USA, China, Indien: Droht ein globaler Abwertungswettlauf?

Immer mehr Länder beginnen, ihre Währung aktiv zu schwächen oder eine Schwäche in Kauf zu nehmen. Droht ein Abwertungswettlauf? Andreas Rees, UniCredit, plädiert für ein neues, multipolares Währungssystem, das die Dominanz des US-Dollars beseitigt. Dann wären der Finanzierung von Leistungsbilanzdefiziten Grenzen gesetzt. Abwertungswettläufe ließen sich zwar auch dann nicht vollständig ausschließen, aber das Gleichgewicht der Kräfte dürfte zumindest für mehr Stabilität sorgen. Markus Taube, Universität Duisburg-Essen, unterstreicht, dass die institutionelle Ausgestaltung des chinesischen Wechselkursregimes der chinesischen Regierung ein breites Spektrum zur Einflussnahme auf die ökonomische Entwicklung im Land bietet. Da oberste Priorität der chinesischen Wirtschaftspolitik die Förderung struktureller Wandlungsprozesse in der chinesischen Volkswirtschaft sei, verliere eine wirtschaftspolitisch motivierte Schwächung des Außenwertes des Renminbi zunehmend an ökonomischer Rationalität. Denn mit der Bereitschaft der chinesischen Regierung, den Wachstumsmotor der chinesischen Volkswirtschaft in die binnenmarktorientierten Zentralprovinzen zu verlagern, wachse die Notwendigkeit einer weiteren Flexibilisierung und Aufwertung des Wechselkurses. Für Bernd Kempa, Universität Münster, hängt die Frage, ob die gegenwärtige Situation in einen Abwertungswettlauf münden kann, entscheidend von dem zukünftigen Verhalten der amerikanischen sowie der chinesischen Notenbank ab. Er stuft die Gefahr einer weiteren Eskalation des Währungskonflikts aber als minimal ein. Georg Erber, Deutsches Institut für Wirtschaftsforschung (DIW), Berlin, sieht derzeit noch keine Änderung im Verhalten der chinesischen Führung - und damit die Fortführung der Unterbewertung der chinesischen Währung. Die EU sollte vor allem ein starkes Interesse haben, dass es nicht innerhalb weniger Jahre zu ähnlich starken Ungleichgewichten in der Leistungsbilanz zwischen China und den EU-Mitgliedstaaten kommt, wie sie zwis

Three-Dimensional Software- and MR-Imaging-Based Muscle Volumetry Reveals Overestimation of Supraspinatus Muscle Atrophy Using Occupation Ratios in Full-Thickness Tendon Tears

Supraspinatus muscle atrophy is widely determined from oblique-sagittal MRI by calculating the occupation ratio. This ex vivo and clinical study aimed to validate the accuracy of 3D software- and MR-imaging-based muscle volumetry, as well as to assess the influence of the tear pattern on the occupation ratio. Ten porcine muscle specimens were volumetrized using the physical water displacement volumetry as a standard of reference. A total of 149 individuals with intact supraspinatus tendons, partial tears, and full-thickness tears had 3T MRI. Two radiologists independently determined occupation ratio values. An excellent correlation with a Pearson's r of 0.95 for the variables physical volumetry using the water displacement method and MR-imaging-based muscle volumetry using the software was found and formed the standard of reference for the patient study. The inter-reader reliability was 0.92 for occupation ratios. The correlation between occupation ratios and software-based muscle volumes was good in patients with intact tendons (0.84) and partial tears (0.93) but considerably lower in patients with full-thickness tears (0.68). Three-dimensional-software- and MR-imaging-based muscle volumetry is reliable and accurate. Compared to 3D muscle volumetry, the occupation ratio method overestimates supraspinatus muscle atrophy in full-thickness tears, which is most likely due to the medial retraction of the myotendinous unit

Hematopoietic islands mimicking osteoblastic metastases within the axial skeleton

Background Hyperplasia of the hematopoietic bone marrow in the appendicular skeleton is common. In contrast, focal hematopoietic islands within the axial skeleton are a rare entity and can confuse with osteoblastic metastases. This study aimed to characterize typical MRI and CT findings of hematopoietic islands in distinction from osteoblastic metastases to help both radiologists and clinicians, on the one hand, not to overdiagnose this entity and, on the other hand, to decide on a reasonable work-up. Methods We retrospectively analyzed the imaging findings of 14 hematopoietic islands of the axial skeleton in ten patients (nine females, median age = 65.5 years [range, 49–74]) who received both MRI and CT at initial diagnosis between 2006 and 2020. CT-guided biopsy was performed in five cases to confirm the diagnosis, while the other five patients received long-term MRI follow-up (median follow-up = 28 months [range, 6–96 months]). Diffusion-weighted imaging was available in three, chemical shift imaging respectively 18 F- fluorodeoxyglucose PET/CT in two, and Technetium 99 m skeletal scintigraphy in one of the patients. Results All lesions were small (mean size = 1.72 cm 2 ) and showed moderate hypointense signals on T1- and T2-weighted MRI sequences. They appeared isointense to slightly hyperintense on STIR images and slightly enhanced after gadolinium administration. To differentiate this entity from osteoblastic metastases, CT provides important additional information, as hematopoietic islands do not show sclerosis. Conclusions Hematopoietic islands within the axial skeleton can occur and mimic osteoblastic metastases. However, the combination of MRI and CT allows for making the correct diagnosis in most cases

