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1.
Neurosurg Rev ; 46(1): 25, 2022 Dec 27.
Article in English | MEDLINE | ID: mdl-36574089

ABSTRACT

The Berlin Grading System assesses clinical severity of moyamoya angiopathy (MMA) by combining MRI, DSA, and cerebrovascular reserve capacity (CVRC). Our aim was to validate this grading system using [15O]H2O PET for CVRC. We retrospectively identified bilateral MMA patients who underwent [15O]H2O PET examination and were treated surgically at our department. Each hemisphere was classified using the Suzuki and Berlin Grading System. Preoperative symptoms and perioperative ischemias were collected, and a logistic regression analysis was performed. A total of 100 hemispheres in 50 MMA patients (36 women, 14 men) were included. Using the Berlin Grading System, 2 (2.8%) of 71 symptomatic hemispheres were categorized as grade I, 14 (19.7%) as grade II, and 55 (77.5%) as grade III. The 29 asymptomatic hemispheres were characterized as grade I in 7 (24.1%) hemispheres, grade II in 12 (41.4%), and grade III in 10 (34.5%) hemispheres. Berlin grades were independent factors for identifying hemispheres as symptomatic and higher grades correlated with increasing proportion of symptomatic hemispheres (p < 0.01). The Suzuki grading did not correlate with preoperative symptoms (p = 0.26). Perioperative ischemic complications occurred in 8 of 88 operated hemispheres. Overall, complications did not occur in any of the grade I hemispheres, but in 9.1% (n = 2 of 22) and 9.8% (n = 6 of 61) of grade II and III hemispheres, respectively. In this study, we validated the Berlin Grading System with the use of [15O]H2O PET for CVRC as it could stratify preoperative symptomatology. Furthermore, we highlighted its relevance for predicting perioperative ischemic complications.


Subject(s)
Cerebral Revascularization , Moyamoya Disease , Male , Humans , Female , Retrospective Studies , Moyamoya Disease/diagnostic imaging , Moyamoya Disease/surgery , Magnetic Resonance Imaging , Cerebral Revascularization/adverse effects , Positron-Emission Tomography
2.
Eur J Neurol ; 27(10): 1937-1947, 2020 10.
Article in English | MEDLINE | ID: mdl-32416613

ABSTRACT

BACKGROUND AND PURPOSE: Post-hypoxic movement disorders and chronic post-hypoxic myoclonus are rare complications after cardiac arrest in adults. Our study investigates the clinical spectrum, neuroimaging results, therapy and prognosis of these debilitating post-hypoxic sequelae. METHODS: This retrospective study included 72 patients from the neurological intensive care unit at a university hospital, who were diagnosed with hypoxic-ischaemic encephalopathy after cardiac arrest between January 2007 and September 2018. Clinical records were screened for occurrence of post-hypoxic movement disorders and chronic post-hypoxic myoclonus. Affected patients were further analysed for applied neuroprognostic tests, administered therapy and treatment response, and the outcome of these movement disorders and neurological function. RESULTS: Nineteen out of 72 screened patients exhibited post-hypoxic motor symptoms. Basal ganglia injury was the most likely neuroanatomical correlate of movement disorders as indicated by T1 hyperintensities and hypometabolism of this region in magnetic resonance imaging and positron emission tomography computed tomography. Levomepromazine and intrathecal baclofen showed first promising and mostly prompt responses to control these post-hypoxic movement disorders and even hyperkinetic storms. In contrast, chronic post-hypoxic myoclonus best responded to co-application of clonazepam, levetiracetam and primidone. Remission rates of post-hypoxic movement disorders and chronic post-hypoxic myoclonus were 58% and 50%, respectively. Affected patients seemed to present a rather good recovery of cognitive functions in contrast to the often more severe physical deficits. CONCLUSIONS: Post-hypoxic movement disorders associated with pronounced basal ganglia dysfunction might be efficiently controlled by levomepromazine or intrathecal baclofen. Their occurrence might be an indicator for a more unfavourable, but often not devastating, neurological outcome.


