H Keck

Publications (79)127.85 Total impact

• Article: Changes at the extracellular matrix during acute and chronic rejection in human liver transplantation

  A.R. Mueller, K.P. Platz, B. Gebauer, C. Schmidt, H. Keck, H. Lobeck, P. Neuhaus
  [show abstract] [hide abstract]
  ABSTRACT: Abstract We have previously observed changes at the extracellular matrix (ECM) which significantly correlated with the extent of preservation and reperfusion injury. In the present study, we attempted to investigate whether the ECM may be also involved in the pathophysiological sequelae of acute and chronic rejection. Of 81 patients monitored for the ECM parameters laminin, hyaluronic acid, fibronectin receptor, and transforming growth factor (TGF)-β 28 patients developed acute rejection (<1 month), in 14 patients (17.4%) acute rejection was steroid resistant, 4 patients (4.5 %) developed early chronic rejection following acute steroiD-resistant rejection. Acute and chronic rejection were confirmed by established clinical and histological criteria. Laminin levels were significantly increased in patients experiencing acute steroiD-resistant rejection (4204 ± 133 ng/ml; P≤ 0.01) compared with patients with steroiD-sensitive rejection (1059 ± 27.3 ng/ml) and with an uneventful postoperative course (1214 ± 17.4 ng/ml). No increase in laminin was observed in those four patients who developed early chronic rejection (1099 ± 58.7 ng/ml). Hyaluronic acid, fibronectin receptor, and TGF-β levels also increased in patients with acute steroiD-resistant rejection; hyaluronic acid: 290 ± 10.8 μg/1 vs 154 ± 13.6 μg/1 and 131 ± 11.7 μg/1 in patients with steroiD-sensitive and no rejection, respectively; fibronectin receptor: 1003 ± 23.5 ng/ml vs 573 ± 24.8 ng/ml and 428 ± 13.6 ng/ml in patients with steroiD-sensitive and no rejection, respectively; and TGF-β: 393 ± 14.9 pg/ml versus 315 ± 10.7 pg/ml and 233 ± 8.9 pg/ml in patients with steroiD-sensitive and no rejection, respectively. A further increase in hyaluronic acid levels was observed in patients who developed early chronic rejection, while fibronectin receptor and TGF-β levels remained low, similarly to laminin levels. The increase in laminin, hyaluronic acid, fibronectin receptor, and TGF-β during acute steroiD-resistant rejection may be stimulated by the rejection-related release of cytokines and adhesion molecules which paralleled the increase in ECM parameters. The lack of increase in laminin and fibronectin receptor levels in those patients who developed early chronic rejection may reflect an inability to recover from acute rejection.
  Transplant International 06/2008; 11(S1):S377 - S382. · 2.92 Impact Factor
• Article: Traumatic disruption of the proximal hepatic duct: endoscopic treatment after failure of surgical repair.

  S C Schmidt, A Adler, H Keck, W Veltzke-Schlieker, R E Hintze, J M Langrehr
  Endoscopy 01/2005; 36(12):1128-9. · 5.21 Impact Factor
• Article: [Partial hepatectomy after post-traumatic liver abscess].

  S C Schmidt, M Knoop, H Keck
  [show abstract] [hide abstract]
  ABSTRACT: Post-traumatic pyogenic liver abscess is a rare disease. We present the case of a 38-year-old man with multilocular liver abscess and pleural empyema following blunt abdominal trauma. The patient had a prodrome lasting 3 months before presenting in our department. The therapy included partial hepatectomy and pleural drainage. Clinical signs, diagnosis and possible therapy are discussed in this case report.
  Der Chirurg 10/1998; 69(9):985-8. · 0.70 Impact Factor
• Article: Incidence and risk factors of prolonged mechanical ventilation and causes of reintubation after liver transplantation.

