43.8%, 75%, and 93.8% stenoses were made with a 3D printer system. These phantoms were filled with an iodine-saline solution mixture at luminal attenuations of 150, 200, 250, 300, and 350 HU and were attached to a cardiac motion simulator. Dual-source CT was performed with a standardized ECG-gated protocol (120 kV, 360 mAs per rotation) at a simulated heart rate of 70 beats/min. Two independent readers quantified the degree of stenosis using area-based measurements. RESULTS. All measurements were highly reproducible (intraclass correlation, ≥ 0.791; p < 0.001). The mean measured degree of stenosis for a phantom with a 3-mm outer diameter at 250-HU luminal attenuation was 49.0% ± 10.0% for 43.8% stenosis, 71.7% ± 9.6% for 75.0% stenosis, and 85.4% ± 5.9% for 93.8% stenosis. With decreasing phantom size, measurement error increased for all degrees of stenosis. The absolute error increased for measurements at a low luminal attenuation of 150 HU (p < 0.001) and for low-grade stenoses compared with medium-and high-grade stenoses (p < 0.001). CONCLUSION. The results are an overview of factors that influence stenosis quantification in simulated coronary arteries. Dual-source CT is highly reproducible and accurate for quantification of low-density stenosis in vessels with a diameter of 3 mm and attenuation of at least 200 HU for different degrees of stenosis and plaque geometry.
    American Journal of Roentgenology 08/2013; 201(2):W227-34. · 2.90 Impact Factor
  • C Herold, M F Reiser, A Graser
    Der Radiologe 04/2013; · 0.47 Impact Factor
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    ABSTRACT: Oncologic imaging includes the morphological description of the primary tumor region for an accurate classification of the tumor and lymph node stage and whether distant metastases have occurred according to the TNM staging system. Knowing the stage of the disease helps to plan the treatment and to estimate the prognosis. In clinical routine this is accomplished by conventional imaging techniques, such as ultrasound (US), computed tomography (CT) and magnetic resonance imaging (MRI). Additionally, oncologic imaging is essential in treatment monitoring to visualize and quantify the effect of cancer therapy according to response evaluation criteria in solid tumors (RECIST) and World Health Organization (WHO) criteria. The tremendous development in oncology and technical innovations in imaging represent a particular challenge for radiology.
    Der Radiologe 03/2013; · 0.47 Impact Factor
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    ABSTRACT: Abstract Objectives: To evaluate the fetal magnetic resonance imaging findings of lymphangiomas. Methods: The magnetic resonance scans of eight fetuses with lymphangiomas were evaluated. Magnetic resonance evaluation included: number; size; signal intensities of the lesions; thickness of the septae; configuration of the margins; presence of blood breakdown products; change in size or signal intensity (in four patients with multiple examinations); exact expansion of the lesions to the adjacent anatomical structures; and concomitant pathological findings. Results were compared with postpartum clinical assessment and imaging in seven patients and with autopsy in one patient. Results: Two retroperitoneal, three thoracic, and three cervical lymphangiomas (diameters between 3.3 and 15.6 cm) were included. All lesions consisted of macrocysts, and additional microcystic parts were found in three lymphangiomas. Blood breakdown products were found in one lesion. Agreement with postpartum imaging was excellent. One patient received intrauterine drainage for chylothorax, and one pregnancy was terminated. Conclusions: Fetal lymphangiomas display the same magnetic resonance imaging features as postnatal lymphangiomas. Intrauterine magnetic resonance characterization of lymphangiomas provides the exact delineation, detection of associated and/or concomitant pathologies, and differential diagnosis among other cystic pathologies. Patient management may be altered with respect to the type and/or time of treatment, and with regard to the continuation or termination of pregnancy.
    Journal of Perinatal Medicine 01/2013; · 1.95 Impact Factor
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    ABSTRACT: PURPOSE: The aim of this study was to survey the current CT protocols used by members of the European Society of Thoracic Imaging (ESTI) to evaluate patients with interstitial lung diseases (ILD). METHODS: A questionnaire was e-mailed to 173 ESTI members. The survey focussed on CT acquisition and reconstruction techniques. In particular, questions referred to the use of discontinuous HRCT or volume CT protocols, the acquisition of additional acquisitions in expiration or in the prone position, and methods of radiation dose reduction and on reconstruction algorithms. RESULTS: The overall response rate was 37 %. Eighty-five percent of the respondents used either volume CT alone or in combination with discontinuous HRCT. Forty-five percent of the respondents adapt their CT protocols to the patient's weight and/or age. Expiratory CT or CT in the prone position was performed by 58 % and 59 % of the respondents, respectively. The number of reconstructed series ranged from two to eight. CONCLUSION: Our survey showed that radiologists with a special interest and experience in chest radiology use a variety of CT protocols for the evaluation of ILD. There is a clear preference for volumetric scans and a strong tendency to use the 3D information. KEY POINTS: • Experienced thoracic radiologists use various CT protocols for evaluating interstitial lung diseases. • Most workers prefer volumetric CT acquisitions, making use of the 3D information • More attention to reducing the radiation dose appears to be needed.
