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  • 1
    Language: English
    In: European Journal of Radiology, December 2013, Vol.82(12), pp.e816-e822
    Description: Evaluation of the efficacy and tolerability of transarterial chemoembolization with gemcitabine in patients with inoperable liver metastases of breast cancer. Open-label, prospective non-randomized single-center study design; patients had previous chemotherapy including anthracyclines and/or taxanes in the metastatic setting, adequate bone marrow reserve, sufficient liver/renal function, no centralnervous system metastases, Karnovsky-performance-status 〉70%, and life expectancy 〉12 weeks. Forty-three patients were enrolled (median 58 years, range 48–71). A suspension of gemcitabine 1.200 mg/m , 2–10 ml/m of Lipiodol, and 5 ml of a degradable starch microsphere (Embocept) suspension, were administered intra-arterially up to 3 times with a 4-weaks-interval. Dose-limiting toxicit is defined as grade 4 thrombocytopenia, neutropenia, or nonhematologic toxicity 〉 grade 3. Tumor response was evaluated by magnetic resonance (MRI) and computed tomography (CT) imaging. All patients tolerated the treatment well; with no dose limiting toxicities. Imaging follow-up according to the RECIST-criteria (Response Evaluation Criteria in Solid Tumors) revealed a partial response in 3 patients, stable disease in 16 patients and progression in 22 patients. The progression free survival was 3.3 months. A significant correlation exists only with the factor vascularization: strongly vascularized tumors show a significantly lowered response. Patients with complete or partial response and the main fraction of the stable disease group showed in the MRI and angiography only a moderate vascularization. The resulting estimate of the total survival rate amounts to a median of 10.2 months. Transarterial chemoembolization with gemcitabine is well tolerated and provides an alternative treatment method for patients with liver metastases of breast cancer.
    Keywords: Transarterial Chemoembolization ; Liver Metastases ; Breast Cancer ; Medicine
    ISSN: 0720-048X
    E-ISSN: 1872-7727
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  • 2
    In: Spine, 2013, Vol.38(20), pp.1730-1736
    Description: STUDY DESIGN.: A novel randomized, controlled, unblinded clinical trial comparing 2 procedural interventions for painful osteoporotic vertebral compression fractures. OBJECTIVE.: The primary study objective was to evaluate cement leakage for a cement directed kyphoplasty system (CDKS) with anteriorly biased cement flow and vertebroplasty. The secondary study objective was to compare adjacent level fracture rates and vertebral body height for these 2 intervention methods. SUMMARY OF BACKGROUND DATA.: Cement leakage remains a significant clinical problem associated with vertebroplasty and kyphoplasty procedures. Uncontrolled cement flow in the posterior direction can result in leakage into the vertebral veins or spinal canal, leading to potentially serious clinical complications. METHODS.: Seventy-seven patients with painful osteoporotic vertebral compression fractures were enrolled. Patients were randomized 2:1 for treatment with CDKS (49 patients, 65 levels) or vertebroplasty (28 patients, 39 levels). Cement leakage was evaluated from radiographs and computed tomographic scans. Three- and 12-month follow-ups included additional radiographs and computed tomographic scans to assess changes in vertebral body height and the incidence of new fractures. RESULTS.: Treatment with CDKS significantly reduced the number of levels with leaks and the total number of leaks per level, as compared with vertebroplasty (P = 0.0132 and P = 0.0012, respectively). Significantly, fewer lateral cortical and spinal canal leaks (posterior leaks) occurred in the CDKS group (P = 0.0050, P = 0.02260, respectively). Three adjacent level fractures occurred in the vertebroplasty group, as compared with 2 in the CDKS group. Vertebral body height maintenance was equivalent. CONCLUSION.: Cement directed kyphoplasty effectively reduces posterior cement leakage, reducing the risk of leakage related complications.Level of Evidence: 2
