Single Coronary Artery with Anomalous Rising of the Right Coronary Artery: A Rare Coronary Anomaly Diagnosed by 256-Multidetector Computed Tomography

Herein we report the diagnostic potential of cardiac computed tomography (cCT) to delineate the origin and course of an anomalous right coronary artery (RCA) originating from the midpart of the left anterior descended artery (LAD) in an adult with no other form of congenital heart disease. The patient was referred to our institution due to exertional dyspnea and suspected coronary artery disease. The patient underwent X-ray coronary angiography, and no high grade lesions were observed in the left coronary vessels. In the course of the mid-left-anterior-descending artery (LAD), an anomalous side branch coursing away from the left circumflex coronary artery (LCX) was observed, while a right coronary ostium could not be depicted. cCT confirmed the absence of a right coronary ostium, and the vessel originating from the mid LAD was identified as an anomalous RCA, which coursed anterior of the aorta and the pulmonary trunk

Computed Tomography and Cardiac Magnetic Resonance in Ischemic Heart Disease

AbstractIschemic heart disease is a complex disease process caused by the development of coronary atherosclerosis, with downstream effects on the left ventricular myocardium. It is characterized by a long preclinical phase, abrupt development of myocardial infarction, and more chronic disease states such as stable angina and ischemic cardiomyopathy. Recent advances in computed tomography (CT) and cardiac magnetic resonance (CMR) now allow detailed imaging of each of these different phases of the disease, potentially allowing ischemic heart disease to be tracked during a patient’s lifetime. In particular, CT has emerged as the noninvasive modality of choice for imaging the coronary arteries, whereas CMR offers detailed assessments of myocardial perfusion, viability, and function. The clinical utility of these techniques is increasingly being supported by robust randomized controlled trial data, although the widespread adoption of cardiac CT and CMR will require further evidence of clinical efficacy and cost effectiveness

Isolation and Characterization of tumor associated MHC class I and class II peptides in Solid Renal Cell and Cholangiocellular Carcinoma

Die Immuntherapie stellt eine viel versprechende Schlüsseltechnologie in der auf den Patienten individualisierten Krebstherapie dar. Einen möglichen Ansatz liefert die Peptid-basierte Vakzinierungstherapie, deren Grundlage die Erkennung von MHC-gebundenen Epitopen auf Tumorzellen durch cytotoxische T-Zellen ist. Das Ziel dieser Arbeit bestand einerseits darin, neue Tumorassoziierte Antigene (TAA) und deren Peptide zu finden, welche für eine Peptid-basierte Vakzinierungstherapie von Patienten mit Nierenzellkarzinom (RCC) oder Cholangiozellulärem Karzinom (CCC) geeignet sein könnten. Zweitens, wurde die Rolle von MHC-II-Molekülen und –Peptiden im RCC untersucht. Aus insgesamt zwei RCCs und einem CCC konnten 88 MHC-I-Peptide isoliert und charakterisiert werden, wovon 11 Peptide aufgrund ihrer biologischen Wirkung und Eigenschaft ihrer Quellproteine als potentiell tumorassoziiert diskutiert wurden. Insbesondere ein Ubiquitin D (UBD)-Peptid wurde aufgrund seiner zusätzlichen Überexpression im RCC in den Impfcocktail aufgenommen. Aus neun weiteren RCCs wurden Eluate angefertigt, welche für zukünftige massenspektrometrische Analysen zur Verfügung stehen. Erstmals wurden mithilfe des oben genannten methodischen Ansatzes CCC-Gewebe im Rahmen einer Heilstudie untersucht und ein Impfcocktail zusammengestellt. Durch histologische und proteomische Studien am RCC konnte gezeigt werden, dass neben den bekannten MHC-II-exprimierenden Zellen auch die RCC-Tumorzellen zur MHC-II-Überexpression fähig sind. Durch Nachweis von Entzündungszellen (Makrophagen und T-Zellen) in unmittelbarer Nähe zu den MHC-II-exprimierenden Tumorzellen und durch Untersuchung des Expressionsprofils (insbesondere IFN-gamma) ist hier am ehesten von einer durch Tumorinflammation induzierten MHC-II-Überexpression in Tumorzellen auszugehen. Insgesamt konnten durch MS-Spektrenanalyse von drei RCC-Eluaten 60 MHC-II-Peptide isoliert und charakterisiert werden, wovon 6 Peptide aufgrund ihrer biologischen Wirkung und Eigenschaft ihrer Quellproteine als potentiell tumorassoziiert diskutiert wurden. In einer weiteren Studie wurden Primärzellsuspensionen aus intraoperativ entnommenen RCC-Geweben angefertigt, mit dem Ziel, diese in Langzeitkulturen überzuführen. Im Wesentlichen aufgrund von Kontaminationen, Selektionierung von Fibroblasten und spontaner Wachstumseinstellung konnte leider keine stabile Langzeitkultur realisiert werden. Die erzielten Protokolloptimierungen und die gewonnen Erfahrungen liefern eine solide Basis für mögliche zukünftige Studien. Zusammenfassend konnten im Rahmen dieser Arbeit neue Impfpeptide identifiziert werden, welche bereits im Rahmen von kontrollierten klinischen Studien für die Tumor-Vakzinierung verwendet worden sind. Darüber hinaus konnte eine Beziehung zwischen MHC-II-Überexpression in primären RCC-Zellen und den tumorinfiltrierenden Immunzellen gezeigt werden.Immunotherapy represents a key technology in patient individualized cancer therapy. A promising approach is peptide based tumor vaccination, which is fundamentally based on the recognition of MHC restricted Peptides on tumor cells by cytotoxic T cells. Aim of this work was the investigation of new tumor associated antigens (TAA) and their peptides with consecutively application in patients suffering from renal cell carcinoma (RCC) or cholangiocellular carcinoma (CCC). Above, the role of MHC II molecules and their peptides were explored for RCC. Analyzing two RCCs and one CCC, 88 MHC I restricted peptides were isolated and charatarized. 11 peptides were discussed as potential candidates for tumor vaccination due to the biological role of their source proteins. An Ubiqutin D (UBD) peptide especially was identified which was also overexpressed in tumor tissue and was used for clinical vaccination. Eluates of further nine RCC tissue probes were prepared and can be utilized for mass spectrometry analysis in future. For the first time CCC tumor tissue was explored according to the methods described above, and a vaccination cocktail consisting of both MHC I and MHC II UBD peptides was designed for tumor vaccination. Histological and proteomical studies revealed the ability of MHC II overexpression in primary RCC cells. Co-localization of tumor infiltrating immune cells (macrophages and T cells) and expression profile analysis (especially IFN-gamma) insinuating a tumor inflammation induced MHC II overexpression in tumor cells. Mass spectrometry of three RCC eluates supplied 60 MHC II restricted peptides. Six peptides were discussed as potential candidates for tumor vaccination due to the biological role of their source proteins. Above cell suspension from intraoperative removed primary RCC tissue was prepared to achieve long term culture. Mainly contamination, fibroblast selection and spontaneously growth stop impede severely the establishment of stable long term cultures. Nevertheless, protocol development and the practical experience are a solid basis for relative cell culture studies in future. In conclusion, during this work new vaccination peptides were identified and used for clinical application within clinical trials. Furthermore, a relation between MHC II overexpression in primary RCC cells and tumor infiltrating immune cells was demonstrated and new MHC II restricted peptides in RCC tumor tissue were characterized

