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Purpose To assess the esophagogastric junction (EGJ) on real-time MRI and compare imaging parameters to EGJ morphology on high-resolution manometry (HRM). Methods A total of 105 of 117 eligible patients who underwent real-time MRI and high-resolution manometry for GERD-like symptoms between 2015 and 2018 at a single center were retrospectively evaluated (male n = 57; female n = 48; mean age 52.5 ± 15.4 years). Real-time MRI was performed at a median investigation time of 15 min (1 frame/40 ms). On HRM, EGJ morphology was assessed according to the Chicago classification of esophageal motility disorders. Real-time MRI was performed at 3 T using highly undersampled radial fast low-angle shot acquisitions with NLINV image reconstruction. A 10 mL pineapple juice bolus served as oral contrast agent at supine position. Real-time MRI films of the EGJ were acquired during swallowing events and during Valsalva maneuver. Anatomic and functional MRI parameters were compared to EGJ morphology on HRM. Results On HRM, n = 42 patients presented with EGJ type I (40.0%), n = 33 with EGJ type II (31.4%), and n = 30 with EGJ type III (28.6%). On real-time MRI, hiatal hernia was more common in patients with EGJ type III (66.7%) than in patients with EGJ type I (26.2%) and EGJ type II (30.3%; p p = 0.017). The mean esophagus–fundus angle of patients was 85 ± 31° at rest and increased to 101 ± 36° during Valsalva maneuver. Conclusion Real-time MRI is a non-invasive imaging method for assessment of the esophagogastric junction. Real-time MRI can visualize dynamic changes of the EGJ during swallowing events.

