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  • 1
    Language: English
    In: Radiology, May 2010, Vol.255(2), pp.451-8
    Description: To test the null hypothesis that there is no quantitative or qualitative difference between respiratory-triggered three-dimensional (3D) T2-weighted magnetic resonance (MR) cholangiography performed before or after administration of gadoxetate disodium. For this retrospective HIPAA-compliant dual-center study, institutional review board approval was obtained, and a waiver of informed consent was granted. Between July and December 2008, 60 patients (age range, 18-82 years) who were referred for liver MR imaging with gadoxetate disodium underwent respiratory-triggered 3D MR cholangiography before and immediately after completion of portal venous phase contrast material-enhanced T1-weighted MR imaging. Quantitative signal-to-noise ratio (SNR) measurements were obtained in the extrahepatic biliary tract in both MR cholangiographic data sets in each patient. Qualitative assessment was performed by four readers with a four-point scale to assess the depiction of extra- and intrahepatic ducts up to the third order. Statistical analysis consisted of a one-sided Wilcoxon signed rank test, with a P value of less than .05 indicating a significant difference. There was a significant decrease in mean SNR in the MR cholangiographic data set after injection of gadoxetate disodium. SNR was 96 + or - 50 [standard deviation] and 78 + or - 47 before and after contrast media administration, respectively (P 〈 .0001). For all readers, qualitative differences were most obvious in the depiction of the common bile duct and second- and third-order biliary branches, with the precontrast MR cholangiographic data sets being preferred (P 〈 .0001). Precontrast data sets were also significantly preferred in the assessment of the right and left hepatic ducts by all readers. Gadoxetate disodium adversely affects respiratory-triggered 3D MR cholangiography, both qualitatively and quantitatively. We recommend that such a sequence be performed before injection of gadoxetate disodium.
    Keywords: Cholangiopancreatography, Magnetic Resonance -- Methods ; Contrast Media -- Administration & Dosage ; Gadolinium Dtpa -- Administration & Dosage ; Liver Diseases -- Diagnosis
    ISSN: 00338419
    E-ISSN: 1527-1315
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  • 2
    Language: English
    In: PLoS ONE, 01 January 2015, Vol.10(7), p.e0134301
    Description: To demonstrate and quantify the heat sink effect in hepatic microwave ablation (MWA) in a standardized ex vivo model, and to analyze the influence of vessel distance and blood flow on lesion volume and shape.108 ex vivo MWA procedures were performed in freshly harvested pig livers. Antennas were inserted parallel to non-perfused and perfused (700,1400 ml/min) glass tubes (diameter 5mm) at different distances (10, 15, 20mm). Ablation zones (radius, area) were analyzed and compared (Kruskal-Wallis Test, Dunn's multiple comparison Test). Temperature changes adjacent to the tubes were measured throughout the ablation cycle.Maximum temperature decreased significantly with increasing flow and distance (p〈0.05). Compared to non-perfused tubes, ablation zones were significantly deformed by perfused tubes within 15 mm distance to the antenna (p〈0.05). At a flow rate of 700 ml/min ablation zone radius was reduced to 37.2% and 80.1% at 10 and 15 mm tube distance, respectively; ablation zone area was reduced to 50.5% and 89.7%, respectively.Significant changes of ablation zones were demonstrated in a pig liver model. Considerable heat sink effect was observed within a diameter of 15 mm around simulated vessels, dependent on flow rate. This has to be taken into account when ablating liver lesions close to vessels.
    Keywords: Sciences (General)
    E-ISSN: 1932-6203
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  • 3
    Language: English
    In: PLoS ONE, 01 January 2018, Vol.13(7), p.e0200887
    Description: PURPOSE:To evaluate transient severe respiratory motion artifacts (TSM) at gadoxetate disodium-enhanced MRI dependent on the mode of contrast agent application. METHODS:200 patients (71f, 129m; mean 51y) were included in this retrospective IRB-approved study. Contrast application protocols (n = 4) differed with regards to injection rate (2ml or 1ml/sec), dose (weight-based or fixed 10ml) and supplemental oxygen administration (yes/no). SNR measurements were performed in the aorta and portal vein. Qualitatively, three readers assessed arterial phase image quality and TSM independently (4- and 5-point scale, respectively). Quantitative and qualitative results were compared (Kruskal-Wallis test, Dunn's multiple comparison test). The influence of different contrast agent application parameters on the occurrence of respiratory motion artifacts was assessed (univariate analysis). Interrater agreement and reliability were calculated (intraclass correlation coefficient, ICC)). RESULTS:Use of a lower contrast injection rate resulted in significantly higher arterial SNR in the aorta and portal vein (p〈0.05). TSM was observed in 12% of examinations. Neither injection rate, contrast dose, nor oxygen had a significant influence. Interrater agreement and reliability for evaluation of image quality and respiratory motion were substantial/ almost perfect (ICC = 0.640-0.915). CONCLUSIONS:Technical factors regarding the specific mode of contrast application do not seem to significantly reduce the incidence of severe transient respiratory motion artifacts.
