Introduction: HPV-associated oropharyngeal squamous cell carcinoma (OSCC) is an own tumor entity ... more Introduction: HPV-associated oropharyngeal squamous cell carcinoma (OSCC) is an own tumor entity with increasing incidence and different metastatic behavior compared to the non-HPV-associated OSCC. PET/CT has been described as a predictive marker for outcome of irradiation therapy in non-HPV-associated[for full text, please go to the a.m. URL]
BackgroundIn the EuroNet Pediatric Hodgkin Lymphoma (EuroNet‐PHL) trials, decision on Waldeyer... more BackgroundIn the EuroNet Pediatric Hodgkin Lymphoma (EuroNet‐PHL) trials, decision on Waldeyer's ring (WR) involvement is usually based on clinical assessment, that is, physical examination and/or nasopharyngoscopy. However, clinical assessment only evaluates mucosal surface and is prone to interobserver variability. Modern cross‐sectional imaging technology may provide valuable information beyond mucosal surface, which may lead to a more accurate WR staging.Patients, materials, and methodsThe EuroNet‐PHL‐C1 trial recruited 2102 patients, of which 1752 underwent central review including reference reading of their cross‐sectional imaging data. In 14 of 1752 patients, WR was considered involved according to clinical assessment. In these 14 patients, the WR was re‐assessed by applying an imaging‐based algorithm considering information from 18F‐fluorodeoxyglucose positron emission tomography, contrast‐enhanced computed tomography, and/or magnetic resonance imaging. For verification ...
Affiliations 1 Department of Diagnostic and Interventional Radiology, University Hospital Gießen,... more Affiliations 1 Department of Diagnostic and Interventional Radiology, University Hospital Gießen, Justus Liebig University, Gießen, Germany 2 Member of the German Centre for Lung Research (DZL), Germany 3 Department of Internal Medicine II, University Hospital Gießen, Justus Liebig University, Gießen, Germany 4 Department of Nuclear Medicine, University Hospital Gießen, Justus Liebig University, Gießen, Germany
RöFo - Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren, 2021
Purpose The purpose of this study was to assess the diagnostic accuracy of computed tomography pu... more Purpose The purpose of this study was to assess the diagnostic accuracy of computed tomography pulmonary angiogram (CTPA) including dual energy and reconstruction of iodine maps for diagnosing CTEPH. This method for detecting embolisms and perfusion failures was compared with V/Q-SPECT. An additional purpose was to compare the applied radiation dose of both techniques. Materials and Methods 71 patients (49 women) with suspected CTEPH were included in this prospective study. The patients received a V/Q-SPECT and a dual-energy CTPA. Iodine maps were reconstructed from the data set. CTPA and the iodine maps were read by an experienced radiologist unaware of the clinical information as well as the results of the V/Q-SPECT. Results were compared to the V/Q-SPECT. DLP and the applied amount of radionuclides (MAA, Technegas) were obtained for comparison of radiation dose. Results For the diagnosis of CTEPH, the sensitivity of DECT was 1.000, specificity 0.966, PPV 0.867 and NPV 1.000, resp...
