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ABSTRACT: PURPOSE: To evaluate the technical and clinical success rates of percutaneous stent revascularization in the treatment of chronic mesenteric ischemia (CMI). PATIENTS AND METHODS: 17 patients (12 female) with typical symptoms of CMI were treated by percutaneous stent placement for stenoses of the splanchnic arteries (celiac trunk; superior mesenteric artery, SMA; inferior mesenteric artery, IMA). The primary and secondary technical success, primary and secondary clinical success, and the long-term clinical outcome were determined. RESULTS: A total of 24 stents were implanted in 21 splanchnic arteries (12 stents in the celiac trunk, 11 in the SMA and 1 in the IMA). The primary technical success rate was 91 % (19 / 21 arteries), the secondary technical success rate was 95 % (21 / 22 arteries). Clinical follow-up was available for 16 patients. The primary clinical success rate was 81 % (13 / 16 patients). Following two secondary interventions, the secondary clinical success rate was 94 % (15 / 16 patients). Long-term clinical success was achieved in 15 of 16 patients (94 %) with a mean follow-up of 26 months. One patient died within 30 days of the intervention and two patients demonstrated major complications (1 dissection, 1 stent dislocation). None of the patients required surgical revascularization and none of the patients died due to recurrent mesenteric ischemia. CONCLUSION: Percutaneous stent placement for the treatment of CMI can be performed with a high technical and clinical success rate as well as an excellent long-term clinical outcome.
RöFo - Fortschritte auf dem Gebiet der R 10/2008; · 2.76 Impact Factor
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ABSTRACT: The objective of this retrospective study was to evaluate the outcome of patients with acute necrotizing pancreatitis treated by active percutaneous necrosectomy. By searching the radiological, surgical and internal medicine databases, all patients with acute necrotizing pancreatitis treated by active percutaneous necrosectomy between 1992 and 2004 were identified. Demographic, laboratory, and clinical data, and details about invasive procedures were collected by reviewing patient charts, radiological and surgical reports. The computed tomography severity index (CTSI) scores were determined by reviewing CT images. Eighteen patients were identified. Median Ranson score on admission was 2. The Acute Physiology and Chronic Health Evaluation (APACHE) II score was median 22. Median CTSI score was 7. Initially all patients were treated with CT-guided drainage placement. Because passive drainage proved not to be effective, subsequent minimally invasive, percutaneous necrosectomy was performed. Eight out of 18 patients recovered fully without the need for surgery. Ten of 18 patients required additional surgical necrosectomy. For one of ten patients, percutaneous necrosectomy allowed postponing surgery by 39 days. Four of ten surgically treated patients died: three from septic multiorgan failure, one from pulmonary embolism. Percutaneous minimally invasive necrosectomy can be regarded as a safe and effective complementary treatment modality in patients with necrotizing pancreatitis. It is suitable for a subset of patients to avoid or delay surgery.
European Radiology 09/2008; 18(8):1604-10. · 3.22 Impact Factor
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S M Klein,
L Prantl,
A Berner,
S Schreml,
T Schubert,
J Rennert,
C Fellner,
A Stopfer,
P Angele,
A G Schreyer,
C I Schreyer, S Feuerbach,
E M Jung
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ABSTRACT: Increasing numbers of patients request lipolytic injection therapy for aesthetic indications. However, only the clinical results of these therapies have been published to date. In most cases, pre- and postprocedure photographs and measurements have been presented. As with every other medical procedure, it is necessary to ensure that the results of lipolytic injections are quantified on an objective and scientific basis with comparable data.
In the past, the size of fat tissue could not be measured properly with conventional ultrasound systems. High-resolution, real-time three-dimensional (RT-3D) ultrasound is a fairly new method for measuring the volume of tissue. Therefore, this study aimed to measure the interscapular fat bodies of New Zealand rabbits before and after lipolytic therapy with Lipostabil, phosphatidycholine and orciprenalin (Alupent).
The ultrasound-controlled injection of the lipolytic substances into the interscapular fat body ensured a precise injection. The RT-3D ultrasound data were compared with the magnetic resonance imaging (MRI) measurements performed at the same time. The greatest decrease in volume, up to 44%, was measured with orciprenalin (Alupent). There was a significant correlation between the data from ultrasound imaging and MRI.
