[Consensus recommendations of the German Radiology Society (DRG), the German Cardiac Society (DGK) and the German Society for Pediatric Cardiology (DGPK) on the use of cardiac imaging with computed tomography and magnetic resonance imaging]. / Konsensusempfehlungen der DRG/DGK/DGPK zum Einsatz der Herzbildgebung mit Computertomografie und Magnetresonanztomografie.

Cardiac magnetic resonance imaging (MRI) and computed tomography (CT) have been developed rapidly in the last decade. Technical improvements and broad availability of modern CT and MRI scanners have led to an increasing and regular use of both diagnostic methods in clinical routine. Therefore, this German consensus document has been developed in collaboration by the German Cardiac Society, German Radiology Society, and the German Society for Pediatric Cardiology. It is not oriented on modalities and methods, but rather on disease entities. This consensus document deals with coronary artery disease, cardiomyopathies, arrhythmias, valvular diseases, pericardial diseases and structural changes, as well as with congenital heart defects. For different clinical scenarios both imaging modalities CT and MRI are compared and evaluated in the specific context.

[Recommendations for utilizing computerized tomography and magnetic resonance tomography in heart diagnosis. 2--Magnetic resonance tomography ]. / Empfehlungen für den Einsatz der Computertomografie und Magnetresonanztomografie in der Herzdiagnostik. Teil 2 - Magnetresonanztomografie.

MRI and CT have become important tools in the diagnosis of cardiac diseases. The permanent technical development and the continuously growing clinical and scientific experience required an update of the previous recommendations regarding the spectrum of clinical applications and the technical aspects of MRI and CT of the heart. The Working group Herzdiagnostik of the German Roentgen Society has revised its recommendations based on the current literature and has updated technical requirements and clinical indications. Part I of the recommendations deals with cardiac computed tomography while part II focuses on MRI in cardiac applications. These recommendations shall serve as a guideline when deciding on appropriate technique for non-invasive cardiac imaging and shall help to perform high quality imaging based on a standardised approach.

[Dual-source computed tomography: effect on regional and global left ventricular function assessment compared to magnetic resonance imaging]. / Untersuchung der regionalen und globalen linksventrikulären Funktion mit der Dual-Source-Computertomografie im Vergleich zur Magnetresonanztomografie.

PURPOSE: To determine regional and global left ventricular (LV) functional parameters and to perform segmental wall thickness (SWT) and motion (WM) analysis of dual-source CT (DSCT) with optimized temporal resolution versus MRI. MATERIALS AND METHODS: 30 patients with known or suspected CAD, non-obstructive HCM, DCM, ARVCM, Fallot Tetralogy, cardiac sarcoidosis and cardiac metastasis underwent DSCT and MRI. The DSCT and MR images were evaluated: end-systolic (ESV), end-diastolic LV (EDV) volumes, stroke volume (SV), ejection fraction (EF), and myocardial mass (MM) as well as LV wall thickening and segmental WM applying the AHA model were obtained and statistically analyzed. RESULTS: The mean LV-EDV (r = 0.96) and ESV (r = 0.98) as well as LV-EF (r = 0.97), SV (r = 0.83), and MM (r = 0.95) correlated well. Bland Altman analysis revealed little systematic underestimation of LV-EF (-1.1 +/- 7.8 %), EDV (-0.3 +/- 18.2 ml), SV (-1.3 +/- 16.7 ml) and little overestimation of ESV (1.1 +/- 7.8 ml) and MM (12.8 +/- 14.4 g) determined by DSCT. Systolic reconstruction time points correlated well (DSCT 32.2 +/- 6.7 vs. MRI 35.6 +/- 4.4 % RR-interval). The LV wall thickness obtained by DSCT and MRI showed close correlation in all segments (Ø diff 0.42 +/- 1 mm). In 413 segments (89 %) WM abnormalities were equally rated, whereas DSCT tended to underestimate the degree of wall motion impairment. CONCLUSION: DSCT with optimized temporal resolution enables regional and global LV function analysis as well as segmental WM analysis in good correlation with MRI. However, the degree of WM impairment is slightly underestimated by DSCT.

