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ABSTRACT: Pain around the greater trochanter is still a common clinical problem that may be secondary to a variety of either intra-articular or periarticular pathologies. Gluteal tendon pathologies are one of the primary causes of greater trochanteric pain, with attrition of the fasciae latae against the gluteus medius and minimus tendons, and the trochanteric bursa being possible causes. Key sonographic findings of gluteal tendinopathy, bursitis, and differential diagnosis are described in this overview. Clinical diagnosis and treatment of greater trochanteric pain syndrome is still challenging; therefore ultrasound is helpful to localize the origin of pain, determine underlying pathology, and, based on these findings, to guide local aspiration and/or injection in cases of tendinopathy and/or bursitis.
Seminars in Musculoskeletal Radiology 03/2013; 17(1):43-8. · 1.40 Impact Factor
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ABSTRACT: Purpose:To compare and determine the level of agreement of findings at conventional B-mode ultrasonography (US) and sonoelastography of the Achilles tendon with findings at histologic assessment.Materials and Methods:This study was conducted with the approval of the institutional review boards, and all cadavers were in legal custody of the study institution. Thirteen Achilles tendons in 10 cadavers (four male, six female; age range, 70-90 years) were examined with B-mode US and sonoelastography. B-mode US grading was as follows: Grade 1 indicated a normal-appearing tendon with homogeneous fibrillar echotexture; grade 2, a focal fusiform or diffuse enlarged tendon; and grade 3, a hypoechoic area with or without tendon enlargement. Sonoelastography grading was as follows: Grade 1 indicated blue (hardest) to green (hard); grade 2, yellow (soft); and grade 3, red (softest). Twenty-five biopsy specimens from representative lesions of the middle and distal thirds of the Achilles tendons were evaluated histologically. The concordance of B-mode US grading compared with sonoelastographic grading was assessed by using κ analysis.Results:With B-mode US and sonoelastography, all 11 tendon thirds of histologically normal tendons were verified as normal (grade 1). Sonoelastography depicted 14 of 14 (100%) tendon thirds with histologic degeneration (grade 2 or 3), whereas B-mode US could depict only 12 of 14 (86%) lesions (grade 2 or 3). Only moderate agreement between B-mode US and sonoelastography was seen (κ = 0.52, P < .001).Conclusion:Sonoelastography might help predict signs of histopathologic degeneration of Achilles tendinosis, potentially more sensitively than B-mode US.© RSNA, 2013.
Radiology 02/2013; · 5.73 Impact Factor
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Tobias De Zordo,
Klemens von Lutterotti,
Christian Dejaco,
Peter F Soegner,
Renate Frank,
Friedrich Aigner,
Andrea S Klauser,
Christoph Pechlaner,
U Joseph Schoepf,
Werner R Jaschke, Gudrun M Feuchtner
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ABSTRACT: To compare image quality and radiation dose of high-pitch dual-source computed tomography (DSCT), dual energy CT (DECT) and conventional single-source spiral CT (SCT) for pulmonary CT angiography (CTA) on a 128-slice CT system.
Pulmonary CTA was performed with five protocols: high-pitch DSCT (100 kV), high-pitch DSCT (120 kV), DECT (100/140 kV), SCT (100 kV), and SCT (120 kV). For each protocol, 30 sex, age, and body-mass-index (mean 25.3 kg/m(2)) matched patients were identified. Retrospectively, two observers subjectively assessed image quality, measured CT attenuation (HU±SD) at seven central and peripheral levels, and calculated signal-to-noise-ratio (SNR) and contrast-to-noise-ratio (CNR). Radiation exposure parameters (CTDIvol and DLP) were compared.
Subjective image quality was rated good to excellent in >92% (>138/150) with an interobserver agreement of 91.4%. The five protocols did not significantly differ in image quality, neither by subjective, nor by objective measures (SNR, CNR). By contrast, radiation exposure differed between protocols: significant lower radiation was achieved by using high-pitch DSCT at 100 kV (p < 0.01 in all). Radiation exposure of DECT was in between SCT at 100 kV and 120 kV.
SCT, high-pitch DSCT, and DECT protocols techniques result in similar subjective and objective image quality, but radiation exposure was significantly lower with high-pitch DSCT at 100 kV.