The data suggest that RT-3D ultrasound imaging could be a simple and fast method for proving the effects on volume size after lipolytic procedures. Of the three investigated substances, orciprenalin (Alupent) showed the highest lipolytic effect in our animal model.
Aesthetic Plastic Surgery 08/2008; 32(4):667-72; discussion 673-4. · 1.41 Impact Factor
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RöFo - Fortschritte auf dem Gebiet der R 08/2008; 180(8):757-8. · 2.76 Impact Factor
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ABSTRACT: To evaluate the value of vascular ultrasound determining the pre-interventional degree of distal stenosis in the extracranial internal carotid artery (ICA) by means of color-coded duplex sonography (CCDS) and B-flow. Comparison with contrast-enhanced 64-line CT angiography (CTA), contrast-enhanced MRA (ceMRA) and digital subtraction angiography (DSA).
Complementary diagnostics and evaluation of the stenosis by means of CCDS, B-flow, CTA, ceMRA and DSA were performed prior to percutaneous stent-assisted PTA in 21 symptomatic ICA stenosis. Ultrasound diagnostics were carried out with high-resolution linear transducers (5-10 MHz and 9-14 MHz). A bolus-triggered contrast-enhanced multislice CTA (collimation 64x0.5 mm) and a ceMRA (1.5 Tesla) as well as selective DSA were performed in every patient. The degree of distal stenosis was established in accordance to NASCET criteria by averaging 5 single measurements per modality and patient. The source images as well as MPR and MIP reconstructions were evaluated in the CTA and ceMRA. Hemodynamic flow parameters were determined with CCDS and B-flow. The images were assessed by two experienced readers in consensus.
The extent of stenosis ranged from 45 to 95%, averaging 73% (+/-13%). There was a high degree of agreement between the B-flow results (r=0.938), the CCDS (r=0.852), the measurements from the source data of the ceMRA (r=0.9117) and reconstructions of the CTA (r=0.8598) compared to quantitative DSA as a reference technique.
Compared to selective DSA, vascular ultrasound in combination with CTA and ceMRA increase the reliability of the diagnostic quantification of ICA stenosis.
Ultraschall in der Medizin 07/2008; 29(3):294-301. · 2.40 Impact Factor
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ABSTRACT: Intestinal ischemia is the prime vascular emergency for the visceral surgeon. However, the diagnosis of mesenteric ischemia is difficult, the surgical options are often limited and the overall outcome is generally poor.
We report on a single center series of 83 patients undergoing surgery for mesenteric ischemia during a 3-year period. Risk factors, clinical presentation, type and timing of imaging studies and their implications for surgical therapy and outcome are analyzed.
Hypertension and diabetes were the most common risk factors (68/64% of all patients). Abdominal pain was the most general symptom upon presentation to the surgical unit (73%). Two-phase, contrast-enhanced computed tomography was applied as the standard preoperative imaging modality (correct diagnosis in 69%). Bowel resections were necessary in most patients; approaches to restore blood flow by vascular surgery interventions were applied in 17 patients (20%). The overall morbidity and mortality rate in our study cohort was expectedly high (59% 1 month mortality).
The diagnosis and surgical treatment of mesenteric ischemia remains a major difficulty. We recommend preoperative CT analysis followed by an aggressive indication for early surgical exploration and bowel resection. An attempt of revascularization is justified for selected patients with limited macrovascular disease.
Digestive surgery 07/2008; 25(3):213-9. · 1.37 Impact Factor
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ABSTRACT: A 68-year-old lady was admitted to a primary care centre with abdominal pain. She presented with a tender abdomen and a lipase level of 29 456 U/L. Cholecystectomy had been performed in 1971. Because her clinical state worsened the patient was transferred to our intensive care unit. Computed tomography and contrast ultrasound revealed necrotising pancreatitis. Antibiotics were started immediately. 10 days later the patient became febrile and an area of liquid necrosis between the spleen and the left kidney was drained under sonographic guidance by a 12 Fr pigtail. Every ten days the drain was replaced by a larger one. ERCP revealed a communication between the pancreatic duct and the growing necrotic cavity. A 7 Fr/ 7 cm plastic stent was put in. After 30 days an unsuccessful endoscopic necrosectomy was attempted with the cholangioscope through a 28 Fr peel-away sheath. In a further session an effective percutaneous necrosectomy was possible through a laparascopy trocar with a standard gastroscope. The patient became afebrile and signs of infection decreased. The persisting communication between the pancreatic duct and the necrotic cavity was closed with onyx. In the following days the dimensions of the necrotic cavity decreased rapidly. Finally the patient could be discharged home in good health. Antibiotics were stopped and the percutaneous drain was taken out after some weeks of ambulatory care.