Off-resonance magnetic resonance angiography improves visualization of in-stent lumen in peripheral nitinol stents compared to conventional T1-weighted acquisitions: an in vitro comparison study.

To compare the value of inversion recovery with on-resonant water suppression (IRON) to conventional T1-weighted (T1w) MRA and computed tomography angiography (CTA) for visualization of peripheral nitinol stents. We visualized 14 different peripheral nitinol stents in vitro both using Gadolinium (Gd) and ultrasmall superparamagnetic iron nanoparticles (USPIOs) for conventional T1w and IRON-MRA using clinical grade 1.5T MR scanner and iodinated contrast material for CTA using a 256-slice CT scanner. Parameter assessment included signal- and contrast-to-noise ratio (S/CNR), relative in-stent signal and artificial lumen narrowing. X-ray angiography served as gold standard for diameter assessment. Gd-enhanced IRON-MRA exhibited highest in-stent SNR and CNR values compared to conventional T1w MRA (IRON (Gd/USPIO): SNR = 30 ± 3/21 ± 2, CNR = 23 ± 2/14 ± 1; T1w: SNR = 16 ± 1/14 ± 2, CNR = 12 ± 1/10 ± 1, all p < 0.05). Furthermore, IRON-MRA achieved highest relative in-stent signal both using Gd and USPIO (IRON (Gd/USPIO): 121 ± 8 %/103 ± 6 %; T1w: 73 ± 2 %/66 ± 4 %; CTA: 84 ± 6 %, all p < 0.05). However, artificial lumen narrowing appeared similar in all imaging protocols (IRON (Gd/USPIO): 21 ± 3 %/21 ± 2 %; T1w: 16 ± 4 %/17 ± 3 %; CTA: 19 ± 2 %, all p = NS). Finally, IRON-MRA provided improvement of the in-stent lumen visualization with an 'open-close-open' design, which revealed a complete in-stent signal loss in T1w MRA. IRON-MRA improves in-stent visualization in vitro compared to conventional T1w MRA and CTA. In light of the in vitro results with Gd-enhanced IRON-MRA, the clinical implementation of such an approach appears promising