The role of today's hospital-based radiologists goes far beyond interpretation-related tasks. This observational study defines these types of activities and quantifies the type of value-adding interactions radiologists experience on a daily basis with referring departments and other health personnel. The purpose of this study is to evaluate the quality and quantity of these value-adding non-image interpretation tasks in the daily routine of hospital-based residents and attending radiologists. A prospective, observational study was performed in the radiology department of a German university hospital. Two experienced radiologists performed a 30-day observation of the entire medical staff. The observers followed the subject radiologists throughout the workday, recording activities using a time and motion methodology. An evaluation matrix was developed to characterize and quantify image interpretation tasks (IITs), non-image interpretation tasks (NITs), and contingency allowance (CA) for residents and attending radiologists. Here, the example of the MRI unit is used. Four main categories of responsibilities for NITs were identified including teaching and education, clinical decision support, management and organization, and patient care. The quantitative analysis for residents showed: IITs 15 h/d (53 %), NITs 9.8 h/d (34 %), CA 2.2 h/d (13 %). For attendings the analysis revealed: IITs 6.7 h/d (40 %), NITs 7.8 h/d (47 %), and CA 1.7 h/d (13 %). This resulted in staff requirements of 2 attendings and 3.4 residents for the MRI unit. On average, 6 TSEs/h occurred in the case of residents and 13 TSEs/h in the case of attendings. NITs consumed a significant portion of a radiologist's workday. Therefore, the number of examinations performed is not a reliable surrogate for the daily workload of hospital-based radiologists especially in cross-sectional imaging units. Though time-consuming, these non-interpretive tasks are greatly contributing to the fact that modern radiology is assuming a central position in patient management, fulfilling a critical role that surpasses image interpretation-related tasks to include a more integrative and consultative role. These findings will help to further define the changing role of radiologists with respect to other physicians, non-medical personnel, hospital administrators, as well as policy makers. · Staff requirements are a significant factor in department strategy.. · Targeted analysis can deliver valuable information about workload per activity and the required staff.. · The number of examinations performed is not a reliable surrogate for the daily workload of hospital-based radiologists.. · NITs comprise a significant portion of a radiologist's workday.. · Though time-consuming, non-interpretive tasks contribute to the fact that modern radiology is assuming a central role in patient management..· Streit U, Uhlig J, Lotz J et al. Qualitative and Quantitative Workplace Analysis of Staff Requirement in an Academic Radiology Department. Fortschr Röntgenstr 2021; 193: 1277 - 1284.ZIEL: Das Aufgabenprofil von heutigen Radiologen wird immer vielseitiger und geht über die reine Bildinterpretation und -befundung hinaus. Ziel dieser Beobachtungsstudie war es, mithilfe einer qualitativen und quantitativen Arbeitsplatzanalyse angepasste radiologische Tätigkeitsprofile zu ermitteln und hieraus den tatsächlichen Personalbedarf einer universitären radiologischen Abteilung abzuleiten. Im Rahmen einer Qualitätsinitiative wurde eine prospektive Beobachtungsstudie an einer deutschen Universitätsklinik durchgeführt. Zwei erfahrene Radiologen führten über 30 Tage eine qualitative und quantitative Arbeitsplatzanalyse durch. Dabei wurde das ärztliche Personal im Alltag begleitet und interpretative Tätigkeiten (IITs) und nichtinterpretative Tätigkeiten (NITs) von Assistenzärzten und Oberärzten dokumentiert unter Anwendung von Zeit- und Bewegungsanalysen sowie Experteninterviews. Ferner wurden Wechselereignisse (TSEs) zwischen NITs und IITs erfasst. Hier wurde das Beispiel der MRT-Funktionseinheit gewählt. Die qualitative Arbeitsplatzanalyse der Funktionseinheit MRT ergab eine Tätigkeitsmatrix mit den übergeordneten Kategorien IIT und NIT und Verteilzeitfaktor (VZ). Ferner ließen sich die NITs in 4 Subkategorien unterteilen: Management und Organisation, Patientenbetreuung, Clinical Decision Support, Ausbildung. Die quantitative Analyse ergab folgenden Zeitaufwand bei Assistenzärzten: IITs 15 h/d (53 %), NITs 9,8 h/d (34 %), VZ 3,7 h/d (13 %). Für Oberärzte ergaben sich folgende Messungen: IITs 6,7 h/d (40 %), NITs 7,8 h/d (47 %), VZ 1,2 h/d (13 %). Insgesamt wurde ein Personalbedarf von 2 Vollzeitkräften an Oberärzten und 3,4 Vollzeitkräften an Assistentsärzten für die Funktionseinheit MRT berechnet. Bei Assistenzärzten wurden durchschnittlich 6 TSEs/h und bei Oberärzten 13 TSEs/h beobachtet. NITs machen einen signifikanten Anteil des radiologischen Alltags aus, daher sind Kennzahlen wie Untersuchungen pro Tag allein nicht repräsentativ für die tägliche Arbeitslast eines Radiologen im Krankenhausbetrieb. Obwohl sie zeitintensiv und disruptiv sind, tragen NITs in erheblichem Maße dazu bei, dass der moderne Radiologe eine zentrale Rolle im Management von Patienten einnimmt. · Die Personalbedarfsplanung ist ein wichtiger interner Einflussfaktor für die Abteilungsstrategie.. · Das Hauptziel der Personalbedarfsermittlung besteht in der Anpassung der Personalkapazitäten an den jeweils aktuellen Bedarf.. · Leistungszahlen sind kein ausreichender Surrogatparameter für den tatsächlichen Arbeitsaufwand.. · Nichtinterpretative Tätigkeiten machen einen signifikanten Anteil des radiologischen Alltags aus.. · Obwohl sie zeitintensiv und disruptiv sind, tragen NITs in erheblichem Maße dazu bei, dass der moderne Radiologe eine zentrale Rolle im Management von Patienten einnimmt..· Streit U, Uhlig J, Lotz J et al. Qualitative and Quantitative Workplace Analysis of Staff Requirement in an Academic Radiology Department. Fortschr Röntgenstr 2021; 193: 1277 – 1284.