  M Glanemann, J M Langrehr, A R Müller, K P Platz, O Guckelberger, B Stange, U Neumann, R Raakow, H Keck, U Settmacher, W O Bechstein, P Neuhaus
  Transplantation Proceedings 09/1998; 30(5):1874-5. · 1.00 Impact Factor
• Article: Anti-IL-2 receptor BT563 versus placebo: a randomized trial for induction therapy after liver transplantation.

  M Glanemann, J M Langrehr, R Raakow, O Guckelberger, R Lohmann, J Klupp, H Lobeck, H Schlag, H Keck, W O Bechstein, U Settmacher, P Neuhaus
  Transplantation Proceedings 09/1998; 30(5):2159-60. · 1.00 Impact Factor
• Article: A randomized, placebo-controlled trial with anti-interleukin-2 receptor antibody for immunosuppressive induction therapy after liver transplantation.

  J M Langrehr, M Glanemann, O Guckelberger, J Klupp, U Neumann, C Machens, R Lohmann, M Knoop, H Lobeck, H Schlag, H Keck, U Settmacher, W O Bechstein, P J Neuhaus
  [show abstract] [hide abstract]
  ABSTRACT: The introduction of quadruple induction therapy after liver transplantation with the murine anti-interleukin-2 receptor (IL-2R) antibody (BT563) has decreased the incidence of serious side effects, such as tachycardia, hypertension, rash, fever and nausea since it does not lyse its target cell. To investigate the immunosuppressive efficacy of BT563, a placebo-controlled trial was performed and BT563 was added to the standard triple induction after liver transplantation. Forty consecutive recipients of primary orthotopic liver transplants (OLT) (median age 47 yr [range 18-65]) were randomized. All patients received triple immunosuppression with cyclosporine A (CyA), prednisolone (PRED) and azathioprine (AZA). In addition, 19 patients received BT563 (Biotest, Dreieich, Germany) at a dose of 10 mg/d from day 0 until day 12. The remaining 21 patients received a placebo infusion at the same days after transplantation. Minimal follow-up for all patients was 3 yr. Patient survival at 3 yr was 74% in the BT563 group and 90% in placebo group. Similar results were observed for graft survival. Two acute rejection episodes were detected in the BT563 group and 9 acute rejections (5 steroid-resistant) were observed in the placebo group (p < 0.034). The incidences of sepsis, pneumonia, cholangitis, urinary tract infections as well as cytomegalo-virus (CMV) infections were similar in both groups. Side effects of the BT563 therapy and/or post-transplant lymphoproliferative disease (PTLD) were not detected. Quadruple induction therapy with BT563 significantly reduces the incidence of rejection episodes after liver transplantation, while infectious complications and/or PTLD is not increased. Therefore, the anti-IL2 receptor antibody BT563 constitutes a safe and efficient addition to the immunosuppressive induction regimen following OLT.
  Clinical Transplantation 08/1998; 12(4):303-12. · 1.67 Impact Factor
• Article: Initially unresectable hilar cholangiocarcinoma: hepatic regeneration after transarterial embolization.

  T J Vogl, J O Balzer, K Dette, R Hintze, W Pegios, J Mäurer, H Keck, P Neuhaus, R Felix
  [show abstract] [hide abstract]
  ABSTRACT: To assess with volumetric computed tomography (CT) the pattern and extent of hepatic regeneration induced with transarterial embolization of initially unresectable hilar cholangiocarcinoma (Klatskin tumor). In this prospective study, 13 patients (four men, nine women) with hilar cholangiocarcinoma, aged 43-74 years (mean +/- 1 standard deviation, 59.9 years +/- 9.6), underwent preoperative embolization of the right hepatic lobe. Embolization was performed transarterially by using four to 15 embolization coils. Volumetric measurements of the entire liver, left hepatic lobe, and spleen were performed with contrast material-enhanced and unenhanced helical CT before and after embolization in all patients. After right lobe embolization, volumetric helical CT measurements revealed a 2%-33% decrease (mean, 10%) in the volume of the affected right hepatic lobe, an 11%-68% increase (mean, 37%) in the volume of left hepatic lobe parenchyma, and variations in splenic volume of -5% to +28% (mean, +11%). Nine patients underwent extended hepatectomy 27-75 days (mean, 44 days) after embolization. No patient had severe complications due to embolization. In patients with an initially unresectable bilateral Klatskin tumor, right lobar arterial coil embolization results in enlargement of the left hepatic lobe (as verified with volumetric helical CT), thus allowing right hemihepatectomy.
  Radiology 08/1998; 208(1):217-22. · 5.73 Impact Factor
• Article: A randomized trial comparing anti-interleukin-2 receptor antibody and placebo for immunosuppressive therapy after OLT.

