The impact of 18F-FDOPA-PET/MRI image fusion in detecting liver metastasis in patients with neuroendocrine tumors of the gastrointestinal tract.

BACKGROUND: This study assesses the value of image fusion using 18F-fluoro-L-DOPA (18F-DOPA) positron emission tomography (PET) and magnetic resonance imaging (MRI) for examining patients with neuroendocrine tumors (NETs) and a suspicion of metastasis of the liver. METHODS: Eleven patients (five women and six men aged between 20 and 81, with a mean age of 54.6 years) were included in the study. All patients underwent whole-body 18F-DOPA PET examinations and contrast-enhanced MRI with diffusion-weighted sequences (DWS). Image fusion was performed using a semiautomatic voxel-based algorithm. Images obtained using PET and MRI were assessed separately. Side-by-side evaluations of fused PET/MRI images were also performed. RESULTS: In total, 55 liver lesions (52 liver metastases and 3 benign lesions) were detected in the 11 patients. Sensitivity detection for liver lesions was higher when using PET/CT than when using contrast-enhanced MRI without DWSs and lower than using MRI with DWSs. The sensitivity of PET/MRI image fusion in the detection of liver metastasis was significantly higher than that of MRI with DWSs (P < 0.05). CONCLUSION: Images of the liver obtained using PET and MRI in patients with NETs exhibited characteristic features. These findings suggest that an appropriate combination of available imaging modalities can optimize patient evaluations.

The Microbiome and Occurrence of Methanotrophy in Carnivorous Sponges.

As shown by recent studies, filter-feeding sponges are known to host a wide variety of microorganisms. However, the microbial community of the non-filtering carnivorous sponges (Porifera, Cladorhizidae) has been the subject of less scrutiny. Here, we present the results from a comparative study of the methanotrophic carnivorous sponge Cladorhiza methanophila from a mud volcano-rich area at the Barbados Accretionary Prism, and five carnivorous species from the Jan Mayen Vent Field (JMVF) at the Arctic Mid-Ocean Ridge. Results from 16S rRNA microbiome data indicate the presence of a diverse assemblage of associated microorganisms in carnivorous sponges mainly from the Gamma- and Alphaproteobacteria, Flavobacteriaceae, and Thaumarchaeota. While the abundance of particular groups varied throughout the dataset, we found interesting similarities to previous microbiome results from non-carnivorous deep sea sponges, suggesting that the carnivorous sponges share characteristics of a previously hypothesized putative deep-sea sponge microbial community. Chemolithoautotrophic symbiosis was confirmed for C. methanophila through a microbial community with a high abundance of Methylococcales and very light isotopic δ13C and δ15N ratios (-60 to -66‰/3.5 to 5.2‰) compared to the other cladorhizid species (-22 to -24‰/8.5 to 10.5‰). We provide evidence for the presence of putative sulfur-oxidizing Gammaproteobacteria in the arctic cladorhizids; however, δ13C and δ15N signatures did not provide evidence for significant chemoautotrophic symbiosis in this case, and the slightly higher abundance of cladorhizids at the JMVF site compared to the nearby deep sea likely stem from an increased abundance of prey rather than a more direct vent association. The phylogenetic position of C. methanophila in relation to other carnivorous sponges was established using a three-gene phylogenetic analysis, and it was found to be closely related to other non-methanotrophic Cladorhiza species with a similar morphology included in the dataset, suggesting a recent origin for methanotrophy in this species. C. methanophila remains the only known carnivorous sponge with a strong, chemolithoautotrophic symbiont association, and methanotrophic symbiosis does not seem to be a widespread property within the Cladorhizidae.

Increased rate of positive biopsies using a combination of MR-Tomography, spectroscopy and diffusion-weighted magnetic resonance imaging prior to prostate biopsies in patients with persistent elevated prostate-specific antigen values: A retrospective analysis.

PURPOSE: Persistently elevated prostate-specific antigen (PSA) values following negative biopsies result in a diagnostic dilemma. In order to improve detection rates in patients with former negative biopsies and persistently elevated PSA values, magnetic resonance tomography (MRT), magnetic resonance spectroscopy (MRS), and diffusion-weighted magnetic resonance imaging (DW-MRI) were performed prior to prostate rebiopsies. MATERIALS AND METHODS: Over a 14-month period, 67 patients (mean age of 66 years) with a history of 1-5 negative biopsies underwent endorectal magnetic resonance imaging (MRI) using T2-weighted MRT MRS and DW-MRI before an additional prostate biopsy was performed. Subsequently, 5 contrast-enhanced transrectal ultrasound-guided biopsies were performed according to a 10-core systematic scheme. Out of the 67 men, 25 patients had positive biopsies and opted for radical prostatectomy. Histological evaluation of cancer localization, PSA, diameters of primary tumors, numbers and diameters of satellite tumors, prostate volume, and staging pathology was performed. These findings were compared with MRI and MRS results. RESULTS: Serum PSA levels ranged from 3.1 to 19.5 g/ml (median level of 7.96 ng/ml). After the 25 patients underwent radical prostatectomy, analysis of 20 whole-mount sections of 25 radical retropubic prostatectomy (RPE) specimens presented results agreeing with the tumor location from MRI and MRS data. CONCLUSIONS: The aim of image-guided diagnostics should be to provide more critical information prior to biopsy. Furthermore, the acquisition of such data is important for better risk stratification in therapeutic decisions.

