Incidental Monotypic (Fat-Poor) Renal Angiomyolipoma Diagnosed by Core Needle Biopsy

We present the case of a 55-year-old patient with a history of chemotherapy and bone marrow transplantation because of acute myeloid leukaemia. An incidental 4 × 3 cm measuring renal mass was detected while performing a magnetic resonance imaging (MRI) for lumbago. The lesion was suspected to be either a renal cell carcinoma (RCC) or a leukemic infiltration. To decide about further treatment a percutaneous core needle biopsy was performed. Histology showed a monotypic angiomyolipoma, a relatively rare benign renal lesion. Interestingly, in cross-sectional imaging, angiomyolipoma was not taken into differential diagnostic account because of lack of a fatty component. Due to bleeding after biopsy the feeding artery of the tumor was occluded by microcoils. This case demonstrates the utility of biopsy of renal tumors, in particular when small tumor-like lesions are incidentally detected to decide about the right treatment and thereby avoiding nephrectomy

Semantic representation of reported measurements in radiology

Background In radiology, a vast amount of diverse data is generated, and unstructured reporting is standard. Hence, much useful information is trapped in free-text form, and often lost in translation and transmission. One relevant source of free-text data consists of reports covering the assessment of changes in tumor burden, which are needed for the evaluation of cancer treatment success. Any change of lesion size is a critical factor in follow-up examinations. It is difficult to retrieve specific information from unstructured reports and to compare them over time. Therefore, a prototype was implemented that demonstrates the structured representation of findings, allowing selective review in consecutive examinations and thus more efficient comparison over time. Methods We developed a semantic Model for Clinical Information (MCI) based on existing ontologies from the Open Biological and Biomedical Ontologies (OBO) library. MCI is used for the integrated representation of measured image findings and medical knowledge about the normal size of anatomical entities. An integrated view of the radiology findings is realized by a prototype implementation of a ReportViewer. Further, RECIST (Response Evaluation Criteria In Solid Tumors) guidelines are implemented by SPARQL queries on MCI. The evaluation is based on two data sets of German radiology reports: An oncologic data set consisting of 2584 reports on 377 lymphoma patients and a mixed data set consisting of 6007 reports on diverse medical and surgical patients. All measurement findings were automatically classified as abnormal/normal using formalized medical background knowledge, i.e., knowledge that has been encoded into an ontology. A radiologist evaluated 813 classifications as correct or incorrect. All unclassified findings were evaluated as incorrect. Results The proposed approach allows the automatic classification of findings with an accuracy of 96.4 % for oncologic reports and 92.9 % for mixed reports. The ReportViewer permits efficient comparison of measured findings from consecutive examinations. The implementation of RECIST guidelines with SPARQL enhances the quality of the selection and comparison of target lesions as well as the corresponding treatment response evaluation. Conclusions The developed MCI enables an accurate integrated representation of reported measurements and medical knowledge. Thus, measurements can be automatically classified and integrated in different decision processes. The structured representation is suitable for improved integration of clinical findings during decision-making. The proposed ReportViewer provides a longitudinal overview of the measurements

Vertebral body fractures of unknown origin in cancer patients receiving MDCT: reporting by radiologists and awareness by clinicians

Background To evaluate prevalence, radiological reporting and clinical management of pathologic vertebral body fractures (VBFs) of unknown origin in cancer patients receiving computed tomography (CT) examinations. Methods We investigated all CT examinations (over 1 year) of male and female patients with an underlying malignancy and an increased risk of osteoporosis (age 55–79 years) for the presence of VBFs. We evaluated midline sagittal CT-reformations of the spine for prevalence, fracture type, severity and location, the accuracy and style of radiological reporting, subsequent clinical management and documentation in hospital discharge letters. Results 848 patients were investigated. We found 143 VBFs in 94 (11 %) patients. 6, 49, and 45 % were grade 1, grade 2, and grade 3 fractures, respectively, while 20, 66, and 14 % were wedge, biconcave and crush fractures, respectively. 32 (34 %) radiological reports correctly classified VBFs as fractures, 25 (27 %) reports recognized VBFs, but did not type them, and VBFs were not described in 37 (39 %) reports. In 3 (3 %) patients further clinical work-up of VBFs was performed, while only 8 (9 %) hospital discharge letters contained the information of the presence of pathologic VBFs of unknown origin. Conclusions VBFs of unknown origin appear frequently in cancer patients, however, clinical management and documentation was found in only few cases. Moreover, especially in cancer patients consistent radiological reporting of VBFs seems important, as aetiology of VBFs could be from osteoporosis, disease progression or oncological therapy, however, reporting is still performed inconsistently