After pulmonary embolisms (PE) up to 4% of patients develop pulmonary hypertension (PH). We exami... more After pulmonary embolisms (PE) up to 4% of patients develop pulmonary hypertension (PH). We examined patients after idiopathic, recurrent or familiar PE with stress echocadiography for non-invasive assessment of pulmonary circulation and pefusions scan. Afterwards patients remain in follow-up. After initial screening of 150 patients, we noninvasively investigated 93 patients (61 female, age 48 +/- 14 years), among them 85% with previous PE and 15% with multiple PE, and 37% of patients with thrombophilia. The age at first thromboembolic event was 39 +/- 14 years. The time between PE and the investigation was 9 +/- 8 years. A rest, 91 patients showed a normal systolic pulmonary artery pressure (sPAP) and normal right ventricular function (sPAP 36 +/- 1 mm Hg). In 2 patients the sPAP was > 40 mm Hg at rest. A hypertensive pulmonary vascular reaction was present in 26 patents with an increase of the sPAP to 48+/-4 mm Hg during exercise. In 55 patients perfusion defects were preset on V/Q scan. One patient had manifest precapillary pulmonary hypertension on right heart catheter. After 8 years, 24 of the 93 patients reported about exertional dyspnea and underwent a repeat investigation. All of them had a hypertensive pulmonary vascular reaction and at least one perfusion defect at initial assessment. In 4 patients pulmonary hypertension was detected on resting echocardiography, which has been confirmed by right heart catheterization (mPAP 31 +/- 5 mm Hg, PVR 478 +/- 133 dynes), consistent with 4.3% of the initial cohort. The presence of a hypertensive pulmonary vascular reaction in combination with a persistent perfusion defect after PE might be a risk constellation for development of PH.
ABSTRACT A 75-year-old woman was found to have left-sided pleural effusion and endoscopy revealed... more ABSTRACT A 75-year-old woman was found to have left-sided pleural effusion and endoscopy revealed the rare entity of adenoid cystic carcinoma metastases in the gastric mucosa. Approximately 20 % of patients with this carcinoma suffer from distant metastases. For the initial staging detection of adenoid cystic carcinoma metastasis with positron emission tomography (PET) or PET computed tomography (CT) is recommended. The recurrent t(6;9)(q22-23;p23-24) translocation that results in a fusion of the two transcription factor genes MYB and NFIB is detectable in half of the cases. As in our case molecular pathology can confirm the correct diagnosis and identification of the localization of the primary tumor.
Zusammenfassung Ziel: Die Indikation zur Radiojodtherapie unifokaler autonomer Adenome wurde bish... more Zusammenfassung Ziel: Die Indikation zur Radiojodtherapie unifokaler autonomer Adenome wurde bisher meist nur dann gestellt, wenn das Adenomvolumen >8 ml oder der Tc-Uptake unter Suppressionsbedingungen >2% waren. Wir haben untersucht, inwieweit bei thyreogenen Beschwerden die Indikation erweitert werden kann. Methode: Im Zeitraum von März 1993 bis April 1994 wurden 11 Patienten einer Radiojodtherapie unterzogen, bei denen das Adenomvolumen unter 8 ml lag und der Tc-Uptake unter Suppression kleiner als 2% war. Ergebnis: Bei allen 11 Patienten waren die thyreogenen Beschwerden nach der Radiojodtherapie deutlich gebessert. Schlußfolgerung: Wir halten es für sinnvoll, die Indikation zur Radiojodtherapie bei kleinen unifokalen Adenomen zu erweitern.
Aim: Diagnosis of infection with help of antigranulocyte scintigraphy near body stem is difficult... more Aim: Diagnosis of infection with help of antigranulocyte scintigraphy near body stem is difficult because of contemporary visualisation of bone marrow. Therefore, we investigated, whether it is possible to improve the accuracy in diagnosing septic loosening of hip endoprosthesis by changing the analyzing methods. Methods: In 28 patients, the results of a visual interpretation of late scan, a visual interpretation and a quantitative interpretation of time-activity-course were compared. These results were verified by histology respectively microbiology. Results: Histological and microbiological verification found 14 septic loosening and 14 aseptic loosening of the hip protheses. Therefore, sensitivity, specifity, negative and positive predictive value for the visual interpretation of late scan were 0.86,0.57,0.80 and 0.67. For visual and quantitative interpretation of time-activity-course we found 0.86,0.79,0.85 and 0.80 respectively 1,0.93,1,0.93. For interobserver agreement we found...