New CT protocols show promising results in pulmonary embolism assessment. High-pitch dual-source CT (DSCT) at 100 kV provides radiation dose savings for pulmonary CTA. High-pitch DSCT at 100 kV maintains diagnostic image quality for pulmonary CTA. Dual energy CT uses more radiation but also provides lung perfusion evaluation. Whether the additional perfusion data is worth the extra radiation remains undetermined.
European Radiology 08/2011; 22(2):279-86. · 3.22 Impact Factor
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ABSTRACT: The assessment of the cardiovascular risk profile in patients with end-stage liver disease is essential prior to liver transplantation (LT) as cardiovascular diseases are major causes of morbidity and mortality in the posttransplant course. The aim of this study was to evaluate the accuracy of a 64-slice coronary computed tomographic angiography (CTA) and coronary calcium scoring (CCS) to predict the postoperative cardiovascular risk of patients assessed for LT. In this single center, observational study we included 54 consecutive patients who were assessed for LT and consequently transplanted. Twenty-four patients (44%) presented with a high CCS above 300 and/or a significant stenosis (>50% percent narrowing due to stenotic plaques) and were further referred to coronary angiography. Three of these patients had a more than 70% LAD stenosis with subsequent angioplasty (n=1) or conservative therapy (n=2). The other patients showed only diffuse CAD without significant stenosis. The remaining 30 patients with normal CTA findings were listed for LT without further tests. None of the 54 patients developed cardiovascular events peri- and postoperatively. This study indicated that CTA combined with CCS is a useful non-invasive imaging technique for pre-LT assessment of coronary artery disease and safe tool in the risk assessment of peri- and postoperative cardiovascular events in patients undergoing LT.
European journal of radiology 06/2011; 81(9):2260-4. · 2.65 Impact Factor
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Gudrun M Feuchtner,
Alexander Spoeck,
Jonathan Lessick,
Wolfgang Dichtl,
Andrè Plass,
Sebastian Leschka,
Silvana Mueller,
Andrea Klauser,
Hans Scheffel,
Florian Wolf,
Werner Jaschke,
Hatem Alkadhi
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ABSTRACT: Evaluate quantification of the aortic regurgitant fraction and volume with computed tomography (CT).
Fifty-three patients with aortic regurgitation (AR) and 29 controls were examined with 64-multi-detector CT coronary angiography and transthoracic echocardiography (TTE). A dedicated software algorithm employing three-dimensional segmentation of left ventricle (LV) and right ventricle (RV) volumes and LV mass was applied. AR volume and fraction was calculated based on RV and LV stroke volumes (SV) and compared with echocardiography. The aortic regurgitant orifice area (ROA) was measured by CT.
A good correlation of the AR fraction and AR volume determined by CT compared to echocardiography was found for mild, moderate, and severe AR with 14.2% ± 9, 28.8% ± 8, and 57.9% ± 9 (r = 0.95, P < .001) for AR fraction, and 15.7 mL ± 11.33 mL ± 14, and 98.9 mL ± 36 for AR volume (r = 0.92, P < .0001), respectively. CT correctly classified severity of AR in 93% of patients based of AR-fraction, and in 89% based on AR volume. The sensitivity and specificity of CT were 98% and specificity 90.3%. The specificity improved to 97%, if the ROA by CT was added as diagnostic criterion.
Aortic regurgitation fraction and volume can be accurately quantified from CT coronary angiography datasets. These parameters can assist clinical management, e.g. in case of pending cardiac surgery decision.
Academic radiology 03/2011; 18(3):334-42. · 2.09 Impact Factor
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ABSTRACT: We sought to assess vascularity in wrist tenosynovitis by using power Doppler ultrasound (PDUS) and to compare detection of intra- and peritendinous vascularity with that of contrast-enhanced grey-scale ultrasound (CEUS).
Twenty-six tendons of 24 patients (nine men, 15 women; mean age ± SD, 54.4 ± 11.8 years) with a clinical diagnosis of tenosynovitis were examined with B-mode ultrasonography, PDUS, and CEUS by using a second-generation contrast agent, SonoVue (Bracco Diagnostics, Milan, Italy) and a low-mechanical-index ultrasound technique. Thickness of synovitis, extent of vascularized pannus, intensity of peritendinous vascularisation, and detection of intratendinous vessels was incorporated in a 3-score grading system (grade 0 to 2). Interobserver variability was calculated.