    Keywords: Aged–Adverse Effects ; Aged, 80 and Over–Therapeutic Use ; Bone Cements–Diagnostic Imaging ; Extravasation of Diagnostic and Therapeutic Materials–Etiology ; Female–Surgery ; Follow-Up Studies–Adverse Effects ; Fractures, Compression–Methods ; Humans–Surgery ; Kyphoplasty–Diagnostic Imaging ; Male–Etiology ; Middle Aged–Surgery ; Osteoporotic Fractures–Diagnostic Imaging ; Postoperative Complications–Surgery ; Prospective Studies–Adverse Effects ; Spinal Fractures–Methods ; Spine–Methods ; Tomography, X-Ray Computed–Methods ; Treatment Outcome–Methods ; Vertebroplasty–Methods ; Bone Cements;
    ISSN: 0362-2436
    E-ISSN: 15281159
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  • 3
    Language: English
    In: Radiology, June 2011, Vol.259(3), pp.903-10
    Description: To examine the feasibility and safety of magnetic resonance (MR)-guided biopsy by using a transgluteal approach in patients with suspicious prostate lesions by using an MR-compatible robotic system and a 1.5-T MR system. The study was approved by the institutional review board of University Frankfurt, and informed consent was obtained from each patient. A total of 20 patients (age range, 57.8-71.9 years; mean age, 65.1 years) underwent biopsy in a closed-bore high-field-strength MR system. Biopsy was performed with an MR-compatible pneumatically driven robotic system. T1-weighted gradient-echo fast low-angle shot and T2-weighted true fast imaging with steady-state precession sequences were used to plan and guide the intervention with a transgluteal access on the external planning computer of the assistance system. The system calculated the trajectory and then moved the guiding arm to the insertion point. The cannula was advanced manually, and biopsies were performed with the coaxial technique by using a 15-gauge pencil tip needle. Intervention time, complications, and biopsy findings were documented. The MR-compatible robotic system did not interfere with image quality, nor did MR imaging cause dysfunction of the robot. In one patient, the interventionist caused a fail-safe system shutdown. This was due to inadvertent displacement of the guiding arm during cannula insertion. This problem was solved by increasing the displacement threshold. Accurate coaxial cannula biopsy could be performed in all subsequent patients. Sufficient histopathologic assessment was performed in 19 patients. Insufficient material was retrieved in the patient who experienced fail-safe system shutdown. The median intervention time was 39 minutes (23-65 minutes). No procedure-related complications were observed. Preliminary results indicate that MR-guided robot-assisted biopsy is feasible and can be performed safely with highly accurate cannula placement.
    Keywords: Biopsy, Needle -- Instrumentation ; Magnetic Resonance Imaging, Interventional -- Instrumentation ; Prostatic Neoplasms -- Diagnosis ; Robotics -- Instrumentation
    ISSN: 00338419
    E-ISSN: 1527-1315
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  • 4
    Language: English
    In: RoFo : Fortschritte auf dem Gebiete der Rontgenstrahlen und der Nuklearmedizin, November 2017, Vol.189(11), pp.1055-1066
    Description:  The locoregional interventional oncological treatment approach is an accepted modality for liver neoplasms, especially for hepatocellular carcinoma (HCC) and oligonodular liver metastases.  The main aim of ablation therapies like microwave ablation (MWA) is to eradicate all malignant cells in a minimally invasive technique under imaging guidance while preserving the healthy tissue with a sufficient safety margin (at least 5 mm) surrounding the ablated lesion.  Ablation therapy can be performed via a percutaneous, laparoscopic or intraoperative approach under ultrasound, MRI or CT guidance for adequate localization and monitoring of the ablation process.  Ablation is the method of choice for oligonodular HCCs ≤ 3 cm. The technical success rate varies from 88 % to 98 % and progression-free survival (PFS) at 3 years from 27 % to 91.7 %. The same criteria apply to the therapy of liver metastases.   · Careful selection of patients proves to be essential for optimum results of MWA. · Interventionists should be familiar with all aspects of complication and rapid assessment of imaging methods in order to evaluate induced damage by thermal ablation. · MWA seems to have some advantages over radiofrequency ablation, like shorter ablation time, less pain, less heat sink effect; however, scientific proof is needed. · Vogl TJ, Nour-Eldin A, Hammerstingl RM et al. Microwave Ablation (MWA): Basics, Technique and Results in Primary and Metastatic Liver Neoplasms - Review Article. Fortschr Röntgenstr 2017; 189: 1055 - 1066.