ZusammenfassungHintergrundBei Patienten, die im Rahmen eines Traumas an Knie- und Sprunggelenk eine Verletzung mit Abscheren eines osteochondralen „flake“ erleiden, ist heute die Refixation mittels resorbierbarer Implantate eine häufig verwendete Therapieoption. Hierzu gibt es bisher wenige Studien mit klinischen Langzeitergebnissen. Ziel dieser Studie war die Erfassung der klinischen und MR-morphologischen Langzeitergebnisse nach Refixation mittels resorbierbarer PLLA-Implantate.Material und MethodenIn dieser retrospektiven Studie wurden 12 Patienten mit 13 Läsionen erfasst, die im Schnitt 13,9 (±1,2) Jahre zuvor eine Refixation eines durchschnittlich 3,33 cm2(±2,33) großen osteochondralen Flake an Knie- (10 Patienten) und oberem Sprunggelenk (2 Patienten) mit resorbierbaren Implantaten (Nägel, Stifte, Schrauben) aus Polylactid (PLLA) (Fa. Bionx, Tampere, Finnland) erhalten hatten. Zur Objektivierung des klinischen Ergebnisses wurden 8 etablierte Scores (VASS, Tegner, Lysholm, McDermott, KSS, WOMAC, AOFAS, FADI+Sports) verwendet. Des Weiteren wurden die knöcherne Integration und Knorpelmorphologie mittels protonengewichteter und knorpelsensitiver „3D-double-echo-steady-state“(DESS)-Sequenzen im MRT (3 T) erfasst. Zur Objektivierung der Ergebnisse diente ein modifizierter MRT-Score nach Henderson et al.ErgebnisseNach 13,9 (±1,2) Jahren zeigten sich sowohl für die Knie- als auch die Sprunggelenkpatienten sehr gute Ergebnisse (Knie: VASS: 1,2 (±1,7); Tegner 4,4 (±1,3); Lysholm 85,7 (±12,2); McDermott 90,7 (±8,6); KSS 189 (±14,2); WOMAC (6,16 % (±8,45))), (OSG: VASS: 2,5 (±2,5); Tegner 5,5 (±1,5); Lysholm 87 (±13), McDermott 88 (±12); WOMAC (8,54 % (±8,54); AOFAS 75,5 (±24,5); FADI+Sports 118 (±18))). In der MRT zeigte sich in allen 12 Fällen eine gute Integration des refixierten Flake. In 5 Fällen kam es zu einer moderaten subchondralen Zystenbildung (∅ ≤1 mm). Allerdings zeigten alle Patienten milde Veränderungen der Knorpelkontur. Hieraus ergab sich ein durchschnittlicher modifizierter Henderson-Score-Wert von 14,4 (±2,0) (Bestwert: 8, schlechtester Wert: 32), was einem guten MR-morphologischen Ergebnis entspricht.SchlussfolgerungAufgrund der klinischen und auch MR-morphologischen Langzeitergebnisse ist die Refixation von osteochondralen Flakes mittels resorbierbarer Implantate (PLLA) als empfehlenswertes Verfahren zu werten.

To assess the diagnostic potential of real-time MRI for assessment of hiatal hernias in patients with GERD-like symptoms compared to endoscopy.One hundred eight patients with GERD-like symptoms were included in this observational cohort study between 2015 and 2017. Real-time MRI was performed at 3.0 Tesla with temporal resolution of 40 ms, dynamically visualizing the esophageal transport of a pineapple juice bolus, its passage through the gastroesophageal junction, and functional responses during Valsalva maneuver. Hernia detection on MRI and endoscopy was calculated using contingency tables with diagnosis of hernia on either modality as reference.Of 108 patients, 107 underwent successful MRI without adverse events; 1 examination was aborted to inability to swallow pineapple juice in supine position. No perforation or acute bleeding occurred during endoscopy. Median examination time was 15 min. Eighty-five patients (79.4%) were diagnosed with hiatal hernia on either real-time MRI or endoscopy. Forty-six hernias were visible on both modalities. Seventeen hernias were evident exclusively on MRI, and 22 exclusively on endoscopy. Sixteen of the 63 MRI-detected hernias (25.4%) were detectable only during Valsalva maneuver, which were smaller compared to hernias at rest (median - 13.5 vs - 33.0 mm, p 0.001). Diagnostic accuracy for hernia detection was comparable for MRI and endoscopy (sensitivity 74% vs 80%, p = 0.4223; specificity 100% vs 100%, p 0.99).Real-time MRI is a fast and safe modality for assessment of the gastroesophageal junction, without radiation exposure or administration of gadolinium-based contrast media. Although MRI and endoscopy yield comparable diagnostic accuracy, dynamic MRI sequences are able to visualize hiatal hernias that were occult on static MRI sequences or endoscopy in a relevant number of cases.• Real-time MRI is a safe and fast imaging modality for examination of the gastroesophageal junction, combining anatomical and functional information for enhanced detection of hiatal hernias. • Real-time MRI and endoscopy yield comparably high diagnostic accuracy: real-time MRI visualizes hiatal hernias that were occult on endoscopy in a relevant number of patients; however, several hiatal hernias detected on endoscopy were occult on real-time MRI. • There is clinical potential of real-time MR imaging in patients with GERD-like symptoms and equivocal findings on endoscopy or pH-metry, for anatomical visualization in patients planned for surgical intervention, or those with suspected fundoplication failures.

