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  • PATIENT  (15)
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  • 1
    Keywords: Diagnostic Imaging ; radiology ; MULTISLICE CT ; imaging ; CT ; CT ANGIOGRAPHY ; ANGIOGRAPHY ; arteries
    Type of Publication: Book chapter
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  • 2
    Keywords: Germany ; THERAPY ; CLASSIFICATION ; RISK ; PATIENT ; treatment ; LESIONS ; EXPERIENCE ; REPAIR ; HIGH-RISK ; SELECTION ; RECONSTRUCTION ; MANAGEMENT ; SURGICAL-TREATMENT ; ABDOMINAL AORTIC-ANEURYSM ; aneurysm ; ARTERY ANEURYSMS ; endograft ; endovascular ; ENDOVASCULAR TREATMENT ; GRAFTS ; iliac artery ; MIDTERM EXPERIENCE
    Abstract: Isolated iliac aneurysms (IIA) are uncommon lesions that require surgical repair to prevent rupture. The aim of this article is to give an update on the current surgical management of IIA. This report also evaluates the application of endovascular repair in IIA, based on a recent Pubmed search and on our own experience in the interventional field: Open reconstruction achieves good longterm results and still represents the golden standard in surgical treatment of IIA. Transluminally placed endovascular stent grafts can be successfully used to exclude isolated iliac aneurysms in selected high risk patients with suitable anatomy. A classification based on aneurysm morphology is useful for patient selection. The value of endovascular therapy has yet to be determined
    Type of Publication: Journal article published
    PubMed ID: 16485205
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  • 3
    Keywords: Germany ; THERAPY ; FOLLOW-UP ; SYSTEM ; SYSTEMS ; MORTALITY ; RISK ; computed tomography ; SURGERY ; PATIENT ; treatment ; DESIGN ; AGE ; REPAIR ; RATES ; tomography ; COMPUTED-TOMOGRAPHY ; COMPLICATIONS ; DISSECTION ; STROKE ; THORACIC AORTA ; THROMBOSIS ; methods ; Male ; VARIABLES ; endovascular ; GRAFTS ; ANEURYSM REPAIR ; DISSECTIONS ; PHANTOMS ; PULSATILE FLOW ; SINGLE-CENTER ; STENT-GRAFT PLACEMENT ; TRUE-LUMEN COLLAPSE
    Abstract: Objective: To outline the complications after endovascular repair in patients with acute symptomatic and chronic expanding Stanford type B aortic dissections. Methods: Between 1997 and 2004, of 125 patients with acute and chronic aortic type B dissections, 88 were treated conservatively. Thirty-seven patients ( 29 male, mean age 58 years, range 30-82 years) underwent endovascular repair (30%) using 44 stent grafts of 3 different designs: Excluder ( W. L. Gore & Associates, Inc, Flagstaff, Ariz), Talent ( Medtronic Vascular, Santa Rosa, Calif), and Endofit (Endomed, Inc, Phoenix, Ariz). Indications for treatment were acute symptomatic type B dissection in 15 patients, chronic expanding aortic dissection greater than 55 mm in 14, rupture in 3, and simultaneous type A repair in 5 patients. Twenty-two operations were performed on an emergency basis. Patient characteristics, procedural variables, outcome, and complications were prospectively recorded. All patients underwent follow-up by computed tomography before discharge, at 6 and 12 months, and annually thereafter ( mean follow-up: 24 months). Results: Correct deployment was achieved in 97% of cases. There were no instances of primary conversion, paraplegia, or stroke. Complete false lumen thrombosis was observed in 11 patients (44%). Perioperative complication rate was 22%. Thirty-day mortality rate in acute and chronic dissections was 19% and 0%, respectively. Freedom from aortic reintervention was 81%, 73%, and 68%, freedom from late rupture was 97%, 90%, and 80%, and overall success rate was 76%, 65%, and 57% at 1, 2, and 5 years, respectively. Results for patients with chronic dissections are significantly ( P =.038) better than results in those with acute dissections. Conclusions: Despite the minimally invasive approach, the complication and mortality rates for endovascular therapy of aortic dissections are still high. Frank reporting of these sequelae is if great importance to clarify the recent limitations of the method
    Type of Publication: Journal article published
    PubMed ID: 16872963
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  • 4
