Retrospective analysis of patients for development of nephrogenic systemic fibrosis following conventional angiography using gadolinium-based contrast agents

Purpose: The purpose was to retrospectively review the data of 27 patients with renal insufficiency who underwent conventional angiography with gadolinium-based contrast agents (GDBCA) as alternative contrast agents and assess the occurrence of nephrogenic systemic fibrosis (NSF) together with associated potential risk factors. Methods: This HIPAA-compliant study had institutional review board approval, and informed consent was waived. Statistical analysis was performed for all available laboratory and clinical data, including dermatology reports. Type and amount of the GDBCA used were recorded for angiography and additional MRI studies, if applicable. Serum creatinine levels (SCr) pre- and post-angiography were recorded, and estimated glomerular filtration rates (eGFR) were calculated. Results: Ten female and 17 male patients who underwent angiography with GDBCA were included. The mean amount of GDBCA administered was 44 ± 15.5ml (range 15-60ml) or 0.24 + 0.12mmol/kg (range 0.1-0.53mmol/kg). At the time of angiography all patients had renal insufficiency (eGFR <60ml/min/1.73m2). Mean eGFR pre-angiography was 26ml/min/1.73m2 and 33ml/min/1.73m2 post-angiography. The mean follow-up period covers 28months, range 1-84months. Additional MRI studies with GDBCA administration were performed in 15 patients. One patient with typical skin lesions had developed biopsy-confirmed NSF. Conclusion: Conventional arterial angiography with GDBCA may play a role in the development of NSF in patients with renal insufficiency. Alternative contrast agents, such as CO2 angiography or rather the use of low doses of iodinated contrast agents, should be considered in these patient

Additional Diffusion-Weighted Imaging with Background Body Signal Suppression (DWIBS) Improves Pre-Therapeutical Detection of Early-Stage (pT1a) Glottic Cancer: A Feasibility and Interobserver Reliability Study

Background: Early-stage glottic cancer is easily missed on magnetic resonance imaging (MRI). Diffusion-weighted imaging (DWI) may improve diagnostic accuracy. Therefore, our aim was to assess the value of adding diffusion-weighted imaging with background body signal suppression (DWIBS) to pre-therapeutic MRI staging. (2 Methods: Two radiologists with 8 and 13 years of experience, blinded to each other’s findings, initially interpreted only standard MRI, later DWIBS alone, and afterward, standard MRI + DWIBS in 41 patients with histopathologically proven pT1a laryngeal cancer of the glottis. Results: Detectability rates with standard MRI, DWIBS only, and standard MRI + DWIBS were 68–71%, 63–66%, and 73–76%, respectively. Moreover, interobserver reliability was calculated as good (κ = 0.712), very good (κ = 0.84), and good (κ = 0.69) for standard MRI, DWIBS only, and standard MRI + DWIBS, respectively. Conclusions: Standard MRI, DWIBS alone, and standard MRI + DWIBS showed an encouraging detection rate, as well as distinct interobserver reliability in the diagnosis of early-stage laryngeal cancer when compared to the definitive histopathologic report

Pulmonary function impairment of asymptomatic and persistently symptomatic patients 4 months after COVID-19 according to disease severity

OBJECTIVE Evaluation of pulmonary function impairment after COVID-19 in persistently symptomatic and asymptomatic patients of all disease severities and characterisation of risk factors. METHODS Patients with confirmed SARS-CoV-2 infection underwent prospective follow-up with pulmonary function testing and blood gas analysis during steady-state cycle exercise 4~months after acute illness. Pulmonary function impairment (PFI) was defined as reduction below 80% predicted of DLCOcSB, TLC, FVC, or FEV1. Clinical data were analyzed to identify risk factors for impaired pulmonary function. RESULTS 76 patients were included, hereof 35 outpatients with mild disease and 41 patients hospitalized due to COVID-19. Sixteen patients had critical disease requiring mechanical ventilation, 25 patients had moderate-severe disease. After 4~months, 44 patients reported persisting respiratory symptoms. Significant PFI was prevalent in 40 patients (52.6%) occurring among all disease severities. The most common cause for PFI was reduced DLCOcSB (n = 39, 51.3%), followed by reduced TLC and FVC. The severity of PFI was significantly associated with mechanical ventilation (p 3~mmHg during cycle exercise occurred in 1/5 of patients after mild disease course. CONCLUSION We characterized pulmonary function impairment in asymptomatic and persistently symptomatic patients of different severity groups of COVID-19 and identified further risk factors associated with persistently decreased pulmonary function. Remarkably, gas exchange abnormalities were revealed upon cycle exercise in some patients with mild disease courses and no preexisting pulmonary condition

