Valsalva maneuver decreases liver and spleen stiffness measured by time-harmonic ultrasound elastography

Ultrasound elastography quantitatively measures tissue stiffness and is widely used in clinical practice to diagnose various diseases including liver fibrosis and portal hypertension. The stiffness of soft organs has been shown to be sensitive to blood flow and pressure-related diseases such as portal hypertension. Because of the intricate coupling between tissue stiffness of abdominal organs and perfusion-related factors such as vascular stiffness or blood volume, simple breathing maneuvers have altered the results of liver elastography, while other organs such as the spleen are understudied. Therefore, we investigated the effect of a standardized Valsalva maneuver on liver stiffness and, for the first time, on spleen stiffness using time-harmonic elastography (THE). THE acquires full-field-of-view stiffness maps based on shear wave speed (SWS), covers deep tissues, and is potentially sensitive to SWS changes induced by altered abdominal pressure in the hepatosplenic system. SWS of the liver and the spleen was measured in 17 healthy volunteers under baseline conditions and during the Valsalva maneuver. With the Valsalva maneuver, SWS in the liver decreased by 2.2% (from a median of 1.36 m/s to 1.32 m/s; p = 0.021), while SWS in the spleen decreased by 5.2% (from a median of 1.63 m/s to 1.51 m/s; p = 0.00059). Furthermore, we observed that the decrease was more pronounced the higher the baseline SWS values were. In conclusion, the results confirm our hypothesis that the Valsalva maneuver decreases liver and spleen stiffness, showing that THE is sensitive to perfusion pressure-related changes in tissue stiffness. With its extensive organ coverage and high penetration depth, THE may facilitate translation of pressure-sensitive ultrasound elastography into clinical routine

Benthic ecosystem functioning under climate change: modelling the bioturbation potential for benthic key species in the southern North Sea

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Assessment of quantitative information for radiation therapy at a first-generation clinical photon-counting computed tomography scanner

As one of the latest developments in X-ray computed tomography (CT), photon-counting technology allows spectral detection, demonstrating considerable advantages as compared to conventional CT. In this study, we investigated the use of a first-generation clinical photon-counting computed tomography (PCCT) scanner and estimated proton relative (to water) stopping power (RSP) of tissue-equivalent materials from virtual monoenergetic reconstructions provided by the scanner. A set of calibration and evaluation tissue-equivalent inserts were scanned at 120 kVp. Maps of relative electron density (RED) and effective atomic number (EAN) were estimated from the reconstructed virtual monoenergetic images (VMI) using an approach previously applied to a spectral CT scanner with dual-layer detector technology, which allows direct calculation of RSP using the Bethe-Bloch formula. The accuracy of RED, EAN, and RSP was evaluated by root-mean-square errors (RMSE) averaged over the phantom inserts. The reference RSP values were obtained experimentally using a water column in an ion beam. For RED and EAN, the reference values were calculated based on the mass density and the chemical composition of the inserts. Different combinations of low- and high-energy VMIs were investigated in this study, ranging from 40 to 190 keV. The overall lowest error was achieved using VMIs at 60 and 180 keV, with an RSP accuracy of 1.27% and 0.71% for the calibration and the evaluation phantom, respectively

Development and evaluation of a questionnaire to measure the perceived implementation of the mission statement of a competency based curriculum

BACKGROUND: A mission statement (MS) sets out the long-term goals of an institution and is supposed to be suited for studying learning environments. Yet, hardly any study has tested this issue so far. The aim of the present study was the development and psychometric evaluation of an MS-Questionnaire (MSQ) focusing on explicit competencies. We investigated to what extent the MSQ captures the construct of learning environment and how well a faculty is following - in its perception - a competency orientation in a competency-based curriculum. METHODS: A questionnaire was derived from the MS “teaching” (Medical Faculty, Heinrich-Heine University Düsseldorf) which was based on (inter-) nationally accepted goals and recommendations for a competency based medical education. The MSQ was administered together with the Dundee Ready Education Environment Measure (DREEM) to 1119 students and 258 teachers. Cronbach’s alpha was used to analyze the internal consistency of the items. Explorative factor analyses were performed to analyze homogeneity of the items within subscales and factorial validity of the MSQ. Item discrimination was assessed by means of part-whole corrected discrimination indices, and convergent validity was analyzed with respect to DREEM. Demographic variations of the respondents were used to analyze the inter-group variations in their responses. RESULTS: Students and teachers perceived the MS implementation as “moderate” and on average, students differed significantly in their perception of the MS. They thought implementation of the MS was less successful than faculty did. Women had a more positive perception of educational climate than their male colleagues and clinical students perceived the implementation of the MS on all dimensions significantly worse than preclinical students. The psychometric properties of the MSQ were very satisfactory: Item discrimination was high. Similarly to DREEM, the MSQ was highly reliable among students (α = 0.92) and teachers (α = 0.93). In both groups, the MSQ correlated highly positively with DREEM (r = 0.79 and 0.80, p < 0.001 each). Factor analyses did not reproduce the three areas of the MS perfectly. The subscales, however, could be identified as such both among teachers and students. CONCLUSIONS: The perceived implementation of faculty-specific goals can be measured in an institution to some considerable extent by means of a questionnaire developed on the basis of the institution’s MS. Our MSQ provides a reliable instrument to measure the learning climate with a strong focus on competencies which are increasingly considered crucial in medical education. The questionnaire thus offers additional information beyond the DREEM. Our site-specific results imply that our own faculty is not yet fully living up to its competency-based MS. In general, the MSQ might prove useful for faculty development to the increasing number of faculties seeking to measure their perceived competency orientation in a competency-based curriculum