Technical and Procedural Aspects of a Staged Repair of a Giant Post-Dissection Aneurysm by Using Endosizing- Based Endovascular Stenting Following Aortic Surgical Repair with Simultaneous Debranching Technique

We report on a giant aortic post-dissection aneurysm of the ascending and descending aorta that was removed in a staged procedure using debranching technique on extracorporeal circulation and later on treated with endovascular repair using a fitted stent after endosizing

Benefits of Long Versus Short Thrombolysis Times for Acutely Thrombosed Hemodialysis Native Fistulas

Introduction: Local thrombolysis with a time of exposure to recombinant tissue plasminogen activator of 15 to 150 minutes is commonly used to declot acutely thrombosed hemodialysis fistulas. The duration of thrombolysis for the restoration of arteriovenous blood flow remains controversial. The aim of this study was to investigate the outcomes of long thrombolysis treatment (LTT, 3 hours or more) and short thrombolysis treatment (STT, less than 3 hours) in our institution. Methods: We retrospectively analyzed 86 interventional declotting procedures (28 STT and 58 LTT) applied to 86 acutely thrombosed hemodialysis fistulas. The intervention time (IT) following thrombolysis (from the initial fistulography to the end of the angioplasty maneuvers), the time of day of the intervention (ie, during working hours vs off-hours), and the need for temporary catheter placement (TCP) were assessed. Success was defined as complete access recanalization, and major adverse events were defined as ischemia, bleeding, and access rupture. Results: The ITs were reduced after LTT (63.3 [9.3] minutes) compared to STT (106.7 [24.7], P = .01), but there was no difference in success rate (85.7% STT, 89.7% LTT, P = .722). While all (100%, 58/58) of the angioplasty maneuvers after LTT were performed during regular working hours, 75% (21/28) of those following STT were managed during off-hours (P < .001). Despite the longer treatment, the need for TCP was not increased after LTT (10.7%) compared to STT (12.1%, P = .515), and the major complication rate was reduced (3.4% after LTT and 28.6% after STT, P = .004). Conclusion: Long thrombolysis treatment results in shorter and less complicated percutaneous stenosis treatments during regular working hours. Despite the LTT of up to 25 hours until access for dialysis was achieved, no increase in the risks of TCP or major adverse events were observed following LTT

Cutting Staff Radiation Exposure and Improving Freedom of Motion during CT Interventions: Comparison of a Novel Workflow Utilizing a Radiation Protection Cabin versus Two Conventional Workflows

This study aimed to evaluate the radiation exposure to the radiologist and the procedure time of prospectively matched CT interventions implementing three different workflows—the radiologist—(I) leaving the CT room during scanning; (II) wearing a lead apron and staying in the CT room; (III) staying in the CT room in a prototype radiation protection cabin without lead apron while utilizing a wireless remote control and a tablet. We prospectively evaluated the radiologist’s radiation exposure utilizing an electronic personal dosimeter, the intervention time, and success in CT interventions matched to the three different workflows. We compared the interventional success, the patient’s dose of the interventional scans in each workflow (total mAs and total DLP), the radiologist’s personal dose (in µSV), and interventional time. To perform workflow III, a prototype of a radiation protection cabin, with 3 mm lead equivalent walls and a foot switch to operate the doors, was built in the CT examination room. Radiation exposure during the maximum tube output at 120 kV was measured by the local admission officials inside the cabin at the same level as in the technician’s control room (below 0.5 μSv/h and 1 mSv/y). Further, to utilize the full potential of this novel workflow, a sterile packed remote control (to move the CT table and to trigger the radiation) and a sterile packed tablet anchored on the CT table (to plan and navigate during the CT intervention) were operated by the radiologist. There were 18 interventions performed in workflow I, 16 in workflow II, and 27 in workflow III. There were no significant differences in the intervention time (workflow I: 23 min ± 12, workflow II: 20 min ± 8, and workflow III: 21 min ± 10, p = 0.71) and the patient’s dose (total DLP, p = 0.14). However, the personal dosimeter registered 0.17 ± 0.22 µSv for workflow II, while I and III both documented 0 µSv, displaying significant difference (p < 0.001). All workflows were performed completely and successfully in all cases. The new workflow has the potential to reduce interventional CT radiologists’ radiation dose to zero while relieving them from working in a lead apron all day

Segmentation of the fascia lata and reproducible quantification of intermuscular adipose tissue (IMAT) of the thigh

