Longitudinal follow-up by MR angiography reveals progressive dilatation of the distal aorta after aortic root replacement in Marfan syndrome.

OBJECTIVES: To define and compare growth rates of the distal aorta in Marfan patients with and without aortic root replacement using serial MR angiography (MRA). METHODS: We retrospectively included 136 Marfan patients with a total of 645 MRAs who underwent a median of five MRAs (range: 2-13) at 1.5 T and 3 T in annual intervals. Of these, 41 patients (34.8 ± 12 years) had undergone aortic root replacement. The remaining 95 patients (29.0 ± 17 years) still had a native aorta and served as the control group. Thoracic aortic diameters were independently measured at eleven predefined levels. Estimated growth rates were calculated using a mixed effects model adjusted for sex, age, BMI, and medication. RESULTS: Marfan patients with aortic root replacement revealed the highest mean estimated growth rate in the proximal descending aorta (0.77 mm/year, CI: 0.31-1.21). Mean growth rates at all levels of the distal thoracic aorta were significantly higher in patients with aortic root replacement (0.28-0.77 mm/year) when compared to patients without aortic root replacement (0.03-0.07 mm/year) (all p < 0.001). Antihypertensive medication, gender, and BMI had no significant impact on the distal aortic growth rates. CONCLUSION: Distal thoracic aortic diameters increase at a significantly higher rate in Marfan patients with aortic root replacement compared to Marfan patients without aortic root replacement. Further studies are warranted to investigate if the increased growth rate of the distal thoracic aorta after aortic root replacement is caused by altered hemodynamics due to the rigid aortic root graft or due to the general genetic disposition of post-operative Marfan patients. CLINICAL RELEVANCE STATEMENT: High growth rates of the distal aorta after aortic root replacement underline the need for careful life-long aortic imaging of Marfan patients after aortic root replacement. KEY POINTS: • Aortic growth rates in Marfan patients with aortic root replacement are highest in the mid-aortic arch, the proximal- and mid-descending aorta. • Growth rates of the distal thoracic aorta are significantly higher in Marfan patients with aortic root replacement compared to Marfan patients without aortic root replacement. • Antihypertensive medication, gender, and BMI have no significant impact on distal aortic growth rates in Marfan patients.

Impact of hepatopathy in pediatric patients after surgery for complex congenital heart disease.

Patients undergoing complex pediatric cardiac surgery in early infancy are at risk of postoperative secondary end-organ dysfunction. The aim of this study was to determine specific risk factors promoting the development of peri- and postoperative hepatopathy after surgery for congenital heart disease. In this retrospective study, we identified 20 consecutive patients operated between 2011 and 2019 from our institutional cohort who developed significant postsurgical hepatic dysfunction. These patients were compared to a control group of 30 patients with comparable initial cardiac conditions and STS-EACTS risk score. Patients who developed hepatopathy in the intensive care unit have chronic cholestasis and decreased liver synthesis. The impact of postoperative hepatopathy on morbidity was marked. In six patients (30%), liver transplantation was executed as ultima ratio, and two (10%) were listed for liver transplantation. The overall mortality related to postoperative hepatopathy is high: We found nine patients (45%) having severe hepatopathy and mostly multiple organ dysfunction who died in the postoperative course. According to risk analysis, postoperative right and left heart dysfunction in combination with a postoperative anatomical residuum needing a re-operation or re-intervention in the postoperative period is associated with a high risk for the development of cardiac hepatopathy. Furthermore, postoperative complications (pleural effusion, heart rhythm disorders, etc.), postoperative infections, and the need for parenteral nutrition also raise the risk for cardiac hepatopathy. Further investigations are needed to reduce hepatic complications and improve the general prognosis of such complex patients.

TAVI in Patients with Mitral Annular Calcification and/or Mitral Stenosis.