[Recommendations of the Heart Diagnosis Working Group of the German Roentgen Society for use of computerized tomography and magnetic resonance tomography in heart diagnosis. 1-- Computerized tomography]. / Empfehlungen der Arbeitsgemeinschaft Herzdiagnostik der Deutschen Röntgengesellschaft für den Einsatz der Computertomografie und Magnetresonanztomografie in der Herzdiagnostik. Teil 1 - Computertomografie.

MRI and CT have become important tools in the diagnosis of cardiac diseases. The permanent technical development and the continuously growing clinical and scientific experience required an update of the previous recommendations regarding the spectrum of clinical applications and the technical aspects of MRI and CT of the heart. The Working group Herzdiagnostik of the German Roentgen Society has revised its recommendations based on the current literature and has updated technical requirements and clinical indications. Part I of the recommendations deals with cardiac computed tomography while part II focuses on MRI in cardiac applications. These recommendations shall serve as a guideline when deciding on appropriate technique for non-invasive cardiac imaging and shall help to perform high quality imaging based on a standardised approach.

Automatic selection of optimal systolic and diastolic reconstruction windows for dual-source CT coronary angiography.

The aim of this study was to assess the performance of a motion-map algorithm that automatically determines optimal reconstruction windows for dual-source coronary CT angiography. In datasets from 50 consecutive patients, optimal systolic and diastolic reconstruction windows were determined using the motion-map algorithm. For manual determination of the optimal reconstruction window, datasets were reconstructed in 5% steps throughout the RR interval. Motion artifacts were rated for each major coronary vessel using a five-point scale. Mean motion scores using the motion-map algorithm were 2.4 +/- 0.8 for systolic reconstructions and 1.9 +/- 0.8 for diastolic reconstructions. Using the manual approach, overall motion scores were significantly better (1.9 +/- 0.5 and 1.7 +/- 0.6, p < 0.05), but diagnostic image quality was reached in >90% of cases using either approach. Using the automated approach, there was a negative correlation between heart rate and motion scores for systolic reconstructions (rho = -0.26, p < 0.05) and a positive correlation for diastolic reconstructions (rho = 0.46, p < 0.01). For the manual approach, no significant correlation was found for systolic reconstructions (rho = -0.1, p = 0.52), while there was a positive correlation for diastolic reconstructions (rho = 0.48, p < 0.01). Thus, the motion-map algorithm is a useful tool to save time in finding an appropriate reconstruction window in patients with heart rates <70 bpm (diastolic reconstruction) and >80 bpm (systolic reconstruction).

[Magnetic resonance imaging findings of the brain in adult HIV and AIDS patients]. / Magnetresonanztomografische Befunde des Gehirns bei adulten Patienten mit HIV und AIDS.

The spectrum of pathology affecting the central nervous system (CNS) in patients suffering from acquired immunodeficiency syndrome (AIDS) includes not only the human immunodeficiency virus (HIV) infection itself but also opportunistic infections and tumors secondary to AIDS. Despite progress in antiretroviral therapy and the subsequent decrease in the incidence of associated diseases, opportunistic infections and tumors secondary to the HIV infection continue to be the limiting factor in terms of survival with AIDS. Therefore, the therapeutic aim is permanent antiretroviral therapy as well as early diagnosis and treatment of opportunistic infections. Magnetic resonance imaging is often the diagnostic method of choice in suspected CNS pathology of HIV patients. In the following, the typical clinical and radiological features of several AIDS-related pathologies are presented and discussed.

Whole-heart coronary magnetic resonance angiography: value for the detection of coronary artery stenoses in comparison to multislice computed tomography angiography.