  J M Langrehr, M Glanemann, A Schneller, U Neumann, O Guckelberger, R Lohmann, J Klupp, S Jonas, M Knoop, H Lobeck, H Schlag, H Keck, U Settmacher, W O Bechstein, P J Neuhaus
  Transplantation Proceedings 07/1998; 30(4):1445-6. · 1.00 Impact Factor
• Article: Partial or total resection of the biliary tract — Surgical strategies for hilar cholangiocarcinoma

  S. Jonas, W. O. Bechstein, H. Keck, W. Veltzke, R. Hintze, T. Vogl, P. Neuhaus
  [show abstract] [hide abstract]
  ABSTRACT: Background: Surgical resection provides the only chance of cure for patients suffering from hilar cholangiocarcinoma. Although appropriate procedures are not agreed upon, an increase in radicality has been observed during the past 20 years. Methods: The literature as well as our own experience after 80 resections of hilar cholangiocarcinomas were reviewed retrospectively. Results: Tumor-free margins represent the most important prognostic parameter. Hilar resections as least radical resective procedure will generate rates of formally curative resections of less than 50%. Curative resection and 5-year survival rates after additional hemihepatectomy generally do not exceed 65% and 25% in the more promising reports, respectively. In our series, the best 5-year survival rate was achieved after right trisegmentectomy with 59%. After conventional liver transplantation, 5-year survivors can only exceptionally be observed. Although extended bile duct resection or abdominal organ cluster transplantation may significantly increase the rate of formally curative resections, long term survival is still disappointing. Conclusions: In our hands, right trisegmentectomy will provide the most pronounced benefit, if this procedure is applicable with respect to tumor extension and functioning hepatic reserve. Extended bile duct resections cannot be evaluated definitely at this stage. However, patterns of recurrence clearly demonstrate the need for adjuvant treatment protocols. Grundlagen: Resektionen stellen die einzigen potentiell kurativen Therapieoptionen beim zentralen Gallengangskarzinom dar. In den vergangenen 20 Jahren konnte eine Zunahme der Radikalität in der chirurgischen Therapie beobachtet werden, ohne daß einheitliche Therapiekonzepte bestünden. Methodik: Retrospektive Untersuchung der Literatur sowie unserer eigenen Erfahrung nach 80 Resektionen zentraler Gallengangskarzinome. Ergebnisse: Formal kurative Resektabilität stellt den wichtigsten Prognosefaktor dar. Hilusresektionen als Verfahren mit der geringsten Radikalität sind in weniger als 50% der Fälle formal kurativ. Die Raten formal kurativer Resektionen sowie des 5-Jahres-Überlebens nach zusätzlicher Hemihepatektomie übersteigen auch in günstigeren Serien in der Regel 65% bzw. 25% nicht. Im eigenen Krankengut wurde mit 59% die höchste 5-Jahres-Überlebensrate nach rechtsseitiger Trisegmentektomie beobachtet. Nach konventioneller Lebertransplantation kommt es nur in Ausnahmefällen zu einem Langzeitüberleben. Erweiterte Gallengangsresektionen sowie auch abdominelle „Cluster-Transplantationen“ können zwar die Rate formal kurativer Resektionen signifikant steigern, führen aber nicht zu einer höheren 5-Jahres-Überlebensrate. Schlußfolgerungen: Nach unserer Erfahrung können die günstigsten Ergebnisse nach Trisegmentektomien beobachtet werden, wenn Tumorausmaß oder Parenchymreserve diese Verfahrenswahl zulassen. Erweiterte Gallengangsresektionen können derzeit nicht abschließend beurteilt werden. Das Rezidivmuster verdeutlicht die Notwendigkeit adjuvanter Therapieansätze.
  European Surgery 04/1998; 30(4):211-214. · 0.28 Impact Factor
• Article: Leberteilresektion nach posttraumatischem Leberabsceß