Clinically focused multi-cohort benchmarking as a tool for external validation of artificial intelligence algorithm performance in basic chest radiography analysis

Artificial intelligence (AI) algorithms evaluating [supine] chest radiographs ([S]CXRs) have remarkably increased in number recently. Since training and validation are often performed on subsets of the same overall dataset, external validation is mandatory to reproduce results and reveal potential training errors. We applied a multicohort benchmarking to the publicly accessible (S)CXR analyzing AI algorithm CheXNet, comprising three clinically relevant study cohorts which differ in patient positioning ([S]CXRs), the applied reference standards (CT-/[S]CXR-based) and the possibility to also compare algorithm classification with different medical experts’ reading performance. The study cohorts include [1] a cohort, characterized by 563 CXRs acquired in the emergency unit that were evaluated by 9 readers (radiologists and non-radiologists) in terms of 4 common pathologies, [2] a collection of 6,248 SCXRs annotated by radiologists in terms of pneumothorax presence, its size and presence of inserted thoracic tube material which allowed for subgroup and confounding bias analysis and [3] a cohort consisting of 166 patients with SCXRs that were evaluated by radiologists for underlying causes of basal lung opacities, all of those cases having been correlated to a timely acquired computed tomography scan (SCXR and CT within < 90 min). CheXNet non-significantly exceeded the radiology resident (RR) consensus in the detection of suspicious lung nodules (cohort [1], AUC AI/RR: 0.851/0.839, p = 0.793) and the radiological readers in the detection of basal pneumonia (cohort [3], AUC AI/reader consensus: 0.825/0.782, p = 0.390) and basal pleural effusion (cohort [3], AUC AI/reader consensus: 0.762/0.710, p = 0.336) in SCXR, partly with AUC values higher than originally published (“Nodule”: 0.780, “Infiltration”: 0.735, “Effusion”: 0.864). The classifier “Infiltration” turned out to be very dependent on patient positioning (best in CXR, worst in SCXR). The pneumothorax SCXR cohort [2] revealed poor algorithm performance in CXRs without inserted thoracic material and in the detection of small pneumothoraces, which can be explained by a known systematic confounding error in the algorithm training process. The benefit of clinically relevant external validation is demonstrated by the differences in algorithm performance as compared to the original publication. Our multi-cohort benchmarking finally enables the consideration of confounders, different reference standards and patient positioning as well as the AI performance comparison with differentially qualified medical readers

Diagnostic Value of Diffusion-Weighted Imaging with Background Body Signal Suppression (DWIBS) for the Pre-Therapeutic Loco-Regional Staging of Cervical Cancer: A Feasibility and Interobserver Reliability Study

Background: Cervical cancer is one of the leading causes of cancer-related deaths and the fourth most common cancer among women worldwide. Magnetic resonance imaging (MRI) is the modality of choice for loco-regional staging of cervical cancer in the primary diagnostic workup beginning with at least stage IB. Methods: We retrospectively analyzed 16 patients with histopathological proven cervical cancer (FIGO IB1–IVA) for the diagnostic accuracy of standard MRI and standard MRI with diffusion-weighted imaging with background body signal suppression (DWIBS) for the correct pre-therapeutic assessment of the definite FIGO category. Results: In 7 out of 32 readings (22%), DWIBS improved diagnostic accuracy. With DWIBS, four (13%) additional readings were assigned the correct major (I–IV) FIGO stages pre-therapeutically. Interobserver reliability of DWIBS was weakest for parametrial infiltration (k = 0.43; CI-95% 0.00–1.00) and perfect for tumor size <2 cm, infiltration of the vaginal lower third, infiltration of adjacent organs and loco-regional nodal metastases (k = 1.000; CI-95% 1.00–1.00). Conclusions: The pre-therapeutic staging of cervical cancer has a high diagnostic accuracy and interobserver reliability when using standard MRI but can be further optimized with the addition of DWIBS sequences when reporting is performed by an experienced radiologist

Mindfulness and skills-based eHealth intervention to reduce distress in cancer-affected patients in the Reduct trial: Intervention protocol of the make it training optimized.