Ziel: Die in der Literatur genannten Mess- und Auswertemethoden fur den Aktivitatsabtransport bei... more Ziel: Die in der Literatur genannten Mess- und Auswertemethoden fur den Aktivitatsabtransport bei der Radiosynoviorthese des Kniegelenkes wurden unter Berucksichtigung der tatsachlichen Streu- und Absorptionsverhaltnisse anhand eines Leichenphantoms evaluiert. Methoden: Die unterschiedliche Verteilung der Aktivitat im Kniegelenk sowie der unterschiedliche Abtransport nach inguinal wurde simuliert und mittels Gamma-Kamera gemessen. Verglichen wurde der tatsachliche Abtransport mit den Ergebnissen aus der alleinigen Messung der Kniegelenksaktivitat aus anteriorer Sicht, aus der Bildung des geometrischen Mittels und aus der Summenbildung bei Messung aus anteriorer und posteriorer Sicht sowie entsprechend aus der Messung von Kniegelenksaktivitat und Aktivitat in den inguinalen Lymphknoten. Zusatzlich wurde der Einfluss der Streustrahlung untersucht. Ergebnisse: Fur mehrere Mess- und Auswerteverfahren fand sich mit Werten zwischen 0,97 und 0,98 fur das Bestimmtheitsmas ein ubereinstimmen...
Summary Aim: Because of a similar tracer accumulation, we assumed to get the same information abo... more Summary Aim: Because of a similar tracer accumulation, we assumed to get the same information about synovitis in arthritic joint disease with HIG scintigraphy and bloodpool scintigraphy using HDP. Therefore, we compared retrospectively 23 patients. Methods: In HIG scintigraphy, synovitis was diagnosed according to increasing activity from early to late image. In bloodpool scintigraphy according to an increased activity in comparison to the surrounding tissues. Results: In 694 joints comparison of both scintigraphic modalities was possible, resulting in a 2 × 2 kappa coefficient of 0.93 or 0.97 by using late-phase bone scintigraphy as an anatomical marker. For intra- and interobserver agreement, 2 × 2 kappa coefficients of 0.93 and 0.88 in HIG scintigraphy, respectively 0.96 and 0.90 in blood-pool scintigraphy were calculated. Conclusion: This study shows an excellent agreement in the visualization of synovitis by HIG and bloodpool scintigraphy. Because of its higher objectivity and ...
Multiple procedures for the quantification of activity leakage in radiation synovectomy of the kn... more Multiple procedures for the quantification of activity leakage in radiation synovectomy of the knee joint have been described in the literature. We compared these procedures considering the real conditions of dispersion and absorption using a corpse phantom. We simulated different distributions of the activity in the knee joint and a different extra-articular spread into the inguinal lymph nodes. The activity was measured with a gamma-camera. Activity leakage was calculated by measuring the retention in the knee joint only using an anterior view, using the geometric mean of anterior and posterior views, or using the sum of anterior and posterior views. The same procedures were used to quantify the activity leakage by measuring the activity spread into the inguinal lymph nodes. In addition, the influence of scattered rays was evaluated. For several procedures we found an excellent association with the real activity leakage, shown by an r(2) between 0.97 and 0.98. When the real value ...
Amyloidosis occurs when certain soluble proteins are transformed into amyloid fibrils in the extr... more Amyloidosis occurs when certain soluble proteins are transformed into amyloid fibrils in the extracellular space. Most common are the light-chain amyloidoses; less common is the AA-amyloidosis, which follows chronic inflammatory diseases, and the amyloidoses of transthyretin (TTR) origin. We report on a women of Italian-German origin with the mutation TTR (Ser23Asn). Whole body scintigraphy using TC99m-DPD showed end stage hereditary amyloidosis caused by ATTR with predominant tracer retention in the myocardium. Myocardial biopsies revealed the presence of amyloid by Congo red staining. Further immunohistochemical analysis showed ATTR amyloidosis. DNA sequencing revealed a point mutation of the transthyretin gene leading to a single amino acid substitution. The only effective treatment in patients with manifest cardiac ATTR amyloidosis is combined heart and liver transplantation. Our patient was placed on a list for this procedure, but unfortunately she died during the standby proce...