    Keywords: Germany ; THERAPY ; chest ; CT ; imaging ; segmentation ; TOOL ; VOLUME ; NEW-YORK ; NUCLEAR-MEDICINE ; TIME ; PATIENT ; QUALITY ; CARE ; REPRODUCIBILITY ; metastases ; MELANOMA ; VARIABILITY ; MALIGNANT-MELANOMA ; malignant melanoma ; nuclear medicine ; FEASIBILITY ; radiology ; ONCOLOGY ; RE ; THERAPIES ; monitoring ; SOFTWARE ; SOLID TUMORS ; analysis ; methods ; NUCLEAR ; CRITERIA ; USA ; lymph node metastases ; lymph nodes ; CANCER-TREATMENT ; MULTISLICE CT ; SMALL PULMONARY NODULES ; therapy monitoring ; postprocessing ; MEDICINE ; VALUES ; INTEROBSERVER ; RECIST ; RECIST CRITERIA ; RESPONSE ASSESSMENT ; volumetric analysis
    Abstract: Therapy monitoring in oncological patient care requires accurate and reliable imaging and post-processing methods. RECIST criteria are the current standard, with inherent disadvantages. The aim of this study was to investigate the feasibility of semi-automated volumetric analysis of lymph node metastases in patients with malignant melanoma compared to manual volumetric analysis and RECIST. Multislice CT was performed in 47 patients, covering the chest, abdomen and pelvis. In total, 227 suspicious, enlarged lymph nodes were evaluated retrospectively by two radiologists regarding diameters (RECIST), manually measured volume by placement of ROIs and semi-automated volumetric analysis. Volume (ml), quality of segmentation (++/-) and time effort (s) were evaluated in the study. The semi-automated volumetric analysis software tool was rated acceptable to excellent in 81% of all cases (reader 1) and 79% (reader 2). Median time for the entire segmentation process and necessary corrections was shorter with the semi-automated software than by manual segmentation. Bland-Altman plots showed a significantly lower interobserver variability for semi-automated volumetric than for RECIST measurements. The study demonstrated feasibility of volumetric analysis of lymph node metastases. The software allows a fast and robust segmentation in up to 80% of all cases. Ease of use and time needed are acceptable for application in the clinical routine. Variability and interuser bias were reduced to about one third of the values found for RECIST measurements
    Type of Publication: Journal article published
    PubMed ID: 18274757
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  • 5
    Keywords: CANCER ; INVASION ; tumor ; carcinoma ; evaluation ; Germany ; CT ; DIAGNOSIS ; FOLLOW-UP ; SPIRAL CT ; TOOL ; DISEASE ; TUMORS ; computed tomography ; RESOLUTION ; PATIENT ; primary ; NO ; METASTASIS ; adenocarcinoma ; COMPUTED-TOMOGRAPHY ; sensitivity ; specificity ; VESSELS ; QUESTIONNAIRE ; pancreatic carcinoma ; HELICAL CT ; HYDRO-CT ; methods ; ROW CT ; CURVED PLANAR REFORMATIONS ; invasion score ; MULTISLICE SPIRAL CT ; resectability ; VASCULAR INVASION
    Abstract: Objective: It was the aim of this study to evaluate a new infiltration score to determine the resectability of pancreatic carcinomas in preoperative planning. Materials and Methods: Eighty patients with suspected pancreatic tumor were examined prospectively using 16-row spiral CT. The scans were evaluated for the presence of pancreatic carcinoma, peripancreatic tumor extension and vascular invasion using a standardized questionnaire. Invasion of the surgically relevant vessels was evaluated using a new invasion score. The operative and histological findings and the clinical follow-up served as the gold standard. Results: Forty patients had a pancreatic carcinoma, 5 had metastasis of a different primary tumor, and in 35 patients, there was no malignant pancreatic disease. The sensitivity for tumor detection was 100%, with a specificity of 88% for differentiating between malignant and benign pancreatic tumors. Invasion of the surrounding vessels was evaluated correctly using the invasion score, with a sensitivity of 89% and a specificity of 99%. In evaluation of resectability, a sensitivity of 94% and a specificity of 89% were achieved. Conclusion: Using 16-row spiral CT, the invasion score is a valid tool for correctly assessing invasion in relevant vessels in cases of pancreatic carcinoma and for determining resectability. Copyright (C) 2008 S. Karger AG, Basel and IAP
    Type of Publication: Journal article published
    PubMed ID: 18434758
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  • 6
    Keywords: computed tomography ; ANGIOGRAPHY ; ABDOMINAL-AORTA ; Aorta ; Aortic pathologies ; COMPUTED-TOMOGRAPHY AN