    Keywords: Ablation Techniques -- Methods ; Carcinoma -- Secondary ; Liver Neoplasms -- Surgery ; Microwaves -- Therapeutic Use ; Surgery, Computer-Assisted -- Methods
    ISSN: 14389029
    E-ISSN: 1438-9010
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  • 5
    Language: English
    In: Future oncology (London, England), July 2013, Vol.9(7), pp.1039-50
    Description: To evaluate magnetic resonance sequences for T(1) and proton resonance frequency (PRF) thermometry during laser-induced thermotherapy (LITT) in liver tissue. During LITT (1064 nm; 30 W; 3-cm diffuser; 2-3 min) in ex vivo porcine liver, temperature was measured (25-70°C) utilizing a fiberoptic thermometer and MRI was performed with a 1.5-T scanner through the following sequences: segmented echo planar imaging (seg-EPI) for the PRF method; fast low-angle shot (FLASH), inversion-recovery turbo FLASH (IRTF), saturation-recovery turbo FLASH (SRTF) and true-fast imaging (TRUFI) for the T(1) method. Phase angle and signal amplitude (regarding PRF/T(1)) was recorded in regions of interest, on images under fiberoptic probe tips. Sequences' thermal coefficients were determined by calibrating phase angle and signal amplitude against temperature and subsequently validated. Coefficients of -0.0089 ± 0.0003 ppm °C(-1) (seg-EPI) and -0.917 ± 0.046, -1.166 ± 0.058, -1.038 ± 0.054 and -1.443 ± 0.118°C(-1) (FLASH, IRTF, SRTF and TRUFI, respectively) were obtained. Precisions of 0.71, 1.34, 2.07, 2.44 and 3.21°C and, through Bland-Altman analysis, accuracies of -0.67, 0.79, 1.65, 1.57 and 2.13°C (seg-EPI, FLASH, IRTF, SRTF and TRUFI, respectively) were determined. The PRF method with seg-EPI sequence is preferred for thermometry during LITT owing to higher precision and accuracy. Among T(1)-method sequences, FLASH showed higher accuracy and robustness.
    Keywords: Hyperthermia, Induced -- Methods ; Liver -- Physiology ; Magnetic Resonance Imaging -- Methods ; Thermometry -- Methods
    ISSN: 14796694
    E-ISSN: 1744-8301
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  • 6
    Language: English
    In: European Journal of Radiology, May 2018, Vol.102, pp.138-145
    Description: To determine overall (OS) and progression-free survival (PFS) for cTACE alone and in combination with percutaneous thermal ablation in patients with non-resectable, chemotherapy-resistant colorectal cancer liver metastases (CRLM). The study included 452 patients undergoing 2654 repetitive cTACE treatments of CRLM. 233 patients were treated palliatively using only cTACE, whereas 219 patients were treated with cTACE in a neoadjuvant intend with subsequent thermal ablation (either microwave ablation or laser-induced thermotherapy). The chemotherapeutics agents used, in either single-, double-, or triple-combinations, included MitomycinC, Gemcitabine, Irinotecan, and Cisplatin. Several factors were analysed to determine their prognostic value in terms of OS and PFS. Palliative use of cTACE resulted in a median OS and PFS of 12.6 and 5.9 months, whereas the neoadjuvant use of cTACE showed a median OS and PFS of 25.8 and 10.8 months. The differences in OS and PFS between the two groups were statistically significant (p 〈 0.001). Extrahepatic metastases were a significant prognostic factor in the OS and PFS analysis of the palliative and neoadjuvant group. In addition, number, location, and mean size of metastases were significant prognostic factors for OS and PFS in the neoadjuvant group. Sex, primary tumor location, T- and N-parameters of the TNM staging system, time of liver metastases appearance, ablation method, and patient age did not significantly impact OS and PFS in either patient group. The most distinct response to cTACE was observed in metastases that were treated with a triple-combination of chemotherapeutics (p = 0.021). cTACE is an effective treatment option in advanced non-resectable CRLM. Chemoembolization followed by ablation further increases survival rates. A triple combination of chemotherapeutics improves response to cTACE.
    Keywords: Colorectal Cancer (Crc) ; Colorectal Cancer Liver Metastases (Crlm) ; Conventional Transarterial Chemoembolization (Ctace) ; Percutaneous Thermal Ablation ; Microwave Ablation (MWA) ; Laser-Induced Thermotherapy (Litt) ; Medicine
    ISSN: 0720-048X
    E-ISSN: 1872-7727
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  • 7
    Language: English
    In: Journal of Clinical Ultrasound, June 2010, Vol.38(5), pp.227-231
    Description: Contrast-enhanced ultrasound can differentiate malignant from benign hepatic tumors, but has not been studied in malignant mesenchymal liver tumors. We describe the findings of contrast-enhanced ultrasound in a cohort of five patients with histological-proven malignant hepatic mesenchymal tumors. The presence of imaging features such as peripheral (nodular) enhancement, chaotic central vascularization, and absence of contrast enhancement in the late phase allowed differentiation from hemangiomas. If these findings are demonstrated in large hepatic tumors, then the diagnosis of hemangioma is unlikely and further workup is necessary.
