Semi-automated computed tomography Volumetry can predict hemihepatectomy specimens’ volumes in patients with hepatic malignancy

Background: One of the major causes of perioperative mortality of patients undergoing major hepatic resections is post-hepatectomy liver failure (PHLF). For preoperative appraisal of the risk of PHLF it is important to accurately predict resectate volume and future liver remnant volume (FLRV). The objective of our study is to prospectively evaluate the accuracy of hemihepatectomy resectate volumes that are determined by computed tomography volumetry (CTV) when compared with intraoperatively measured volumes and weights as gold standard in patients undergoing hemihepatectomy. Methods: Twenty four patients (13 women, 11 men) scheduled for hemihepatectomy due to histologically proven primary or secondary hepatic malignancies were included in our study. CTV was performed using a semi-automated module (S, hereinafter) (syngo.CT Liver Analysis VA30, Siemens Healthcare, Germany). Conversion factors between CT volumes on the one side and intraoperative volumes and weights on the other side were calculated using the method of least squares. Absolute and relative disagreements between CT volumes and intraoperative volumes were determined. Results: A conversion factor of c = 0.906 most precisely predicted intraoperative volumes of exsanguinated hemihepatectomy specimens from CT volumes in all patients with mean absolute and relative disagreements between CT volumes and intraoperative volumes of 57 ml and 6.3%. The use of operation-specific conversion factors yielded even better results. Conclusions: CTV performed with S accurately predicts intraoperative volumes of hemihepatectomy specimens when applying conversion factors which compensate for exsanguination. This allows to precisely estimate the FLRV and thus minimize the risk of PHLF in patients undergoing major hepatic resections

Off-Label Use of Ceftolozane/Tazobactam for the Successful Treatment of Healthcare-Associated Meningitis Caused by Extensively Drug-Resistant Pseudomonas aeruginosa in a Polytraumatized Patient—A Case Report

Background: Hospital-acquired infections with extensively drug-resistant (XDR) Pseudomonas aeruginosa (PA) have become a worrisome concern because of unfavorable outcomes and limited antimicrobial treatment options. Studies with new antimicrobial substances against XDR-PA show very promising results in different infection types, but the data for central nervous system (CNS) infections are scarce. Case presentation: Here, we report the case of a young patient with healthcare-associated meningitis caused by XDR-PA following severe craniocerebral injury. An off-label use of high-dose ceftolozane/tazobactam (C/T) monotherapy was administered for 10 days in parallel with source-controlling measures. Clinical and microbial recovery could be accomplished promptly. Conclusion: In patients with hospital-acquired CNS infections due to XDR-PA, C/T might be a new, safe and effective alternative with fewer adverse effects compared to older polymyxin- or aminoglycoside-based regimens

Off-Label Use of Ceftolozane/Tazobactam for the Successful Treatment of Healthcare-Associated Meningitis Caused by Extensively Drug-Resistant <i>Pseudomonas aeruginosa</i> in a Polytraumatized Patient—A Case Report

Background: Hospital-acquired infections with extensively drug-resistant (XDR) Pseudomonas aeruginosa (PA) have become a worrisome concern because of unfavorable outcomes and limited antimicrobial treatment options. Studies with new antimicrobial substances against XDR-PA show very promising results in different infection types, but the data for central nervous system (CNS) infections are scarce. Case presentation: Here, we report the case of a young patient with healthcare-associated meningitis caused by XDR-PA following severe craniocerebral injury. An off-label use of high-dose ceftolozane/tazobactam (C/T) monotherapy was administered for 10 days in parallel with source-controlling measures. Clinical and microbial recovery could be accomplished promptly. Conclusion: In patients with hospital-acquired CNS infections due to XDR-PA, C/T might be a new, safe and effective alternative with fewer adverse effects compared to older polymyxin- or aminoglycoside-based regimens

Balanced steady-state free precession MRCP is a robust alternative to respiration-navigated 3D turbo-spin-echo MRCP

Background!#!Despite synchronization to respiration, respiration-navigated (RN) 3D turbo-spin-echo MRCP is limited by susceptibility to motion artifacts. The aim of this study was to assess the quality of pancreaticobiliary duct visualization of a non-RN MRCP alternative based on balanced steady-state free precession imaging (BSSFP) with overlapping slices compared with RN-MRCP.!##!Methods!#!This is a retrospective study on 50 patients without pancreaticobiliary duct disease receiving MRCP at 1.5 T. We performed an intraindividual comparison of coronal RN-MRCP with combined coronal and transverse BSSFP-MRCP. Image quality was scored by 3 readers for 6 pancreaticobiliary duct segments (3 pancreatic, 3 biliary) using a 6-point scale. A segment score of 3 or lower as assessed by at least 2 of 3 readers was defined as insufficient segment visualization. Nonparametric tests and interrater reliability testing were used for statistical analysis.!##!Results!#!Overall duct visualization averaged over all readers was scored with 4.5 ± 1.1 for RN-MRCP (pancreatic, 4.1 ± 0.5; biliary, 5.0 ± 0.4) and 4.9 ± 0.9 for combined coronal and transverse BSSFP-MRCP (pancreatic, 4.6 ± 0.6; biliary, 5.1 ± 0.6), respectively (p &amp;lt; 0.001). The number of segments visualized insufficiently was 81/300 for RN-MRCP and 43/300 for BSSFP-MRCP (p &amp;lt; 0.001). Segments visualized insufficiently only in RN-MRCP had a mean score of 4.4 ± 0.8 in BSSFP-MRCP. Overall interrater agreement on superiority of BSSFP-MRCP segment scores over corresponding RN-MRCP was 0.70. Mean acquisition time was 98% longer for RN-MRCP (198.0 ± 98.7 s) than for combined coronal and transverse BSSFP-MRCP (100.2 ± 0.4 s).!##!Conclusions!#!Non-RN BSSFP-MRCP with overlapping slices is a fast alternative to RN-MRCP, frequently providing sufficient duct visualization when RN-MRCP fails

Accuracy of estimation of graft size for living-related liver transplantation: first results of a semi-automated interactive software for CT-volumetry.