With CEUS, a significantly greater extent of vascularity could be detected than by using PDUS (P < 0.001). In terms of peri- and intratendinous vessels, CEUS was significantly more sensitive in the detection of vascularization compared with PDUS (P < 0.001). No significant correlation between synovial thickening and extent of vascularity could be found (P = 0.089 to 0.097). Interobserver reliability was calculated to be excellent when evaluating the grading score (κ = 0.811 to 1.00).
CEUS is a promising tool to detect tendon vascularity with higher sensitivity than PDUS by improved detection of intra- and peritendinous vascularity.
Arthritis research & therapy 11/2010; 12(6):R209. · 4.27 Impact Factor
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ABSTRACT: Coronary CT angiography (CCTA) has emerged as a promising non-invasive tool to detect coronary artery disease (CAD) which provides additional information about atherosclerotic plaque composition. We aimed to assess whether differences in plaque composition and plaque burden exist across patients with more and <50% coronary stenosis.
1060 patients (58±11 years, 43% females) with an intermediate risk of CAD referred for 64-slice CCTA were studied. Plaque characteristics and burden was analyzed on CCTA images on a per-segment basis (modified 16-segment AHA classification). Plaques types were classified as: calcified (type 1), mixed (predominantly calcified) (type 2), mixed (predominantly non-calcified) (type 3), and non-calcified (type 4). Plaque types in patients with more and <50% stenosis were compared.
Overall 373 (35.2%) patients had normal coronaries without evidence of plaque. In the remaining 687 patients, 353 (33%) and 334 (31%) were found to have luminal narrowing of <50% and ≥50% in at-least one coronary artery segment, respectively. Those with ≥50% stenotic CAD demonstrated were more likely to have segments with mixed plaque subtype and less likely to be exclusively non-calcified (relative distribution of 58%, 22%, 10%, 11% for type 1-4 respectively) compared to those with <50% stenosis with (59%, 11%, 6% and 24%, respectively (p=0.006). In multivariable adjustment models, individuals with significant CAD were 5-fold more likely to have increased burden type 1 plaque (≥3 coronary segments) as compared to those with non-obstructive CAD (OR: 5.00, 95% CI: 1.05-23.78). The respective odds ratio (95% CI) for ≥3 coronary segments of type 2, 3 and 4 were 8.73 (3.01-25.23), 4.62 (2.99-0.22-1.55), respectively.
Plaque composition is different according to severity of CAD with a higher mixed plaque and lesser non-calcified plaque burden among those patients with ≥50% stenotic CAD. These findings should stimulate further investigations to assess the prognostic value of coronary plaque subtypes according to their underlying composition.
Atherosclerosis 08/2010; 215(1):90-5. · 3.79 Impact Factor
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ABSTRACT: To evaluate if image fusion, a technology matching real-time ultrasonography (US) and a previously obtained computed tomographic (CT) scan, is a feasible aid for sacroiliac (SI) joint injections in cadavers and patients.
This study was approved by institutional review board, and written informed consent was obtained from each patient. In five human cadavers (10 joints) and seven consecutive patients (10 joints; four male, three female patients; mean age, 33.6 years; range, 22-44 years), SI joint injections were performed by using image fusion guidance technology. Registration errors were calculated automatically by the software and reported as mean registration error. In cadavers, needle placement was confirmed by means of CT, while in patients, a subjective rating of pain (score of 0-10) was recorded before and 3 months after injection. Procedure time was calculated.
Matching of real-time US and CT images by image fusion software was reliable in all tests (mean registration error, 0.3 mm). In all cadavers, correct intraarticular needle positioning by using image fusion guidance was confirmed on CT scans. In patients, no intraprocedural complications were noted, and 3 months after injection pain score decreased (mean pain score before procedure, 8.05; after, 0.3). In patients, mean time for the whole procedure was 20.4 minutes (range, 17-22 minutes), with a mean duration of 15.4 minutes (range, 14-17 minutes) for image matching and 5 minutes (range, 3-7 minutes) for needle placement.
