Jasmin D. Busch

Follow-up of radiologically totally implanted central venous access ports of the upper arm: long-term complications in 127,750 catheter-days.

OBJECTIVE The purpose of this article is to retrospectively evaluate radiologically totally implanted central venous access ports (VAPs) of the upper arm in terms of safety, technical feasibility, and device-related complications. MATERIALS AND METHODS Five hundred seven consecutive patients (mean [± SD] age, 59.2 ± 11.4 years) who received a totally implanted central VAP between January 2005 and July 2010 were included. The insertion procedure was performed in an interventional radiology suite using the Seldinger technique. Neither antibiotic prophylaxis nor long-term anticoagulation was administered. RESULTS In 507 patients, a total of 523 devices were implanted. Of these 523 procedures, 512 complete datasets were available during follow-up. The primary technical success rate was 99.04%. All procedures were completed without major complications. During follow-up and with a total number of 127,750 days of totally implanted central VAP implantation (248 ± 279 days/patient; range, 1-1687 days/patient), 50 devices had to be revised because of complications (9.8%). Complications occurred at a mean of 114 ± 183 days (range, 1-1113 days) after placement. Early complications were noted in 21 of 512 cases (4.1%), and late complications were noted in 29 of 512 cases (5.7%). Complications were as follows: local infections, 4.9% (25/512); systemic infections, 0.4% (2/512); venous thrombosis, 1.6% (8/512); paralysis of the median nerve, 0.6% (3/512); skin dehiscence at the port site, 0.2% (1/512); and mechanical problems including catheter line displacement, port hub rotation, and catheter fracture, 2.1% (11/512). CONCLUSION Radiologic placement of a totally implanted central VAP is a safe procedure with a low rate of both early and late device-related complications. The method is effective for delivery of chemotherapy, parenteral nutrition, and frequent IV medication.

Feasibility of 11C-Acetate PET/CT for Imaging of Fatty Acid Synthesis in the Atherosclerotic Vessel Wall

Fatty acids are a common constituent of atherosclerotic plaque and may be synthesized in the plaque itself. Fatty acid synthesis requires acetyl-coenzyme-A (CoA) as a main substrate, which is produced from acetate. Currently, 11C-acetate PET/CT is used for the evaluation of malignancies. There are no data concerning its potential for the characterization of atherosclerotic plaque. Therefore, the purpose of the present study was to examine the prevalence, distribution, and topographic relationship of arterial 11C-acetate uptake and vascular calcification in major arteries. Methods: Thirty-six patients were examined by whole-body 11C-acetate PET/CT. Tracer uptake in various arterial segments was analyzed both qualitatively and semiquantitatively by measuring the blood-pool–corrected standardized uptake value (target-to-background ratio). CT images were used to measure calcified plaque burden. Results: 11C-acetate uptake was observed at 220 sites in 32 (88.8%) of the 36 study patients, and mean target-to-background ratio was 2.5 ± 1.0. Calcified atherosclerotic lesions were observed at 483 sites in 30 (83.3%) patients. Sixty-four (29.1%) of the 220 lesions with marked 11C-acetate uptake were colocalized with arterial calcification. However, only 13.3% of all arterial calcification sites demonstrated increased radiotracer accumulation. Conclusion: Our data indicate the feasibility of using 11C-acetate PET/CT for imaging of fatty acid synthesis in the atherosclerotic vessel wall. This study provides a rationale to incorporating 11C-acetate PET into further preclinical and clinical studies to obtain new insights into fatty acid synthesis in atherosclerotic lesions and to evaluate whether it may be used to monitor pharmacologic intervention with fatty acid synthase inhibitors.

Age-related distribution of vertebral bone-marrow diffusivity

PURPOSE To determine age-related diffusivity changes of the lumbar bone marrow by measurement of apparent diffusion coefficient (ADC) values. MATERIALS AND METHODS The local ethics committee approved this study and written informed consent was obtained. The study group comprised 88 individuals including 75 healthy volunteers and 13 patients (48 female, 40 male; mean age 36 years, range 0-84 years). The pediatric cases were recruited from patients. Echo-planar diffusion weighted imaging (DWI) was performed with b-values of 50, 400 and 800 s/mm(2). ADC-values were calculated and measured in the 1st and 2nd vertebral body of the lumbar spine. Correlation between age and ADC-values was analyzed with Spearmans rho test. RESULTS The ADC values of the vertebral bone marrow of the lumbar spine showed a significant negative correlation with age (rho=-0.398, p=0.001). The mean ADC values (×10(-3)mm(2)/s) in the age groups 0-29 years (mean age 18.0 years, n=42) and 30-88 years (mean age 51.6 years, n=46) were 0.54 ± 0.07 and 0.47 ± 0.08, respectively (p<0.001, T-test). No significant differences were found between children and young adults. CONCLUSION Bone marrow ADC values of the lumbar spine show a linear decrease with growing age and thereby reflect the gradual changes of cell composition occurring during marrow conversion.