  S. C. Schmidt, M. Knoop, H. Keck
  [show abstract] [hide abstract]
  ABSTRACT: Der posttraumatische pyogene Leberabsceß ist ein seltenes Krankheitsbild. Wir stellen den Fall eines 38 jährigen Patienten vor, der sich 3 Monate nach einem stumpfen Bauchtrauma mit einem ausgedehnten, multiloculären Leberabsceß und rechtsseitigem Pleuraempyem in unserer Klinik vorstellte. Die definitive Therapie bestand aus einer Hemihepatektomie rechts und Pleuradrainage. Symptomatik, Diagnose und die verschiedenen therapeutischen Möglichkeiten werden anhand dieses Fallberichts erörtert. Post-traumatic pyogenic liver abscess is a rare disease. We present the case of a 38-year-old man with multilocular liver abscess and pleural empyema following blunt abdominal trauma. The patient had a prodrome lasting 3 months before presenting in our department. The therapy included partial hepatectomy and pleural drainage. Clinical signs, diagnosis and possible therapy are discussed in this case report.
  Der Chirurg 04/1998; 69(9):985-988. · 0.70 Impact Factor
• Article: [Results of laparoscopic fundoplication for treatment of gastroesophageal reflux].

  R Raakow, J Langrehr, H Keck, P Neuhaus
  [show abstract] [hide abstract]
  ABSTRACT: We report on 48 patients, treated by laparoscopic fundoplication for pronounced gastroesophageal reflux disease. The results show that laparoscopic fundoplication is a very safe, gentle, and successful procedure for the therapy of gastroesophageal reflux disease. We regard laparoscopic fundoplication as a good alternative to long term medical therapy if a careful diagnosis and indication is provided.
  Langenbecks Archiv für Chirurgie. Supplement. Kongressband. Deutsche Gesellschaft für Chirurgie. Kongress 02/1998; 115:1526-8.
• Article: [Extended partial Kausch-Whipple duodenopancreatectomy by resection of tumor infiltrated vascular segments].

  J M Langrehr, T Steinmüller, V Henneken, H Keck
  [show abstract] [hide abstract]
  ABSTRACT: The experience with standard Kausch-Whipple procedure is reviewed and compared with partial duodenopancreatectomies extended by partial resection of the portal vein. Perioperative morbidity has decreased to below 5% and survival rates with and without vessel resection are not significantly different. Therefore, infiltration of mesentericoportal vessels is not a contraindication for Kausch-Whipple procedure.
  Langenbecks Archiv für Chirurgie. Supplement. Kongressband. Deutsche Gesellschaft für Chirurgie. Kongress 02/1998; 115:1338-40.
• Article: Effective therapy for hepatic M. Osler with systemic hypercirculation by ligation of the hepatic artery and subsequent liver transplantation.