Image fusion of real-time US and previously obtained CT scans is feasible to guide needle insertion into the SI joint.
Radiology 08/2010; 256(2):547-53. · 5.73 Impact Factor
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Florian Wolf,
Petr Ourednicek,
Christian Loewe,
Bernhard Richter,
Heinz David Gössinger,
Marianne Gwechenberger,
Christina Plank,
Rüdiger Egbert Schernthaner,
Michael Toepker,
Johannes Lammer, Gudrun M Feuchtner
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ABSTRACT: The purpose of this study was to compare a manual and automated 3D volume segmentation tool for evaluation of left atrial (LA) function by 64-slice multidetector-CT (MDCT).
In 33 patients with paroxysmal atrial fibrillation a MDCT scan was performed before radiofrequency-catheter ablation. Atrial function (minimal volume (LAmin), maximal volume (LAmax), stroke volume (SV), ejection fraction (EF)) was evaluated by two readers using a manual and an automatic tool and measurement time was evaluated.
Automated LA volume segmentation failed in one patient due to low LA enhancement (103HU). Mean LAmax, LAmin, SV and EF were 127.7 ml, 93 ml, 34.7 ml, 27.1% by the automated, and 122.7 ml, 89.9 ml, 32.8 ml, 26.3% by the manual method with no significant difference (p>0.05) and high Pearsons correlation coefficients (r=0.94, r=0.94, r=0.82 and r=0.85, p<0.0001), respectively. The automated method was significantly faster (p<0.001). Interobserver variability was low for both methods with Pearson's correlation coefficients between 0.98 and 0.99 (p<0.0001).
Evaluation of LA volume and function with 64-slice MDCT is feasible with a very low interobserver variability. The automatic method is as accurate as the manual method but significantly less time consuming permitting a routine use in clinical practice before RF-catheter ablation.
European journal of radiology 08/2010; 75(2):e141-6. · 2.65 Impact Factor
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Gudrun M Feuchtner,
Hatem Alkadhi,
Christoph Karlo,
Ammar Sarwar,
Andreas Meier,
Wolfgang Dichtl,
Sebastian Leschka,
Ron Blankstein,
Juerg Gruenenfelder,
Paul Stolzmann,
Ricardo C Cury
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ABSTRACT: To evaluate the diagnostic performance of coronary computed tomographic (CT) angiography for the diagnosis of mitral valve prolapse (MVP).
The retrospective case-controlled multicenter study protocol was approved by the institutional review boards. The U.S. part of the study was HIPAA compliant. One hundred twelve patients who underwent electrocardiographically gated 64-section coronary CT angiography (n = 60) or dual-source coronary CT angiography (n = 52) and transthoracic echocardiography (TTE) were included. Fifty-three patients with MVP were matched for age and sex with 59 patients without MVP. CT images were analyzed on three-, two-, and four-chamber (CH) views by two independent observers. MVP was defined as a greater than 2-mm displacement of leaflets below the annulus plane and was subclassified as "billowing" (bowing) or "flail leaflet" (free leaflet margin displacement). Leaflet thickness was measured and defined as thickened if it was greater than 2 mm.
The diagnostic performance of CT when three- and two-CH views were combined for the diagnosis of MVP was as follows: sensitivity, 96%; specificity, 93%; positive predictive value (PPV), 93%; and negative predictive value, 96%. On four-CH views, the excursion of billowing was higher than it was on three-CH views (P <.001), and the PPV of the four-CH view for diagnosis of MVP was 89%. The correlation between CT and TTE for excursion of billowing was high (r = 0.80-0.91). In a subset of 32 patients, the agreement between CT and TTE for differentiation of billowing (n = 13) and flail leaflet (n = 2) was 100%. Leaflet thickening was more prevalent in patients with MVP than it was in those without (71% vs 20%, P <.001), and correlation with TTE was good (r = 0.81 [anterior leaflet] and 0.77 [posterior leaflet]). Conclusion: The combined use of three- and two-CH views allows an accurate diagnosis of MVP at coronary CT angiography.