Introduction Cancer-affected patients experience high distress due to various burdens. One way to expand psycho-oncological support is through digital interventions. This protocol describes the development and structure of a web-based psycho-oncological intervention, the Make It Training optimized. This intervention is currently evaluated in the Reduct trial, a multicenter randomized controlled trial. Methods The Make It Training optimized was developed in six steps: A patient need and demand assessment, development and acceptability analysis of a prototype, the formation of a patient advisory council, the revision of the training, implementation into a web app, and the development of a motivation and evaluation plan. Results Through a process of establishing cancer-affected patients' needs, prototype testing, and patient involvement, the Make It Training optimized was developed by a multidisciplinary team and implemented in a web app. It consists of 16 interactive self-guided modules which can be completed within 16 weeks. Discussion Intervention protocols can increase transparency and increase the likelihood of developing effective web-based interventions. This protocol describes the process and results of developing a patient-oriented intervention. Future research should focus on the further personalization of web-based psycho-oncological interventions and the potential benefits of combining multiple psychotherapeutic approaches

Limited capability of MRI radiomics to predict primary tumor histology of brain metastases in external validation

Background Growing research demonstrates the ability to predict histology or genetic information of various malignancies using radiomic features extracted from imaging data. This study aimed to investigate MRI-based radiomics in predicting the primary tumor of brain metastases through internal and external validation, using oversampling techniques to address the class imbalance. Methods This IRB-approved retrospective multicenter study included brain metastases from lung cancer, melanoma, breast cancer, colorectal cancer, and a combined heterogenous group of other primary entities (5-class classification). Local data were acquired between 2003 and 2021 from 231 patients (545 metastases). External validation was performed with 82 patients (280 metastases) and 258 patients (809 metastases) from the publicly available Stanford BrainMetShare and the University of California San Francisco Brain Metastases Stereotactic Radiosurgery datasets, respectively. Preprocessing included brain extraction, bias correction, coregistration, intensity normalization, and semi-manual binary tumor segmentation. Two-thousand five hundred and twenty-eight radiomic features were extracted from T1w (± contrast), fluid-attenuated inversion recovery (FLAIR), and wavelet transforms for each sequence (8 decompositions). Random forest classifiers were trained with selected features on original and oversampled data (5-fold cross-validation) and evaluated on internal/external holdout test sets using accuracy, precision, recall, F1 score, and area under the receiver-operating characteristic curve (AUC). Results Oversampling did not improve the overall unsatisfactory performance on the internal and external test sets. Incorrect data partitioning (oversampling before train/validation/test split) leads to a massive overestimation of model performance. Conclusions Radiomics models’ capability to predict histologic or genomic data from imaging should be critically assessed; external validation is essential

Test site for road weather and road surface condition monitoring

Ein wichtiges Ziel von Streckenbeeinflussungsanlagen (SBA) ist die Erhöhung der Verkehrssicherheit. Dies kann nicht nur durch dynamische Reaktionen auf vorherrschende Verkehrszustände, sondern auch aufgrund von Informationen zu aktuellen Umfeldbedingungen wie Niederschlagsintensität, Sichtweite und Wasserfilmdicke erreicht werden. Kritische Situationen müssen von den entsprechenden Sensoren ausreichend genau und schnell erkannt werden, wobei die Zuverlässigkeit dieser Sensoren nur unter realen Bedingungen getestet werden kann. Hierfür wurde bei München ein Testfeld aufgebaut, sodass den Herstellern dezidierte Rückmeldungen bezüglich möglicher Schwächen gegeben werden können und letztendlich die Eignung verschiedener Sensoren und Erfassungstechnologien für den Einsatz in SBA eingeschätzt werden kann.An important objective of Corridor Control System is the increase in traffic safety through a dynamic reaction not only to prevailing traffic situations, but also to current road weather and road surface conditions, especially precipitation intensity, visibility and waterfilm thickness. Sensors must detect critical conditions sufficiently accurate and fast. The suitability of sensors can only be tested under real conditions. Therefore, a test site has been established near Munich / Germany to evaluate sensors in order to give dedicated feedback to the manufacturers towards potential weaknesses of their sensors and to assess the applicability of different sensors and technologies

Validierung des konvektiven Wärmeübergangs der Freeware Z88Aurora® mithilfe analytischer Beispiele und kommerzieller Software