Diffusion-weighted imaging of the healthy pancreas: ADC values are age and gender dependent

To investigate the healthy pancreas with diffusion‐weighted imaging (DWI) for characterization of age and gender‐related differences in apparent diffusion coefficient (ADC) values.

Intraindividual comparison of 123I-mIBG SPECT/MRI, 123I-mIBG SPECT/CT, and MRI for the detection of adrenal pheochromocytoma in patients with elevated urine or plasma catecholamines.

Purpose To determine the diagnostic performance of 123I-metaiodobenzylguanidine (mIBG) SPECT/MRI fusion, 123I-mIBG SPECT/CT and adrenal MRI for the detection of pheochromocytoma in patients with elevated urine or plasma catecholamines. Patients and Methods Twenty-two consecutive patients underwent both a whole-body 123I-mIBG scan with SPECT/CT of the adrenal region and MRI of the adrenal glands. Fused SPECT/MRI, SPECT/CT, and MRI scans were evaluated. Imaging results were analyzed both on a per-patient and on a per-lesion basis. Histopathology and/or clinical and radiological follow-up served as the reference standard. Results Sixteen adrenal tumors were found in thirteen patients. On a per-lesion basis, SPECT/CT had a sensitivity of 87.5%, a specificity of 93.8%, and an overall accuracy of 92.5%. MRI had a sensitivity of 87.5%, a specificity of 96.9%, and an overall accuracy of 95.0%. On a per-patient basis, both SPECT/CT and MRI had a sensitivity of 85.7%, a specificity of 93.3%, and an overall accuracy of 90.9%. SPECT/CT was concordant with MRI in 81.8% of cases. SPECT/MRI fusion was superior to both SPECT/CT and MRI and had a sensitivity of 100% on both a per-lesion and a per-patient basis. Conclusions 123I-mIBG SPECT/MRI has the highest sensitivity and accuracy for the detection and localization of pheochromocytomas. SPECT/CT and MRI of the adrenal glands are equivalent diagnostic procedures. However, MRI offers the advantage of fully diagnostic assessment of adrenal lesions other than pheochromocytoma undetectable by 123I-mIBG.

99mtc-mdp Spect/ct for Assessment of Condylar Hyperplasia

We report a case of condylar hyperplasia diagnosed with 99mTc-MDP SPECT/CT. A 21-year-old woman with facial asymmetry was referred for assessment of condylar growth activity. SPECT/CT confirmed condylar hyperactivity, and simultaneous low-dose CT contributed to the diagnosis of hemimandibular hyperplasia. SPECT/CT may become a valuable tool for the diagnosis and comprehensive assessment of condylar hyperplasia, providing both functional and morphological information.

Material Failure of Silicone Catheter Lines: A Retrospective Review of Partial and Complete Ruptures in 553 Patients

OBJECTIVE This present study reports the frequency and outcome of material failure of the silicone catheter lines of a port device implanted in the upper arm during a 5-year period. MATERIALS AND METHODS From 2006 to 2011, a total of 553 patients had a port device implanted percutaneously in the upper arm. In the spring of 2013, several instances of material failure led to device withdrawal. At that time, 39 patients (7.1%) with the specific device in situ were still alive, and 36 of these patients agreed to removal. Linear mixed-effects models were used to analyze the log-transformed device dwell time. Random effects were modeled using group variables. The mean estimated values and their corresponding 95% CIs were reported. Nominal p values were reported, and two-sided p < 0.05 was considered to denote statistical significance. RESULTS Among the 553 patients, material failure was noticed in 19 patients (3.4%), with a mean estimated dwell time of 243 days (95% CI, 104-570 days). Specifically, complete rupture occurred in 10 patients (1.8%) after a mean of 322 days (95% CI, 95-1089 days), partial rupture occurred in eight patients (1.4%) after a mean of 190 days (95% CI, 61-596 days), and disconnection occurred in one patient (0.2%) 8 days after device placement. CONCLUSION The frequency of catheter line rupture was 3.4%. The mean estimated interval to rupture was less than a year, with an increasing probability of rupture noted in association with a longer dwell time. The exact cause of material failure remains unexplained, and further investigation of the mechanical properties contributing to rupture is required. Insight into the safety profile of these devices is needed to avoid potentially severe injury and improve the management of affected patients.