Radiology 02/2010; 254(2):374-83. · 5.73 Impact Factor
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ABSTRACT: In percutaneous aortic valve replacement (AVR), whilst calcifications are used as landmarks in fluoroscopic placement of the stent, they may also complicate stent placement. In response to this problem, the study aim was to examine severe aortic root calcification by using multi-detector computed tomography (MDCT), to better understand the pathology complicating percutaneous valve placement.
In 33 patients with severe aortic stenosis and scheduled for surgery, the 'inner orifice' and 'outer fibrous' annulus diameter and area (with and without calcification) were measured, in addition to the distances of the calcifications and coronary ostia from the annulus, using by ECG-gated 64-slice MDCT. Aortic root calcification was evaluated as minimal (< 25% of total circumference), mild (25-50%), moderate (50-75%), and severe (75-100%).
The inner orifice annulus area was 5.9 +/- 1.9 cm2 (range: 1.4-10.1 cm2), while the outer fibrous area was 7.5 +/- 1.8 cm2 (range: 4.7-11.5 cm2). The proximal-to-distal extent of valve calcification from the annulus in the mid-center of leaflets was 0.8 +/- 0.26 cm. In 36% of patients, valvular calcification extended +/- 3 mm within the coronary-ostium level. The distance of the coronary ostia from the annulus was variable, with a mean of 1.3 +/- 0.35 cm (range: 0.6-2.4 cm) for the left coronary artery. In 42% of patients, a 'low coronary ostium' (< or = 1.1 cm), and in 6% a 'critical-low-coronary ostium' (< or = 8 mm) was identified. Annulus calcification was present in 100% of cases, but the severity varied widely (severe 50%, moderate 35%, mild 15%). In 36% of cases, the aortic annulus calcification extended caudally into the membranous part of the interventricular septum (and thus into the left ventricular outflow tract), and in 42% of cases (n = 14) into the anterior mitral valve leaflet.
The present results indicated that cardiac MDCT may qualify as a primary pre-procedural imaging modality to select patients for percutaneous AVR, based on the measurement and characterization of the aortic root and valve calcification. In comparison to echocardiography, CT will reduce--if not eliminate--difficulties in visualizing the aortic orifice area in heavily calcified valves. Furthermore, knowledge of the exact location of calcific deposits provides a distinct advantage to the fluroscopist for precise placement of the percutaneous aortic valve. Likewise, knowledge of the coronary arteries orifice in relation to the valve plane is critical to prevent inadvertent coronary artery occlusion, and would clearly be beneficial when planning future valve designs.
The Journal of heart valve disease 11/2009; 18(6):662-70. · 0.81 Impact Factor
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ABSTRACT: The purpose of this study was to compare 64-MDCT scanners from four vendors in the in vitro evaluation of coronary artery stents.
Twelve coronary artery stents (nominal outer diameter, 2.5-5.0 mm) oriented in the z-axis were placed in a combined cardiac-chest phantom and imaged with 64-MDCT scanners from four vendors. Quantitative image quality parameters, including artificial in-stent luminal narrowing, image noise, and artificial in-stent luminal attenuation were measured on longitudinal and axial reformations. Imaging of stents with a luminal diameter of 3 mm or less and that of stents with a diameter greater than 3 mm also were compared.
Artificial in-stent luminal narrowing was not different among the four vendors (range, 37-42%) on longitudinal reformations. Image noise inside the stent was significantly greater for one vendor (Siemens Healthcare; SD, 48 HU) than for the others (SD range, 21-26 HU) on longitudinal but not on axial images. For the same vendor, artificial in-stent luminal attenuation was significantly lower than for the other vendors. For all vendors, image noise inside the stent was significantly greater on axial than on longitudinal reformations (p < 0.001), and artificial luminal attenuation was significantly greater for all but one vendor (GE Healthcare). Stents 3 mm and narrower had significantly greater artificial luminal narrowing and artificial luminal attenuation (p < 0.05) than those with a diameter greater than 3 mm.
For longitudinal reformations, scanners from the four leading vendors do not differ in artificial luminal narrowing, but there are differences in artificial luminal attenuation and image noise. The quality of images of the in-stent lumen is better on longitudinal reformations and for stents with a diameter greater than 3 mm. Except for image noise, differences between axial and longitudinal reformations are vendor specific.