Near- and Offshore Macrofauna Communities and Their Physical Environment in a South-Eastern North Sea Sandy Beach System

The aim of the study is to compare spatial variation of macrofauna communities in the near- and offshore zone of the beach system of the island of Spiekeroog (German North Sea) in order to environmental parameters such as hydrodynamics and sediment type. The analysis of hydroacoustic backscatter signals have been used to classify the sea bottom characteristics in terms of surface roughness. Sampling was carried out in May 2014. Samples were taken along a 3.4 km transect in north-south direction. The analyses of the spatial distribution structure of the environmental parameters and the macrofauna communities revealed a clear zonation of the transect line into an inner, outer nearshore, and offshore zone. The inner nearshore was exposed to high hydrodynamic energy with a high variability in sediment composition, a lack of biogenic structures, lowest taxa numbers, but a considerably high diversity (Shannon Wiener index). The hydrodynamic conditions in the nearshore zone were more stable. Sediment distribution was homogenous. Taxa number and abundances increased and polychaete species such as Magelona johnstonii, Spiophanes bombyx, and Lanice conchilega characterized the community. In the offshore zone, taxa number and abundances increased even further. Lanice conchilega dominated the community. While current velocities of the bottom layers decreased, mud contents slightly increased

Visualization of bone details in a novel photon-counting dual-source CT scanner—comparison with energy-integrating CT

OBJECTIVES: Photon-counting detector CT (PCD-CT) promises a leap in spatial resolution due to smaller detector pixel sizes than implemented in energy-integrating detector CTs (EID-CT). Our objective was to compare the visualization of smallest bone details between PCD-CT and EID-CT using a mouse as a specimen. MATERIALS AND METHODS: Two euthanized mice were scanned at a 20-slice EID-CT and a dual-source PCD-CT in single-pixel mode at various CTDI(Vol) values. Image noise and signal-to-noise ratio (SNR) were evaluated using repeated ROI measurements. Edge sharpness of bones was compared by the maximal slope within CT value plots along sampling lines intersecting predefined bones of the spine. Two readers evaluated bone detail visualization at four regions of the spine on a three-point Likert scale at various CTDI(Vol)’s. Two radiologists selected the series with better detail visualization among each of 20 SNR-matched pairs of EID-CT and PCD-CT series. RESULTS: In CTDI(Vol)-matched scans, PCD-CT series showed significantly lower image noise (Noise(CTDI=5 mGy): 16.27 ± 1.39 vs. 23.46 ± 0.96 HU, p < 0.01), higher SNR (SNR(CTDI=5 mGy): 20.57 ± 1.89 vs. 14.00 ± 0.66, p < 0.01), and higher edge sharpness (Edge Slope(lumbar spine): 981 ± 160 vs. 608 ± 146 HU/mm, p < 0.01) than EID-CT series. Two radiologists considered the delineation of bone details as feasible at consistently lower CTDI(Vol) values at PCD-CT than at EID-CT. In comparison of SNR-matched reconstructions, PCD-CT series were still considered superior in almost all cases. CONCLUSIONS: In this head-to-head comparison, PCD-CT showed superior objective and subjective image quality characteristics over EID-CT for the delineation of tiniest bone details. Even in SNR-matched pairs (acquired at different CTDI(Vol)’s), PCD-CT was strongly preferred by radiologists. KEY POINTS: • In dose-matched scans, photon-counting detector CT series showed significantly less image noise, higher signal-to-noise ratio, and higher edge sharpness than energy-integrating detector CT series. • Human observers considered the delineation of tiny bone details as feasible at much lower dose levels in photon-counting detector CT than in energy-integrating detector CT. • In direct comparison of series matched for signal-to-noise ratio, photon-counting detector CT series were considered superior in almost all cases. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00330-021-08441-4

Optimal conspicuity of liver metastases in virtual monochromatic imaging reconstructions on a novel photon-counting detector CT—effect of keV settings and BMI