Hepatic shear wave elastography in children under free-breathing and breath-hold conditions

ObjectivesTo compare hepatic 2D shear wave elastography (2D SWE) in children between free-breathing and breath-hold conditions, in terms of measurement agreement and time expenditure.MethodsA cohort of 57 children (12.7±4.3 years) who underwent standardized 2D SWE between May and October 2015 were retrospectively evaluated. Liver elastograms were obtained under free-breathing and breath-hold conditions and time expenditure was measured. Median stiffness, interquartile range (IQR), and IQR/median ratio were calculated based on 12, six, and three elastograms. Results were compared using Pearson correlation coefficient, intraclass correlation coefficient (ICC), Bland-Altman analysis, and Student’s t.ResultsMedian liver stiffness under free-breathing and breath-hold conditions correlated strongly (7.22±4.5kPa vs. 7.21±4.11kPa; r=0.97, P<0.001). Time to acquire 12 elastograms with free-breathing was lower than that with breath-holding (79.3±32.5sec vs. 143.7±51.8sec, P<0.001). Results for median liver stiffness based of 12, six, and three elastograms demonstrated very high agreement for free-breathing (ICC 0.993) and for breath-hold conditions (ICC 0.994).ConclusionsHepatic 2D SWE performed with free-breathing yields results similar to the breath-hold condition. With a substantially lower time requirement, which can be further reduced by lowering the number of elastograms, the free-breathing technique may be suitable for infants and less cooperative children not capable of breath-holding.Key Points• Hepatic 2D SWE performed with free-breathing yields results similar to breath-hold condition.• Benefit of the free-breathing approach is the substantially lower time requirement.• Lowering the number of elastograms can further reduce time expenditure.• Free-breathing 2D SWE is suitable in children with suspected liver disease.

Radiologically inserted gastrostomy: differences of maintenance of balloon- vs. loop-retained devices

Abstract Purpose: To compare outcome and associated complications of ballon- vs. loop-retained devices for radiologically inserted gastrostomy (RIG). Methods: From 2007 to 2011 233 patients (age 63.7 ± 10.6 years) were referred for a RIG because of pharyngeal stricture Intervention was performed with four different devices: balloon-retained – Freka® GastroTube, Fresenius Kabi (n = 121); MIC® Gastrostomy Feeding Tube, Kimberly–Clark (n = 34); Russell® Gastrostomy Tray, Cook Medical Inc. (n = 17); and loop-retained – Tilma® Gastrostomy Set, Cook Medical Inc. (n = 50). Follow-up was performed with regard to RIG-related complications, cause of removal and fatalities. Revision-free survival times after RIG were evaluated using Kaplan–Meier analysis and group differences by log-rank tests. For analysis of demographic and methodical variables multivariate Cox regression models were used. Results: With a primary technical success rate of 95.3% (222/233) a total of 92 instances of revisions were necessary in 66 patients (66/233, 28.3%) during follow-up (mean 182.8 ± 86.6 days). The most common complication was tube dislodgement (14.3%). There were no significant differences between the distinct devices (p = 0.098), but analyzing the data in subgroups of balloon-compared to loop-retained gastrostomy tubes we observed a significantly higher probability of minor complications for the latter (p = 0.023). Conclusion: As it is significantly less prone to minor complications we recommend the use of balloon-retained gastrostomy tubes to improve the practicability and maintenance of RIG.

Age-related differences in the activity of arterial mineral deposition and regional bone metabolism: a 18F-sodium fluoride positron emission tomography study

SummaryFunctional 18F-fluoride PET demonstrated an inverse relationship between the activity of arterial mineral deposition and regional bone metabolism. While bone metabolism decreases with age, the activity of arterial mineral deposition increases.IntroductionThe extent of arterial calcification increases with age, whereas bone mineral density decreases, evidencing a well-known inverse correlation on morphological basis. The aim of this study was to evaluate the functional relationship between the activity of arterial mineral deposition and regional bone metabolism as assessed by 18F-sodium fluoride (NaF) PET/CT.MethodsThree hundred four subjects were examined by 18F-NaF PET/CT. Tracer accumulation in the femoral arteries was analyzed both qualitatively and semiquantitatively by measuring the blood-pool-corrected standardized uptake value (target-to-background ratio). Uptake was compared with cardiovascular risk factors (RFs), calcified plaque burden, and regional bone metabolism as assessed by PET/CT.ResultsThe activity of arterial mineral deposition significantly increased with age (p < 0.001), whereas regional bone metabolism significantly decreased (p < 0.001). There was a significant inverse correlation between bone metabolism and arterial mineral deposition (unadjusted, p < 0.001); that association was not significant (p = 0.79) when controlled for age and other RFs. Both high activity of arterial mineral deposition and low bone metabolism were significantly associated with cardiovascular events and other RFs.Conclusion18F-NaF PET/CT provides a tool to visualize and quantify the activity of arterial mineral deposition and regional bone metabolism. In this study, we observed an inverse correlation between the activity of arterial mineral deposition and regional bone metabolism. While the activity of arterial mineral deposition significantly increases with age, regional bone metabolism decreases.