BACKGROUND: Coronary magnetic resonance imaging and computed tomography are being discussed as alternatives to catheter angiography in the detection of coronary artery disease. Yet, only few comparative validations have been performed. PURPOSE: To compare steady-state free precession whole heart coronary magnetic resonance imaging (MRI) with multidetector coronary computed tomography angiography (CTA) for the detection of coronary artery disease using catheter angiography as the standard of reference. MATERIAL AND METHODS: Twenty patients with known CAD were examined with navigator (NAV) gated and corrected free-breathing 3D balanced gradient echo whole heart coronary MRI and coronary CTA. Subjective overall image quality (4 point scale, 1 = excellent), visibility of vessel segments and accuracy for the detection of significant coronary stenoses (>50%) were compared to coronary x-ray angiography by two blinded readers. RESULTS: Median of subjective image quality was 3 for coronary MRI and 2 for coronary CTA. Of a total of 209 segments, 67 segments (32%) had to be excluded from the evaluation by coronary MRI (61 due to insufficient image quality and 6 due to stent artifacts). For coronary CTA, 31 segments (15%) had to be excluded from the evaluation (12 due to insufficient image quality, 15 due to severe calcifications superimposing the vessel lumen and 4 due to stent artifacts. Segment based values for the detection of >/=50% diameter coronary x-ray angiographic stenoses were: specificity: MRI 88%, CTA 95%; sensitivity: MRI 82%, CTA 84%; diagnostic accuracy: MRI 87%, CTA 93%; positive predictive value: MRI 68%, CTA 77% and negative predictive value: MRI 94%, CTA 95%. CONCLUSION: Coronary WH-MRI was inferior to coronary CTA regarding image quality and number of evaluable segments but both had similar diagnostic value for the detection and exclusion of CAD when only evaluable segments were included.

[Whole-heart coronary MR angiography -- initial results]. / Whole-Heart-MR-Koronarangiographie -- erste Ergebnisse.

PURPOSE: To evaluate a new coronary MR angiography technique covering the whole coronary artery tree in one data set acquisition. MATERIALS AND METHODS: Six healthy volunteers and 15 patients with known CAD were examined with a navigator gated and corrected (NAV) free-breathing 3D steady-state free precession sequence covering the whole heart (WH-MRA) (TR = 5.4, TE = 2.7, SENSE factor = 2, 160 slices, 0.75 mm reconstructed slice thickness, in-plane resolution = 0.99 x 0.99 mm(2), scan time 14 min [50 % NAV efficiency]) and a vessel targeted 3D SSFP MRA sequence (t-MRA) (TR = 5.6 ms, TE = 2.8 ms, 20 slices of 1.5 mm reconstructed slice thickness, in-plane resolution = 0.99 x 0.99 mm(2), scan time = 7 min [50 % NAV efficiency]). Subjective image quality (4-point scale) and objective image quality parameters including vessel sharpness, vessel diameter and CNR were calculated for WH-MRA and t-MRA. In patients, the accuracy for detection of stenosis larger than 50 % was compared to the accuracy of X-ray coronary angiography (XA), which was considered the standard. RESULTS: WH-MRA demonstrated good vessel visibility in healthy subjects (100 %) whereas vessel visibility in patients was limited (78 % in an 8 segment evaluation). Vessel sharpness was inferior to that of t-MRA in patients (37 vs. 42 %) but equal in healthy subjects (42 %). Vessel diameter did not differ significantly between WH-MRA and t-MRA. CNR was significantly reduced for WH-MRA (CNR 7.4 vs. 11.5). The diagnostic accuracy for the detection of CAD was comparable for both MRA approaches (85.5 vs. 86.2 %). CONCLUSION: WH-MRA allows good coronary artery visualization in healthy subjects and patients and provides a simplified scanning procedure and advantages in 3D post-processing. Regarding image parameters and the detection of CAD, the results are comparable to those acquired with t-MRA. The major disadvantage remains the high number of diagnostically insufficient images.

[Brachioradial pruritus: a rare, localized, neuropathic form of itching]. / Brachioradialer Pruritus : Eine seltene, lokalisierte, neuropathische Juckreizform.