American Journal of Roentgenology 09/2009; 193(3):787-94. · 2.78 Impact Factor
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ABSTRACT: Real-time sonoelastography is a new ultrasound-based technique able to assess tissue elasticity that has already shown feasibility in tumor diagnosis. The aim of this study was to assess the performance of real-time sonoelastography in depicting the Achilles tendons of healthy volunteers and to compare sonoelastography findings with conventional ultrasound findings.
Eighty asymptomatic Achilles tendons of 40 healthy volunteers (19 men, 21 women; mean age, 38 years; range, 20-76 years) were examined on real-time sonoelastography and ultrasound. The Achilles tendons were divided into the following thirds for image evaluation: proximal (musculotendinous junction), middle (2-6 cm above insertion at the calcaneus), and distal (insertion at the calcaneus). Longitudinal and axial images of each tendon third were obtained using ultrasound and real-time sonoelastography. Real-time sonoelastography images were evaluated by reviewers using an experimentally proven color grading system.
The Achilles tendons showed mainly a hard structured pattern (86.7%) (208/240 tendon thirds) on sonoelastography; however, mild softening was found in 12.1% (29/240) of the tendons. Distinct softening corresponding to alterations found also on ultrasound and, therefore, suggesting subclinical changes was detected in 1.3% (3/240). The overall correlation (kappa) between real-time sonoelastography and ultrasound findings was 1.00.
In healthy volunteers, the Achilles tendon appeared hard on real-time sonoelastography with excellent correlation to ultrasound. Further investigation including pathologic tendons should be performed to prove the value of real-time sonoelastography in the assessment of Achilles tendinopathy.
American Journal of Roentgenology 09/2009; 193(2):W134-8. · 2.78 Impact Factor
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ABSTRACT: To evaluate a 100-kilovoltage (kV) tube voltage protocol regarding radiation dose and image quality, in comparison with the standard 120 kV setting in cardiac computed tomography angiography (CCTA).
103 patients undergoing retrospective ECG-gated helical 64-slice CCTA were enrolled (100 kV group: 51 patients; 120 kV group: 52 patients). Inclusion criteria were: (1) BMI <28 kg/m(2); (2) weight <85 kg; (3) coronary calcium score <300 Agatston Units (AU). Quantitative image quality parameters were calculated [image noise, contrast-to-noise ratio (CNR), intracoronary CT-attenuation (HU)]. Each coronary artery segment (AHA/ACC-16-segments-classification) was evaluated for image quality on a 4-point scale.
There was no statistical difference in age, gender, BMI and eff. tube current (mAs), and the use of ECG-tube current modulation (50.9% vs. 50% of patients) between both groups. 84.2% of patients in the 100 kV group had zero calcium score or less than 100 AU, the remaining had between 100 and 300 AU. The effective radiation dose was significantly lower in the 100 kV group with mean 7.1 mSv+/-2.4 (range, 3.4-11.1) compared to the 120 kV group with 13.4 mSv+/-5.2 (range, 6.3-22.7) (p<0.001) (dose reduction, 47%). In the 100 kV group, the use of ECG-dependent tube current modulation reduced the radiation exposure (by 44.8%) to 5.3 mSv+/-1.1 (range, 3.4-8.5 mSv) (p<0.001), the dose without was 9.6 mSv+/-1.1 (range, 6.3-11.1). Image noise in the coronary arteries was not different between both groups with 29.8 and 30.5 SD [HU], respectively. CNR in the 100 kV group was with 20.9+/-6.8 for the coronary arteries and with 19.9+/-5.9 for the aorta similar to the 120 kV group. Intraluminal CT-attenuation (HU) of the coronary arteries were higher in the 100 kV group (p<0.001). Image quality on 100 kV scans was excellent in 86.3%, good in 9.2%, acceptable in 3.1% of coronary segments; 1.4% were non-interpretable (in 1/4 due to increased image noise because of BMI >25 kg/m(2)).
The 100 kV protocol significantly reduces the radiation dose in CCTA in patients with a low BMI <25 kg/m(2) and a low calcium load while maintaining high image quality and the advantages of helical scan algorithm.