Purpose: To compare the efficacy of right portal vein embolization using ethylene vinyl alcohol (EVOH-PVE) compared to other embolic agents and surgical right portal vein ligation (PVL).Material an...

To assess the diagnostic potential of dynamic real-time MRI for fundoplication failure in patients with persistent or recurrent GERD-like (gastroesophageal reflux disease) complaints. Twenty-two consecutive patients (male n = 11; female n = 11; median age 59 years) with recurrent or persistent GERD-like symptom after fundoplication were enrolled between 2015 and 2017. Median duration of GERD-like symptoms was 21 months. Real-time MRI (3 Tesla) was performed at 40 ms temporal resolution using undersampled radial fast low-angle shot acquisitions with nonlinear inverse image reconstruction. MRI movies dynamically visualized bolus transit of pineapple juice through the gastroesophageal junction, position of the fundoplication wrap and recurring hernia or reflux during Valsalva maneuver. MRI results were compared to endoscopic findings. Real-time MRI was successfully completed in all patients without adverse events (average examination time 15 min). Morphological correlates for GERD-like symptoms were evident in 20 patients (90.1%) with gastric reflux in 19 cases. Nine patients (40.1%) had wrap disruption and recurrent gastric hernia. Wrap migration or telescoping hernia was detected in nine patients (40.1%). One patient presented with continued reflux despite intact fundoplication wrap. Esophageal dysmotility with delayed bolus passage was observed in one case. On endoscopy, gastric hernia or wrap disruption was diagnosed in seven cases, and esophagitis or Barret’s metaplasia in nine cases. Real-time MRI is a fast and safe modality for dynamic imaging after fundoplication, without radiation exposure or administration of gadolinium-based contrast media. In a relevant number of cases, real-time MRI reveals correlates for GERD-like symptoms. • Real-time MRI reliably visualizes the gastroesophageal junction after fundoplication surgery. • Patients with recurring GERD-like symptoms have a high rate of morphological failure patterns that can be identified by real-time MRI. • Dynamic assessment of gastroesophageal junction by real-time MRI is a perspective diagnostic tool for detection of fundoplication failure.

To analyze core processes of the MRI workflow and to evaluate efficiency for improved patient throughput and capacity utilization.Prospective data collection was conducted during a four-week time period and a total sum of 160 working hours for each of the two 1.5 T MRI scanners. Three core processes defined the value stream of patient handling before, during and after the MRI examination: i) SchedulingRegistration, ii) OrganizationPreparation, and iii) MR scan. Quantitative data was collected for six essential time intervals of the MRI workflow.A total of 302 MRI examinations were assessed. The workflow analysis revealed that effective utilization of scan capacity during operating hours varied by scanner (Scanner 1: 77 % / Scanner 2: 85 %). Mean process times for were: patient preparation time 18.9 min (±15.1) p = 0.11, scan preparation time 5.7 min (±4.0) p = 0,015, effective scan time 39.6 min (±18.0) p 0.0001, scan room occupation time 50.9 min (±21.0) p 0.0001, clean-up time 5.6 min (±3.2) p = 0.001, total patient handling time 69.7 min (±26.3) p 0.0001, turnover time 13.4 min (±21.4) p = 0.65.This study demonstrates the utility and applicability of a standardized core processes analyses for MRI scanning, which identified underutilization of scanning capacities, related to multiple factors, such as punctuality of patients, the number of same day cancellations, the process of placing an IV access and patient transport contribute to underutilization of MRI scanners. Furthermore, proactive patient management and effective communication with patients and referring physicians might have relevant time saving potential in the scan room.