Introduction: HPV-associated oropharyngeal squamous cell carcinoma (OSCC) is an own tumor entity ... more Introduction: HPV-associated oropharyngeal squamous cell carcinoma (OSCC) is an own tumor entity with increasing incidence and different metastatic behavior compared to the non-HPV-associated OSCC. PET/CT has been described as a predictive marker for outcome of irradiation therapy in non-HPV-associated[for full text, please go to the a.m. URL]
BackgroundIn the EuroNet Pediatric Hodgkin Lymphoma (EuroNet‐PHL) trials, decision on Waldeyer... more BackgroundIn the EuroNet Pediatric Hodgkin Lymphoma (EuroNet‐PHL) trials, decision on Waldeyer's ring (WR) involvement is usually based on clinical assessment, that is, physical examination and/or nasopharyngoscopy. However, clinical assessment only evaluates mucosal surface and is prone to interobserver variability. Modern cross‐sectional imaging technology may provide valuable information beyond mucosal surface, which may lead to a more accurate WR staging.Patients, materials, and methodsThe EuroNet‐PHL‐C1 trial recruited 2102 patients, of which 1752 underwent central review including reference reading of their cross‐sectional imaging data. In 14 of 1752 patients, WR was considered involved according to clinical assessment. In these 14 patients, the WR was re‐assessed by applying an imaging‐based algorithm considering information from 18F‐fluorodeoxyglucose positron emission tomography, contrast‐enhanced computed tomography, and/or magnetic resonance imaging. For verification ...
Affiliations 1 Department of Diagnostic and Interventional Radiology, University Hospital Gießen,... more Affiliations 1 Department of Diagnostic and Interventional Radiology, University Hospital Gießen, Justus Liebig University, Gießen, Germany 2 Member of the German Centre for Lung Research (DZL), Germany 3 Department of Internal Medicine II, University Hospital Gießen, Justus Liebig University, Gießen, Germany 4 Department of Nuclear Medicine, University Hospital Gießen, Justus Liebig University, Gießen, Germany
RöFo - Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren, 2021
Purpose The purpose of this study was to assess the diagnostic accuracy of computed tomography pu... more Purpose The purpose of this study was to assess the diagnostic accuracy of computed tomography pulmonary angiogram (CTPA) including dual energy and reconstruction of iodine maps for diagnosing CTEPH. This method for detecting embolisms and perfusion failures was compared with V/Q-SPECT. An additional purpose was to compare the applied radiation dose of both techniques. Materials and Methods 71 patients (49 women) with suspected CTEPH were included in this prospective study. The patients received a V/Q-SPECT and a dual-energy CTPA. Iodine maps were reconstructed from the data set. CTPA and the iodine maps were read by an experienced radiologist unaware of the clinical information as well as the results of the V/Q-SPECT. Results were compared to the V/Q-SPECT. DLP and the applied amount of radionuclides (MAA, Technegas) were obtained for comparison of radiation dose. Results For the diagnosis of CTEPH, the sensitivity of DECT was 1.000, specificity 0.966, PPV 0.867 and NPV 1.000, resp...
