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  • 1
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    German Medical Science GMS Publishing House; Düsseldorf
    In:  17. Jahrestagung der Deutschen Gesellschaft für Thoraxchirurgie; 20080911-20080913; Bremen; DOC08dgt04 /20081022/
    Publication Date: 2008-10-23
    Keywords: ddc: 610
    Language: German
    Type: conferenceObject
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  • 2
    Keywords: Germany ; LUNG ; CT ; EMPHYSEMA ; HIGH-RESOLUTION CT ; QUANTIFICATION ; VOLUME ; PATIENT ; IMPACT ; REDUCTION ; SIMULATION ; PARAMETERS ; COMPUTED-TOMOGRAPHY ; OBSTRUCTIVE PULMONARY-DISEASE ; THIN-SECTION CT ; HELICAL CT ; RE ; multidetector CT ; LUNG-VOLUME ; low dose ; MULTISLICE CT ; 3-dimensional quantitative volumetric analysis ; ALPHA-1-ANTITRYPSIN DEFICIENCY ; dose simulation ; LUNG DENSITY-MEASUREMENTS ; MACROSCOPIC MORPHOMETRY ; multidetector computed tomography ; VOLUME REDUCTION
    Abstract: Purpose: Quantitative evaluation of the lung parenchyma might be impaired or unreliable by use of reduced-dose CT protocols. Aim of the study was to define the threshold where reduced dose has significant impact on quantitative emphysema parameters. Materials and Methods: Thirty patients with severe centrilobular emphysema underwent multidetector computed tomography (120 kV, 150 mAs). Original CT raw data were simulated using 10 mAs settings (10-100 SlMmAs). Quantitative analysis provided lung volume, emphysema volume, emphysema index, mean lung density, and 4 emphysema volume classes. Simulated low-dose results were compared with original acquisition. Results: Emphysema index showed no clinical relevant variation down to 30 SlMmAs. The large emphysema volume class was significantly different below 50 SlMmAs. The intermediate and small classes showed an overproportional variation below 50 SlMmAs. Conclusions: Dose reduction down to 30 SlMmAs is possible for clinical routine. Settings below 50 SlMmAs significantly alter the indetailed 3-dimensional emphysema quantification
    Type of Publication: Journal article published
    PubMed ID: 16778622
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  • 3
    Keywords: CANCER ; tumor ; carcinoma ; Germany ; LUNG ; neoplasms ; SYSTEM ; SYSTEMS ; TUMORS ; SURGERY ; PATIENT ; kidney ; EXPERIENCE ; RADIOFREQUENCY ABLATION ; RESECTION ; FEASIBILITY ; RADIO-FREQUENCY ABLATION ; THERMAL ABLATION ; surgical resection ; CANDIDATES ; INITIAL-EXPERIENCE ; PULMONARY METASTASES
    Abstract: Background. Radiofrequency ablation (RFA) has received high interest in the treatment of primary and secondary lung neoplasms. Clinical experience continues to accumulate; however, the biologic effects after ablation remain poorly understood. This study evaluated the safety and feasibility of RFA in an open thoracotomy setting and investigated the early histopathologic changes after RFA. Methods. The study enrolled 18 subjects with multiple pulmonary metastases from a solid primary tumor. RFA was performed at an open thoracotomy setting, followed by wedge resection of the ablated tumor. Results. No intraoperative complications during the RFA procedure occurred. Immunostaining revealed a complete ablation in 7 patients (39%). The grade of ablation was greater than 90% in 9 patients (50%), and less than 90% in 2 (11%). No correlation was found between the grade of ablation and the applied energy and the diameter of the lesion. Conclusions. Intraoperative RFA in an open thoracotomy setting appears to be a safe and feasible technique. Tumor devitalization sufficient for local control was achieved in 89% in our series. Ablation was incomplete in 11%, subject to the methods used in this study. This result appears to be inferior to metastasectomy by surgical resection
    Type of Publication: Journal article published
    PubMed ID: 19161742
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  • 4
    Keywords: CANCER ; radiotherapy ; SURVIVAL ; LUNG ; LUNG-CANCER ; TIME ; PATIENT ; prognosis ; score ; RADIATION-THERAPY ; RATES ; SAFETY ; CRITERIA ; external beam radiotherapy ; Palliation ; Airway stent ; ESOPHAGEAL STENTS ; Malignant airway obstruction ; TEMPORARY ; Therapeutic bronchoscopy