Artifact characterization of Nitinol needles in magnetic resonance imaging-guided musculoskeletal interventions at 3.0 tesla: a phantom study

PURPOSETo characterize the artifacts of an 18-gauge coaxial nickel-titanium needle using a balanced steady-state free precession sequence in magnetic resonance imaging-guided interventions at 3.0 tesla.METHODSThe influence of flip angle (FA), bandwidth, matrix, slice thickness (ST), and read-out direction on needle artifact behavior was investigated for different intervention angles (IA). Artifact diameters were rated at predefined positions. Subgroup differences were assessed using Bonferroni-corrected non-parametric tests and correlations between continuous variables were expressed using the Bravais–Pearson coefficient. Interrater reliability was quantified using intraclass correlation coefficients (ICCs), and a contrast-enhanced target lesion to non-enhanced muscle tissue contrast ratio was quantified.RESULTSThe artifact diameters decreased with an increase in FA for all IAs (P 7 mm, and, if possible, an IA of 45°–60°. The visibility of the target lesion and the needle’s artifact behavior must be weighed up against each other when choosing the ST, while higher FAs (40°–60°) and matrices (224 × 224/256 × 256) are associated with low artifacts and sufficient lesion visibility

Differentiation of benign and malignant vertebral fractures using a convolutional neural network to extract CT-based texture features.

PURPOSE To assess the diagnostic performance of three-dimensional (3D) CT-based texture features (TFs) using a convolutional neural network (CNN)-based framework to differentiate benign (osteoporotic) and malignant vertebral fractures (VFs). METHODS A total of 409 patients who underwent routine thoracolumbar spine CT at two institutions were included. VFs were categorized as benign or malignant using either biopsy or imaging follow-up of at least three months as standard of reference. Automated detection, labelling, and segmentation of the vertebrae were performed using a CNN-based framework ( https://anduin.bonescreen.de ). Eight TFs were extracted: Varianceglobal, Skewnessglobal, energy, entropy, short-run emphasis (SRE), long-run emphasis (LRE), run-length non-uniformity (RLN), and run percentage (RP). Multivariate regression models adjusted for age and sex were used to compare TFs between benign and malignant VFs. RESULTS Skewnessglobal showed a significant difference between the two groups when analyzing fractured vertebrae from T1 to L6 (benign fracture group: 0.70 [0.64-0.76]; malignant fracture group: 0.59 [0.56-0.63]; and p = 0.017), suggesting a higher skewness in benign VFs compared to malignant VFs. CONCLUSION Three-dimensional CT-based global TF skewness assessed using a CNN-based framework showed significant difference between benign and malignant thoracolumbar VFs and may therefore contribute to the clinical diagnostic work-up of patients with VFs

Hospitalized patients dying with SARS-CoV-2 infection—an analysis of patient characteristics and management in ICU and general ward of the LEOSS registry

BACKGROUND: COVID-19 is a severe disease with a high need for intensive care treatment and a high mortality rate in hospitalized patients. The objective of this study was to describe and compare the clinical characteristics and the management of patients dying with SARS-CoV-2 infection in the acute medical and intensive care setting. METHODS: Descriptive analysis of dying patients enrolled in the Lean European Open Survey on SARS-CoV-2 Infected Patients (LEOSS), a non-interventional cohort study, between March 18 and November 18, 2020. Symptoms, comorbidities and management of patients, including palliative care involvement, were compared between general ward and intensive care unit (ICU) by univariate analysis. RESULTS: 580/4310 (13%) SARS-CoV-2 infected patients died. Among 580 patients 67% were treated on ICU and 33% on a general ward. The spectrum of comorbidities and symptoms was broad with more comorbidities (≥ four comorbidities: 52% versus 25%) and a higher age distribution (>65 years: 98% versus 70%) in patients on the general ward. 69% of patients were in an at least complicated phase at diagnosis of the SARS-CoV-2 infection with a higher proportion of patients in a critical phase or dying the day of diagnosis treated on ICU (36% versus 11%). While most patients admitted to ICU came from home (71%), patients treated on the general ward came likewise from home and nursing home (44% respectively) and were more frequently on palliative care before admission (29% versus 7%). A palliative care team was involved in dying patients in 15%. Personal contacts were limited but more often documented in patients treated on ICU (68% versus 47%). CONCLUSION: Patients dying with SARS-CoV-2 infection suffer from high symptom burden and often deteriorate early with a demand for ICU treatment. Therefor a demand for palliative care expertise with early involvement seems to exist