Zeitschrift für Gastroenterologie 06/2008; 46(5):425-30. · 0.90 Impact Factor
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ABSTRACT: The aim of our study was to determine whether planimetry of the anatomic regurgitant orifice (ARO) in patients with aortic regurgitation (AR) by magnetic resonance imaging (MRI) is feasible and whether ARO by MRI correlates with the severity of AR.
Planimetry of ARO by MRI was performed on a clinical magnetic resonance system (1.5 T Sonata, Siemens Medical Solutions) in 45 patients and correlated with the regurgitant fraction (RgF) and regurgitant volume (RgV) determined by MRI phase velocity mapping (PVM; MRI-RgF, MRI-RgV, n = 45) and with invasively quantified AR by supravalvular aortography (n = 32) and RgF upon cardiac catheterisation (CATH-RgF, n = 15). Determination of ARO was possible in 98% (44/45) of the patients with adequate image quality. MRI-RgF and CATH-RgF were modestly correlated (n = 15, r = 0.71, p<0.01). ARO was closely correlated with MRI-RgF (n = 44, r = 0.88, p<0.001) and was modestly correlated with CATH-RgF (n = 14, r = 0.66, p = 0.01). Sensitivity and specificity of ARO to detect moderately severe and severe aortic regurgitation (defined as MRI-RgF > or =40%) were 96% and 95% at a threshold of 0.28 cm2 (AUC = 0.99). Of note, sensitivity and specificity of ARO to detect moderately severe and severe AR at catheterisation (defined as CATH-RgF > or =40% or supravalvular aortography > or =3+) were 90% and 91% at a similar threshold of 0.28 cm2 (AUC = 0.95). Lastly, sensitivity and specificity of ARO to detect severe aortic regurgitation (defined as MRI-RgF > or =50% and/or regurgitant volume > or =60 ml) were 83% and 97% at a threshold of 0.48 cm2 (AUC = 0.97).
Visualisation and planimetry of the ARO in patients with AR are feasible by MRI. There is a strong correlation of ARO with RgV and RgF assessed by PVM and with invasively graded AR at catheterisation. Therefore, determination of ARO by MRI is a new non-invasive measure for assessing the severity of AR.
Heart (British Cardiac Society) 03/2008; 94(3):e8. · 4.22 Impact Factor
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ABSTRACT: Whole-body CT scans for patients with multiple trauma represent an increasingly accepted first diagnostic tool. The multidetector approach in particular provides appropriate diagnostic algorithms for detecting nearly all relevant traumatic findings in a short time with a high grade of sensitivity and specificity. Non-trauma-associated additional findings are commonly depicted based on these CT examinations. The aim of this study is to evaluate the number and quality of these additional findings in consecutive patients with multiple trauma.
Between 3 / 04 and 8 / 06 we scanned 304 patients according to our dedicated multiple trauma protocol. The examination protocol includes a head scan without intravenous contrast followed by a whole-body scan including the neck, thorax and abdomen acquired by a 16-row CT Scanner (Siemens, Sensation 16). The CT scans were retrospectively analyzed by two radiologists with respect to non-trauma-associated findings. Lesions were assessed according to their clinical relevance (highly relevant, moderately relevant, not relevant). For patients with highly relevant findings, additional follow-up research was performed.
The average age was 43 years (range 3 - 92). 236 of the patients were male (77.6 %), 68 female (22.4 %). 153 patients (50.3 %) had additional non-trauma-associated findings. In 20 cases (6.6 %) lesions with high clinical relevance were detected (e. g. carcinoma of the kidney or the ovary). In 71 patients (23.4 %) findings with moderate relevance were described. In 63 patients (20.7 %) additional findings without major relevance were diagnosed.
Whole-body CT scans of patients randomized by a trauma show a considerable number of non-trauma-associated additional findings. In about 30 % of cases, these findings are clinically relevant because further diagnostic workup or treatment in the short or medium-term is needed. The results of these analyses emphasize the diagnostic value of CT examinations with high demands on the examining radiologist.