    Keywords: Contrast‐Enhanced Ultrasound ; Malignant Mesenchymal Liver Tumors ; Angiosarcoma ; Malignant Fibrous Histiocytoma ; Hemangioma
    ISSN: 0091-2751
    E-ISSN: 1097-0096
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  • 8
    Language: English
    In: European Radiology, 2010, Vol.20(10), pp.2358-2366
    Description: Byline: Sotirios Bisdas (1), Oliver Seitz (2), Markus Middendorp (3), Nicole Chambron-Pinho (2), Theodosios Bisdas (4), Thomas J. Vogl (5), Renate Hammerstingl (5), Ulrike Ernemann (1), Martin G. Mack (5) Keywords: Magnetic resonance imaging; Functional tumour imaging; PET-CT imaging; Carcinoma; Squamous cell; Fluorodeoxyglucose F18 Abstract: Objectives: To examine the feasibility of deriving quantitative microcirculatory parameters and to investigate the relationship between vascular and metabolic characteristics of head and neck tumours in vivo, using dynamic contrast-enhanced (DCE) MRI and fluorodeoxyglucose (FDG) PET imaging. Methods: Twenty-seven patients with primary squamous cell carcinoma (SCCA) underwent DCE-MRI and combined PET/CT imaging. DCE-MRI data were post-processed by using commercially available software. Transfer constant (K .sup.trans), extravascular extracellular blood volume (v .sub.e), transfer constant from the extracellular extravascular space to plasma (k .sub.ep) and iAUC (initial area under the signal intensity--time curve) were calculated. 3D static PET data were acquired and standardised uptake values (SUV) calculated. Results: All microcirculatory parameters in tumours were higher than in normal muscle tissue (Pa$?0.0019). Significant correlations were shown between k .sub.ep and K .sup.trans ([rho]=0.77), v .sub.e and k .sub.ep ([rho]=-0.7), and iAUC and v .sub.e ([rho]=0.53). Significant correlations were observed for SUV.sub.mean and v .sub.e as well as iAUC ([rho]=0.42 and [rho]=0.66, respectively). SUV.sub.max was significantly correlated with iAUC ([rho]=0.69). Conclusions: The demonstrated relationships between vascular and metabolic characteristics of primary SCCA imply a complex interaction between vascular delivery characteristics and tumour metabolism. The lack of correlation between SUV and K .sup.trans/k .sub.ep suggests that both diagnostic techniques may provide complementary information. Author Affiliation: (1) Department of Neuroradiology, Eberhard Karls University Hospital, Hoppe Seyler Str. 3, 72076, Tubingen, Germany (2) Department of Oromaxillofacial Surgery, Johann Wolfgang Goethe University, Frankfurt, Germany (3) Department of Nuclear Medicine, Johann Wolfgang Goethe University, Frankfurt, Germany (4) Department of Cardiothoracic and Vascular Surgery, Hannover Medical School, Hannover, Germany (5) Department of Radiology, Johann Wolfgang Goethe University, Frankfurt, Germany Article History: Registration Date: 16/04/2010 Received Date: 18/11/2009 Accepted Date: 17/03/2010 Online Date: 05/05/2010
    Keywords: Magnetic resonance imaging ; Functional tumour imaging ; PET-CT imaging ; Carcinoma ; Squamous cell ; Fluorodeoxyglucose F18
    ISSN: 0938-7994
    E-ISSN: 1432-1084
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  • 9
    Language: English
    In: Molecular Imaging and Biology, April, 2013, Vol.15(2), p.148(7)
    Description: Byline: Huedayi Korkusuz (1), Karsten Ulbrich (2), Katerina Welzel (10), Verena Koeberle (3), Waralee Watcharin (2), Ute Bahr (4), Valery Chernikov (5), Thomas Knobloch (2), Sabine Petersen (10), Frank Huebner (10), Hanns Ackermann (6), Svetlana Gelperina (7), Wolfgang Kromen (10), Renate Hammerstingl (10), Joerg Haupenthal (3,9), Frank Gruenwald (1), Jens Fiehler (8), Stefan Zeuzem (3), Joerg Kreuter (2), Thomas J. Vogl (10), Albrecht Piiper (3) Keywords: Contrast agent; Nanoparticles; Gd-DTPA-human serum albumin-transferrin; Biodistribution; Human serum albumin Abstract: Purpose In this study, the contrasting properties of human serum albumin nanoparticles (HSA-NPs) loaded with gadolinium-diethylenetriamine pentaacetic acid (Gd-DTPA) and coated with transferrin in MRI in mice are evaluated. Procedures HSA-NPs were conjugated with Gd-DTPA (Gd-HSA-NPs) and coupled with transferrin (Gd-HSA-NP-Tf). Mice underwent MRI before or after injection of Gd-DTPA, Gd-HSA-NP, or Gd-HSA-NP-Tf. Results All the studied contrast agents provided a contrast enhancement (CE) in the blood, heart