BACKGROUND: We herein aimed for analysis of influence of mitral annular calcification (MAC) and mitral stenosis (MS) on outcomes in transcatheter aortic valve implantation (TAVI). METHODS: Between 11/2009 and 06/2017, 1,058 patients underwent TAVI in the presence of concomitant MAC or MS at our center. Subgroups were built and multivariate logistic regression, COX regression, Kaplan-Meier survival analyses, and receiver operating characteristics method were performed. RESULTS: Thirty-day mortality was 7.5% (79/1,058) with highest mortality in patients severe MS (MAC: 3.4% vs. mild MS: 5.9% vs. moderate MS: 15.0% vs. severe MS: 72.7%; p < 0.001). Moderate-to-severe MS (odds ratio [OR]: 7.75, confidence interval [CI]: 3.94-16.26, p < 0.001), impaired left ventricular ejection fraction (OR: 1.38, CI: 1.10-1.72, p < 0.01), and coronary artery disease (OR: 1.36, CI: 1.11-1.67, p < 0.01) were predictive of 30-day survival. Left ventricular systolic/end-diastolic pressure drop of <59.5 mm Hg / <19.5 mm Hg was associated with increased mortality. CONCLUSIONS: TAVI in the presence of MAC and mild MS is associated with acceptable acute outcomes but should be considered high-risk procedures in patients with moderate and especially those with severe MS. Our results suggest adverse hemodynamics after TAVI with concomitant MS, which may be caused by underfilling of the left ventricle leading to low-cardiac output.

Efficiency of Dexamethasone for Treatment of Vasogenic Edema in Brain Metastasis Patients: A Radiographic Approach.

Background and Purpose: To date, imaging studies quantifying the amount of vasogenic edema reduction (VE) in patients with brain metastases (BM) treated with glucocorticoids (GC) have included a very limited number of patients and showed ambiguous results. Here, we aim to determine the radiological effect of GC on VE in BM patients in a large cohort with multiple primary tumor entities in a cross-sectional approach. Materials and Methods: This monocentric retrospective study includes 299 patients first-ever diagnosed with 2,759 intra-axial BM on the respective MRI. 126/299 patients received GC prior to MRI due to mass effect of edema on cranial CT scan and clinical symptoms (GC-pos) and 173 patients did not (GC-neg). GC dose was documented in 85/126 patients. All BM and their respective VE were semi-automatically segmented on post-contrast T1-weighted images. Results: VE volumes were higher in GC-pos compared to GC-neg (p = 0.009) and did not correlate with GC dose. Multivariate linear regression analysis with interaction terms on the assumption that BM volume and BM number influence the probability of GC administration shows that large and higher numbers of BM under GC treatment generate less VE than without (p < 0.001 and p = 0.038, respectively). The primary tumor type and total BM volume did not influence VE volume. Conclusion: Use of GC is especially effective for treatment of VE formation in patients with larger and multiple BM regardless of primary tumor type and dosage. However, based on the present data a direct causative relationship between GC and VE cannot be proven.

T2 relaxation times of the anterolateral femoral cartilage in patients after ACL-reconstruction with and without a deep lateral femoral notch sign.

PURPOSE: To quantitatively assess T2 relaxation times of the anterolateral femoral cartilage following anterior cruciate ligament (ACL)-reconstruction with and without a positive deep lateral femoral notch sign (DLNS) at post-traumatic MRI. MATERIALS AND METHODS: In 52 patients post-traumatic MRI as well as 12 months after ACL-rupture (ACLR) and surgical treatment were analysed. In 28 patients a positive DLNS was present at post-traumatic MRI. For quantitative analysis, T2 relaxation time measurements (7 TE: 10-70 ms) were performed at time of re-evaluation. Three polygonal ROIs encompassing the full cartilage layer were placed in the anterolateral femoral cartilage. Clinical assessment included Lysholm-Tegner-Activity-Score, Rasmussen's clinical score and modified Cincinnati-Rating-System-Questionnaire. Description and differences were calculated as means and confidence intervals of means, controlled for the cluster effect of person, if appropriate. RESULTS: In patients with a positive DLNS after ACLR, relaxation times in the notch region were significantly prolonged compared to patients without a positive DLNS (Δ 7.4 ms, CI: 5.6-9.2; p-value <0.001) as well as to the adjacent anterior (Δ 5.7 ms, CI: 4.7-6.7; p-value <0.001) and central femoral cartilage (Δ 6.6 ms, CI: 5.7-7.6; p-value <0.001). Solely insignificant differences were noticed in the performed clinical scores comparing the two groups (p > 0.05). CONCLUSION: Significantly prolonged T2 relaxation times of the anterolateral femoral cartilage were found in patients with a positive DLNS following ACL-reconstruction compared to patients without a DLNS. Based on these results, it has to be assumed that a positive DLNS is associated with higher cartilage degradation.

