High volume retrograde portography for better discrimination of the portal vein during TIPS procedure.

Background: Imaging of the portal vein prior to puncture for TIPS is essential. Purpose: With this study, we examined a modified retrograde portography with regard to the reliable representation of the portal vein. Material and Methods: Prospective evaluation of 65 TIPS interventions with regard to the delimitation of the portal vein and the exact parameters of retrograde portography such as catheter diameter and contrast medium volume per injection. Results: Retrograde portographies with a large-lumen catheter (10 F) and a large contrast medium volume (40 mL) were performed in 35/63 patients with significantly better delineation of the portal vein than when using 5 F catheters with 10 mL contrast medium. Conclusion: The so-called high volume retrograde portography leads to better delimitation of the portal vein during TIPS application.

The Barrel Vascular Reconstruction Device : A Retrospective, Observational Multicentric Study.

BACKGROUND AND PURPOSE: The Barrel device is an electrolytically detachable laser cut, closed-cell microstent that is used for neck reconstruction in wide-necked bifurcation and branching aneurysms to support coiling. The key feature is a barrel section that herniates over the aneurysmal ostium. The objective was to evaluate the safety, feasibility and the immediate and mid-term occlusion results of this new device. MATERIAL AND METHODS: The databases of two tertiary care centers were screened for all Barrel-based stent-assisted intracranial coil embolization of wide-necked aneurysms between June 2015 and September 2016. Case files and imaging data were retrospectively analyzed for angiographic and clinical outcome parameters, including immediate and mid-term modified Raymond-Roy aneurysm occlusion classification (RROC) rates and procedural complications. RESULTS: A total of 21 patients comprising 21 intracranial aneurysms (20 unruptured, 1 ruptured) were treated with the Barrel device and additional coiling of the aneurysm sac. All aneurysms were wide-necked, saccular bifurcation aneurysms defined by a dome/neck ratio ≤2. Immediate complete occlusion (RROC1) was observed in 19/21 (90%). An intra-interventional in-stent thrombus formation in two cases (10%) was medically resolved without neurological sequelae. A single case of symptomatic in-stent stenosis (5%) was cleared by balloon angioplasty. Follow-up (FU) was available in 20/21 cases (95%) after a median of 282 days (range: 17-591 days). At follow-up 19/20 aneurysms (95%) were completely occluded (RROC1). CONCLUSION: The Barrel device showed a satisfactory safety profile and a promising rate of immediate and mid-term complete aneurysm occlusion for stent-assisted coil embolization of wide-necked intracranial bifurcation aneurysms, warranting further investigation of the device.

18FDG-PET to assess recurrence and long term survival in patients with malignant melanoma.

AIM: To assess the diagnostic and prognostic value of FDG-PET/CT in the follow-up of malignant melanoma in comparison to the serum protein S100B. PATIENTS AND METHODS: A total of ninety patients with either low-risk or high-risk malignant melanoma, respectively, were included in this study. The follow-up of the patients was pursuant with the guidelines of the German Dermatological Association. The diagnostic accuracy and diagnostic power were determined for PET/CT and for the serum protein S100B. RESULTS: In 28 of the 90 patients PET/CT was positive in the follow up, 47 patients had an elevated Serum S100B level. Sensitivity, specificity, PPV and NPV of PET/CT for the total groups of patients were 87%, 93%, 87% and 93%. The corresponding values for the serum protein S100B were 65%, 52%, 43% and 74%, respectively. PET/CT positive patients showed a significantly (p < 0.001) higher risk of melanoma associated death compared to patients with PET/CT negative findings. No statistical significance could be found in the 5 year survival rate between the S100B positive and S100B negative patients. CONCLUSION: PET/CT is suitable to confirm or exclude recurrences and can be used to assess the prognosis in melanoma patients. The diagnostic accuracy and the prognostic power is much higher compared to the serum protein S100B.

[Assessment of pedicle screws following dorsal instrumentation of the spine: a comparison of conventional radiographs with multidetector CT]. / Lagebeurteilung transpedikulA currencyrer Schrauben nach dorsaler Spondylodese mittels konventioneller RA paragraph signntgenaufnahmen: ein Vergleich zur Mehrzeilen-Computertomografie.