Subject(s)
Brain Injuries , Heart Arrest , Movement Disorders , Myoclonus , Adult , Heart Arrest/complications , Humans , Movement Disorders/diagnostic imaging , Movement Disorders/etiology , Myoclonus/diagnostic imaging , Myoclonus/drug therapy , Myoclonus/etiology , Retrospective Studies
3.
Sci Rep ; 10(1): 3398, 2020 02 25.
Article in English | MEDLINE | ID: mdl-32099001

ABSTRACT

Lymphatic spread determines treatment decisions in prostate cancer (PCa) patients. 68Ga-PSMA-PET/CT can be performed, although cost remains high and availability is limited. Therefore, computed tomography (CT) continues to be the most used modality for PCa staging. We assessed if convolutional neural networks (CNNs) can be trained to determine 68Ga-PSMA-PET/CT-lymph node status from CT alone. In 549 patients with 68Ga-PSMA PET/CT imaging, 2616 lymph nodes were segmented. Using PET as a reference standard, three CNNs were trained. Training sets balanced for infiltration status, lymph node location and additionally, masked images, were used for training. CNNs were evaluated using a separate test set and performance was compared to radiologists' assessments and random forest classifiers. Heatmaps maps were used to identify the performance determining image regions. The CNNs performed with an Area-Under-the-Curve of 0.95 (status balanced) and 0.86 (location balanced, masked), compared to an AUC of 0.81 of experienced radiologists. Interestingly, CNNs used anatomical surroundings to increase their performance, "learning" the infiltration probabilities of anatomical locations. In conclusion, CNNs have the potential to build a well performing CT-based biomarker for lymph node metastases in PCa, with different types of class balancing strongly affecting CNN performance.


Subject(s)
Deep Learning , Membrane Glycoproteins/administration & dosage , Organometallic Compounds/administration & dosage , Positron Emission Tomography Computed Tomography , Prostatic Neoplasms/diagnostic imaging , Tomography, X-Ray Computed , Aged , Gallium Isotopes , Gallium Radioisotopes , Humans , Lymphatic Metastasis , Male , Prostatic Neoplasms/pathology , Retrospective Studies
4.
Mol Imaging Biol ; 19(3): 437-445, 2017 06.
Article in English | MEDLINE | ID: mdl-27743210

ABSTRACT

PURPOSE: The purpose of this study was to assess the value of the spatial heterogeneity of somatostatin receptor (SSR) volume, quantified as asphericity (ASP), and to predict response to peptide receptor radionuclide therapy (PRRT) in patients with metastatic gastroenteropancreatic neuroendocrine neoplasms (GEP-NEN). PROCEDURES: From June 2011 to May 2013, patients suffering from GEP-NEN who underwent pretherapeutic [111In-DTPA0]octreotide scintigraphy (Octreoscan®) prior to [177Lu-DOTA0-Tyr3]octreotate ([177Lu]DOTATATE)-PRRT were enrolled in this retrospective evaluation. SSR expression in 20 NEN patients was qualitatively and quantitatively assessed using the Krenning score, the metastasis to liver uptake ratio (M/L ratio), and ASP at baseline. Response to PRRT was evaluated based on lesions, which were classified as responding lesions (RL) and non-responding lesions (NRL) after 4- and 12-month follow-ups. The values of the Krenning score, M/L ratio, and ASP for response prediction were compared by using the Mann-Whitney U test, Kruskal-Wallis test, and receiver operating characteristic (ROC) curves. RESULTS: Seventy-seven metastases (liver, n = 40; lymph node, n = 24; bone, n = 11; pancreas, n = 2) showed SSR expression. A higher ASP level was significantly associated with poorer response at both time points. ROC analyses revealed the highest area under the curve (AUC) for discrimination between RL and NRL for ASP after 4 months (AUC 0.97; p = 0.019) and after 12 months (AUC 0.96; p < 0.001), followed by the Krenning score (AUC 0.74; p = 0.082 and AUC 0.85; p < 0.001, respectively) and M/L ratio (AUC 0.77; p = 0.107 and AUC 0.82; p < 0.001). The optimal cutoff value for ASP was 5.12 % (sensitivity, 90 %; specificity, 93 %). CONCLUSION: Asphericity of SSR-expressing lesions in pretherapeutic single-photon emission computed tomography with integrated computed tomography (SPECT/CT) is a promising parameter for predicting response to PRRT in gastroenteropancreatic neuroendocrine neoplasms.