Inverse Perfusion Requirements of Supra- and Infratentorial Brain Metastases Formation.

Background and Aims: Vascular border zones and the gray-white matter junction are preferred sites for the development of brain metastases (BM), whereas microvascular lesions are known to be a protective factor. In this proof of concept study, we aim to study the relationship of blood perfusion and the spatial distribution of BM. Materials and Methods: An average CT perfusion atlas of 107 healthy patients was created. Voxel-wise reference perfusion values were extracted from BM-negative and BM-positive regions in a second cohort of 100 untreated patients harboring 809 BM confirmed by MRI. A comparison of regional perfusion values was performed using the independent t-test. Results: In contrast to supratentorial BM that develop preferably in areas with lower CBV/CBF and longer MTT/TTP compared to the average regional perfusion (p < 0.001), infratentorial BM showed a higher CBV/CBF and shorter MTT/TTP (p < 0.001). Conclusion: Our results imply differing pathophysiological mechanisms underlying supra- and infratentorial BM spreading. The inverse perfusion patterns may result from differences in vascular supply, hemodynamic requirements, and/or production of pro-angiogenic factors.

Outcomes with a latest generation self-expandable, intra-annular, re-sheathable transcatheter heart valve system: analysis of patients with impaired left ventricular function and determinants for pacemaker implantation.

OBJECTIVES: We herein report a single-center experience with the Portico TAVI system. Main focus was set on outcomes in patients with impaired left ventricular (LV) function and predictors for permanent pacemaker (PPM) implantation. METHODS: Between 05/2014 and 10/2017, 106 consecutive patients received TAVI using the Portico device. For comparison of patients with/without impaired LV function, and determination of multi-slice computed tomography and electrocardiogram correlates for PPM implantation subgroups were built (Subgroup I: LVEF ≥ 50%, n = 69, Subgroup II: LVEF < 50%, n = 37; Subgroup A: no PPM implantation, n = 89; Subgroup B: PPM implantation, n = 17). Data were retrospectively analyzed. RESULTS: Device success was 95.3% (101/106) with resulting transvalvular peak/mean pressure gradients of 10.6 ± 5.6/5.4 ± 3.1 and PVL ≥ moderate in 5/106 patients (4.7%). 30-day mortality was 4.7% (5/106; subgroup I 3/69, 4.3%; subgroup II 2/37, 5.4%; p = 1.0). Regarding VARC-2 adjudicated clinical endpoints stroke (3/106, 2.8%; subgroups I/II: 2/69 vs. 1/37, p = 1.0) and acute kidney injury (9/106, 8.5%; subgroups I/II: 6/69 vs. 3/37, p = 1.0), no significant differences were found. Postprocedural PPM implantation occurred in 17.9% (19/106) of the patients. Logistic regression for PPM implantation demonstrated predictive character of left coronary cusp (LCC) calcium load in zone 1 (annular plane to coronary ostia) (p = 0.05, threshold 193 mm3) and total calcium load of zone 1 (p = 0.05, threshold 751.2 mm3). CONCLUSIONS: The Portico valve demonstrates a satisfying safety outcome, especially for patients with impaired LV function. Results of the CE-mark trial were confirmed, except for higher PPM rates. PPM rates are in accordance with other reports on this TAVI platform.

Use of ultrasonic scalpel and monopolar electrocautery for skin incisions in neck dissection: a prospective randomized trial.