    Abstract: Purpose: We retrospectively evaluated the outcome and toxicity of external beam radiotherapy (EBRT) after airway stents were placed in patients treated for malignant airway obstruction. Methods and Materials: Between 2004 and 2009, we performed airway stenting followed by EBRT in 43 patients for symptomatic primary lung cancer (n = 31) or other thoracic malignancies (n = 12). The median time interval between stent placement and first irradiation was 14 days. A median total dose of 50 Gy was delivered. Sixty-seven percent of the patients had reduced performance status (Karnofsky performance score, 〈= 70). Results: EBRT had to be stopped prematurely in 16 patients (37%), at a median total dose of 17 Gy, for various reasons. In this group of patients, the survival was poor, with a median overall survival (OS) of only 21 days. Twenty-seven patients (63%) completed radiotherapy as planned, with a median OS of 8.4 months. Fourteen of 43 patients (33%) developed at least one Common Terminology Criteria for Adverse Event of grade 3 to 5. The most common event was a malignant restenosis of the stent leading to asphyxia (n = 7), followed by fistula formation (n = 4), necrosis (n = 3), mediastinitis with abscess (n = 1), secondary nonmalignant airway stenosis (n = 1), and hemoptysis (n = 1). With the exception of one event, all events were associated with a local progression of the tumor. Conclusions: Although the long-term prognosis for patients with malignant airway obstruction is poor, airway stenting combined with EBRT offers a possible therapeutic option, achieving fast relief of acute respiratory distress with an associated antitumor effect, resulting in a potential survival benefit. However, due to local advanced tumor growth, increased rates of adverse events are to be expected, necessitating careful monitoring.
    Type of Publication: Journal article published
    PubMed ID: 22516383
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  • 5
    Keywords: ANGIOGENESIS ; CANCER ; EXPRESSION ; carcinoma ; LUNG ; DISEASE ; MORTALITY ; TISSUE ; DENDRITIC CELLS ; BREAST ; MALIGNANCIES ; CALCIUM ; GENE-EXPRESSION ANALYSIS ; PULMONARY NODULES ; non-small-cell lung cancer ; TENASCIN-C ; Bronchoscopic microsampling ; CXCL14 ; Endobronchial epithelial-lining fluid ; Solitary pulmonary nodule ; Surrogate marker
    Abstract: Introduction: Early detection of malignancies in the lung by less-invasive methods aims at achieving efficient intervention and subsequently a reduction of the high mortality rate. We investigated whether biomarker analysis in endobronchial epithelial-lining fluid (ELF) collected by bronchoscopic microsampling (BMS) may be useful for a definitive preoperative diagnosis. Methods: ELF was collected from subsegmental bronchi close to the indeterminate pulmonary nodule, which was detected by computed tomography, and from the contralateral lung. Diagnosis was confirmed by transbronchial biopsy or surgery. The study includes 142 ELF samples from 51 non-small-cell lung cancer patients and 20 benign cases. Microarray analysis was done with a patient subset (n = 15) to narrow down genes associated with a malignant phenotype. Thirteen potential biomarkers have been further analyzed by quantitative real-time polymerases chain reaction in an independent patient cohort (n = 56). Results: All patients underwent BMS without complications. Gene-expression analyses by microarrays and quantitative real-time polymerases chain reaction could be reliably applied to ELF samples, and resulted in potential biomarkers for malignant pulmonary nodules. Four genes (tenascin-C, [C-X-C motif] ligand 14, S100 calcium binding protein A9, and keratin 17) were found to be upregulated in ELF of non-small-cell lung cancer patients with adenocarcinoma or squamous cell carcinoma. Combined analysis of tenascin-C expression and the nodule size improved the prediction of malignancy in this patient cohort. Conclusions: Our study suggests that the analysis of specific biomarkers in ELF collected by BMS could be a potentially useful adjunct to other diagnostic techniques aiming at the preoperative diagnosis of malignant pulmonary nodules
    Type of Publication: Journal article published
    PubMed ID: 22588153
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  • 6
    Keywords: CT ; DIAGNOSIS ; EMPHYSEMA ; MRI ; COMPUTED-TOMOGRAPHY ; MANAGEMENT ; COLLAPSE ; COPD ; TRACHEOBRONCHOMALACIA
    Abstract: BACKGROUND: Advanced-stage chronic obstructive pulmonary disease (COPD) is associated with severely altered respiratory dynamics. Dynamic airway instability is usually diagnosed by invasive bronchoscopy. Cine-computed tomography (CT) may be used alternatively, but is limited to predefined anatomical positions. Also, a paradoxical diaphragmatic motion has been described in patients with emphysema. OBJECTIVES: As the airways and chest wall show inherently high contrast to airway lumen and lung tissue, low-dose CT acquisitions potentially suffice for depicting tracheobronchial and chest wall motion. Therefore, we propose low-dose dynamic respiratory-gated multidetector CT (4D-CT) of the whole chest as a new method to assess respiratory dynamics. METHODS: 4D-CT was performed in 3 patients (52, 62 and 76 years old) with suspected tracheal instability due to COPD or tracheal stenosis at minimal pitch (0.09) and radiation