We report on a female patient with brachioradial pruritus, in whom the cause could be verified by purposeful diagnostics (e. g., MRI). The clinical symptoms with localized itching result from circumscribed nerve root compression and hyperexcitation of the nerve fibers. Under treatment with gabapentin, an anticonvulsant with a very good analgesic and good antipruritic effect, the itch ceased and the skin changes healed. This case shows that this special form of neuropathic itch requires targeted therapy, which apart from symptomatic treatment should primarily focus on remedying the cause, if feasible.

Biochemical properties of isoprene synthase in poplar (Populus x canescens).

Isoprene synthase (ISPS) catalyzes the elimination of pyrophosphate from dimethylallyl diphosphate (DMADP) forming isoprene, a volatile hydrocarbon emitted from many plant species to the atmosphere. In the present work, immunological techniques were applied to study and localize ISPS in poplar leaves (Populus x canescens). Immunogold labeling using polyclonal antibodies generated against His-tagged recombinant ISPS protein detected ca. 44% of ISPS in the stroma of the chloroplasts and ca. 56% of gold particles attached to the stromal-facing side of the thylakoid membranes. ISPS isolated from leaves exhibited the same biochemical properties as the recombinant ISPS without the plastid-targeting peptide heterologous expressed in E. coli, whereas an additional C- or N-terminal His-tag changed the biochemical features of the recombinant enzyme with regard to temperature, pH, and substrate dependence. In comparison to the closely related class of monoterpene synthases from angiosperms and ISPS of oaks, the most striking feature of the poplar ISPS is a cooperative substrate dependence which is characteristic to enzymes with positive substrate activation. The detection of four immunoreactive bands in poplar leaf extracts with isoelectric points from 5.0 to 5.5 and a native molecular weight of ca. 51 kDa give reason for future studies on post-translational modifications of ISPS.

[Transarterial chemoembolization of liver metastases of colorectal carcinoma using degradable starch microspheres (Spherex): personal investigations and review of the literature]. / Transarterielle Chemoembolisation von Lebermetastasen kolorektaler Karzinome mit abbaubaren Stärkepartikeln (Spherex). Eigene Beobachtungen und Literaturübersicht.

Since two decades transarterial chemoembolization (TACE) of liver metastases has been investigated in numerous studies. However, no standardized therapeutic procedure exists so far. The present study retrospectively investigated survival, response and side effects after TACE of liver metastases in 21 patients with colorectal cancer and results are compared with previous literature. A total of 68 TACE procedures were performed. A suspension of degradable starch microspheres (DSM, Spherex) and Mitomycin C was applied selectively into hepatic arteries via a transfemoral approach. DSM effect a temporary arterial occlusion. Follow-up studies were performed by contrast enhanced spiral computed tomography (CT). The median survival was 13.8 months. Therapeutic response (according to WHO) was observed only in three patients. The progression free interval was 5.8 months. Patients developed a postembolization-syndrome (abdominal pain, fever, nausea) and increased transaminases in 27-43% of all interventions. A gastric ulcer occurred after four, cholecystitis after two TACE. As already shown in most previous studies, regardless of the used agents, also this investigation underlines the moderate therapeutic effect of TACE on colorectal liver metastases. So far, no significant survival benefit has been shown in the literature and the response rates are rather limited. In general, complications of TACE seem to be rare, but should not to be underestimated. Compared to TACE with long or permanent arterial occlusion, postembolization syndrome seems to be less pronounced using DSM. As TACE is rather a palliative therapeutic approach, DSM therefore might be more suited. Further studies on TACE of liver metastases should focus on to the patients' quality of life.

[Automatic injectors in magnetic resonance imaging and computed tomography: pilot study on hygienic aspects]. / Injektionsautomaten in der Magnetresonanz- und Computertomographie: Pilotstudie zu hygienischen Aspekten.