RöFo - Fortschritte auf dem Gebiet der R 03/2008; 180(2):120-6. · 2.76 Impact Factor
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T Bruennler,
J Langgartner,
S Lang,
C E Wrede,
F Klebl,
S Zierhut,
S Siebig,
F Mandraka,
F Rockmann,
B Salzberger, S Feuerbach,
J Schoelmerich,
O W Hamer
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ABSTRACT: To assess the outcome of patients with acute necrotizing pancreatitis treated by percutaneous drainage with special focus on the influence of drainage size and number.
We performed a retrospective analysis of 80 patients with acute pancreatitis requiring percutaneous drainage therapy for infected necroses. Endpoints were mortality and length of hospital stay. The influence of drainage characteristics such as the median drainage size, the largest drainage size per patient and the total drainage plane per patient on patient outcome was evaluated.
Total hospital survival was 66%. Thirty-four patients out of all 80 patients (43%) survived acute necrotizing pancreatitis with percutaneous drainage therapy only. Eighteen patients out of all 80 patients needed additional percutaneous necrosectomy (23%). Ten out of these patients required surgical necrosectomy in addition, 6 patients received open necrosectomy without prior percutaneous necrosectomy. Elective surgery was performed in 3 patients receiving cholecystectomy and one patient receiving resection of the parathyroid gland. The number of drainages ranged from one to fourteen per patient. The drainage diameter ranged from 8 French catheters to 24 French catheters. The median drainage size as well as the largest drainage size used per patient and the total drainage area used per patient did not show statistically significant influence on mortality.
Percutaneous drainage therapy is an effective tool for treatment of necrotizing pancreatitis. Large bore drainages did not prove to be more effective in controlling the septic focus.
World Journal of Gastroenterology 03/2008; 14(5):725-30. · 2.47 Impact Factor
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ABSTRACT: A free-flap graft refers to the free transfer of tissue to cover tissue defects caused by trauma or malperfusion in plastic surgery. The basic principle, which makes a free flap working is an adequate blood flow. We applied new techniques which are able to detect the blood flow of the anastomosis and of dermal and subdermal tissue layers in a reliable way.
To this end we applied innovative Ultrasound-techniques (contrast enhanced high resolution Ultrasound (US), color coded Doppler sonography (CCDS), Cross Beamtrade mark, Power Doppler, Tissue Harmonic Imagingtrade mark (THI), Speckle Reduction Imagingtrade mark (SRI)), as well as the Indocyanine Green (ICG) fluorescence angiography to evaluate the vascular integrity of 15 parascapular flaps implanted to the fore foot over a period of four years. The age of the subjects ranged from 16 to 60 years. The US machine (GE Logiq 9) was equipped with a Logiq 9L transducer (6-9 MHz) and the modalities of CHI (Contrast Harmonic Imaging) and True Agent Detection (dual view of B-Mode and contrast mode).
The borders of the investigated flaps could be best detected using Cross Beamtrade mark Technology with SRItrade mark and THItrade mark. Power Doppler was able to detect anastomotic vessels even if they were twisted or elongated. Reduced perfusion curves were seen in cases with low anastomotic flow in CCDS. The CHItrade mark allowed dynamic flow detection of the microcirculation of the tissue graft over a depth of up to 3 cm including quantitative perfusion curves of tissue microcirculation by using TICtrade mark analysis. There is a strong correlation between the perfusion indices measured by ICG fluorescence angiography and CHItrade mark. Furthermore the ICG showed a remarkable enhancement of fluorescence in the flap borders, which need to be explored in future investigations.
These new applications provide useful and effective methods for improved postoperative monitoring of free flaps in plastic surgery and can lead to substantial reduction in the overall risk of flap failure.
Clinical hemorheology and microcirculation 02/2008; 39(1-4):253-63. · 3.40 Impact Factor
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ABSTRACT: To evaluate a newly introduced high resolution linear transducer for vascularization and mural perfusion assessment using contrast harmonic imaging (CHI) with quantitative time intensity curve analysis (TIC) in patients with active Crohn's disease (CD).