After pulmonary embolisms (PE) up to 4% of patients develop pulmonary hypertension (PH). We exami... more After pulmonary embolisms (PE) up to 4% of patients develop pulmonary hypertension (PH). We examined patients after idiopathic, recurrent or familiar PE with stress echocadiography for non-invasive assessment of pulmonary circulation and pefusions scan. Afterwards patients remain in follow-up. After initial screening of 150 patients, we noninvasively investigated 93 patients (61 female, age 48 +/- 14 years), among them 85% with previous PE and 15% with multiple PE, and 37% of patients with thrombophilia. The age at first thromboembolic event was 39 +/- 14 years. The time between PE and the investigation was 9 +/- 8 years. A rest, 91 patients showed a normal systolic pulmonary artery pressure (sPAP) and normal right ventricular function (sPAP 36 +/- 1 mm Hg). In 2 patients the sPAP was > 40 mm Hg at rest. A hypertensive pulmonary vascular reaction was present in 26 patents with an increase of the sPAP to 48+/-4 mm Hg during exercise. In 55 patients perfusion defects were preset on V/Q scan. One patient had manifest precapillary pulmonary hypertension on right heart catheter. After 8 years, 24 of the 93 patients reported about exertional dyspnea and underwent a repeat investigation. All of them had a hypertensive pulmonary vascular reaction and at least one perfusion defect at initial assessment. In 4 patients pulmonary hypertension was detected on resting echocardiography, which has been confirmed by right heart catheterization (mPAP 31 +/- 5 mm Hg, PVR 478 +/- 133 dynes), consistent with 4.3% of the initial cohort. The presence of a hypertensive pulmonary vascular reaction in combination with a persistent perfusion defect after PE might be a risk constellation for development of PH.
ABSTRACT A 75-year-old woman was found to have left-sided pleural effusion and endoscopy revealed... more ABSTRACT A 75-year-old woman was found to have left-sided pleural effusion and endoscopy revealed the rare entity of adenoid cystic carcinoma metastases in the gastric mucosa. Approximately 20 % of patients with this carcinoma suffer from distant metastases. For the initial staging detection of adenoid cystic carcinoma metastasis with positron emission tomography (PET) or PET computed tomography (CT) is recommended. The recurrent t(6;9)(q22-23;p23-24) translocation that results in a fusion of the two transcription factor genes MYB and NFIB is detectable in half of the cases. As in our case molecular pathology can confirm the correct diagnosis and identification of the localization of the primary tumor.
Zusammenfassung Ziel: Die Indikation zur Radiojodtherapie unifokaler autonomer Adenome wurde bish... more Zusammenfassung Ziel: Die Indikation zur Radiojodtherapie unifokaler autonomer Adenome wurde bisher meist nur dann gestellt, wenn das Adenomvolumen >8 ml oder der Tc-Uptake unter Suppressionsbedingungen >2% waren. Wir haben untersucht, inwieweit bei thyreogenen Beschwerden die Indikation erweitert werden kann. Methode: Im Zeitraum von März 1993 bis April 1994 wurden 11 Patienten einer Radiojodtherapie unterzogen, bei denen das Adenomvolumen unter 8 ml lag und der Tc-Uptake unter Suppression kleiner als 2% war. Ergebnis: Bei allen 11 Patienten waren die thyreogenen Beschwerden nach der Radiojodtherapie deutlich gebessert. Schlußfolgerung: Wir halten es für sinnvoll, die Indikation zur Radiojodtherapie bei kleinen unifokalen Adenomen zu erweitern.
Aim: Diagnosis of infection with help of antigranulocyte scintigraphy near body stem is difficult... more Aim: Diagnosis of infection with help of antigranulocyte scintigraphy near body stem is difficult because of contemporary visualisation of bone marrow. Therefore, we investigated, whether it is possible to improve the accuracy in diagnosing septic loosening of hip endoprosthesis by changing the analyzing methods. Methods: In 28 patients, the results of a visual interpretation of late scan, a visual interpretation and a quantitative interpretation of time-activity-course were compared. These results were verified by histology respectively microbiology. Results: Histological and microbiological verification found 14 septic loosening and 14 aseptic loosening of the hip protheses. Therefore, sensitivity, specifity, negative and positive predictive value for the visual interpretation of late scan were 0.86,0.57,0.80 and 0.67. For visual and quantitative interpretation of time-activity-course we found 0.86,0.79,0.85 and 0.80 respectively 1,0.93,1,0.93. For interobserver agreement we found...