Subject(s)
Neuroendocrine Tumors/drug therapy , Octreotide/analogs & derivatives , Pancreatic Neoplasms/diagnostic imaging , Pancreatic Neoplasms/drug therapy , Pentetic Acid/analogs & derivatives , Radiopharmaceuticals/therapeutic use , Receptors, Peptide/therapeutic use , Single Photon Emission Computed Tomography Computed Tomography , Tomography, X-Ray Computed , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Octreotide/chemistry , Pentetic Acid/chemistry , ROC Curve , Treatment Outcome
5.
Nuklearmedizin ; 52(4): 148-56, 2013.
Article in English | MEDLINE | ID: mdl-23928982

ABSTRACT

AIM: To evaluate the use and reliability of the PET-based response criteria for interim PET (iPET) in terms of interobserver variability in pediatric and adolescent patients suffering from non-Hodgkin´s lymphoma (NHL). Particular attention was given to the identification of visual cutoff to separate patients with a favourable outcome. PATIENTS, METHODS: Retrospective analysis of PET-datasets of 18 children and adolescents suffering from NHL who underwent iPET after two cycles of chemotherapy for response assessment. Datasets were evaluated and rated in three independent review centers (RC) (blinded-read, intra-center consensus) using a visual 5-point response scale. Ratings were compared to clinical outcome. Pairwise interobserver agreement was analysed with Cohen's kappa-test (κ). Overall agreement (between attended RCs) was assessed with Fleiss' κ-test. RESULTS: Four patients suffered relapse (early, n = 2; late, n = 2). Per region analyses on interobserver variability revealed a "substantial" agreement (Fleiss' κ = 0.618). Per patient analyses revealed concordant iPET-ratings in eight patients: iPET-negative (iPET-), n = 5; iPET-positive (iPET+), n = 2; iPET-inconclusive (iPET±), n = 1. Discordant ratings were found in the remaining patients. Patients with early relapse were concordantly identified using mediastinal blood pool structures (MBPS, score ≥ 3) as visual cutoff between iPET+ or iPET-, respectively. However, patients with late relapse were not concordantly identified taking the MBPS as visual cutoff. CONCLUSION: The iPET interpretation using a dedicated PET-based response scale assured a low interobserver variability in per-region but not in per-patient analyses in a multicenter read. Using a sensitive read out (iPET+, score ≥ 3) a reliable identification of patients suffering relapse was limited to those with early relapse.


Subject(s)
Antineoplastic Agents/therapeutic use , Fluorodeoxyglucose F18 , Lymphoma, Non-Hodgkin/diagnostic imaging , Lymphoma, Non-Hodgkin/drug therapy , Positron-Emission Tomography/methods , Adolescent , Child , Child, Preschool , Female , Germany , Humans , Male , Prognosis , Radiopharmaceuticals , Reproducibility of Results , Retrospective Studies , Sensitivity and Specificity , Treatment Outcome , Young Adult
6.
Urologe A ; 51(12): 1708-13, 2012 Dec.
Article in German | MEDLINE | ID: mdl-23160606

ABSTRACT

Magnetic resonance urography (MRU) provides high resolution imaging of the urogenital system and the use of paramagnetic contrast agents enables a functional depiction. This review summarizes existing data concerning this diagnostic procedure in pediatric urology. A systematic search and assessment of the literature was performed.A total of 12 studies were reviewed in detail. In mostly small study populations a great heterogeneity concerning methodology, use of comparative examinations and standards of reference was noted. Besides the quality of anatomical imaging, the functional study of renal excretory function and differential renal function was also assessed. Only a few studies performed statistical analyses.The authors' rating of MRU was mostly positive. Due to methodical weaknesses, lack of independent standards of reference and statistical analyses the overall level of evidence was low. Further high quality studies will be necessary to assess the value of MRU for the diagnostic workup in pediatric urology.


Subject(s)
Magnetic Resonance Imaging/statistics & numerical data , Pediatrics/statistics & numerical data , Practice Patterns, Physicians'/statistics & numerical data , Urography/statistics & numerical data , Urologic Diseases/epidemiology , Urologic Diseases/pathology , Urology/statistics & numerical data , Child , Humans , Prevalence , Reproducibility of Results , Sensitivity and Specificity
7.
Klin Padiatr ; 224(5): 296-302, 2012 Sep.
Article in English | MEDLINE | ID: mdl-22821289