    European Radiology 12/2012; · 4.34 Impact Factor
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    ABSTRACT: Purpose:To retrospectively assess the detection rate for intracranial hematomas achieved with use of curved maximum intensity projections (MIPs) that parallel the inner table of the skull compared with the rate achieved by reading transverse sections of computed tomography (CT) only.Materials and Methods:This retrospective study was approved by the institutional review board, which waived informed consent. A total of 314 consecutive patients who underwent CT for cranial trauma (155 male, 159 female; mean age ± standard deviation, 58 years ± 24 [range, 2-98 years]) were included. The algorithm unfolded the meningeal spaces into four images per patient. Four radiologists independently evaluated all cases. Hematomas less than 3 mm thick were considered thin. Radiologists were blinded to patient names, and patient and group orders were randomly assigned. The results were compared with a reference standard built by two experts. Logistic regression with repeated measurements was used for statistical analysis.Results:Use of the reference standard helped confirm 121 intracranial hematomas in 39 patients. For all readers, reading time for hematoma detection was significantly shorter (3-5 times shorter, P < .001) for curved MIPs. Mean lesion-based detection rate for all readers was 80% (193 of 242) for transverse sections and 83% (200 of 242) for curved MIPs. For thin hematomas, the mean detection rate increased from 20% (eight of 40) with transverse sections to 83% (33 of 40) with curved MIPs.Conclusion:Curved MIPs of the meningeal spaces may shorten detection time for epidural and subdural hematomas, increase sensitivity (especially for thin hematomas), and reduce the required operator experience for detection.© RSNA, 2013.
    Radiology 12/2012; · 6.34 Impact Factor
  • Christian J. Herold
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    ABSTRACT: LEARNING OBJECTIVES 1) Review the strengths and limitations of radiologic techniques suitable for detecting and characterizing primary and metastatic lesions in the lungs. 2) Understand the imaging findings relevant for lung cancer T, N and M staging, and appraise the implications of the new IASLC lung cancer staging system. 3) Discuss the imaging findings used to assess response to conventional and new therapies for lung cancers.
    Radiological Society of North America 2012 Scientific Assembly and Annual Meeting; 11/2012
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    ABSTRACT: PURPOSE/AIM To demonstrate the diagnostic value of contrast-enhanced MRI with different contrast agents to establish an accurate diagnosis and sub-classification of hepatocellular adenomas (HCAs). CONTENT ORGANIZATION Although HCA is classified as a benign liver lesion, clinically, it is considered a borderline tumor due to the risk of hemorrhage, rupture, and even malignant transformation. Therefore, the management of this lesion varies, and can include invasive biopsy, long term follow up, surgical resection or even radiofrequeny ablation, based on the size, histological subtype, and clinical presentation. Recently, HCAs have been divided into genotype/phenotype subgroups, including (1) hepatocyte nuclear factor 1α(HNF-1α)–inactivated, (2) β-catenin–activated, (3) inflammatory, and (4) a unclassified or mixed type. These genotype/phenotype subgroups are associated with different prognostic profiles. The recent literature has reported a close correlation between pathological classification of HCAs and imaging features on magnetic resonance imaging (MRI). SUMMARY In this educational exhibition, we demonstrate the correlation of the MRI features of hepatocellular adenomas and their genotype/phenotype subgroups. We highlight the role of contrast-enhanced MRI as a predictive tool to estimate the malignant potential of the different subgroups of HCAs and guide the therapy.