PURPOSE: Ultrasonic scalpel (UC) and monopolar electrocautery (ME) are standard equipment for soft tissue surgery. The aim of the present study was to compare intraoperative and postoperative patterns of patients using either UC or ME for skin incisions in neck dissection. MATERIAL AND METHODS: In a prospective randomized study of 30 patients, the thermal effects of UC (n = 15) and ME (n = 15) were examined using real-time infrared thermographic imaging. Additionally, tissue damage was evaluated histopathologically. The other measured variables were operation and bleeding time, postoperative pain score (only neck incision area), in-patient time, and complications. RESULTS: UC significantly reduces the thermal effects, compared to ME (p < 0.001). The mean depth of tissue damage (i.e., necrosis) was 272.7 µm for UC and 284.7 µm for ME with no significant difference (p = 0.285). From the third postoperative day, patients treated using UC had noticeably less pain in the neck incision area (t3 p = 0.010; t4 p < 0.001; t5 p < 0.005). Cutting time was reduced for ME by 36.1 s (p < 0.001) and the bleeding time was decreased by 40.9 s for UC (p < 0.001). The total preparation time was the same (p = 0.402). When comparing in-patient time (p = 0.723), as well as complications, no significant differences were seen. CONCLUSION: UC results in less postoperative pain and less bleeding in the neck incision area. Accordingly, UC is superior to ME for skin incisions in neck dissection.

Syndecan-1 as a biomarker for sepsis survival after major abdominal surgery.

AIM: Sepsis is a serious complication following surgery and identification of patients at risk is of high importance. Syndecan-1 (sSDC1) levels are known to be elevated during sepsis. MATERIALS & METHODS: Fifty-five patients scheduled for major abdominal surgery were prospectively included and sSDC1 concentrations were measured during hospital stay. RESULTS: Patients with postoperative sepsis showed a continued increase of sSDC1 levels and exhibited higher median sSDC1 concentrations at day 1 compared with nonseptic patients 90.3 versus 16.5 ng/ml. A significant association of sSDC1 levels with the incidence of sepsis and death was demonstrated. CONCLUSION: This study identifies sSDC1 as potential biomarker for sepsis and survival after abdominal surgery.

Stentless vs. stented bioprosthesis for aortic valve replacement: A case matched comparison of long-term follow-up and subgroup analysis of patients with native valve endocarditis.

BACKGROUND: Current retrospective evidence suggests similar clinical and superior hemodynamic outcomes of the Sorin Freedom Solo stentless aortic valve (SFS) (LivaNova PLC, London, UK) compared to the Carpentier Edwards Perimount stented aortic valve (CEP) (Edwards Lifesciences Inc., Irvine, California, USA). To date, no reports exist describing case-matched long-term outcomes and analysis for treatment of native valve endocarditis (NVE). METHODS: From 2004 through 2014, 77 consecutive patients (study group, 59.7% male, 68.9 ± 12.5 years, logEuroSCORE II 7.6 ± 12.3%) received surgical aortic valve replacement (SAVR) with the SFS. A control group of patients after SAVR with the CEP was retrieved from our database and matched to the study group regarding 15 parameters including preoperative endocarditis. Acute perioperative outcomes and follow-up data (mean follow-up time 48.7±29.8 months, 95% complete) were retrospectively analyzed. RESULTS: No differences in early mortality occurred during 30-day follow up (3/77; 3.9% vs. 4/77; 5.2%; p = 0.699). Echocardiographic findings revealed lower postprocedural transvalvular pressure gradients (max. 17.0 ± 8.2 vs. 24.5 ± 9.2 mmHg, p< 0.001/ mean pressure of 8.4 ± 4.1 vs. 13.1 ± 5.9 mmHg, p< 0.001) in the SFS group. Structural valve degeneration (SVD) (5.2% vs. 0%; p = 0.04) and valve explantation due to SVD or prosthetic valve endocarditis (PVE) (9.1% vs. 1.3%; p = 0.04) was more frequent in the SFS group. All-cause mortality during follow-up was 20.8% vs. 14.3% (p = 0.397). When patients were divided into subgroups of NVE and respective utilized bioprosthesis, the SFS presented impaired outcomes regarding mortality in NVE cases (p = 0.031). CONCLUSIONS: The hemodynamic superiority of the SFS was confirmed in this comparison. However, clinical outcomes in terms of SVD and PVE rates, as well as survival after NVE, were inferior in this study. Therefore, we are reluctant to recommend utilization of the SFS for treatment of NVE.