PURPOSE: To evaluate the performance of conventional radiographs (CR) for the assessment of pedicle screws in comparison with CT including MPR. MATERIALS AND METHODS: Comparison of CR and CT for the evaluation of screw length, extracorporal perforation (grade A: 0 - 2 mm, B: 3 - 4 mm, C: 5 - 6 mm, D: > 6 mm, relevant: grade C and D), screw contact/loosening, and subjective image quality (1: excellent to 4: non-diagnostic). The sensitivity (SE), specificity (SP), positive (PPV) and negative predictive value (NPV), and overall accuracy (OA) were calculated with 4x4 contingency tables. The subjective image quality was evaluated using the Wilcoxon test (p < 0.05). RESULTS: 411 screws were evaluated. The relevant medial perforation was diagnosed with CR/CT in 53(13 %)/ 11(3 %) screws, while the relevant lateral perforation was found in 3(1 %)/ 43(11 %) screws. Pedicle screw contact was diagnosed by CR/CT in 10(2 %)/ 18(4 %) cases and incorrect length was confirmed in 80(20 %)/ 90(22 %) screws. A diagnosis of loosening was established in 10(2 %) screws by CR and in 7(2 %) screws by MDCT. In summary, CR demonstrated SE, SP, PPV, NPV, and OA for the following variables: relevant medial perforation = 64 / 89 / 13 / 99 / 88 %, relevant lateral perforation = 4 / 99 / 67 / 90 / 90 %, screw contact = 11 / 98 / 20 / 96 / 94 %, incorrect screw length = 86 / 58 / 89 / 51 / 81 %, and screw loosening = 71 %/ 99 %/ 50 %/ 100 %/ 98 %. The subjective image quality of CR was significantly lower compared to CT (2.19 A + or - 0.84 and 1.11 A + or - 0.31; p < 0.001). CONCLUSION: CR evaluation of pedicle screws following dorsal instrumentation of the spine demonstrated an OA < or = 90 % for relevant medial and lateral perforation and for incorrect screw length compared to CT. Thus, reliable evaluation of pedicle screws based solely on CR does not seem feasible.

[Vertebral fractures in patients with ankylosing spondylitis: a retrospective analysis of 66 patients]. / Wirbelfrakturen bei patienten mit spondylitis ankylosans: eine retrospektive analyse von 66 patienten.

PURPOSE: Retrospective analysis of vertebral fractures in patients with ankylosing spondylitis (AS) for the evaluation of associations with mortality, concurrent neurological deficits, and other complications. MATERIALS AND METHODS: Image analysis (conventional radiographs, CT, MRI) was applied to all patients with AS admitted between 1997 and 2007 due to vertebral fractures to determine fracture location and classification. Patient characteristics, trauma mechanism, neurological symptoms, and other complications were documented. RESULTS: 66 patients (54 male, age 64 +/- 11 years) were enrolled in the study. 74 % of patients suffered from minor trauma. 51 % and 56 % had cervicothoracic and thoracolumbar fractures, respectively, while 8 % had multi-level fractures. 63 % of patients suffered combined vertebrodiscal fractures. 70 % revealed neurological symptoms, significantly correlating with spinal stenosis (p = 0.024; Odds ratio 4.265) and hyperlordosis (p = 0.014; OR 4.806). 68 % developed complications with non-combined fractures (p = .042; OR 4.954) and paravertebral hematomas (p = .009; OR 16.969) representing independent risk factors. The female gender (p = 0.005; OR 15.617) and conservative therapy (p = 0.040; OR.094) exerted significant influence on the mortality rate. CONCLUSION: Vertebral fractures frequently occur in patients with AS after minor trauma and often lead to neurological symptoms, which in turn are associated with spinal stenosis and hyperlordosis. Paravertebral hematomas and non-combined fractures are accompanied by higher incidences of other complications. The female gender entails a higher mortality rate.