  U P Neumann, M Knoop, J M Langrehr, H Keck, W O Bechstein, H Lobeck, T Vogel, P Neuhaus
  [show abstract] [hide abstract]
  ABSTRACT: Hereditary hemorrhagic teleangiectasia, or M. Osler (Osler-Weber-Rendu disease), is an autosomal dominant, systemic fibrovascular dysplasia. This may lead to increased liver blood flow from arteriovenous fistulas. A 45-year-old woman with a known M. Osler was admitted for liver transplantation. On admission, exertional dyspnea was the predominant symptom. Radiological investigations revealed multiple intrahepatic arteriovenous fistulas and consecutive high-output heart failure. Laboratory findings revealed remarkably elevated bilirubin and alkaline phosphatase. To alleviate the high-output cardiac failure, the hepatic artery was ligated. Fourteen months later, the patient presented again with increased levels of bilirubin and recurrent bleeding episodes from esophageal varices grade IV. The patient underwent liver transplantation and post-transplant recovery was excellent. A hyperdynamic circulatory state due to a hepatic M. Osler has been treated in several cases by ligation or embolization of the hepatic artery. This procedure, however, is recommended only for patients with normal liver function and carries a considerably risk of bile duct necrosis.
  Transplant International 02/1998; 11(4):323-6. · 2.92 Impact Factor
• Article: Orthotopic liver transplantation after extended bile duct resection as treatment of hilar cholangiocarcinoma. First long-terms results.

  S Jonas, N Kling, O Guckelberger, H Keck, W O Bechstein, P Neuhaus
  [show abstract] [hide abstract]
  ABSTRACT: Although the surgical treatment of hilar cholangiocarcinoma represents the only potentially curative option, survival figures remain low over the long term. After hilar and partial hepatic resections for hilar cholangiocarcinoma, loco-regional tumor recurrence appears as the primary site of failure. From April 1992 to April 1996, 14 patients underwent extended bile duct resections. Extended bile duct resections combine total hepatectomy, partial pancreatoduodenectomy, and liver transplantation in an attempt to eradicate the entire biliary tract without dissecting the hepatoduodenal ligament. The postoperative 60-day mortality rate was 14% (n = 2). The rate of curative resections was 93% (13 of 14 extended bile duct resections). One- and 4-year survival rates after curative resections were 56% and 30%, respectively. The rate of curative resections increased by combining total hepatectomy, partial pancreatoduodenectomy, and liver transplantation, i.e., extended bile duct resection. However, survival figures have not improved accordingly. Therefore, this extended surgical procedure has to be implemented with caution and possibly not without modifications (e.g., multimodal treatment).
  Transplant International 02/1998; 11 Suppl 1:S206-8. · 2.92 Impact Factor
• Article: Changes at the extracellular matrix during acute and chronic rejection in human liver transplantation.

  A R Mueller, K P Platz, B Gebauer, C Schmidt, H Keck, H Lobeck, P Neuhaus
  [show abstract] [hide abstract]
  ABSTRACT: We have previously observed changes at the extracellular matrix (ECM) which significantly correlated with the extent of preservation and reperfusion injury. In the present study, we attempted to investigate whether the ECM may be also involved in the pathophysiological sequelae of acute and chronic rejection. Of 81 patients monitored for the ECM parameters laminin, hyaluronic acid, fibronectin receptor, and transforming growth factor (TGF)-beta, 28 patients developed acute rejection (< 1 month), in 14 patients (17.4%) acute rejection was steroid resistant, 4 patients (4.5%) developed early chronic rejection following acute steroid-resistant rejection. Acute and chronic rejection were confirmed by established clinical and histological criteria. Laminin levels were significantly increased in patients experiencing acute steroid-resistant rejection (4204 +/- 133 ng/ml; P < or = 0.01) compared with patients with steroid-sensitive rejection (1059 +/- 27.3 ng/ ml) and with an uneventful postoperative course (1214 +/- 17.4 ng/ml). No increase in laminin was observed in those four patients who developed early chronic rejection (1099 +/- 58.7 ng/ml). Hyaluronic acid, fibronectin receptor, and TGF-beta levels also increased in patients with acute steroid-resistant rejection; hyaluronic acid: 290 +/- 10.8 micrograms/l vs 154 +/- 13.6 micrograms/l and 131 +/- 11.7 micrograms/l in patients with steroid-sensitive and no rejection, respectively; fibronectin receptor: 1003 +/- 23.5 ng/ml vs 573 +/- 24.8 ng/ml and 428 +/- 13.6 ng/ ml in patients with steroid-sensitive and no rejection, respectively; and TGF-beta: 393 +/- 14.9 pg/ml versus 315 +/- 10.7 pg/ml and 233 +/- 8.9 pg/ml in patients with steroid-sensitive and no rejection, respectively. A further increase in hyaluronic acid levels was observed in patients who developed early chronic rejection, while fibronectin receptor and TGF-beta levels remained low, similarly to laminin levels. The increase in laminin, hyaluronic acid, fibronectin receptor, and TGF-beta during acute steroid-resistant rejection may be stimulated by the rejection-related release of cytokines and adhesion molecules which paralleled the increase in ECM parameters. The lack of increase in laminin and fibronectin receptor levels in those patients who developed early chronic rejection may reflect an inability to recover from acute rejection.
  Transplant International 01/1998; 11 Suppl 1:S377-82. · 2.92 Impact Factor
• Article: Liver transplantation in HBsAg+ patients with postoperative immunoprophylaxis.