    Abstract: Current imaging of the aorta saw an improvement in terms of diversity and quality in recent years. In addition to verifying and documenting a clinical suspicion, it provides the basis for establishing an indication, choosing a therapy (conservative, surgical, interventional), as well as therapy planning and follow-up. Besides B-mode and duplex sonography, as well as transesophageal echocardiography (TEE), contrast-enhanced cross-sectional imaging, computer tomography (CT), with the option for CT angiography (CTA), and magnetic resonance tomography (MRT), with the option for MR angiography (MRA), play a significant role. The present article describes the possibilities offered by CTA and MRA for the diagnosis of aortic pathologies from the point of view of the radiologist in a maximum care hospital
    Type of Publication: Journal article published
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  • 7
    Keywords: Germany ; FOLLOW-UP ; PATIENT ; INFECTION ; EXPERIENCE ; REPAIR ; tomography ; COMPUTED-TOMOGRAPHY ; COMPLICATIONS ; conversion ; PLACEMENT ; AORTIC-ANEURYSMS ; complication ; endovascular repair ; FISTULAS ; GRAFT INFECTION ; material fatigue ; pseudoaneurysm ; stent-graft ; STENT-GRAFTS ; thoracic aortic aneurysm ; wire fracture
    Abstract: Purpose: To report complications from a thoracic endograft wire fracture and early experience with elective conversion after thoracic endografting. Case Report: A 43-year-old man underwent urgent endovascular repair of a symptomatic post-traumatic thoracic aneurysm in 1999. The patient had been involved in a car accident 14 years before. He developed clinical and radiological signs of graft infection 46 months after stent-graft implantation. Multidetector computed tomography confirmed a fracture of the longitudinal support wire in the Excluder thoracic stent-graft. Additionally, radiological signs of suspected endograft infection were described. Due to concerns over a potential chronic infection, the stent-graft was successfully excised, and a polyester graft was implanted 50 months after primary endovascular repair. Conclusions: Recognition or strong suspicion of endograft infection requires conversion with removal of the device. Long-term follow-up after endografting is necessary to assess material fatigue that undermines the durability of these implants
    Type of Publication: Journal article published
    PubMed ID: 15683278
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  • 8
    Keywords: Germany ; chest ; CT ; SYSTEM ; TOOL ; DEATH ; DISEASE ; MORTALITY ; RISK ; SURGERY ; PATIENT ; INJURIES ; MECHANISM ; IMPACT ; CONTRAST ; mechanisms ; treatment ; EXPERIENCE ; DISRUPTION ; REPAIR ; REGION ; ANGIOGRAPHY ; MANAGEMENT ; THORACIC AORTA ; HEIGHT ; wound ; STABILIZATION ; endovascular ; Cause of Death ; BLUNT ; DELAYED TREATMENT ; intracranial ; RUPTURE
    Abstract: Acute traumatic aortic tear (ATAT) is the second most common cause of deaths in trauma patients (about 8,000 deaths/year in the USA). Due to circumferential aortic disruption, up to 90% die at the scene. Responsible trauma mechanisms are: penetrating (gunshot/stab wounds), iatrogenic (interventional catheterization) and, most frequently, blunt chest trauma (high-speed motor vehicles, falls from heights, crushes, explosions) resulting in injury at the aortic isthmus region (loco typico, about 90%). Severe multiple system injuries (polytrauma), especially to intracranial and intraabdominal organs, are characteristic and prognostically predicitive. Immediate transthoracic open repair of ATAT has a mortality risk of 8% to 33% and paraplegia risk of 2% to 26%. Contrast enhanced CT scan has replaced the classical angiography as the diagnostic tool of choice. Patients with life-threatening multisystem injuries are scheduled for delayed repair after initial stabilization. Currently, the use of endovascular stent-grafts (EVAR) is being investigated. Our personal series confirms that EVAR for ATAT is a viable alternative to open repair while minimizing the morbidity and mortality of the open procedure and having a limited impact on trauma destabilization. The assessment of long-term durability of EVAR is one of the key issues to consider EVAR as the first choice of treatment
    Type of Publication: Journal article published
    PubMed ID: 16533692
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  • 9
    Keywords: ANGIOGENESIS ; CANCER ; SURVIVAL ; tumor ; Germany ; THERAPY ; DENSITY ; DIAGNOSIS ; imaging ; liver ; NEW-YORK ; SAMPLE ; SAMPLES ; TISSUE ; TUMORS ; NUCLEAR-MEDICINE ; PATIENT ; BIOMARKERS ; TISSUES ; MAGNETIC-RESONANCE ; magnetic resonance imaging ; BREAST ; immunohistochemistry ; REGION ; REGIONS ; MUSCLE ; PARAMETERS ; NORMAL TISSUE ; SERIES ; CONTRAST-ENHANCED MRI ; nuclear medicine ; ASBESTOS ; mesothelioma ; MALIGNANT MESOTHELIOMA ; LUNG-CARCINOMA ; HETEROGENEITY ; radiology ; RE ; THERAPIES ; monitoring ; dynamic contrast enhanced MRI ; biomarker ; analysis ; methods ; SUBTYPES ; NUCLEAR ; USA ; correlation ; spleen ; Aorta ; microvascular density ; MEDICINE ; quantitative ; PHARMACOKINETIC ANALYSIS ; DCE-MRI ; neoplasm ; CD-34 ; IMAGING BIOMARKER