exposure (1.4-1.9 mSv) during regular tidal breathing registered by a belt system. Image reconstruction involved a raw data-based iterative algorithm (1.5-mm slice thickness, 1.0-mm z-axis increment, 5% respiratory increment), resulting in a stack of 6,700 images, which were evaluated with a 4D-viewing tool. Results: An excessive dynamic collapse of the trachea in combination with tracheobronchomalacia (TBM) of the main-stem and segmental bronchi, and a paradoxical diaphragmatic motion were demonstrated in 1 case. Moreover, we detected a saber-sheath trachea and main-stem TBM in another case. The third case showed a fixed tracheal stenosis. CONCLUSIONS: 4D-CT provides unprecedented z-axis coverage and time-resolved volumetric datasets of the whole chest. Airway instability, stenosis and paradoxical diaphragmatic motion may be assessed simultaneously, preceding interventions such as airway stabilization or lung volume reduction.
    Type of Publication: Journal article published
    PubMed ID: 24557362
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  • 7
    Keywords: QUANTIFICATION ; COMPUTED-TOMOGRAPHY ; OBSTRUCTIVE PULMONARY-DISEASE ; SMOKERS ; multidetector CT ; SEX-DIFFERENCES ; SHORT-TERM ; COPD ; VOLUME-REDUCTION SURGERY ; AIR-FLOW OBSTRUCTION
    Abstract: Purpose: The change of emphysema distribution with increasing COPD severity is not yet assessed. Especially, involvement of the upper aspect of the lower lobe is unknown. The primary aim was to quantitatively determine regional distribution of emphysema in anatomically (lung lobes) and non-anatomically defined lung regions (upper/lower lung halves as well as core and rind regions) in a cohort covering equally all COPD severity stages using CT. Material and Methods: Basically 100 CT data sets were quantitatively evaluated for regional distribution of emphysema. Emphysema characteristics (emphysema index, mean lung density and 15th percentile of the attenuation values of lung voxels) were compared (t-test) in: upper lobes vs. upper halves, lower lobes vs. lower halves, core vs. rind region. Results: In patients with 〈= GOLD II, a significantly higher emphysema burden was found in the upper lobes as compared to upper halves. In subjects with GOLD III/IV the differences were not significant for all emphysema characteristics. A high difference between lobes and halves in subjects with 〈= GOLD II was found, in contrast to low difference in higher GOLD stages. Conclusions: Lobar segmentation provides improved characterization of cranio-caudal emphysema distribution compared to a non-anatomic approach in subjects up to GOLD stage II.
    Type of Publication: Journal article published
    PubMed ID: 25230093
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  • 8
    Keywords: DISEASE ; SURGERY ; SCINTIGRAPHY ; FUNCTION TESTS ; ARTERY ; HYPERTENSION ; COPD ; QUANTITATIVE COMPUTED-TOMOGRAPHY ; LUNG-VOLUME-REDUCTION ; CT EVALUATION
    Abstract: PURPOSE: Distinct morphological emphysema phenotypes were assessed by CT to show characteristic perfusion defect patterns. MATERIAL/METHODS: Forty-one patients with severe emphysema (GOLD III/IV) underwent three-dimensional high resolution computed tomography (3D-HRCT) and contrast-enhanced magnetic resonance (MR) perfusion. 3D-HRCT data was visually analyzed for emphysema phenotyping and quantification by consensus of three experts in chest-radiology. The predominant phenotype per segment was categorized as normal, centrilobular, panlobular or paraseptal. Segmental lung perfusion was visually analyzed using six patterns of pulmonary perfusion (1-normal; 2-mild homogeneous reduction in perfusion; 3-heterogeneous perfusion without focal defects; 4-heterogeneous perfusion with focal defects; 5-heterogeneous absence of perfusion; 6-homogeneous absence of perfusion), with the extent of the defect given as a percentage. RESULTS: 730 segments were evaluated. CT categorized 566 (78%) as centrilobular, 159 (22%) as panlobular and 5 (〈1%) as paraseptal with no normals. Scores with regards to MR perfusion patterns were: 1-0; 2-0; 3-28 (4%); 4-425 (58%); 5-169 (23%); 6-108 (15%). The predominant perfusion pattern matched as follows: 70 % centrilobular emphysema - heterogeneous perfusion with focal defects (score 4); 42% panlobular--homogeneous absence of perfusion (score 5); and 43% panlobular--heterogeneous absence of perfusion (score 6). CONCLUSION: MR pulmonary perfusion patterns correlate with the CT phenotype at a segmental level in patients with severe emphysema. KEY POINTS: * MR perfusion patterns correlate with the CT phenotype in emphysema. * Reduction of MR perfusion is associated with loss of lung parenchyma on CT * Centrilobular emphysema shows heterogeneous perfusion reduction while panlobular emphysema shows loss of perfusion.