PURPOSE: To evaluate hygienic conditions using automatic injectors in magnetic resonance imaging (MRI) and computed tomography (CT) during clinical routine. MATERIALS AND METHODS: The surfaces of medical devices (e. g., control console) and the palms of the technical and medical staff were microbiologically analyzed by taking imprints before and after hygienic education. In addition, the injector syringes for contrast medium (CM) and saline were checked for microbiological contamination following multiple (MRI: 14 h; CT 8 h) and single use. Furthermore, the potential of retrograde contamination from the patient along the tube was analyzed. RESULTS: A bacterial contamination with typical dermal bacteria was documented for the surfaces of the medical devices, the palms of the technical and medical staff, and the injection syringes following multiple use (MRI: 10/10 CM syringes, 6/10 saline syringes; CT: 8/10 CM syringes, 5/10 saline syringes). Correct hand disinfection in combination with single use of syringes avoided bacterial colonization. Retrograde bacterial contamination from the patient was not observed. CONCLUSION: Regular hygienic teaching sessions for technical and medical staff in MRI and CT departments using automatic injectors should be mandatory. Furthermore, the multiple use of syringes should be avoided until investigations addressing the potential of bacterial contamination are performed.

Assessment of coronary arterial stents by multislice-CT angiography.

PURPOSE: To assess patency and lumen visibility of coronary artery stents by multislice-CT angiography (MSCTA) in comparison with conventional coronary angiography as the standard of reference. MATERIAL AND METHODS: 47 stents of 13 different types were evaluated in 29 patients. MSCTA was performed on a 4-slice scanner with a standard coronary protocol (detector collimation 4 x 1 mm; table feed 1.5 mm/rotation, 400 mAs, 120 kV). Image evaluation was performed by two readers who were blinded to the reports from the catheter angiography. MIP reconstructions were evaluated for image quality on a 4-point scale (1 = poor, 4 = excellent) and stent patency (contrast distal to the stent as an indirect patency sign). Axial images and multiplanar reformations through the stents were used for assessment of stent lumen visibility (measurement of the visible stent lumen diameter) and detection of relevant in-stent stenosis (> or =50%). RESULTS: Image quality was fair to good on average (score 2.64 +/- 1.0) and depended on the heart rate (heart rate 45-60: average score 3.2, heart rate 61-70: average score 2.8, heart rate >71: average score 1.4). Thirty-seven stents were correctly classified as patent, 1 was correctly classified as occluded and 9 stents were not assessible due to insufficient image quality because of triggering artifacts. Parts of the stent lumen could be visualized in 30 cases. On average, 20-40% of the stent lumen diameter was visible. Twenty-five stents were correctly classified as having no stenosis, 1 was falsely classified as stenosed, 1 was correctly classified as occluded. In 20 stents lumen visibility was not sufficient for stenosis evaluation. CONCLUSION: Although the stent lumen may be partly visualized in most stents, a reliable evaluation of in-stent stenoses does not seem practical by 4-slice MSCT. Nevertheless, for stent patency evaluation, MS-CTA might provide valuable clinical information. With submillimeter MSCT (e.g., 16-slice scanners) and more sophisticated reconstruction algorithms, further improvements may be expected.

[Aneurysm of the subclavian artery after operatively corrected coarctation of the aorta: 20 years of follow-up and review of the current literature]. / Aneurysma der Arteria subclavia nach Korrektur einer Aortenisthmusstenose. 20-jähriger Langzeitverlauf und Literaturübersicht.

We report of long-term follow-up of a combined fusiform aneurysm of the right subclavian artery extending to the thyreocervical trunk (3.2 x 2.8 x 2.2 cm (width x height x depth)) in a 33-year old patient. As a newborn, the clinical diagnosis of an aortic isthmus stenosis was made without need for intervention at this stage. Further development of the child remained unremarkable until the age of eleven years when he experienced dizziness after sporting activities. Due to clinically proven progress, cardiac catheterization was performed and confirmed the initial diagnosis of a juxtaductale stenosis of the aortic isthmus, which was operated thereafter with an end-to-end anastomosis. Furthermore, an aneurysm of the right subclavian artery was revealed. Since then, non-invasive routine follow-up showed no significant worsening of this aneurysm, which extends to the thyreocervical trunk. The patient has been event free and completely asymptomatic. This case report illustrates the more than twenty years of follow-up of an asymptomatic combined fusiform aneurysm of the subclavian artery and thyreocervical trunk and provides a review of the literature on this topic.