    Abstract: Rationale and Objectives. Malignant mesothelioma (MM) of the pleura is an aggressive and often fatal neoplasm. Because MM frequently demonstrates marked angiogenesis, it may be responsive to antiangiogenic therapy, but effective methods for selecting and monitoring of patients are further needed. We employed dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and quantitative immunohistochemistry (IHC) to characterize the microvascularity of MM using both a physiologic and ultrastructural method. Materials and Methods. Nineteen patients diagnosed with MM were enrolled and DCE-MRI was performed before antiangiogenic treatment. For each patient, tumor regions were characterized by their DCE-MRI-derived pharmacokinetic parameters (Amp, k(ep), k(el)), which were also compared to those of normal tissue (aorta, liver, spleen, and muscle). In addition, quantitative ITIC of representative samples was performed with CD-34 staining to compare the calculated microvessel density (MVD) results with DCE-MRI results. Results. MM demonstrated markedly abnormal pharmacokinetic properties compared with normal tissues. Among the parameters tested, Amp was significantly different in MM (P :5.001) compared to normal organs. Despite the observation that the MVD of mesotheliomas in this series was high compared to other tumors, DCE-MRI pharmacokinetic parameters had a moderately positive correlation with MVD (r = 0.5). Conclusions. DCE-MRI and IHC can be used in patients with MM to visualize tumor microvascularity and to characterize tumor heterogeneity. DCE-MRI and IHC results positively correlated, though moderately, but these two methods present as essential tumor biomarkers. This multimodal characterization may be useful in selecting possible tumor subtypes that would benefit from antiangiogenic therapy
    Type of Publication: Journal article published
    PubMed ID: 18423312
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  • 10
    Keywords: MODEL ; VISUALIZATION ; DISEASE ; BLOOD-FLOW ; MAGNETIC-RESONANCE ; magnetic resonance imaging ; SURVEILLANCE ; ANGIOGRAPHY ; endovascular repair ; endovascular ; ANEURYSM REPAIR ; Aorta ; stent graft ; phase-contrast flow ; blood flow velocity
    Abstract: PURPOSE: To validate flow measurements within an aortic nickel-titanium (nitinol) stent graft using velocity-encoded cine magnetic resonance imaging (VEC MRI) and to assess intraobserver agreement of repeated flow measurements. MATERIALS AND METHODS: An elastic tube phantom mimicking the descending aorta was developed with the possibility to insert an aortic nitinol stent graft. Different flow patterns (constant, sinusoidal and pulsatile aortic flow) were applied by a gear pump. A two-dimensional phase-contrast sequence was used to acquire VEC perpendicular cross-sections at six equidistant levels along the phantom. Each acquisition was performed twice with and without stent graft, and each dataset was analysed twice by the same reader. The percental difference of the measured flow volume to the gold standard (pump setting) was defined as the parameter for accuracy. Furthermore, the intraobserver agreement was assessed. RESULTS: Mean accuracy of flow volume measurements was -0.45+/- 1.63% without stent graft and -0.18+/- 1.45% with stent graft. Slightly lower accuracy was obtained for aortic flow both without (-2.31%) and with (-1.29%) stent graft. Accuracy was neither influenced by the measurement position nor by repeated acquisitions. There was significant intraobserver agreement with an intraclass correlation coefficient of 0.87 (without stent graft, p〈0.001) and 0.80 (with stent graft, p〈0.001). The coefficient of variance was 0.25% without stent graft and 0.28% with stent graft. CONCLUSION: This study demonstrated high accuracy and excellent intraobserver agreement of flow measurements within an aortic nitinol stent graft using VEC MRI. VEC MRI may give new insights into the haemodynamic consequences of endovascular aortic repair.
    Type of Publication: Journal article published
    PubMed ID: 20888719
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