Integration of clinical parameters and CT-based radiomics improves machine learning assisted subtyping of primary hyperaldosteronism

ObjectivesThe aim of this study was to investigate an integrated diagnostics approach for prediction of the source of aldosterone overproduction in primary hyperaldosteronism (PA).Methods269 patients from the prospective German Conn Registry with PA were included in this study. After segmentation of adrenal glands in native CT images, radiomic features were calculated. The study population consisted of a training (n = 215) and a validation (n = 54) cohort. The k = 25 best radiomic features, selected using maximum-relevance minimum-redundancy (MRMR) feature selection, were used to train a baseline random forest model to predict the result of AVS from imaging alone. In a second step, clinical parameters were integrated. Model performance was assessed via area under the receiver operating characteristic curve (ROC AUC). Permutation feature importance was used to assess the predictive value of selected features.ResultsRadiomics features alone allowed only for moderate discrimination of the location of aldosterone overproduction with a ROC AUC of 0.57 for unilateral left (UL), 0.61 for unilateral right (UR), and 0.50 for bilateral (BI) aldosterone overproduction (total 0.56, 95% CI: 0.45-0.65). Integration of clinical parameters into the model substantially improved ROC AUC values (0.61 UL, 0.68 UR, and 0.73 for BI, total 0.67, 95% CI: 0.57-0.77). According to permutation feature importance, lowest potassium value at baseline and saline infusion test (SIT) were the two most important features.ConclusionIntegration of clinical parameters into a radiomics machine learning model improves prediction of the source of aldosterone overproduction and subtyping in patients with PA

Analyse der kontrastmittelverstärkten Magnetresonanztomographie in der Diagnostik von Krankheitsbildern der muskuloskelettalen Radiologie

Diese kumulative Habilitation behandelt die wissenschaftliche Analyse der kontrastmittelverstärkten Magnetresonanztomographie in der Diagnostik von Krankheitsbildern der muskuloskelettalen Radiologie. Die MRT-basierte Bildgebung hat in der Diagnostik sowohl gutartiger als auch maligner muskuloskelettaler Erkrankungen einen hohen Stellenwert. Teilprojekt 1 beschäftigte sich mit der MRT-basierten Diagnostik der Frozen Shoulder, auch genannt adhäsive Kapsulitis. Die Frozen Shoulder ist eine häufige Erkrankung in der Bevölkerung mittleren Alters, bei der die Patientinnen und Patienten unter einer schmerzhaft eingeschränkten Bewegungsfähigkeit der Schulter leiden, wobei primär konservative Therapieverfahren eingesetzt werden. Eine korrekte und frühzeitige klinische und radiologische Diagnose ist dabei wesentlich für eine adäquate Behandlung. Ziel des Projektes war es, die Relevanz kontrastmittelverstärkter Sequenzen für die MRT-basierte Diagnosestellung zu eruieren. Teilprojekt 2 behandelte den Einfluss neuartiger, dynamisch-kontrastverstärkter MRT-Sequenzen sowie einzelner MRT-Bildgebungsparameter auf die diagnostische Aussagekraft der MRT in der Erkennung von Rezidiven von Weichteilsarkomen nach multimodaler Therapie. Die MRT ist derzeit eine wichtige Säule in der Nachsorge dieser Patientengruppe und wird in den ersten drei Jahren nach Resektion routinemäßig alle 3-4 Monate durchgeführt. Zentrale Fragestellungen waren die mögliche Verbesserung der diagnostischen Aussagekraft der MRT durch dynamisch-kontrastverstärkte Sequenzen sowie die Relevanz von MRT-Voruntersuchungen und einzelner MR-morphologischer Bildparameter. In Teilprojekt 3 wurden Assoziationen des Ödems des Quadrizeps-Fettkörpers mit Alterationen der Sehne des M. quadriceps femoris untersucht. Ein Ödem des Quadrizeps-Fettkörpers wird in der Literatur als Ursache für vorderen Knieschmerz betrachtet, seine Ätiologie bleibt jedoch umstritten. Ziel dieser Studie war es, einen möglichen Zusammenhang zwischen dem Ödem des Quadrizeps-Fettkörpers, Veränderungen der angrenzenden Quadrizepssehne sowie Strukturen im vorderen Knie zu analysieren