Quantitative T2 * relaxation time analysis of articular cartilage of the tibiotalar joint in professional football players and healthy volunteers at 3T MRI.

PURPOSE: To compare T2 * relaxation times of the tibiotalar cartilage between professional football players and matched healthy male volunteers. MATERIALS AND METHODS: Twenty-two ankles of professional football players (24.3 ± 3.8 years) and 20 age- and body mass index-matched healthy individuals (25.6 ± 2.4 years) were investigated. The study protocol consisted of multiplanar T1 -weighted, fat-saturated proton-density weighted (Pdw) and a 3D multiecho T2 * sequence with 22 echo times (4.6-53.6 msec). The articular cartilage was subdivided into six segments. Regions of interest were manually drawn in three zones (lateral, central, medial). Differences and confidence intervals were estimated applying a random effects models. Fixed effects were professional football players versus healthy individuals and areas. The random effect was defined as the person cluster of the different individuals. RESULTS: T2 * values were significantly prolonged in football players compared to male volunteers in all predefined cartilage segments (mean, 17.5 vs. 15.5 msec; P < 0.001). In both groups, the highest relaxation times were found in the lateral zone, with statistically higher relaxation times in professional football players (18.5 vs. 16.5 msec, P = 0.003). Separate evaluation revealed the longest relaxation times in the posterior tibiotalar cartilage, with 21.0 msec for professional football players compared to 19.4 msec for healthy volunteers (P = 0.064). CONCLUSION: Based on these initial results, T2 * values of the tibiotalar cartilage seem to be elevated in professional football players compared to healthy volunteers. Prospective longitudinal studies should be encouraged to show if these results represent early subtle cartilage lesions prior to clinical manifestation or rather temporary adaptation related to daily high-level loading. LEVEL OF EVIDENCE: 1 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2018;47:372-379.

Perihematomal diffusion restriction as a common finding in large intracerebral hemorrhages in the hyperacute phase.

PURPOSE: There is growing evidence that a perihematomal area of restricted diffusion (PDR) exists in intraparenchymal hemorrhages (IPH) within 1 week of symptom onset (SO). Here, we study characteristics and the clinical impact of the PDR in patients with hyperacute (≤ 6 hours from SO) IPH by means of apparent diffusion coefficient (ADC). METHODS: This monocentric, retrospective study includes 83 patients with first-ever primary IPH from 09/2002-10/2015. 3D volumetric segmentation was performed for the IPH, PDR, and perihematomal edema (PHE) on fluid-attenuated inversion recovery, T2*/susceptibility weighted images, and ADC images. RESULTS: A PDR was seen in 56/83 patients (67.5%) presenting with hyperacute IPH. Multivariate logistic regression analysis revealed every 10-year increase of age (HR 1.929, 95% CI 1.047-3.552, P = .035) and male gender (HR 5.672, 95% CI 1.038-30.992, P = .045) as significant predictors of the presence of a PDR, but not IPH size, IPH location, nor National Institutes of Health Stroke Scale Score (NIHSS) at admission. We found no difference in NIHSS at discharge, hematoma removal, or mortality rate in PDR-positive patients. ADC values of the PDR show a step-wise normalization with increasing time from SO. CONCLUSIONS: Occurrence of a PDR is a common finding in supratentorial hyperacute IPH, but shows no adverse short-term clinical impact. It may represent transient oligemic and metabolic changes.

Comparison of latest generation transfemoral self-expandable and balloon-expandable transcatheter heart valves.