ABSTRACT

OBJECTIVES: To analyze the impact of functional magnetic resonance urography (fMRU) on the therapeutic management in infants with complex obstructive uropathy (OU) compared to the conventional diagnostic algorithm [CDA, ultrasound, radioisotope nephrography (RN)]. METHODS: Retrospective analysis on 10 consecutive infants [female, n=3; male, n=7; age, 10.7 (2-17) months] with OU. Patients were examined according to CDA. If CDA revealed inconclusive results, fMRU was performed additionally. Split kidney function was assessed by RN [single kidney function (SKF)] and fMRU [volumetric differential renal function (vDRF)]. Findings were presented to an interdisciplinary truth-panel in a 2-step decision process (with and without fMRU). Clinical decision was determined. RESULTS: CDA indicated surgical intervention in 8 patients and conservative treatment in 2. Information by fMRU changed treatment strategy in 3 patients and led to the modification of the initially chosen surgical approach in 8 cases. The comparison of SKF and vDRF was not possible in 1 patient, whereas concordance was observed in 7 patients. SKF and vDRF differed >5% in 2 patients. CONCLUSIONS: fMRU has potential to improve therapeutic management of OU in infants. If surgical treatment is advised, the morphological information by fMRU has to be emphasized. Regarding kidney function estimation preliminary results are encouraging.


Subject(s)
Algorithms , Magnetic Resonance Imaging/methods , Urinary Tract/abnormalities , Urography/methods , Constriction, Pathologic/diagnosis , Constriction, Pathologic/physiopathology , Constriction, Pathologic/surgery , Diagnosis, Differential , Female , Humans , Hydronephrosis/congenital , Hydronephrosis/diagnosis , Hydronephrosis/physiopathology , Image Enhancement/methods , Image Interpretation, Computer-Assisted/methods , Infant , Kidney Function Tests , Male , Pilot Projects , Radioisotope Renography , Retrospective Studies , Sensitivity and Specificity , Urinary Tract/physiopathology , Urinary Tract/surgery , Urodynamics/physiology
8.
Nuklearmedizin ; 51(3): 88-94, 2012.
Article in English | MEDLINE | ID: mdl-22473075

ABSTRACT

AIM: This study was set up to determine the value of magnetic resonance imaging (MRI) and bone scintigraphy (BS) for the diagnosis of stress injuries in athletes, and furthermore to assess reliability and prediction of healing time. PATIENTS, METHODS: Imaging data was analyzed retrospectively from 28 athletes who had received MRI and BS examinations for suspected stress injuries. MRI- and BS-data were rated by three specialists each in a blinded read, using a 5-point score (i.e. 0-4: inconspicuous to high-grade stress fracture). An interdisciplinary expert truth-panel set the reference standard. Standard statistical parameters, Fleiss' kappa (κ), and group comparisons were calculated. RESULTS: The sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) for detection of stress injuries were 71.4%, 85.7%, 78.6%, 83.3% and, 75.0%, for MRI and 92.9%, 73.8%, 83.3%, 78.0% and, 91.2% for BS, respectively. Interobserver reliability for the diagnosis of a stress injury was κ = 0.9 for BS and κ = 0.85 for MRI. Mean healing times of mild (grades 1 and 2) and severe (grades 3 and 4) stress injuries were 88 days (d) versus 142d for BS and 57d versus 116d for MRI. No significant difference in healing time could be shown. CONCLUSIONS: MRI and BS reliably detect stress injuries. MRI is to be recommended as the primary imaging modality due to its potential for assessment of differential diagnoses and the lack of radiation exposure, the value of BS lies in the exclusion of stress fractures after inconclusive MRI examinations.


Subject(s)
Athletic Injuries/diagnosis , Athletic Injuries/therapy , Diphosphonates , Fractures, Stress/diagnosis , Fractures, Stress/therapy , Magnetic Resonance Imaging/methods , Organotechnetium Compounds , Radionuclide Imaging/methods , Female , Fracture Healing , Humans , Male , Radiopharmaceuticals , Reproducibility of Results , Retrospective Studies , Sensitivity and Specificity , Young Adult
9.
Ann Oncol ; 22(5): 1198-1203, 2011 May.
Article in English | MEDLINE | ID: mdl-20966182

ABSTRACT

BACKGROUND: The aim of this study was to evaluate the use and reliability of the new positron emission tomography (PET)-based response criteria for interim positron emission tomography (iPET) in patients with paediatric Hodgkin's lymphoma (pHL). Particular emphasis was put on interobserver variability and on identification of a visual cut-off defining patients with very low risk for relapse. PATIENTS AND METHODS: The iPET scans of 39 pHL patients were evaluated in two independent centres by two PET-experienced specialists in nuclear medicine (blinded read, centre consensus) each. The iPET scans were interpreted using a 5-point scale and were compared with the outcome. Cohen's kappa-test (κ) was used to analyse the interobserver agreement. RESULTS: Concordant ratings were assessed in 19 patients with iPET-negative findings, in 11 patients with iPET-positive findings and in 2 patients with inconclusive ratings. A 'substantial agreement' between attended centres was achieved (κ = 0.748). All patients suffering relapse were concordantly identified, taking mediastinal blood pool structures (MBPS) as visual cut-off between PET-positive and PET-negative findings, respectively. All pHL patients with uptake lower than or equal to MBPS remained in complete remission. CONCLUSION(S): The iPET interpretation assured low interobserver variability. High sensitivity for identification of pHL patients suffering relapse is achieved if [18F]-fluorodeoxyglucose uptake above the MBPS value is rated as a PET-positive finding.