In dual-energy CT datasets, the conspicuity of liver metastases can be enhanced by virtual monoenergetic imaging (VMI) reconstructions at low keV levels. Our study investigated whether this effect can be reproduced in photon-counting detector CT (PCD-CT) datasets. We analyzed 100 patients with liver metastases who had undergone contrast-enhanced CT of the abdomen on a PCD-CT (n = 50) or energy-integrating detector CT (EID-CT, single-energy mode, n = 50). PCD-VMI-reconstructions were performed at various keV levels. Identical regions of interest were positioned in metastases, normal liver, and other defined locations assessing image noise, tumor-to-liver ratio (TLR), and contrast-to-noise ratio (CNR). Patients were compared inter-individually. Subgroup analyses were performed according to BMI. On the PCD-CT, noise and CNR peaked at the low end of the keV spectrum. In comparison with the EID-CT, PCD-VMI-reconstructions exhibited lower image noise (at 70 keV) but higher CNR (for ≤70 keV), despite similar CTDIs. Comparing high- and low-BMI patients, CTDI-upregulation was more modest for the PCD-CT but still resulted in similar noise levels and preserved CNR, unlike the EID-CT. In conclusion, PCD-CT VMIs in oncologic patients demonstrated reduced image noise–compared to a standard EID-CT–and improved conspicuity of hypovascularized liver metastases at low keV values. Patients with higher BMIs especially benefited from constant image noise and preservation of lesion conspicuity, despite a more moderate upregulation of CTDI

Historical Data Reveal 30-Year Persistence of Benthic Fauna Associations in Heaviy Modified Waterbody

Baseline surveys form the cornerstone of coastal impact studies where altered conditions, for example through new infrastructure development, are assessed against a temporal reference state. They are snapshots taken before construction. Due to scarcity of relevant data prior to baseline surveys long-term trends can often not be taken into account. Particularly in heavily modified waterbodies this would however be desirable to control for changes in anthropogenic use over time as well as natural ecological variation. Here, the benthic environment of an industrialized embayment was investigated (Swansea Bay, Wales, UK) where it is proposed to build a tidal lagoon that would generate marine renewable energy from the tidal range. Since robust long-term baseline data was not available, the value of unpublished historical benthos information from 1984 by a regional water company was assessed with the aim to improve certainty about the persistence of current benthic community patterns. A survey of 101 positions in 2014 identified spatially discrete benthic communities with areas of high and low diversity. Habitat characteristics including sediment properties and the proximity to a sewage outfall explained 17–35% of the variation in the community structure. Comparing the historical information from 1984 with 2014 revealed striking similarity in the benthic communities between those years, not just in their spatial distribution but also to a large extent in the species composition. The 30-year-old information confirmed spatial boundaries of discrete species associations and pinpointed a similar diversity hotspot. A group of five common species was found to be particularly persistent over time (Nucula nitidosa, Spisula elliptica, Spiophanes bombyx, Nephtys hombergii, Diastylis rathkei). According to the Infauna Quality Index (IQI) linked to the EU Water Framework Directive (WFD) the average ecological status for 2014 was “moderate,” but 11 samples showing “poor” and “bad” status indicated possible negative impacts of dredge spoil disposal. Generally the study demonstrated the value of historical information for assessing the persistence of benthic community characteristics, while also highlighting shortcomings if raw data is lost and if the historical baseline does not reflect pristine ecological conditions

Fluid preinjection for microwave ablation in an ex vivo bovine liver model assessed with volumetry in an open MRI system

PURPOSEWe aimed to detect possible differences in microwave ablation (MWA) volumes after different fluid preinjections using magnetic resonance imaging (MRI).MATERIALS AND METHODSMWA volumes were created in 50 cuboid ex vivo bovine liver specimens (five series: control [no injection], 10 mL water, 10 mL 0.9% NaCl, 10 mL 6% NaCl, and 10 mL 12% NaCl preinjections; n=10 for each series). The operating frequency (915 megahertz), ablation time (7 min), and energy supply (45 watts) were constant. Following MWA, two MR sequences were acquired, and MR volumetry was performed for each sequence.RESULTSFor both sequences, fluid preinjection did not lead to significant differences in MWA ablation volumes compared to the respective control group (sequence 1: mean MWA volumes ranged from 7.0±1.2 mm [water] to 7.8±1.3 mm [12% NaCl] vs. 7.3±2.1 mm in the control group; sequence 2: mean MWA volumes ranged from 4.9±1.4 mm [12% NaCl] to 5.5±1.9 mm [0.9% NaCl] vs. 4.7±1.6 mm in the control group). The ablation volumes visualized with the two sequences differed significantly in general (P < 0.001) and between the respective groups (control, P ≤ 0.001; water, P < 0.001; 0.9% NaCl, P < 0.001; 6% NaCl, P ≤ 0.001; 12% NaCl, P < 0.001). The volumes determined with sequence 1 were closer to the expected ablation volume of 8 mL compared to those determined with sequence 2.CONCLUSIONFor the fluid qualities and concentrations assessed, there is no evidence that fluid preinjection results in larger coagulation volumes after MWA. Because ablation volumes determined by MRI vary with the sequence used, interventionalists should gain experience in how to interpret postinterventional imaging findings (with the MR scanner, sequences, and parameters used) to accurately estimate the outcome of the interventions they perform