OBJECTIVES: We herein aimed to compare acute 30-day outcomes of latest-generation self-expandable and balloon-expandable transcatheter heart valves. METHODS: From 2012 through 2016, 104 consecutive patients (study group, 69.2% female, 81.7 ± 5.5 years, logEuroSCORE I 15.9 ± 9.3%) received transfemoral transcatheter aortic valve implantation using the Symetis ACURATE neo® transcatheter heart valve. A control group of patients after transfemoral transcatheter aortic valve implantation with the Edwards Sapien 3™ transcatheter heart valve was retrieved from our database and matched to the study group. Data were retrospectively analysed according to updated Valve Academic Research Consortium definitions. RESULTS: Device success was 94.2% (98 of 104) and 98.1% (102 of 104) in study and control groups, respectively (P = 0.157). All-cause 30-day mortality was 3.9 (4 of 104) vs 0.9% (1 of 104) (P = 0.317). Resultant transvalvular peak/mean gradients and effective orifice area were 14.2 ± 5.7 vs 22.6 ± 6.8 mmHg (P < 0.001)/7.3 ± 2.8 vs 11.8 ± 3.5 mmHg (P < 0.001) and 2.0 ± 0.4 vs 1.7 ± 0.4 cm2 (P = 0.063). Paravalvular leakage ≥moderate was observed in 4.8% (5 of 104) and 1.9% (2 of 104) (P = 0.257). Rate of permanent pacemaker implantation was 10.6% (11 of 104) vs 16.4% (17 of 104) (P = 0.239). CONCLUSIONS: Next-generation self-expandable transcatheter heart valves preserve superiority in terms of post-interventional haemodynamics without presenting former drawbacks: rate of postoperative permanent pacemaker implantation and severity of residual paravalvular leakage were similar to balloon-expandable transcatheter heart valves.

Edema is not a reliable diagnostic sign to exclude small brain metastases.

No prior systematic study on the extent of vasogenic edema (VE) in patients with brain metastases (BM) exists. Here, we aim to determine 1) the general volumetric relationship between BM and VE, 2) a threshold diameter above which a BM shows VE, and 3) the influence of the primary tumor and location of the BM in order to improve diagnostic processes and understanding of edema formation. This single center, retrospective study includes 173 untreated patients with histologically proven BM. Semi-manual segmentation of 1416 BM on contrast-enhanced T1-weighted images and of 865 VE on fluid-attenuated inversion recovery/T2-weighted images was conducted. Statistical analyses were performed using a paired-samples t-test, linear regression/generalized mixed-effects model, and receiver-operating characteristic (ROC) curve controlling for the possible effect of non-uniformly distributed metastases among patients. For BM with non-confluent edema (n = 545), there was a statistically significant positive correlation between the volumes of the BM and the VE (P < 0.001). The optimal threshold for edema formation was a diameter of 9.4 mm for all BM. The primary tumors as interaction term in multivariate analysis had a significant influence on VE formation whereas location had not. Hence VE development is dependent on the volume of the underlying BM and the site of the primary neoplasm, but not from the location of the BM.

Frequency and volumetry of infraorbital ethmoid cells (Haller cells) on cone-beam computed tomograms (CBCT) of the mid-face.

Objective: The aim of this study was to determine the frequency and morphology of Haller cells using a new radiological technique that allows examination of the facial skull. Material and methods: In a single center retrospective cohort study the cone-beam computed tomography (CBCT) volume data of the maxillary sinus of 199 patients were analysed (398 paranasal sinuses). If Haller cells were found, their capacity was determined. If orthopantomograms (OPG) were taken in a narrow time frame around the CBCT investigation, the rate of correspondence of the radiological findings was determined. The correlation between frequency of Haller cells and age and gender was calculated. Results: Out of 199 patients 47 showed at least one Haller cell (23.62%). The total number of Haller cells was 64. Correspondence was rare in the same case between the results from different examination procedures with respect to the target object. Conclusions: Bony variants of paranasal sinuses can be analysed using CBCT as an alternative to computed tomography (CT), whereas OPG images do not reliably detect Haller cells.

Diagnostic Yield of Multidetector Computed Tomography in Patients with Acute Spondylodiscitis.