[Clinical relevance and indications for cardiac magnetic resonance imaging 2013: an interdisciplinary expert statement]. / Klinischer Stellenwert und Indikationen zur Magnetresonanztomografie des Herzens 2013: Ein interdisziplinäres Expertenstatement.

During the last years the indications of Cardiac Magnetic Resonance Imaging (CMRI) have been continuously expanded. However, the acceptance of the method by cardiologists and radiologists does not correlate with respect to the diagnostic potential. Several factors, such as expensive equipment, relatively long examination times, high technical know how and lack of remuneration, limit the application of CMRI in everyday clinical practice. Furthermore, doctors tend to apply more conventional, well established diagnostic procedures, the access to the method is still limited and there exist difficulties in the interdisciplinary collaboration. The interdisciplinary Austrian approach to Cardiac Imaging is aimed to improve the aforementioned problems and to support the implementation of CMRI in the diagnostic tree of cardiac diseases thus enabling a cost efficient management of patients in cardiology.

[Health economics evaluation of magnetic resonance imaging for the staging of prostate cancer for Austria and Germany]. / Gesundheitsökonomische Evaluation der Magnetresonanzbildgebung im Staging von Prostatakarzinomen für Österreich und Deutschland.

PURPOSE: The aim of this study was the health economics analysis of MR imaging in the preoperative staging of patients with prostate carcinoma (PCa). MATERIALS AND METHODS: The health economics analysis consisted of the following steps: modeling, determination of probabilities and parameters based on a detailed literature search, evaluation using the averages of the parameters, and sensitivity analyses of the results over the ranges of values. We performed a cost-utility analysis from health insurance's perspective for Austria and Germany. The population under investigation included patients with confirmed PCa. The alternative was a decision for therapy with or without staging using MR imaging. A localized PCa was treated by prostatectomy and locally advanced PCa by radiation/hormone therapy. The result parameters were quality adjusted life years (QALYs) and costs per patient. RESULTS: The evaluation showed that MR imaging is useful regarding costs and utilities prior to radical prostatectomy which is expensive and may be associated with serious clinical consequences. The costs per patient were lower by € 2635 and the utilities were higher by 0.099 QALYs. The strategy without MR imaging for staging was dominated by the strategy using MR imaging for staging in the evaluation using the base values and in almost all sensitivity analyses. CONCLUSION: For the parameters used and almost all scenarios of the sensitivity analysis, our decision-analytic model revealed a higher cost-utility ratio for the strategy using MR imaging for the staging of PCa.

[Health-economic evaluation of magnetic resonance imaging before biopsy for diagnosis of prostate cancer]. / Gesundheitsökonomische Evaluation einer Magnetresonanzbildgebung vor Biopsie zur Diagnose von Prostatakarzinomen.

PURPOSE: The aim of this study was the health-economic analysis of MR imaging in the diagnostics of suspicious prostate carcinoma (PCa) before execution of a first biopsy. MATERIALS AND METHODS: The health-economic analysis included four steps: modeling, determination of probabilities, evaluation, and sensitivity analyses. We performed an effectiveness analysis from the patient perspective as well as a cost-effectiveness and a cost-utility analysis from the health insurance perspective for Austria and Germany. The effectiveness and cost-effectiveness analysis used a hypothetical cohort of 100,000 patients. The result parameters were number of biopsies, number of detected PCa, and monetary costs. For the cost-efficiency analysis, the result parameters, quality-adjusted life years (QALYs) and costs, were calculated for an individual patient. RESULTS: The efficiency analysis showed that MRI before a first biopsy can prevent ca. 64,000 unnecessary biopsies/ 100,000 patients. The diagnostic efficiency was higher by a factor of 1.7. Due to MRI, eight PCas were additionally detected. From a health insurance perspective, MRI was not cost-effective. Extra costs of ca. 42 m. € per 100,000 patients and of 650 € per prevented biopsy were calculated. The costs per detected PCa were increased by 1395 €. The attainable QALYs were a little higher for the MRI alternative, which was therefore not dominated. CONCLUSION: Our results do not permit a clear recommendation for or against the application of MRI in the diagnostics of PCa. From the patient perspective, it is to be endorsed due to the higher medical efficiency. However, it is connected with higher health insurance costs.