muscle, and liver. Compared to Gd-DTPA, CE with HSA-NP was achieved at lower Gd doses. Gd-HSA-NP-Tf yielded significantly higher CE than Gd-HSA-NP in the skeletal muscle, blood, cardiac muscle, and liver (p〈0.05). Gd-HSA-NP-Tf achieved a significantly higher CE than Gd-HSA-NP and Gd-DTPA in the blood, cardiac muscle, and liver (p〈0.05). In the brain, only Gd-HSA-NP-Tf was found to cause a significant CE (p〈0.05). Conclusions The Gd-HSA nanoparticles have potential as MRI contrast agents. In particular, Gd-HSA-NP-Tf has a potential as a specific contrast agent for the brain, while the blood--brain barrier is still intact, as well as in the heart, liver, and skeletal muscle. Author Affiliation: (1) Department of Nuclear Medicine, Johann Wolfgang Goethe University Hospital, Theodor-Stern-Kai 7, 60590, Frankfurt/Main, Germany (2) Institute of Pharmaceutical Technology, Biocenter of Johann Wolfgang Goethe University, Max-von-Laue -Str. 9, 60438, Frankfurt, Germany (3) Department of Medicine I, Johann Wolfgang Goethe University Hospital, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany (4) Institute of Pharmaceutical Chemistry, Johann Wolfgang Goethe University, Max-von-Laue-Str. 9, 60438, Frankfurt, Germany (5) Institute of Human Morphology, Russian Academy of Medical Sciences, Zurupa st. 3, 117418, Moscow, Russia (6) Department of Biomathematics, Johann Wolfgang Goethe University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany (7) Nanosystem Ltd, 7-th Kozhuhovskaya st., 20, 115193, Moscow, Russia (8) Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany (9) Helmholtz Institute for Pharmaceutical Research Saarland, Department of Drug Design and Optimization, University of Saarland, 66123, Saarbrucken, Germany (10) Department of Diagnostic and Interventional Radiology, Johann Wolfgang Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany Article History: Registration Date: 06/07/2012 Online Date: 19/07/2012 Article note: Karsten Ulbrich, Katerina Welzel, and Verena Koeberle contributed equally to this work. Joerg Kreuter, Thomas J. Vogl, and Albrecht Piiper shared senior authorship.
    ISSN: 1536-1632
    Source: Cengage Learning, Inc.
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  • 10
    Language: English
    In: Cancer imaging : the official publication of the International Cancer Imaging Society, 07 March 2012, Vol.12, pp.72-8
    Description: Genetically engineered mouse models, such as double transgenic c-myc/TGFα mice, with specific pathway abnormalities might be more successful at predicting the clinical response of hepatocellular carcinoma (HCC) treatment. But a major drawback of the tumour models is the difficulty of visualizing endogenously formed tumours. The optimal imaging procedure should be brief and minimally invasive. Magnetic resonance imaging (MRI) satisfies these criteria and gadoxetate acid-enhanced MRI improves the detection of HCC. Fat content is stated to be an additional tool to help assess tumour responses, for example, in cases of radiofrequency ablation. Therefore the aim of this study was to investigate if gadoxetate acid-enhanced MRI could be used to detect HCC in c-myc/TGFα transgenic mice by determining the relation between the signal intensity of HCC and normal liver parenchyma and the corresponding fat content as a diagnostic marker of HCC. In our study, 20 HCC in c-myc/TGFα transgenic male mice aged 20-34 weeks were analyzed. On gadoxetate acid-enhanced MRI, the signal intensity was 752.4 for liver parenchyma and 924.5 for HCC. The contrast to noise ratio was 20.4, the percentage enhancement was 267.1% for normal liver parenchyma and 353.9% for HCC. The fat content was 11.2% for liver parenchyma and 16.2% for HCC. There was a correlation between fat content and signal intensity with r = 0.7791. All parameters were statistically significant with P 〈 0.05. Our data indicate that gadoxetate acid contrast enhancement allows sensitive detection of HCC in c-myc/TGFα transgenic mice and determination of the fat content seems to be an additional useful parameter for HCC.
    Keywords: Contrast Media ; Fats ; Gadolinium Dtpa ; Carcinoma, Hepatocellular -- Diagnosis ; Liver -- Pathology ; Liver Neoplasms -- Diagnosis ; Magnetic Resonance Imaging -- Methods
    ISSN: 17405025
    E-ISSN: 1470-7330
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