European journal of radiology 09/2009; 75(1):e51-6. · 2.65 Impact Factor
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The Journal of thoracic and cardiovascular surgery 08/2009; 138(1):234-6. · 3.41 Impact Factor
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ABSTRACT: The purpose of this study was to evaluate real-time sonoelastography in the assessment of the origins the common extensor tendon in healthy volunteers and in patients with symptoms of lateral epicondylitis. The findings were compared with those obtained at clinical examination, ultrasonography, and power Doppler sonography.
Thirty-eight elbows of 32 consecutively registered patients with symptoms of lateral epicondylitis and 44 asymptomatic elbows of 28 healthy volunteers were assessed with ultrasound and real-time sonoelastography. A clinical examination was performed, and pain was classified with a visual analog scale.
In healthy volunteers, real-time sonoelastographic images showed hard tendon structures in 96% of tendon thirds and mild alterations in 4%. Real-time sonoelastography of patients showed hard structures in 33% of tendon thirds but softening of different grades in 67%, a statistically significant difference in relation to the findings in healthy volunteers (p < 0.001). Lateral collateral ligament involvement and overlying fascial involvement were more commonly detected with real-time sonoelastography. The sensitivity of real-time sonoelastography was 100%, the specificity 89%, and the accuracy 94% with clinical examination as the reference standard. Good correlation with ultrasound findings was found (r > or = 0.900). No correlation was observed between ultrasound or real-time sonoelastographic findings and power Doppler sonographic findings, but power Doppler sonographic findings had a strong correlation with the visual analog scale score.
Real-time sonoelastography is valuable in the detection of the intratendinous and peritendinous alterations of lateral epicondylitis and facilitates differentiation between healthy and symptomatic extensor tendon origins with excellent sensitivity and excellent correlation with ultrasound findings.
American Journal of Roentgenology 07/2009; 193(1):180-5. · 2.78 Impact Factor
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ABSTRACT: To determine whether a recently available contrast-enhanced ultrasound (CEUS) technique using second-generation microbubbles allows for the detection of active sacroiliitis, and to measure CEUS enhancement depth at the dorsocaudal part of the sacroiliac (SI) joints in healthy volunteers compared with patients with sacroiliitis.
Forty-two consecutive patients (84 SI joints) presenting with a clinical diagnosis of sacroiliitis in 50 SI joints and 21 controls (42 SI joints) were investigated by CEUS using a standardized low mechanical index ultrasound protocol. Detected vascularity was used to retrospectively measure the enhancement depth in the dorsocaudal part of the SI joints.
CEUS detected enhancement in all clinically active SI joints, showing an enhancement depth into the dorsal SI joint cleft of 18.5 mm (range 16-22.1), which was significantly higher compared with both inactive joints of patients (3.6 mm, range 0-12; P < 0.001) and healthy controls (3.1 mm, range 0-7.8; P < 0.001). All inactive joints were correctly classified based on a lack of deep enhancement in patients with sacroiliitis and controls (42 of 42, 100% sensitivity, 100% specificity; Cohen's kappa = 1).
CEUS allowed the differentiation of active sacroiliitis from inactive SI joints, and proved to be a feasible method for the detection of vascularity in clinically active sacroiliitis by showing deep contrast enhancement into the SI joints not detectable in inactive joints of patients or controls. If this technique might add information to the earlier detection of sacroiliitis, it should be addressed in further studies.
Arthritis & Rheumatism 07/2009; 61(7):909-16. · 7.87 Impact Factor
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ABSTRACT: US guided procedures for diagnosis or treatment of different forms of arthritis are becoming more and more important. This review describes general considerations for fluid aspiration, articular or periarticular injections and biopsies by US guidance according to the recent literature. Guidelines regarding instrumentation, different techniques, pre- and postprocedural care as well as complications are outlined and in the second part a more detailed overview of different interventions in joints, tendons and other periarticular regions (nerves, bursae, etc.) is included. Furthermore, some newer, more sophisticated techniques are briefly discussed.
European journal of radiology 06/2009; 71(2):197-203. · 2.65 Impact Factor
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ABSTRACT: To assess the spectrum and clinical relevance of extracoronary findings in coronary CT angiography (CCTA), and to compare a small (cardiac) field of view (FOV) to a large (thoracic) FOV setting.