Subject(s)
Hodgkin Disease/diagnostic imaging , Outcome and Process Assessment, Health Care , Adolescent , Child , Disease Management , Disease-Free Survival , Female , Hodgkin Disease/therapy , Humans , Male , Neoplasm Recurrence, Local/prevention & control , Observer Variation , Positron-Emission Tomography , Treatment Outcome
10.
Pediatr Blood Cancer ; 47(5): 607-11, 2006 Oct 15.
Article in English | MEDLINE | ID: mdl-16261559

ABSTRACT

In patients with Ewing sarcoma, precise staging is not only crucial for the therapeutic regimen but also for a reliable evaluation of response to therapy. We report on a 15-year-old girl with metastatic spread of a Ewing sarcoma who, apart from conventional staging by bone scan, chest X-ray and CT, was subsidiary examined by FDG-PET and whole-body MRI before and after chemotherapy. Both modalities detected more bone lesions than the bone scan, which led to an altered strategy for radiotherapy. Both examinations might be a great asset to stage-adjusted therapy regimens, ultimately influencing patient outcome.


Subject(s)
Bone Neoplasms/diagnosis , Bone Neoplasms/therapy , Magnetic Resonance Imaging/methods , Positron-Emission Tomography/methods , Sarcoma, Ewing/diagnosis , Sarcoma, Ewing/therapy , Adolescent , Bone Neoplasms/secondary , Female , Follow-Up Studies , Humans , Neoplasm Staging , Predictive Value of Tests , Sarcoma, Ewing/secondary , Sensitivity and Specificity
11.
Klin Padiatr ; 217(6): 327-33, 2005.
Article in English | MEDLINE | ID: mdl-16307418

ABSTRACT

BACKGROUND: The use of FDG-PET was evaluated for initial staging and therapy efficacy in paediatric patients with non-Hodgkin's lymphoma (NHL) and compared to the established conventional imaging modalities (CIM). The results of this retrospective analysis are presented in conjunction with a critical review of the current literature. PATIENTS AND METHODS: Ten paediatric patients with NHL were examined using whole-body FDG-PET initially (n = 6), during therapy (n = 5) and after completion of therapy (n = 5), respectively. FDG-PET findings were compared to CIM performed according to the protocol of the German NHL-BFM 95 study. The results were evaluated for their impact on disease classification and therapy decision (St. Jude, REAL) in correspondence to a clinical follow-up of at least 24 months. RESULTS: Concerning initial staging, all lymphoma manifestations detected by conventional imaging were also detected by FDG-PET (15 nodal, 2 extranodal). Furthermore, an additional nodal lesion was detected by FDG-PET in three patients. This resulted in an upstaging followed by an intensified poly-chemotherapy in one patient. In five patients showing unclear residual masses on conventional imaging during therapy, FDG-PET indicated viable residual tumours in one case. This patient showed a relapse during follow-up while the four FDG-PET negative patients did not. After completion of initial therapy, FDG-PET revealed in one out of five patients persistent tumour metabolism in the primary lesions and also detected new manifestations. The patient died shortly after restaging due to disease progression. CONCLUSIONS: These first results on the use of FDG-PET in paediatric non-Hodgkin lymphoma indicate a high potential to improve the therapeutic management.


Subject(s)
Fluorodeoxyglucose F18 , Lymphoma, Non-Hodgkin/diagnostic imaging , Positron-Emission Tomography , Adolescent , Child , Child, Preschool , Female , Follow-Up Studies , Humans , Lymph Nodes/diagnostic imaging , Lymph Nodes/pathology , Lymphoma, Non-Hodgkin/drug therapy , Lymphoma, Non-Hodgkin/pathology , Magnetic Resonance Imaging , Male , Neoplasm Staging , Neoplasm, Residual/diagnostic imaging , Neoplasm, Residual/pathology , Retrospective Studies , Sensitivity and Specificity
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