  J M Langrehr, O Guckelberger, U Neumann, T Berg, H Schrem, B Kratschmer, M Knoop, T Steinmüller, H P Lemmens, H Keck, W O Bechstein, R Neuhaus, U Hopf, P Neuhaus
  Transplantation Proceedings 12/1997; 29(7):2841-2. · 1.00 Impact Factor
• Article: A prospective randomized trial comparing interleukin-2 receptor antibody versus antithymocyte globulin as part of a quadruple immunosuppressive induction therapy following orthotopic liver transplantation.

  J M Langrehr, N C Nüssler, U Neumann, O Guckelberger, R Lohmann, A Radtke, S Jonas, J Klupp, T Steinmüller, H Lobeck, S Meuer, H Schlag, H P Lemmens, M Knoop, H Keck, W O Bechstein, P Neuhaus
  [show abstract] [hide abstract]
  ABSTRACT: Quadruple immunosuppressive induction therapy has been shown to markedly reduce the incidence of acute rejection episodes without increasing the incidence of infectious complications after liver transplantation. However, the use of polyclonal antibody preparations (e.g. antithymocyte globulin [ATG]) is associated with side effects such as fever and tachycardia. To evaluate the efficacy and the safety of a monoclonal antibody directed against the interleukin-2 receptor (BT563) in comparison with ATG as part of a quadruple induction regimen, a prospective, randomized study was conducted. Eighty consecutive adult recipients of primary orthotopic liver transplants were randomized to receive either BT563 (10 mg/day; days 0-12; n=39) or ATG (5 mg/kg/day; days 0-6; n=41) in addition to the standard immunosuppressive protocol consisting of cyclosporine, and prednisolone, and azathioprine. Patients treated with BT563 had a significantly lower incidence of steroid-sensitive rejection episodes (3 vs. 11; P<0.025) and also significantly fewer drug-related side effects (4 vs. 18, P<0.038) when compared with patients treated with ATG. The incidence of infectious complications was not different between the two groups. Patient survival did not differ significantly between the two groups (84.6% at 1, 2, and 3 years in the BT563 group and 90.2% at 1 year and 87.8% at 2 and 3 years for the ATG group). Analysis of graft function showed an advantage for the BT563 group in terms of postoperative bilirubin levels. However, no differences were observed in long-term follow-up between the two groups. Our results indicate that treatment with anti-interleukin-2 receptor antibody as part of quadruple induction therapy after orthotopic liver transplantation is safe and effective and shows fewer steroid-sensitive rejection episodes as well as fewer side effects when compared with quadruple induction therapy including ATG.
  Transplantation 07/1997; 63(12):1772-81. · 4.00 Impact Factor
• Article: Mycophenolate mofetil added to immunosuppression after liver transplantation--first results.