    Type of Publication: Journal article published
    PubMed ID: 25163898
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  • 9
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    Radiologe 46 (4), 251-254 
    Keywords: brain ; CANCER ; carcinoma ; Germany ; LUNG ; CT ; imaging ; lung cancer ; LUNG-CANCER ; SYSTEM ; EXPOSURE ; RISK ; TUMORS ; RESOLUTION ; radiation ; CONTRAST ; MRI ; SEQUENCE ; SEQUENCES ; MAGNETIC-RESONANCE ; magnetic resonance imaging ; metastases ; POSITRON-EMISSION-TOMOGRAPHY ; SCINTIGRAPHY ; COMPUTED-TOMOGRAPHY ; sensitivity ; specificity ; magnetic resonance imaging (MRI) ; contrast media ; staging ; INFILTRATION ; technique ; functional imaging ; lymph node ; LYMPH-NODE ; PULMONARY NODULES ; RADIATION EXPOSURE ; abdomen ; BONE METASTASES ; PET/CT ; WHOLE-BODY MRI
    Abstract: Purpose. Overview of magnetic resonance imaging (MRI) in staging of lung cancer. Material and methods. Currently available methods of imaging lung cancer, lymph node and distant metastases by MRI are explained. At present, MRI is mainly used in the detection of cerebral metastases and assessment of infiltration of the thoracic wall and of the mediastinum. The capabilities of T2-weighted single-shot TSE (HASTE) and T1-weighted 3D gradient echo techniques (VIBE) are demonstrated. Results. With the advent of new fast sequences like HASTE and VIBE the spatial resolution comes close to that of computed tomography but with an outstanding soft sue contrast and without radiation exposure. The introduction of lymph node specific contrast media will improve sensitivity and specificity in N staging. Additionally, whole-body MRI is capable of detecting distant metastases, in particular in the organs at risk, i.e. brain, upper abdomen and musculoskeletal system. Conclusion. MRI is gaining importance as part of a multimodal imaging approach for staging of lung cancer
    Type of Publication: Journal article published
    PubMed ID: 16440188
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  • 10
    Keywords: 3D-HRCT, ABNORMALITIES, CANDIDATES, chest, CLUSTER, CLUSTERS, CT, DISEASE, EMPHYSEMA, FUNCTION TESTS
    Abstract: Purpose: To assess the relationship between lung parenchymal destruction and impaired pulmonary perfusion on a lobar level using CT and MRI in patients with emphysema. Material and methods: Forty-five patients with severe emphysema (GOLD III and IV) underwent inspiratory 3D-HRCT and contrast-enhanced MR-perfusion (1.5T; 3.5 mm x 1.9 mm x 4 mm). 3D-HRCT data was analyzed using a software for detection and visualization of emphysema. Emphysema was categorized in four clusters with different volumes and presented as overlay on the CT. CT and lung perfusion were visually analyzed for three lobes on each side using a four-point-score to grade the abnormalities on CT (1: predominantly small emphysema-clusters to 4: 〉75% large emphysema-clusters) and MRI (1: normal perfusion to 4: no perfusion). Results: A total of 270 lobes were evaluated. At CT, the score was 1 for 9 lobes, 2 for 43, 3 for 77, and 4 for 141 lobes. At MRI, the score was 1 for 13 lobes, 2 for 45, 3 for 92, and 4 for 120 lobes. Matching of lung parenchymal destruction and reduced perfusion was found in 213 lobes (weighted kappa = 0.8). The score was higher on CT in 44, and higher on MRI in 13 lobes. Conclusion: 3D-HRCT and 3D MR-perfusion show a high lobar agreement between parenchymal destruction and reduction of perfusion in patients with severe emphysema. (c) 2007 Elsevier Ireland Ltd. All rights reserved
    Type of Publication: Journal article published
    PubMed ID: 17320333
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