    Radiological Society of North America 2012 Scientific Assembly and Annual Meeting; 11/2012
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    ABSTRACT: This report is to complement the original Fleischner Society recommendations for incidentally detected solid nodules by proposing a set of recommendations specifically aimed at subsolid nodules. The development of a standardized approach to the interpretation and management of subsolid nodules remains critically important given that peripheral adenocarcinomas represent the most common type of lung cancer, with evidence of increasing frequency. Following an initial consideration of appropriate terminology to describe subsolid nodules and a brief review of the new classification system for peripheral lung adenocarcinomas sponsored by the International Association for the Study of Lung Cancer (IASLC), American Thoracic Society (ATS), and European Respiratory Society (ERS), six specific recommendations were made, three with regard to solitary subsolid nodules and three with regard to multiple subsolid nodules. Each recommendation is followed first by the rationales underlying the recommendation and then by specific pertinent remarks. Finally, issues for which future research is needed are discussed. The recommendations are the result of careful review of the literature now available regarding subsolid nodules. Given the complexity of these lesions, the current recommendations are more varied than the original Fleischner Society guidelines for solid nodules. It cannot be overemphasized that these guidelines must be interpreted in light of an individual's clinical history. Given the frequency with which subsolid nodules are encountered in daily clinical practice, and notwithstanding continuing controversy on many of these issues, it is anticipated that further refinements and modifications to these recommendations will be forthcoming as information continues to emerge from ongoing research.© RSNA, 2012.
    Radiology 10/2012; · 6.34 Impact Factor
  • C Herold, H Prosch
    Der Radiologe 10/2012; 52(10):891. · 0.47 Impact Factor
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    ABSTRACT: To determine, in patients with melanoma, the dependence of PET sensitivity on pulmonary metastasis size, and to determine patients who require further evaluation for definite staging. Of 183 melanoma patients who underwent (18)F-fluorodeoxyglucose PET/computed tomography (CT) for staging or follow-up between January 2008 and June 2011, 38 patients (18 women and 20 men; mean age 62.0 ± 14.7 years) with one or more pulmonary metastases visible on CT were included in the retrospective study. Each pulmonary metastasis was rated as positive or negative on PET, and lesion size (maximum transverse diameter) was assessed on CT. PET sensitivity was calculated according to the lesions' size, in 2-mm steps. A total of 181 pulmonary metastases were analysed. PET sensitivity was 7.9 % for lesions of 4-5 mm; 33.3 % for lesions of 6-7 mm; 56.8 % for lesions of 8-9 mm; 63.6 % for lesions of 10-11 mm; 100 % for lesions of 12-14 mm; and 100 % for lesions of at least 15 mm. The differences in sensitivity between the size groups were significant (P < 0.001) With current state-of-the-art PET/CT technology, additional tests are necessary for definitive staging of melanoma patients who have one or more PET-negative lung nodules less than 12 mm in diameter on expiratory CT. KEY POINTS : • PET cannot rule out malignancy in pulmonary nodules less than 12 mm on expiratory CT. • Melanoma patients with PET-negative pulmonary nodules less than 12 mm require additional tests. • Knowledge of these factors can help interpretation of PET and PET/CT findings.
    European Radiology 06/2012; 22(11):2451-7. · 4.34 Impact Factor
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    ABSTRACT: To evaluate the reliability of attenuation values in virtual non-contrast images (VNC) reconstructed from contrast-enhanced, dual-energy scans performed on a second-generation dual-energy CT scanner, compared to single-energy, non-contrast images (TNC). Sixteen phantoms containing a mixture of contrast agent and water at different attenuations (0-1400 HU) were investigated on a Definition Flash-CT scanner using a single-energy scan at 120 kV and a DE-CT protocol (100 kV/SN140 kV). For clinical assessment, 86 patients who received a dual-phase CT, containing an unenhanced single-energy scan at 120 kV and a contrast enhanced (110 ml Iomeron 400 mg/ml; 4 ml/s) DE-CT (100 kV/SN140 kV) in an arterial (n=43) or a venous phase, were retrospectively analyzed. Mean attenuation was measured within regions of interest of the phantoms and in different tissue types of the patients within the corresponding VNC and TNC images. Paired t-tests and Pearson correlation were used for statistical analysis. For all phantoms, mean attenuation in VNC was 5.3±18.4 HU, with respect to water. In 86 patients overall, 2637 regions were measured in TNC and VNC images, with a mean difference between TNC and VNC of -3.6±8.3 HU. In 91.5% (n=2412) of all cases, absolute differences between TNC and VNC were under 15HU, and, in 75.3% (n=1986), differences were under 10 HU. Second-generation dual-energy CT based VNC images provide attenuation values close to those of TNC. To avoid possible outliers multiple measurements are recommended especially for measurements in the spleen, the mesenteric fat, and the aorta.