  J Klupp, W O Bechstein, K P Platz, H Keck, H P Lemmens, M Knoop, J M Langrehr, R Neuhaus, J Pratschke, P Neuhaus
  [show abstract] [hide abstract]
  ABSTRACT: Mycophenolate mofetil (MMF) has been used successfully as an immunosuppressive agent after kidney and heart transplantation, but experience with MMF after liver transplantation is still limited. Between August 1995 and January 1996, we treated 20 patients with MMF after orthotopic liver transplantation in an open, prospective study. Five out of eight patients with acute rejection and one patient with early chronic rejection showed a complete response after MMF was added to the immunosuppression. Three patients with chronic rejection did not improve, one died, and two have stable graft function at present. In eight patients who suffered from toxicity, a reduction in the dosage of tacrolimus was attempted with simultaneous MMF therapy. One patient died due to multiple organ failure. Liver function improved completely in one other patient, and partially in three patients after adding MMF. In the remaining three patients, a reduced dosage of tacrolimus or cyclosporin, together with MMF, reduced toxicity, not significantly. In conclusion, MMF appears to be a safe and potentially useful adjuvant immunosuppressive agent for rescue and maintenance therapy.
  Transplant International 02/1997; 10(3):223-8. · 2.92 Impact Factor
• Article: [Outcome of primary surgical management of liver trauma].

  J M Langrehr, S Buchen, C von Fournier, A Tempka, H Keck, P J Neuhaus
  [show abstract] [hide abstract]
  ABSTRACT: We evaluated retrospectively 43 patients with liver trauma undergoing laparotomy between 1/89 and 12/95. Blunt trauma (27 patients) and penetrating trauma (16 patients) to the liver had a mortality of 37% and 0%, respectively. The overall mortality was 23.3% and was significantly related to concomitant injuries (p = 0.002), whereas age, severity of the liver trauma as well as the surgical treatment had no significant influence on the outcome.
  Langenbecks Archiv für Chirurgie. Supplement. Kongressband. Deutsche Gesellschaft für Chirurgie. Kongress 01/1997; 114:1247-8.
• Article: Superparamagnetic iron oxide--enhanced versus gadolinium-enhanced MR imaging for differential diagnosis of focal liver lesions.

  T J Vogl, R Hammerstingl, W Schwarz, M G Mack, P K Müller, W Pegios, H Keck, A Eibl-Eibesfeldt, J Hoelzl, B Woessmer, C Bergman, R Felix
  [show abstract] [hide abstract]
  ABSTRACT: To assess AMI-25- versus gadolinium-enhanced magnetic resonance (MR) imaging in the differential diagnosis of liver tumors. Twenty-nine patients with liver tumors underwent unenhanced, AMI-25-enhanced (15 micromol/kg), and gadolinium-enhanced(0.1 mmol/kg) imaging within 2 weeks. A significant (P< .05) difference in percentage signal intensity loss (PSIL) was seen in benign tumors on AMI-25-enhanced proton-density-weighted images (nine focal nodular hyperplasia [FNH], 41%; one adenoma, 32.4%) versus malignant tumors. Gadolinium-enhanced T1-weighted gradient-echo images showed strong enhancement in benign lesions (seven FNH, 147.5%; one adenoma, 91.3%) and moderate enhancement in malignant tumors (eight hepatocellular carcinomas, 116.2%, 11 metastases, 39.7%). Receiver operating characteristic analysis revealed a threshold PSIL of 10% on AMI-25-enhanced images as the most essential criteria to distinguish benign from malignant lesions (sensitivity, 88%; specificity. 89%). Interobserver analysis for two observers revealed specificity of 93% for AMI-25-enhanced imaging versus 81.5% for gadolinium-enhanced MR imaging. AMI-25 decreased the SI of benign tumors and helped differentiate benign from malignant tumors.
  Radiology 03/1996; 198(3):881-7. · 5.73 Impact Factor