    Keywords: Sciences (General)
    E-ISSN: 1932-6203
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  • 4
    Language: English
    In: Best Practice & Research Clinical Gastroenterology, April 2015, Vol.29(2), pp.253-265
    Description: The purpose of radiological imaging in patients with suspected or known cholangiocarcinoma (CCA) is tumour detection, lesion characterization and assessment of resectability. Different imaging modalities are implemented complementary in the diagnostic work-up. Non-invasive imaging should be performed prior to invasive biliary procedures in order to avoid false positive results. For assessment of intraparenchymal tumour extension and evaluation of biliary and vascular invasion, MRI including MRCP and CT are the primarily used imaging modalities. The role of PET remains controversial with few studies showing benefit with the detection of unexpected metastatic spread, the differentiation between benign and malignant biliary strictures, and for discriminating post therapeutic changes and recurrent CCA.
    Keywords: Cholangiocarcinoma ; Computed Tomography ; Magnetic Resonance Imaging ; Positron Emission Tomography ; Medicine
    ISSN: 1521-6918
    E-ISSN: 1532-1916
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  • 5
    Language: English
    In: European Journal of Radiology, 2011, Vol.79(2), pp.201-205
    Description: The purpose of this study was to determine transit times for excretion of Gd-EOB-DTPA into different segments of the hepatobiliary system in patients with normal liver function. This retrospective study was IRB approved with a waiver of consent granted. 61 patients (39 female, 22 male, mean age 52.5 years) with normal liver and renal function who underwent contrast enhanced hepatic MRI after injection of 10 mLGd-EOB-DTPA at 1.5 T and 3 T were included. Two readers evaluated all delayed images (3–20 min post contrast) for the presence of contrast agent in the intrahepatic bile ducts (IBD), the common bile duct (CBD), the gallbladder and the duodenum. A two-tailed, unpaired Student's -test with 〈 0.05 deemed significant was used to determine whether transit times were affected by patient gender, age or body mass index. 20 min after contrast initiation, Gd-EOB-DTPA could be detected in the IBD and the CBD in all patients (100%); gallbladder reflux was visible in 53 (86.9%), duodenal excretion in 40 patients (65.5%), respectively. Mean transit times for contrast appearance in the various segments were as follows: IBD 12 min 13 s; CBD 12 min 27 s; gallbladder 13 min 32 s. Transit times were not significantly affected by patient gender, age or BMI. Within 20 min post contrast initiation, Gd-EOB-DTPA can be expected in the IBD and the CBD in patients with normal liver function. However, functional information about the sphincter Oddi complex can be ascertained only in about two thirds of these patients within this timeframe.
    Keywords: Gd-Eob-Dtpa ; Mri ; Hepatobiliary Imaging ; Transit Time ; Medicine
    ISSN: 0720-048X
    E-ISSN: 1872-7727
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  • 6
    Language: English
    In: European Radiology, 2012, Vol.22(1), pp.259-268
    Description: Byline: Daniele Marin (1), Brian M. Dale (3), Mustafa R. Bashir (1), Timothy J. Ziemlewicz (1), Kristina I. Ringe (2), Daniel T. Boll (1), Elmar M. Merkle (1) Keywords: Adrenal glands; Adrenal gland neoplasms; Adrenocortical adenoma; Magnetic resonance imaging; Diagnosis; Differential Abstract: Objective To compare the sensitivity, specificity, and diagnostic accuracy of fat-only datasets reconstructed using a two-point Dixon technique, with corresponding opposed-phase (OP) and in-phase (IP) datasets for characterization of adrenal lesions at 3 Tesla (T). Methods Fifty-nine patients (21 male, 38 female) with 66 adrenal lesions (49 adenomas, 17 nonadenomas) underwent 3D dual gradient-echo 3-T adrenal MR imaging with reconstruction of OP/IP and fat/water datasets. Sensitivity, specificity, and diagnostic accuracy were compared between OP/IP datasets, using the signal intensity index (SII), and fat/water datasets, using the fat fraction and fat ratio. Four radiologists qualitatively assessed OP/IP and fat-only datasets for reader confidence in lesion characterization and image quality. Results There were significant differences between adenomas and nonadenomas with regard to mean SII, fat fraction, and fat ratio (P〈0.001). There was no significant difference in mean diagnostic accuracy among different evaluation methods using OP/IP and fat/water datasets. Mean readers' scores for lesion characterization were significantly higher for adenomas than for nonadenomas using OP/IP and fat-only datasets. There was no significant difference between the two datasets regarding mean readers' scores for image quality. Conclusion Fat-only images can readily differentiate adrenal adenomas from nonadenomas, with diagnostic accuracy comparable to OP/IP images. Key Points aC/ Incidental adrenal lesions are commonly encountered in radiology practice aC/ MR has been used to identify lesions giving cause for concern. aC/ 3T MR provides excellent demonstration of the effects of fat within structures aC/ Fat-only 3T MR images can readily differentiate adrenal adenomas from nonadenomas Author Affiliation: (1) Department of Radiology, Duke University Medical Center, Duke North--Room 1417, Erwin Road, Durham, NC, 27710, USA (2) Department of Radiology, Hannover Medical School, Carl-Neuberg Strasse 1, 30625, Hannover, Germany (3) Siemens Medical Solutions, Cary, NC, 27560-7127, USA Article History: Registration Date: 09/08/2011 Received Date: 27/05/2011 Accepted Date: 05/08/2011 Online Date: 28/08/2011
    Keywords: Adrenal glands ; Adrenal gland neoplasms ; Adrenocortical adenoma ; Magnetic resonance imaging ; Diagnosis ; Differential
    ISSN: 0938-7994
    E-ISSN: 1432-1084
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  • 7
    Language: English
    In: Journal of Surgical Case Reports, 2015
    Description: Sebahattin Celik, Kristina I. Ringe, Cristian E. Boru, Victor Constantinica, Huseyin Bektas
    Keywords: Pancreatic Cancer – Risk Factors ; Pancreatic Cancer – Care and Treatment ; Pancreaticoduodenectomy – Usage ; Treatment Outcome – Analysis
    ISSN: 2042-8812
    Source: Cengage Learning, Inc.