    European journal of radiology 03/2012; 81(3):e398-405. · 2.65 Impact Factor
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    ABSTRACT: Purpose: To evaluate the stand-alone performance of a computer-aided detection (CAD) algorithm for colorectal polyps in a large heterogeneous CT colonography (CTC) database that included both tagged and untagged datasets. Methods: Written, informed consent was waived for this institutional review board-approved, HIPAA-compliant retrospective study. CTC datasets from 2063 patients were assigned to training (n = 374) and testing (n = 1689). The test set consisted of 836 untagged and 853 tagged examinations not used for CAD training. Examinations were performed at 15 sites in the United States, Asia, and Europe, using 4- to 64-multidetector-row computed tomography and various acquisition parameters. CAD sensitivities were calculated on a per-patient and per-polyp basis for polyps measuring ≥6 mm. The reference standard was colonoscopy in 1588 (94%) and consensus interpretation by expert radiologists in 101 (6%) patients. Statistical testing employed χ2, logistic regression, and Mann-Whitney U tests. Results: In 383 of 1689 individuals, 564 polyps measuring ≥6 mm were identified by the reference standard (347 polyps: 6–9 mm and 217 polyps: ≥10 mm). Overall, CAD per-patient sensitivity was 89.6% (343/383), with 89.0% (187/210) for untagged and 90.2% (156/173) for tagged datasets (P = 0.72). Overall, per-polyp sensitivity was 86.9% (490/564), with 84.4% (270/320) for untagged and 90.2% (220/244) for tagged examinations (P = 068). The mean false-positive rate per patient was 5.14 (median, 4) in untagged and 4.67 (median, 4) in tagged patient datasets (P = 0.353). Conclusion: Stand-alone CAD can be applied to both tagged and untagged CTC studies without significant performance differences. Detection rates are comparable to human readers at a relatively low false-positive rate, making CAD a useful tool in clinical practice.
    Investigative Radiology 01/2012; 47(2):99–108. · 5.46 Impact Factor
  • Christian J. Herold, Heber Macmahon
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    ABSTRACT: LEARNING OBJECTIVES ABSTRACT Sub-Events
    Radiological Society of North America 2011 Scientific Assembly and Annual Meeting; 11/2011
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    ABSTRACT: To evaluate the accuracy of multidetector computed tomography with water filling (Hydro-MDCT) in the T-staging of patients with oesophageal cancer. There were 131 consecutive patients who were preoperatively and prospectively examined in the prone position on arterial phase contrast-enhanced MDCT, after ingestion of 1,000-1,500 ml tap water and effervescent granules. Two readers staged the local tumour growth (T-staging) independently. They assessed tumour location, size, presence of stenosis, and morphology of the outer border of the oesophageal wall and perioesophageal fat planes on CT. CT findings were compared with histopathological results from resected specimens. Data were analyzed using the SPSS statistical package. Both readers obtained a high sensitivity of 95% and a high positive predictive value of 96%. Accurate local staging was achieved in 76.3% and 68.7% for readers 1 and 2, respectively. Inter-reader agreement was excellent (weighted κ value of 0.93 and un-weighted κ of 0.89). Using the hydro-technique and applying specific assessment criteria, MDCT appears to be an accurate, non-invasive diagnostic tool for local tumour staging of oesophageal cancer.
    European Radiology 06/2011; 21(11):2326-35. · 4.34 Impact Factor

Publication Stats

2k Citations
352.33 Total Impact Points

Institutions

  • 2005–2013
    • Medical University of Vienna
      • Department of Radiology
      Wien, Vienna, Austria
  • 2001–2013
    • Vienna General Hospital
      Wien, Vienna, Austria
  • 1988–2005
    • University of Vienna
      • • Department of Anaesthesiology and General Intensive Care
      • • Department of Neurobiology
      • • MR Institute
      Wien, Vienna, Austria
  • 2002
    • Ludwig Boltzmann Institute for Experimental and Clinical Traumatology
      Wien, Vienna, Austria
    • Ludwig Boltzmann Institut für Experimentelle und Klinische Traumatologie
      Wien, Vienna, Austria
    • Harvard University
      Cambridge, Massachusetts, United States
  • 1996
    • Ludwig Boltzmann Institute Of Electrical Stimulation
      Wien, Vienna, Austria