1084 consecutive patients (mean 57 years) with low-to-intermediate risk of coronary artery disease were enrolled. 542 CCTA scans were interpreted with small FOV (160-190mm(2)) encompassing the cardiac region. In another 542 CCTA (patients matched for age and gender), read-out of an additional full FOV (>320mm(2)) covering the thorax was performed. Clinical relevance of extracoronary findings was considered as either "significant" or "non-significant". "Significant" findings were subclassified as either score 1: findings necessitating immediate therapeutic actions, or score 2: findings with undoubted clinical or prognostic relevance, requiring clinical awareness, follow-up or further investigations (non-urgent). "Non-significant" findings were assigned to either score 3: findings not requiring follow-up or further tests, or as score 4: irrelevant incidental findings.
Significantly more patients with extracoronary findings were identified by using a full FOV with 43.2% (234/542) compared to a small FOV with 33.6% (182/542) (p=0.001). Similarly, a higher total number of extracoronary findings (n=394) was found on full FOV compared to small FOV (n=250) (p<0.001). The detection rate of clinically significant findings was higher by using full FOV compared to small FOV (25.6% versus 15.4%) (p<0.001), out of those 2.2% versus 1.8% of findings required immediate actions (score 1), and 23.4% versus 13.6% (p=0.0001), respectively were of clinical relevance (non-urgent, score 2). The rate of malign findings was 0.2%, and of acute pulmonary embolism 0.1%. More lung pathologies were observed by using full FOV compared to small FOV (22% versus 7%) (p<0.0001), and the detection rate of intrapulmonary nodules increased by 2.1%. Prevalence of aortic valve calcification (n=72) was 13.3%, out of those 7% had less than 2cm(2) aortic valve orifice area.
The interpretation of extracoronary findings on CCTA scans is mandatory given high prevalence of clinically significant findings by using a full "thoracic" FOV.
European journal of radiology 03/2009; 74(1):166-74. · 2.65 Impact Factor
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Gudrun M Feuchtner,
Paul Stolzmann,
Wolfgang Dichtl,
Thomas Schertler,
Johannes Bonatti,
Hans Scheffel,
Silvana Mueller,
André Plass,
Ludwig Mueller,
Thomas Bartel,
Florian Wolf,
Hatem Alkadhi
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ABSTRACT: The aim of this study was to assess the value of multislice computed tomography (CT) for the assessment of valvular abnormalities in patients with infective endocarditis (IE) in comparison with transesophageal echocardiography (TEE) and intraoperative findings.
Multislice CT has recently shown promising data regarding valvular imaging in a 4-dimensional fashion.
Thirty-seven consecutive patients with clinically suspected IE were examined with TEE and 64-slice CT or dual-source CT. Twenty-nine patients had definite IE and underwent surgery.
The diagnostic performance of CT for the detection of evident valvular abnormalities for IE compared with TEE was: sensitivity 97%, specificity 88%, positive predictive value (PPV) 97%, and negative predictive value (NPV) 88% on a per-patient basis (n = 37; excellent intermodality agreement kappa = 0.84). CT correctly identified 26 of 27 (96%) patients with valvular vegetations and 9 of 9 (100%) patients with abscesses/pseudoaneurysms compared with the intraoperative specimen. On a per-valve-based analysis, diagnostic accuracy for the detection of vegetations and abscesses/pseudoaneurysms compared with surgery was: sensitivity 96%, specificity 97%, PPV 96%, NPV 97%, and sensitivity 100%, specificity 100%, PPV 100%, NPV 100%, respectively, without significant differences as compared with TEE. Vegetation size measurements by CT correlated (r = 0.95; p <0.001) with TEE (mean 7.6 +/- 5.6 mm). The mobility of vegetations was accurately diagnosed in 21 of 22 (96%) patients with CT, but all of 4 leaflet perforations (<or=2 mm) were missed. CT provided more accurate anatomic information regarding perivalvular extent of abscess/pseudoaneurysms than TEE.
Multislice CT shows good results in detecting valvular abnormalities in IE and could be applied in pre-operative planning and exclusion of coronary artery disease before surgery.
Journal of the American College of Cardiology 02/2009; 53(5):436-44. · 14.16 Impact Factor