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  • 8
    Language: English
    In: Journal of Surgical Case Reports, Dec, 2015
    Description: Sebahattin Celik, Kristina I. Ringe, Cristian E. Boru, Victor Constantinica, Huseyin Bektas
    Keywords: Pancreatic Cancer -- Risk Factors ; Pancreatic Cancer -- Care And Treatment ; Pancreaticoduodenectomy -- Usage ; Treatment Outcome -- Analysis
    ISSN: 2042-8812
    Source: Cengage Learning, Inc.
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  • 9
    Language: English
    In: European Journal of Radiology, February 2015, Vol.84(2), pp.215-220
    Description: To assess the value of oral effervescent powder (EP) for evaluation of esophageal distension, and for detection and staging of esophageal cancer with contrast-enhanced CT. 84 patients without esophageal pathology and 52 patients with histological confirmed diagnosis of esophageal cancer were included in this prospective IRB-approved study. Half of the patients in both groups received EP prior to CT. Esophageal distension was assessed by planimetry of the inner (IA) and outer area (OA). Two blinded readers evaluated the datasets separately with regard to diagnosis of esophageal cancer (yes/no) and staging (T0-T4), if applicable. Distension results were compared ( -Test). In patients with cancer sensitivity, specificity, NPV and PPV were calculated. CT staging results were compared to histopathology (Cohen-k). IA and IA/OA were significantly larger after EP as compared to the group without EP ( 〈 0.05). Sensitivity, specificity, NPV and PPV for cancer detection cancer were as follows: 78%/78%, 98%/98%, 95%/95%, 87%/87% with EP; 60%/68%, 98%/98%, 94%/94%, 80%/83% without EP. Staging with EP was good ( = 0.84/0.67) and moderate without EP ( = 0.58/0.59). Administration of EP prior to CT results in good distension of the esophagus, and improves detection and staging of esophageal cancer, as compared to control studies without EP.
    Keywords: Esophagus ; Esophageal Cancer ; Effervescent Powder ; Medicine
    ISSN: 0720-048X
    E-ISSN: 1872-7727
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  • 10
    Language: English
    In: International Journal of Surgery Case Reports, 2015, Vol.10, pp.107-110
    Description: Portal vein (PV) disorders are various, but rare. Here, we report a preduodenal superior mesenteric vein (PDSMV) in a patient who underwent a pancreaticoduodenectomy. A 67-year old woman with familial adenomatosis polyposis was suspicious for cancer of the papilla of vater and scheduled for surgery. Pre-operative diagnostic revealed a PDSMV continuing into the left PV. The splenic vein (SV) continued directly into the right PV without forming ananatomic PV confluence. Eight centimetre of the PDSMV were resected during the pancreaticoduodenectomy and reconnected using a polytetrafluoroethylene prosthesis. On day 1, early graft thrombosis was treated by thrombectomy and change to a larger graft. Pathology confirmed a R0-resection of the adenocarcinoma of the papilla of vater (pTis pN0,G2). At three-month follow-up, the patient was cancer-free and clinically asymptomatic, although, a late graft thrombosis with accompanying newly build venous collaterals passing mesenteric blood to the SV were found. Rare PV disorders like a PDSMV do not contradict pancreatic surgery, but should be treated in experienced centres. Skills of SMV/PV reconstruction and its peri-operative management might be beneficial for successful outcome. Despite late graft thrombosis no clinical disadvantage occurred most likely due to preservation of the SV and of potential venous collateral pathways. Extended surgical procedures like a pancreaticoduodenectomy are realisable in patients with PV disorders, but require awareness, adequate radiological interpretation and specific surgical experience for secure treatment.
    Keywords: Portal Vein Disorder ; Preduodenal Superior Mesenteric Vein ; Pancreaticoduodenectomy ; Portal Vein Reconstruction ; Portal Vein Thrombosis ; Prosthetic Graft Thrombosis
    ISSN: 2210-2612
    E-ISSN: 2210-2612
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