In total knee arthroplasty the femoral posterior condylar offset (PCO) may serve as a potential branch for correct femoral component positioning. The technique of adjusting the sagittal magnetic resonance imaging (MRI)-scan on which it is measured has not been investigated in previous literature, but may be subject to variances due to knee joint positioning or axial localizer scan angulation. The purpose of this study was to investigate the effect of simulated femur rotation on the accuracy of PCO measurement. Ten asymptomatic knee joints underwent MRI investigations. A sagittal plane perpendicular to the transepicondylar axis was defined as the true-sagittal plane (tsP). Sagittal images were reformatted in the tsP and angulated by 5° and − 5° in medial and lateral direction. In total each knee received three scans in 0°, 5° and − 5° axial localizer scan angulation. Medial and lateral PCO measurement was performed in each MRI-scan angulation. Simulated external rotation decreased medial PCO size by 1.7 mm (95% CI 0.5994–3.127) (p = 0.012), and simulated internal rotation increased medial PCO size by 2.1 mm (95% CI 1.142–2.994) (p = 0.001). Lateral PCO size increased by 1.9 mm (95% CI 0.5660–3.412) and decreased by 2.1 mm (95% CI 1.142–2.994) with simulated external and internal rotation, respectively (p = 0.011; p = 0.0007). This study shows the high sensitivity of medial and lateral PCO measurements to small changes of MRI axial localizer scan angulations simulating minor degrees of internal or external femur rotation. Thus, absolute PCO values should be interpreted with caution if the sagittal image acquisition is not standardized.

Purpose To evaluate the diagnostic potential of real-time MRI for dynamic assessment of gastroesophageal reflux in patients with GERD (gastroesophageal reflux disease)-like symptoms compared to pH-metry and impedance. Methods Patients who underwent real-time MRI and pH-metry between 2015-2018 were included in this retrospective study. Real-time MRI at 3 Tesla was achieved by undersampled radial FLASH acquisitions with iterative image reconstruction by NLINV. Real-time MRI visualized transit of pineapple juice through the gastroesophageal junction and during Valsalva maneuver. MRI results were compared to 24 -h pH-metry to assess acidic reflux (following Lyon Consensus guidelines) and to impedance to assess non-acidic reflux. A standard 2 × 2 table was chosen to calculate diagnostic performance. Results 91/93 eligible patients fulfilled inclusion criteria (male n = 49; female n = 42; median age 55 y). All MRI studies were successfully completed without adverse events at a mean examination time of 15 minutes. On real-time MRI, reflux was evident in 60 patients (66%). pH-metry revealed reflux in 41 patients (45%), and impedance in 54 patients (59%). Compared to pH-metry and impedance, real-time MRI sensitivity was 0.78 (95% CI: 0.66-0.87), specificity 0.67 (95% CI: 0.45-0.84) and PPV 0.87 (95% CI: 0.75-0.94). Conclusion Real-time MRI is an imaging method for assessment of gastroesophageal reflux in patients with GERD-like symptoms. Considering its high positive predictive value, real-time MRI can accurately identify patients in which further invasive testing with pH-metry and impedance might be considered.

Splenic torsion is an uncommon condition becoming clinically apparent when the spleen twists or rotates around the organ’s vascular pedicle. In the case of a wandering spleen the organ is only attached to an elongated vascular pedicle while the peritoneal attachments are absent. However, splenic torsion could also occur in patients with abnormal laxity of the splenic peritoneal attachments. We report a case of a splenic torsion due to absence of splenic ligaments with pancreatic volvulus and partial involvement of descending colon in a 9-year-old boy.