Abstract Objective To develop a precise semi-automated segmentation of the fascia lata (FL) of the thigh to quantify IMAT volume in T1w MR images and fat fraction (FF) in Dixon MR images. Materials and methods A multi-step segmentation approach was developed to identify fibrous structures of the FL and combining them into a closed 3D surface. 23 healthy young men with low and 50 elderly sarcopenic men with moderate levels of IMAT were measured by T1w and 6pt Dixon MRI at 3T. 20 datasets were used to determine reanalysis precision errors. IMAT volume was compared using the new FL segmentation versus an easier to segment but less accurate, tightly fitting envelope of the thigh muscle ensemble. Results The segmentation was successfully applied to all 73 datasets and took about 7 min per 28 slices. In particular, in elderly subjects, it includes a large amount of adipose tissue below the FL typically not accounted for in other segmentation approaches. Inter- and intra-operator RMS-CVs were 0.33% and 0.14%, respectively, for IMAT volume and 0.04% and 0.02%, respectively, for FFMT. Discussion The FL segmentation is an important step to quantify IMAT with high precision and may be useful to investigate effects of aging and treatment on changes of IMAT and FF. ClinicalTrials.gov identifier NCT2857660, August 5, 2016. Trial registration ClinicalTrials.gov identifier NCT2857660, August 5, 2016

Cardiac MRI: An Alternative Method to Determine the Left Ventricular Function

(1) Background: With the conventional contour surface method (KfM) for the evaluation of cardiac function parameters, the papillary muscle is considered to be part of the left ventricular volume. This systematic error can be avoided with a relatively easy-to-implement pixel-based evaluation method (PbM). The objective of this thesis is to compare the KfM and the PbM with regard to their difference due to papillary muscle volume exclusion. (2) Material and Methods: In the retrospective study, 191 cardiac-MR image data sets (126 male, 65 female; median age 51 years; age distribution 20–75 years) were analysed. The left ventricular function parameters: end-systolic volume (ESV), end-diastolic volume (EDV), ejection fraction (EF) and stroke volume (SV) were determined using classical KfW (syngo.via and cvi42 = gold standard) and PbM. Papillary muscle volume was calculated and segmented automatically via cvi42. The time required for evaluation with the PbM was collected. (3) Results: The size of EDV was 177 mL (69–444.5 mL) [average, [minimum–maximum]], ESV was 87 mL (20–361.4 mL), SV was 88 mL and EF was 50% (13–80%) in the pixel-based evaluation. The corresponding values with cvi42 were EDV 193 mL (89–476 mL), ESV 101 mL (34–411 mL), SV 90 mL and EF 45% (12–73%) and syngo.via: EDV 188 mL (74–447 mL), ESV 99 mL (29–358 mL), SV 89 mL (27–176 mL) and EF 47% (13–84%). The comparison between the PbM and KfM showed a negative difference for end-diastolic volume, a negative difference for end-systolic volume and a positive difference for ejection fraction. No difference was seen in stroke volume. The mean papillary muscle volume was calculated to be 14.2 mL. The evaluation with PbM took an average of 2:02 min. (4) Conclusion: PbM is easy and fast to perform for the determination of left ventricular cardiac function. It provides comparable results to the established disc/contour area method in terms of stroke volume and measures “true” left ventricular cardiac function while omitting the papillary muscles. This results in an average 6% higher ejection fraction, which can have a significant influence on therapy decisions

Impact of velocity- and acceleration-compensated encodings on signal dropout and black-blood state in diffusion-weighted magnetic resonance liver imaging at clinical TEs.

PurposeThe study aims to develop easy-to-implement concomitant field-compensated gradient waveforms with varying velocity-weighting (M1) and acceleration-weighting (M2) levels and to evaluate their efficacy in correcting signal dropouts and preserving the black-blood state in liver diffusion-weighted imaging. Additionally, we seek to determine an optimal degree of compensation that minimizes signal dropouts while maintaining blood signal suppression.MethodsNumerically optimized gradient waveforms were adapted using a novel method that allows for the simultaneous tuning of M1- and M2-weighting by changing only one timing variable. Seven healthy volunteers underwent diffusion-weighted magnetic resonance imaging (DWI) with five diffusion encoding schemes (monopolar, velocity-compensated (M1 = 0), acceleration-compensated (M1 = M2 = 0), 84%-M1-M2-compensated, 67%-M1-M2-compensated) at b-values of 50 and 800 s/mm2 at a constant echo time of 70 ms. Signal dropout correction and apparent diffusion coefficients (ADCs) were quantified using regions of interest in the left and right liver lobe. The blood appearance was evaluated using two five-point Likert scales.ResultsSignal dropout was more pronounced in the left lobe (19%-42% less signal than in the right lobe with monopolar scheme) and best corrected by acceleration-compensation (8%-10% less signal than in the right lobe). The black-blood state was best with monopolar encodings and decreased significantly (p ConclusionAll of the diffusion encodings used in this study demonstrated suitability for routine DWI application. The results indicate that a perfect value for the level of M1-M2-compensation does not exist. However, among the examined encodings, the 84%-M1-M2-compensated encodings provided a suitable tradeoff