Ziel: Die in der Literatur genannten Mess- und Auswertemethoden fur den Aktivitatsabtransport bei... more Ziel: Die in der Literatur genannten Mess- und Auswertemethoden fur den Aktivitatsabtransport bei der Radiosynoviorthese des Kniegelenkes wurden unter Berucksichtigung der tatsachlichen Streu- und Absorptionsverhaltnisse anhand eines Leichenphantoms evaluiert. Methoden: Die unterschiedliche Verteilung der Aktivitat im Kniegelenk sowie der unterschiedliche Abtransport nach inguinal wurde simuliert und mittels Gamma-Kamera gemessen. Verglichen wurde der tatsachliche Abtransport mit den Ergebnissen aus der alleinigen Messung der Kniegelenksaktivitat aus anteriorer Sicht, aus der Bildung des geometrischen Mittels und aus der Summenbildung bei Messung aus anteriorer und posteriorer Sicht sowie entsprechend aus der Messung von Kniegelenksaktivitat und Aktivitat in den inguinalen Lymphknoten. Zusatzlich wurde der Einfluss der Streustrahlung untersucht. Ergebnisse: Fur mehrere Mess- und Auswerteverfahren fand sich mit Werten zwischen 0,97 und 0,98 fur das Bestimmtheitsmas ein ubereinstimmen...
Summary Aim: Because of a similar tracer accumulation, we assumed to get the same information abo... more Summary Aim: Because of a similar tracer accumulation, we assumed to get the same information about synovitis in arthritic joint disease with HIG scintigraphy and bloodpool scintigraphy using HDP. Therefore, we compared retrospectively 23 patients. Methods: In HIG scintigraphy, synovitis was diagnosed according to increasing activity from early to late image. In bloodpool scintigraphy according to an increased activity in comparison to the surrounding tissues. Results: In 694 joints comparison of both scintigraphic modalities was possible, resulting in a 2 × 2 kappa coefficient of 0.93 or 0.97 by using late-phase bone scintigraphy as an anatomical marker. For intra- and interobserver agreement, 2 × 2 kappa coefficients of 0.93 and 0.88 in HIG scintigraphy, respectively 0.96 and 0.90 in blood-pool scintigraphy were calculated. Conclusion: This study shows an excellent agreement in the visualization of synovitis by HIG and bloodpool scintigraphy. Because of its higher objectivity and ...
Multiple procedures for the quantification of activity leakage in radiation synovectomy of the kn... more Multiple procedures for the quantification of activity leakage in radiation synovectomy of the knee joint have been described in the literature. We compared these procedures considering the real conditions of dispersion and absorption using a corpse phantom. We simulated different distributions of the activity in the knee joint and a different extra-articular spread into the inguinal lymph nodes. The activity was measured with a gamma-camera. Activity leakage was calculated by measuring the retention in the knee joint only using an anterior view, using the geometric mean of anterior and posterior views, or using the sum of anterior and posterior views. The same procedures were used to quantify the activity leakage by measuring the activity spread into the inguinal lymph nodes. In addition, the influence of scattered rays was evaluated. For several procedures we found an excellent association with the real activity leakage, shown by an r(2) between 0.97 and 0.98. When the real value ...
Amyloidosis occurs when certain soluble proteins are transformed into amyloid fibrils in the extr... more Amyloidosis occurs when certain soluble proteins are transformed into amyloid fibrils in the extracellular space. Most common are the light-chain amyloidoses; less common is the AA-amyloidosis, which follows chronic inflammatory diseases, and the amyloidoses of transthyretin (TTR) origin. We report on a women of Italian-German origin with the mutation TTR (Ser23Asn). Whole body scintigraphy using TC99m-DPD showed end stage hereditary amyloidosis caused by ATTR with predominant tracer retention in the myocardium. Myocardial biopsies revealed the presence of amyloid by Congo red staining. Further immunohistochemical analysis showed ATTR amyloidosis. DNA sequencing revealed a point mutation of the transthyretin gene leading to a single amino acid substitution. The only effective treatment in patients with manifest cardiac ATTR amyloidosis is combined heart and liver transplantation. Our patient was placed on a list for this procedure, but unfortunately she died during the standby proce...
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