Purpose To determine the value of multidetector computed tomography (MDCT) in patients with acute spondylodiscitis. Methods and Materials For data acquisition, we searched our radiological database for all patients who had undergone magnetic resonance imaging (MRI) for suspected spondylodiscitis between 2007 and 2015 (n = 325). For further analyses, we included all patients (n = 67) who initially underwent MDCT prior to MRI. Overall accuracy, sensitivity, specificity and positive and negative predictive values were calculated for MDCT and, separately, for contrast-enhanced CT (CECT, n = 36) and for non-enhanced CT (NECT, n = 31). MRI together with clinical evaluation served as the standard of reference. RESULTS: In 34 of 43 patients with acute spondylodiscitis on MRI, correct diagnosis was already made by the initial MDCT scan. The specificity and positive predictive value were 100 % for MDCT. The sensitivity was 79 % and the negative predictive value was 72 %. The overall accuracy was 87 %. Accuracy was higher for CECT (89 %) than for NECT (84 %), however without statistical significance (p = 0.55). MDCT detected 90 % of paravertebral abscesses (34/38), but only 6 % of epidural abscesses (2/36). Conclusion MDCT has moderate sensitivity, but high specificity for acute spondylodiscitis. Thus, if MDCT is positive for spondylodiscitis, treatment can be started without further delay. However, MRI should be added to both MDCT negative and positive cases to rule out complications such as epidural abscesses that cannot reliably be detected by MDCT. Key Points: · Patients with acute spondylodiscitis are often initially suspected of having other differential diagnosis because of nonspecific symptoms.. · Therefore, MDCT is frequently performed prior to MRI in patients with acute spondylodiscitis.. · MDCT proved moderate sensitivity but high specificity for the diagnosis of acute spondylodiscitis.. · Paravertebral abscess is a strong indicator for the presence of spondylodiscitis on MDCT.. · However, MRI is crucial to rule out epidural abscesses, an important complication.. Citation Format · Rausch VH, Bannas P, Schoen G et al. Diagnostic Yield of Multidetector Computed Tomography in Patients with Acute Spondylodiscitis. Fortschr Röntgenstr 2017; 189: 339 - 346.

Serum-Sphingosine-1-Phosphate Concentrations Are Inversely Associated with Atherosclerotic Diseases in Humans.

BACKGROUND AND OBJECTIVES: Atherosclerotic changes of arteries are the leading cause for deaths in cardiovascular disease and greatly impair patient's quality of life. Sphingosine-1-phosphate (S1P) is a signaling sphingolipid that regulates potentially pro-as well as anti-atherogenic processes. Here, we investigate whether serum-S1P concentrations are associated with peripheral artery disease (PAD) and carotid stenosis (CS). METHODS AND RESULTS: Serum was sampled from blood donors (controls, N = 174) and from atherosclerotic patients (N = 132) who presented to the hospital with either clinically relevant PAD (N = 102) or CS (N = 30). From all subjects, serum-S1P was measured by mass spectrometry and blood parameters were determined by routine laboratory assays. When compared to controls, atherosclerotic patients before invasive treatment to restore blood flow showed significantly lower serum-S1P levels. This difference cannot be explained by risk factors for atherosclerosis (old age, male gender, hypertension, hypercholesteremia, obesity, diabetes or smoking) or comorbidities (Chronic obstructive pulmonary disease, kidney insufficiency or arrhythmia). Receiver operating characteristic curves suggest that S1P has more power to indicate atherosclerosis (PAD and CS) than high density lipoprotein-cholesterol (HDL-C). In 35 patients, serum-S1P was measured again between one and six months after treatment. In this group, serum-S1P concentrations rose after treatment independent of whether patients had PAD or CS, or whether they underwent open or endovascular surgery. Post-treatment S1P levels were highly associated to platelet numbers measured pre-treatment. CONCLUSIONS: Our study shows that PAD and CS in humans is associated with decreased serum-S1P concentrations and that S1P may possess higher accuracy to indicate these diseases than HDL-C.

The immediate effect of long-distance running on T2 and T2* relaxation times of articular cartilage of the knee in young healthy adults at 3.0 T MR imaging.