We prospectively evaluated 14 consecutive patients (7 women, 7 males, age range 19-42 years, median 28 years) with histologically proven CD having an acute episode of the disease applying contrast enhanced MRI and high resolution ultrasound. For the ultrasound we used a newly introduced high resolution linear multi-frequency transducer (6-9 MHz, Logiq 9, GE). Ultrasound was performed by an experienced radiologist applying color coded Doppler sonography (CCDS), power Doppler (PD) and contrast enhanced CHI using the 'true agent detection mode'. Additionally, 5 healthy volunteers were examined by ultrasound applying CCDS, PD and CHI. After the injection of 2.4 ml ultrasound contrast agent (SonoVue) the dynamic CHI cine sequences were recorded as digital raw data for 60 seconds. Therefore we were able to perform a quantitative perfusion analysis using TIC retrospectively. CCDS, PD and CHI with TIC were compared and analyzed.
In all 14 patients MRI showed inflammatory changes in the terminal or pre-terminal ileum. Using PD and CCDS enlarged vessels surrounding the bowel wall were visualized in all patients. PD as well as CCDS diagnosed just in 9 of 14 patients augmented mural vessels. Having CHI with TIC increased mural contrast enhancement was diagnosed in all 14 patients. Patients with CD showed a maximum enhancement 36 s after injection with 9 dB (range 5.9-13.2 dB), while healthy volunteers reached the maximum level of 2.8 dB (range 2-3.8 dB) after 23 s (p<0.05).
Using high resolution linear transducer mural perfusion changes in active Crohn's disease can be appreciated applying CHI with TIC. This technique could be an effective dynamic imaging modality for diagnosis and especially follow-up examination to monitor treatment in CD.
Clinical hemorheology and microcirculation 02/2008; 40(2):143-55. · 3.40 Impact Factor
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L Prantl,
St Schmitt,
S Geis,
T Y Tsui,
P Lamby,
M Nerlich,
R Kubale,
N Zorger,
T Herold, S Feuerbach,
E M Jung
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ABSTRACT: Contrast harmonic ultrasound (CHI) with a linear transducer is a new diagnostic approach that allows dynamic and quantitative flow detection of tissue perfusion in microsurgery. The aim of the study was the evaluation of perfusion of the dermal and subdermal layers of microvascular tissue transplants with CHI in comparison to ICG-fluorescence angiography.
In a prospective clinical study Indocyanine-Green Fluorescence Video Angiography and Contrast Enhanced High Resolution Ultrasound (5-10 MHz; linear transducer; Logiq 9; GE) were used for evaluation of the microcirculation in 10 transplanted free parascapular flaps. Two regions were analysed, the centre of the flap and the region of the anastomosis. The perfusion patterns of both methods were compared.
The perfusion indexes measured by ICG-fluorescence angiography correlated very precisely in all patients with the quantitative perfusion curves of contrast-enhanced US with CHI. Two flaps with slow filling and low dye intensity showed low contrast enhancement in CHI with modified perfusion curves with slow increase. In two cases a reduced perfusion and filling were found. There were no statistical differences between the two diagnostic methods (p>0.01).
CHI improves US detections of dermal and subdermal microcirculation in comparison to ICG fluorescence angiography. CHI is a new diagnostic method for postoperative monitoring of free flaps.
Clinical hemorheology and microcirculation 01/2008; 38(2):105-18. · 3.40 Impact Factor
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L Prantl,
St Schmitt,
S Gais,
T Y Tsui,
P Lamby,
P Babilas,
M Nerlich,
R Kubale,
N Zorger,
T Herold, S Feuerbach,
E M Jung
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ABSTRACT: Contrast harmonic ultrasound (CHI) with a linear transducer is a new diagnostic approach that allows dynamic and quantitative flow detection of tissue perfusion in microsurgery. The aim of the study was the evaluation of perfusion of the dermal and subdermal layers of microvascular tissue transplants with CHI in comparison to ICG-fluorescence angiography.
In a prospective clinical study indocyanine-green fluorescence video angiography and contrast enhanced high resolution ultrasound (5-10 MHz; linear transducer; Logiq 9; GE) were used for evaluation of the microcirculation in 10 transplanted free parascapular flaps. Two regions were analysed, the centre of the flap and the region of the anastomosis. The perfusion patterns of both methods were compared.
The perfusion indexes measured by ICG-fluorescence angiography correlated very precisely in all patients with the quantitative perfusion curves of contrast-enhanced US with CHI. Two flaps with slow filling and low dye intensity showed low contrast enhancement in CHI with modified perfusion curves with slow increase. In two cases a reduced perfusion and filling were found. There were no statistical differences between the two diagnostic methods (p>0.01).