[Treating papillomatous intradermal nevi: lasers - yes or no? A prospective study]. / Management papillomatöser intradermaler Nävi: Laser ja oder nein? Eine Prospektivstudie.

BACKGROUND: Papillomatous intradermal nevi are common acquired melanocytic nevi. Although harmless, they can be - especially on the face - cosmetically disturbing. At selected sites on the trunk, they may be traumatized by clothing, so that patients often wish to have them removed with a low likelihood of recurrence. MATERIAL AND METHODS: In a prospective study with 90 (female symbol=77, male symbol=13) patients aged between 13 and 67 years, 130 intradermal nevi (female symbol=114, male symbol=16) were removed using a combined therapy with CO(2), erbium: YAG and ruby lasers. RESULTS: After therapy, 2.3% of intradermal nevi recurred as a pigmented macule, while 6.9% reappeared as a papule or nodule (volume recurrence). 88% of the patients were very satisfied with the result; 11%, satisfied; and 1%, not satisfied. 99% would undergo the therapy again. CONCLUSION: The combined laser method (CO(2), erbium: YAG and ruby lasers) for the treatment of intradermal nevi produces excellent cosmetic results, is easily performed, leads to high patient satisfaction and is safe if correctly applied.

[Cost-effectiveness of percutaneous core needle breast biopsy (CNBB) versus open surgical biopsy (OSB) of nonpalpable breast lesions: metaanalysis and cost evaluation for German-speaking countries]. / Kosteneinsparungspotenzial der Nadelbiopsie im Vergleich zur offenen Biopsie bei der Diagnose suspekter, nichtpalpabler Brustläsionen: Metaanalyse der Literatur und Vergleich mit Daten aus dem deutschen Sprachraum.

PURPOSE: To analyze the cost-effectiveness of percutaneous image-guided CNBB (stereotactic-/ultrasound-guided; large/vacuum-assisted) of non-palpable breast lesions vs. OSB and to compare and discuss the results reported in the literature with results for German-speaking countries. MATERIALS AND METHODS: A key word search in three databases, limited to the period from 1/1994 to 12/2006 was performed. Only original papers were selected. No published articles for German-speaking countries were identified; therefore a comprehensive data collection was made. RESULTS: On the basis of 377 abstracts, nine studies were evaluated for final assessment. The data of German-speaking countries were compared with results reported in the literature. This study demonstrates that CNBB compared to OSB leads to reduction in cost ranging from 51-96 %. The cost reduction depends on biopsy modality and lesion type and is subject to national fluctuations. CNBB can replace a surgical procedure in 71-85 % of cases. CONCLUSION: Use of CNBB as an alternative to OSB has the potential to substantially reduce healthcare costs. The data are based almost exclusively on the North American literature. A potential cost reduction in the Netherlands and Switzerland confirms these findings. Future work must include cost evaluation studies for German-speaking countries since this is an issue with important national economic ramifications.

Carotid endarterectomy (CE) of the internal carotid artery (ICA) with and without patch angioplasty: comparison of hemodynamical and morphological parameters.

The aim of this study was to show, if patch angioplasty or direct closure of the blood vessel following carotid endarterectomy of the ICA resulted in any hemodynamical or morphological differences. Studies were carried out in eighteen and twenty patients, respectively within an average postoperative period of twenty-six month. All patients were examined with continuous-wave Doppler ultrasound, multi-channel pulse Doppler ultrasound and Duplex ultrasonography scanning. Comparing the two groups, differences are predominantly found at or near the site of the endarterectomized segment. Patients who received PTFE (Gore-Tex) patch angioplasty to close the arteriotomy, show in about 50% of all cases a dilatation--pantaloon effect (10)--at the carotid bifurcation (lumina greater than 1.1 cm) when investigating the vessel lumen with duplex sonography. This results in a statistical significant increase in turbulent flow disturbances at the bulb and the origin of the ICA. Furthermore, ICA flow velocity patterns after the endarterectomy point are still within the normal range when compared with patients not receiving a patch plasty, but still significantly elevated. Changes of the vessel wall, as such as intima elevation and intraluminal deposits are more frequently found distal to the endarterectomized segment and do obviously reduce the lumen. However, changes of flow volumina were not quantifiable. Atherosclerotic patients who underwent surgical treatment show as a characteristic finding due to atherosclerosis, a less laminar flow-pattern within the whole extracranial area, when compared with a normal healthy population.