OBJECTIVE: To quantitatively assess the immediate effect of long-distance running on T2 and T2* relaxation times of the articular cartilage of the knee at 3.0 T in young healthy adults. METHODS: 30 healthy male adults (18-31 years) who perform sports at an amateur level underwent an initial MRI at 3.0 T with T2 weighted [16 echo times (TEs): 9.7-154.6 ms] and T2* weighted (24 TEs: 4.6-53.6 ms) relaxation measurements. Thereafter, all participants performed a 45-min run. After the run, all individuals were immediately re-examined. Data sets were post-processed using dedicated software (ImageJ; National Institute of Health, Bethesda, MD). 22 regions of interest were manually drawn in segmented areas of the femoral, tibial and patellar cartilage. For statistical evaluation, Pearson product-moment correlation coefficients and confidence intervals were computed. RESULTS: Mean initial values were 35.7 ms for T2 and 25.1 ms for T2*. After the run, a significant decrease in the mean T2 and T2* relaxation times was observed for all segments in all participants. A mean decrease of relaxation time was observed for T2 with 4.6 ms (±3.6 ms) and for T2* with 3.6 ms (±5.1 ms) after running. CONCLUSION: A significant decrease could be observed in all cartilage segments for both biomarkers. Both quantitative techniques, T2 and T2*, seem to be valuable parameters in the evaluation of immediate changes in the cartilage ultrastructure after running. ADVANCES IN KNOWLEDGE: This is the first direct comparison of immediate changes in T2 and T2* relaxation times after running in healthy adults.

Improving outcomes: case-matched comparison of novel second-generation versus first-generation self-expandable transcatheter heart valves.

OBJECTIVES: The published literature has extensively documented clinical benefit derived from transcatheter aortic valve implantation (TAVI) in high-risk patients using self-expanding current-generation transfemoral (TF) transcatheter heart valves (THVs). However, it has also demonstrated apparent shortcomings such as paravalvular leakage (PVL) or need for permanent pacemaker (PM) implantation. We here present a case-matched analysis of acute 30-day outcomes using a novel nitinol-based THV (Symetis Acurate Neo TF™), which may overcome some limitations of currently used devices. METHODS: From 2012 to 2015, 69 consecutive patients (study group, 65.2% female, 81.4 ± 6.1 years, logEuroSCORE I 19.9 ± 14.2%) received TF-TAVI using the novel Symetis Acurate Neo TF™ THV. A control group of patients after TF-TAVI with the CoreValve™ THV was retrieved from our database (control group) and matched to the study group utilizing 16 parameters. Data were retrospectively analysed according to updated Valve Academic Research Consortium (VARC-2) definitions. The 30-day follow-up was completed in all cases. RESULTS: Apart from gender (65.2 vs 44.9% females, P = 0.023), matching was successful with parameters showing no significant differences. The device success rate was 95.6% (66/69) and 89.9% (62/69) in the study and control groups, respectively (P = 0.20). The all-cause 30-day mortality rate was 5.8% (4/69) vs 10.14% (7/69) (P = 0.36), and disabling stroke was observed in 2.9% (2/69) vs 5.8% (4/69) (P = 0.41), respectively. Resultant transvalvular maximum/mean gradient and effective orifice area (EOA) were 13.8 ± 5.5 vs 18.1 ± 8.1 mmHg (P = 0.001)/7.0 ± 2.8 vs 8.8 ± 4.0 mmHg (P = 0.006) and 1.9 ± 0.3 vs 1.8 ± 0.2 cm(2) (P = 0.015), respectively. PVL ≥grade II was observed in 2.9% (2/69) and 15.94% (11/69) (P = 0.013) of patients and the rate of PM implantation was 8.7% (6/69) vs 44.9% (31/69) (P < 0.001), respectively. DISCUSSION: TF-TAVI was feasible and safe using this new type of nitinol-based THV. Superiority to the current generation of self-expanding THVs was achieved regarding post-interventional pressure gradients and EOA, severity of residual PVL and rate of PM implantation. Results set a promising quality standard for TF-TAVI with a self-expanding THV, but will have to be confirmed in a larger patient cohorts for further clinical evaluation.