The purpose of this study was to assess the reproducibility of functional and anatomical parameters of swallowing events as determined by real-time MRI at 40 ms temporal resolution (25 frames per second). Twenty-three consecutive patients with gastroesophageal reflux disease (GERD) underwent real-time MRI of the gastroesophageal junction at 3.0 T. Real-time MRI was based on highly undersampled radial fast low angle shot (FLASH) acquisitions with iterative image reconstruction by regularized nonlinear inversion (NLINV). MRI movies visualized the esophageal transport of a pineapple juice bolus, its passage through the gastroesophageal junction and functional responses during a Valsalva maneuver. His-angle, sphincter position, sphincter length and sphincter transit time were assessed by two radiologists. Interobserver and intraobserver intraclass correlation coefficients (ICC) were evaluated and Bland-Altman plots were constructed to assess the observer agreement. Interobserver agreement was excellent for sphincter transit time (ICC = 0.92), His-angle (ICC = 0.93), His-angle during Valsalva maneuver (ICC = 0.91) and sphincter-to-diaphragm distance (ICC = 0.98). Sphincter length and oesophageal diameter showed good interobserver agreement (ICC = 0.62 and ICC = 0.70). Intraobserver agreement was good for sphincter length (ICC = 0.80) and excellent for sphincter transit time, His-angle and His-angle during Valsalva maneuver, sphincter-to-diaphragm distance, and esophageal diameter (ICC = 0.91; ICC = 0.97; ICC = 0.97; ICC = 0.998; ICC = 0.93). All functional parameters of the gastroesophageal junction had good to excellent reproducibility. Visual assessment of Bland Altman plots did not reveal any systematic interobserver bias. In conclusion, the visualization of swallowing events by real-time MRI has a high potential for clinical application in gastroesophageal reflux disease.

The present study investigated whether endothelial nitric oxide synthase (eNOS) activation may be dysregulated in cardiac tissue of patients suffering from type 2 diabetes (T2D). We performed immunohistochemical measurements of translocated eNOS activation as well as eNOS phosphorylation at Ser1177, Thr495, Ser 635, Ser114, and of the protein kinase B (Akt) in isolated right atrial trabeculae of patients undergoing cardiac bypass or valve surgery with ( n = 12, 68.1 ± 2.5 yr) and without T2D ( n = 12, 64.7 ± 2.7 yr). In addition, we investigated oxidative (8-isoprostane) and nitrosative stress markers (nitrotyrosine) as well as the effect of pharmacological stimulation of angiotensin (AT)-receptors on eNOS-phosphorylation. Translocation-dependent eNOS activation was similar in both groups. The same holds true for eNOS phosphorylation at Ser114. eNOS phosphorylation at Ser635 was significantly increased, whereas eNOS phosphorylation of Ser1177 was significantly decreased in the diabetic group paralleled by a decrease in phosphorylation of Akt and Thr495. These alterations were accompanied by a significant decrease in nitrotyrosine. After application of angiotensin II (10 μM, 2 min) for investigation of the AT-receptor-dependent eNOS stimulation, we did not find differences between the increases in eNOS Ser1177-phosphorylation in the nondiabetic (+39.7 ± 23.5%) and in the diabetic group (32.22 ± 11.45%). A simultaneous increase in Akt phosphorylation could not be observed. The present study indicates that T2D goes along with a decrease in eNOS phosphorylation at Ser1177 under basal conditions in cardiac tissue. Whether this may be attributed to the insulin resistance of cardiac muscle has to be further investigated. Receptor-stimulated eNOS activation still works at least for angiotensin II-dependent eNOS activation.

Purpose The purpose of the study was to determine the prevalence of fractures and incidental findings (IF) with emphasis on clinical significance. Materials and methods A total of 784 patients were evaluated by computed tomography. Fractures and IF were registered and classified as significant if they were recommended for additional diagnostics or therapy. Results Four hundred seventy of 784 patients (60%) sustained a fracture. Significant fractures were found in 694/1213 fractures (57%); nonsignificant fractures were found in 519/1213 (43%) fractures. A total of 972 IF were observed in 464/784 (59%) patients. Significant findings were found in 358/972 findings (37%). There were 1.5 fractures and 1.2 IF per patient. Conclusion There is a high prevalence of significant fractures (57%) and IF (37%).