CHI improves US detections of dermal and subdermal microcirculation in comparison to ICG fluorescence angiography. CHI is a new diagnostic method for postoperative monitoring of free flaps.
Clinical hemorheology and microcirculation 01/2008; 38(1):31-44. · 3.40 Impact Factor
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ABSTRACT: To establish the extent to which contrast enhancement with SonoVue in combination with quantitative evaluation of contrast-medium dynamics facilitates the detection of hepatic tumors.
One hundred patients with histologically confirmed malignant or benign hepatic tumor (maximum size 5 cm) were analyzed. Contrast-enhanced ultrasound (bolus injection 2.5 mL SonoVue) was carried out with intermittent breath-holding technique using a multifrequency transducer (2.5-4 MHz). Native vascularization was analyzed with power Doppler. The contrast-enhanced dynamic ultrasound investigation was carried out with contrast harmonic imaging in true detection mode during the arterial, portal venous and late phases. Mechanical index was set at 0.15. Perfusion analysis was performed by post-processing of the raw data [time intensity curve (TIC) analysis]. The cut-off of the gray value differences between tumor and normal liver tissue was established using Receiver Operating Characteristic (ROC) analysis 64-line multi-slice computed tomography served as reference method in all cases. Magnetic resonance tomography was used additionally in 19 cases.
One hundred patients with 59 malignant (43 colon, 5 breast, 2 endocrine metastases, 7 hepatocellular carcinomas and 2 kidney cancers) and 41 benign (15 hemangiomas, 7 focal nodular hyperplasias, 5 complicated cysts, 2 abscesses and 12 circumscribed fatty changes) tumors were included. The late venous phase proved to be the most sensitive for classification of the tumor type. Fifty-eight of the 59 malignant tumors were classified as true positive, and one as false negative. This resulted in a sensitivity of 98.3%. Of the 41 benign tumors, 37 were classified as true negative and 4 as false negative, which corresponds to a specificity of 90.2%. Altogether, 95.0% of the diagnoses were classified as correct on the basis of the histological classification. No investigator-dependency (P = 0.23) was noted.
The results show the possibility of accurate prediction of malignancy of hepatic tumors with a positive prognostic value of 93.5% using advanced contrast-enhanced ultrasound. Contrast enhancement with SonoVue in combination with quantitative evaluation of contrast-medium dynamics is a valuable tool to discriminate hepatic tumors.
World Journal of Gastroenterology 01/2008; 13(47):6356-64. · 2.47 Impact Factor
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ABSTRACT: Feasibility of intraarterial MR angiography of the renal arteries and comparison of the accuracy of intraarterial MR angiography with selective intraarterial digital subtraction angiography (DSA) for detection of stenoses.
Ten consecutive patients (mean, 68 years) with suspected renal artery stenosis underwent a digital subtraction angiography and an intraarterial gadolinium-enhanced MR angiography, performed on a 1.5-T system. For intraarterial MR angiography 60 ml diluted contrast agent (10 ml gadodiamide in 50 ml 0.9% saline solution) was injected through a conventional angiography catheter placed in the suprarenal abdominal aorta using a flow rate of 3.5 ml/s. A three-dimensional (3D) gradient-echo sequence was performed. Differences in the quantitative measurement of stenoses of lesions between DSA and intraarterial MR angiography were evaluated by three observers. Overall impression of the intraarterial MR angiography was documented on a four-point scale (1 = excellent to 4 = poor). Interobserver variability was calculated.
Intraarterial MR angiography of the renal arteries was feasible in all patients (100%) with a mean overall impression of all images of 1.8 (SD: 0.71). One of 9 accessory renal arteries was not visualized with intraarterial MR angiography. The overall sensitivity/specificity for detection of significant stenoses (>or=50% stenosis) were 83%/87%. Interobserver variability of intraarterial MR angiography ranged between fair and substantial (0.359-0.622).
Intraarterial MR angiography of the renal arteries in humans is feasible and has an acceptable sensitivity in detecting stenoses using injections of diluted contrast agent at concentrations as low as 17%.