ObjectivesTo evaluate accuracy of estimated graft size for living-related liver transplantation using a semi-automated interactive software for CT-volumetry.Materials and methodsSixteen donors for living-related liver transplantation (11 male; mean age: 38.2±9.6 years) underwent contrast-enhanced CT prior to graft removal. CT-volumetry was performed using a semi-automated interactive software (P), and compared with a manual commercial software (TR). For P, liver volumes were provided either with or without vessels. For TR, liver volumes were provided always with vessels. Intraoperative weight served as reference standard. Major study goals included analyses of volumes using absolute numbers, linear regression analyses and inter-observer agreements. Minor study goals included the description of the software workflow: degree of manual correction, speed for completion, and overall intuitiveness using five-point Likert scales: 1--markedly lower/faster/higher for P compared with TR, 2--slightly lower/faster/higher for P compared with TR, 3--identical for P and TR, 4--slightly lower/faster/higher for TR compared with P, and 5--markedly lower/faster/higher for TR compared with P.ResultsLiver segments II/III, II-IV and V-VIII served in 6, 3, and 7 donors as transplanted liver segments. Volumes were 642.9±368.8 ml for TR with vessels, 623.8±349.1 ml for P with vessels, and 605.2±345.8 ml for P without vessels (PConclusionsCT-volumetry performed with P can predict accurately graft size for living-related liver transplantation while improving workflow compared with TR

Daily AI-Based Treatment Adaptation under Weekly Offline MR Guidance in Chemoradiotherapy for Cervical Cancer 1: The AIM-C1 Trial

(1) Background: External beam radiotherapy (EBRT) and concurrent chemotherapy, followed by brachytherapy (BT), offer a standard of care for patients with locally advanced cervical carcinoma. Conventionally, large safety margins are required to compensate for organ movement, potentially increasing toxicity. Lately, daily high-quality cone beam CT (CBCT)-guided adaptive radiotherapy, aided by artificial intelligence (AI), became clinically available. Thus, online treatment plans can be adapted to the current position of the tumor and the adjacent organs at risk (OAR), while the patient is lying on the treatment couch. We sought to evaluate the potential of this new technology, including a weekly shuttle-based 3T-MRI scan in various treatment positions for tumor evaluation and for decreasing treatment-related side effects. (2) Methods: This is a prospective one-armed phase-II trial consisting of 40 patients with cervical carcinoma (FIGO IB-IIIC1) with an age ≥ 18 years and a Karnofsky performance score ≥ 70%. EBRT (45–50.4 Gy in 25–28 fractions with 55.0–58.8 Gy simultaneous integrated boosts to lymph node metastases) will be accompanied by weekly shuttle-based MRIs. Concurrent platinum-based chemotherapy will be given, followed by 28 Gy of BT (four fractions). The primary endpoint will be the occurrence of overall early bowel and bladder toxicity CTCAE grade 2 or higher (CTCAE v5.0). Secondary outcomes include clinical feasibility, quality of life, and imaging-based response assessment

Semi-automated Interactive Software (P) – Image Example.

<p>A Transverse image of the portal-venous phase – automated outline of the entire liver after manual correction of false-positive and false-negative extractions. B Manual positioning of the anatomical landmark “first bifurcation of the right portal vein” (blue circle) according to <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0110201#pone-0110201-g001" target="_blank">Fig. 1A</a>. C Automated definition of segments of Couinaud for right liver - transverse image. D Automated definition of segments of Couinaud for left liver - sagittal image. E Volume rendering (coronal view) with automated definition of segments of Couinaud of the entire liver. F List of volumes for the different segments of Couinaud. G Transverse image of the portal-venous phase – automated outline of the entire liver after manual correction of false-positive and false-negative extractions. H Volume rendering (coronal view) with automated definition of vessels (liver veins in light blue and portal veins in dark blue). Note: in each live liver donor, CT-volumetry of the entire liver was performed to ensure that the postoperative liver volume, calculated on the basis of Fig. 5F, is adequate.</p

Manual Commercial Software (TR) – Image Example.

<p>A Transverse image of the portal-venous phase – manual outline of the entire liver (yellow). B Transverse image of the portal-venous phase – manual outline of liver segments II/III (yellow). C Volume rendering (coronal view) resulting after manual outline of the entire liver. D Volume rendering (coronal view) resulting after manual outline of liver segments II/III. Note: in each live liver donor, CT-volumetry of the entire liver as well as of the future liver graft (transplanted liver segments) were performed to ensure that the postoperative liver volume is adequate.</p

Intraoperative Weights and Volumes of Transplanted Liver Segments.

<p>Note: *statistically significant differences between the 3 different techniques were evaluated applying ANOVA for repeated measures; mean of 4 reads (Read 1 and Read 2 for Observer 1 as well as Read 1 and Read 2 for Observer 2); given numbers are mean±SD (range).</p><p>Intraoperative Weights and Volumes of Transplanted Liver Segments.</p

Patient Demographics.

<p>Note: given numbers are mean±SD (range).</p><p>Patient Demographics.</p