Die Finite Elemente Analyse hat sich in vielen industriellen Anwendungsgebieten zu einem elementaren Werkzeug für den Produktentwicklungsprozess entwickelt. Zu diesen Anwendungsbereichen zählen u. a. der Fahrzeugbau, die Medizintechnik und der Sondermaschinenbau. Neben Strömungssimulationen und der numerischen Berechnung von elastomechanischen Strukturen sind auch thermomechanische Analysen mithilfe der FEA durchführbar. Kleine und mittelständische Unternehmen können jedoch nicht immer auf einen wirtschaftlichen Einsatz von kommerziellen FEA-Tools zurückgreifen und sind folglich auf Freeware Programme wie Z88Aurora® angewiesen. Die häufig für den Entwickler interessierende stationäre Wärmeleitung und die aus dem Temperaturunterschied resultierende thermische Dehnung von Bauteilkomponenten gehören längst zum Tagesgeschäft. Für eine realitätsnahe Auslegung von beispielsweise Kühlkörpern oder Rippen muss zusätzlich die konvektive Wärmeübertragung berücksichtigt werden. Hierbei wird der Wärmetransport zwischen einer Bauteiloberfläche und dem Umgebungsmedium, wie z. B. Luft oder Kühlwasser, untersucht. Diese erweiterte Abbildung der Temperaturanalyse definiert als Randbedingung eine Wärmestromdichte auf einer Bauteiloberfläche, welche proportional zur Temperaturdifferenz beider Systemkomponenten ermittelt wird. Zudem gehen nichtlineare Einflüsse aus den Materialeigenschaften des Fluids und aus dem entstehenden Strömungsverhalten über den sog. Wärmeübergangskoeffizienten in die Simulation ein. Aufgrund dieser Komplexität kann über empirisch ermittelte Korrelationsgleichungen die Bestimmung des Wärmeübergangskoeffizienten erreicht werden. Diese Erweiterung des Thermomoduls wird in der neuen Version von Z88Aurora®V5 dem Anwender zur Produktentwicklung angeboten. Eine für den industriellen Einsatz essentielle Validierung der Berechnungsergebnisse wird über analytische Vergleichsrechnungen am Beispiel einer Kühlrippe nachgewiesen

Validierung des konvektiven Wärmeübergangs der Freeware Z88Aurora® mithilfe analytischer Beispiele und kommerzieller Software

Die Finite Elemente Analyse hat sich in vielen industriellen Anwendungsgebieten zu einem elementaren Werkzeug für den Produktentwicklungsprozess entwickelt. Zu diesen Anwendungsbereichen zählen u. a. der Fahrzeugbau, die Medizintechnik und der Sondermaschinenbau. Neben Strömungssimulationen und der numerischen Berechnung von elastomechanischen Strukturen sind auch thermomechanische Analysen mithilfe der FEA durchführbar. Kleine und mittelständische Unternehmen können jedoch nicht immer auf einen wirtschaftlichen Einsatz von kommerziellen FEA-Tools zurückgreifen und sind folglich auf Freeware Programme wie Z88Aurora® angewiesen. Die häufig für den Entwickler interessierende stationäre Wärmeleitung und die aus dem Temperaturunterschied resultierende thermische Dehnung von Bauteilkomponenten gehören längst zum Tagesgeschäft. Für eine realitätsnahe Auslegung von beispielsweise Kühlkörpern oder Rippen muss zusätzlich die konvektive Wärmeübertragung berücksichtigt werden. Hierbei wird der Wärmetransport zwischen einer Bauteiloberfläche und dem Umgebungsmedium, wie z. B. Luft oder Kühlwasser, untersucht. Diese erweiterte Abbildung der Temperaturanalyse definiert als Randbedingung eine Wärmestromdichte auf einer Bauteiloberfläche, welche proportional zur Temperaturdifferenz beider Systemkomponenten ermittelt wird. Zudem gehen nichtlineare Einflüsse aus den Materialeigenschaften des Fluids und aus dem entstehenden Strömungsverhalten über den sog. Wärmeübergangskoeffizienten in die Simulation ein. Aufgrund dieser Komplexität kann über empirisch ermittelte Korrelationsgleichungen die Bestimmung des Wärmeübergangskoeffizienten erreicht werden. Diese Erweiterung des Thermomoduls wird in der neuen Version von Z88Aurora®V5 dem Anwender zur Produktentwicklung angeboten. Eine für den industriellen Einsatz essentielle Validierung der Berechnungsergebnisse wird über analytische Vergleichsrechnungen am Beispiel einer Kühlrippe nachgewiesen