Clinical hemorheology and microcirculation 01/2008; 38(2):97-104. · 3.40 Impact Factor
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ABSTRACT: Ziel: Ganzkçrper-CT bei polytraumatisierten Patienten gelten mittlerweile als etabliertes und bewährtes diagnostisches Verfahren. Insbesondere die Mehrzeilentechnik ermçglicht entsprechende Untersuchungsprotokolle, die in kürzester Zeit nahezu alle relevanten Traumabefunde mit hoher Sensitivität und Spezifität erfassen können. Dabei werden häufig auch inzidenzielle Nebenbefunde dedektiert. Ziel der Auswertung ist die Anzahl und Art dieser sogenannten Nebenbefunde in ei-nem grçßeren Patientenkollektiv zu erfassen. Material und Methoden: Im Zeitraum 3/2004 – 8/2006 wurden 304 Patienten entsprechend unserem Polytraumaprotokoll untersucht. Das Untersuchungsprotokoll beinhaltet ein natives CCT sowie ein CT von Hals, Thorax und Abdomen in einem einzigen Spiralscan mit intravençser Kontrastierung (Siemens, Sensation 16). Die Un-tersuchungen wurden retrospektiv von zwei Ra-diologen bezüglich nicht traumaassoziierter Ne-benbefunde ausgewertet. Die Befunde wurden nach ihrer klinischen Relevanz in drei Kategorien (hohe, mittlere, keine klinische Relevanz) einge-teilt. Bei Patienten mit klinisch hoch relevanten Nebenbefunden erfolgte zudem eine weitere Recherche des klinischen Verlaufs. Ergebnisse: Das Durchschnittsalter der 304 Pa-tienten betrug 43 Jahre (Range 3 – 92). 236 der un-tersuchten Patienten waren männlich (77,6%), 68 weiblich (22,4%). 153 (50,3%) der Patienten wie-sen inzidenzielle Nebenbefunde auf. Bei 20 (6,6%) Patienten wurden Befunde mit hoher klinischer Relevanz (z. B. Nierenzell-bzw. Ovarialkarzinom) diagnostiziert. Bei 71 (23,4%) Patienten zeigten sich Nebenbefunde von mittlerer klinischer Rele-vanz. 63 (20,7%) Patienten wiesen klinisch nicht relevante Nebenbefunde auf. Schlussfolgerung: Ganzkçrper-CT in einem durch ein Trauma randomisierten Patientenkollektiv weisen eine beträchtliche Anzahl an nicht verletzungsbedingten Nebenbefunden auf. In etwa 30% der Fälle stellen sich diese Zufallsdiagnosen als klinisch relevant dar, da sie eine weiterführende diagnostische Abklärung bzw. eine mittel- bis kurzfristige Therapie erfordern. Die Ergebnisse dieser Auswertung unterstreichen die diagnostische Vielseitigkeit des CT sowie die damit verbundenen hohen Ansprüche an den Untersucher.
RöFo - Fortschritte auf dem Gebiet der R 01/2008; · 2.76 Impact Factor
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Endoskopie heute 01/2008; 28018. · 0.14 Impact Factor
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Ultraschall in Der Medizin - ULTRASCHALL MED. 01/2008; 29(3):294-301.
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ABSTRACT: The introduction of multidetector-row computed tomography (MDCT) has revolutionized the initial management of multiply injured patients. This technology has the potential to improve the imaging of traumatic vascular injuries.
To evaluate the quality of multidetector-row computed tomography angiography (MDCTA) of the carotid arteries in the setting of a routine whole-body trauma scan.
87 trauma patients underwent a routine whole-body CT scan in a 16-detector-row scanner including an MDCTA with a reconstructed axial slice thickness of 3 mm. Images were reviewed by three experienced radiologists with emphasis on image quality. Contrast density, severity, and origin of artifacts and the occurrence of vessel lesions were assessed for different vessel segments.
3642 separate vessel segments were evaluated. Contrast density was rated good or sufficient for diagnosis in 99.8%. A total of 67.3% of vessel segments were free of artifacts, while 27.9% of vessel segments showed minor artifacts not impairing diagnostic evaluation. Clinically relevant artifacts obscuring a vessel segment occurred in 4.7% and were mostly caused by dental hardware. Four dissections of the internal carotid artery were diagnosed by all three radiologists.
As a rapid screening test for blunt carotid artery injury, integration of MDCTA in the routine imaging workup of trauma patients utilizing a whole-body CT trauma scan is possible and practicable. Image quality is mostly sufficient for diagnosis, but impaired in a few cases by artifacts deriving primarily from dental hardware.
Acta Radiologica 10/2007; 48(7):798-805. · 1.37 Impact Factor
