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MRI-related anxiety is present in 30% of patients and may evoke motion artifacts/failed scans, which impair clinical efficiency. It is unclear how patient anxiety can be countered most effectively. Habitual preferences for coping with stressful situations by focusing or distracting one’s attention thereof (coping style) may play a key role in this context. This study aimed to compare the effectiveness of two patient-preparation videos with informational vs. relaxational content and to determine whether the fit between content and coping style affects effectivity. The sample consisted of 142 patients (M = 48.31 ± 15.81 years). Key outcomes were anxiety, and cortisol as a physiological stress marker. When not considering coping style, neither intervention improved the patients’ reaction; only patient preparation that matched the patients’ coping style was associated with an earlier reduction of anxiety. This suggests that considering individual preferences for patient preparation may be more effective than a one-size-fits-all approach.

Lipomatosis of peripheral nerves (LPN, also known as fibrolipomatous or lipofibromatous hamartoma of peripheral nerves) is a very rare, benign, intraneural, tumorous lesion that predominantly involves the median nerve but may rarely affect any peripheral nerve. Recently, PIK3CA mutations have been reported in macrodactyly, a rare condition related to LPN, and in other localized lipomatous overgrowth syndromes. In this retrospective study, we report 6 cases of FPN involving the median nerve (4 of them identified among 570 patients with carpal tunnel syndrome who underwent surgical decompression at our center from 2012 to 2022 and two seen in consultation by one of the authors). All cases were diagnosed via biopsy or resection supplemented by MRI. Patients were 4 males and 2 females aged 23 to 60 years (mean 38 years). One patient with bilateral lesions had in addition extensive angiomatosis of the paravertebral region. Histological examination showed an abnormal amount of mature fatty tissue containing disordered fibrous bands, entrapping normal-looking nerve fibers with prominent perineurial and endoneurial fibrosis. Genetic analysis using snapshot assay constructed to detect hotspots mutations in PIK3CA revealed similar PIK3CA mutations (p.H1047R; c.3140A>G) in 5/6 cases (83.3%). Our study represents a further contribution to the literature on LPN and highlights the diagnostic value of PIK3CA mutation testing as surrogate tool in equivocal cases and in those lesions without associated macrodactyly, especially as the biopsy findings of this lesion are essentially nonspecific.

Venous malformations are one of the most common vascular anomalies. Our study aimed to investigate the effect of medical compression stockings of class I and II on the volume of venous malformations. Patients with venous malformations on upper or lower extremities were enrolled. They wore flat-knitted medical compression stockings of class I and II in a randomized order for four weeks each. Magnetic resonance imaging (MRI) and perometry were performed with and without wearing compression stockings. The 12-Item Short Form Survey (SF-12) questionnaire was performed before and after wearing compression stockings for four weeks each. A total of 18 patients completed the evaluations. Both compression classes showed a significant reduction of the volume of the venous malformations in the lesion itself based on MRI in comparison with baseline (both p < 0.001). Measurements taken with perometry did not reveal a significant difference in comparison to baseline (p = 0.09 and p = 0.22). The results of the SF-12 questionnaire demonstrated no significant differences before and after wearing the compression stockings of class I or class II for four weeks or between the two classes of compression therapy. Our results indicate that wearing medical compression stockings of both class I and class II significantly reduces the volume of venous malformation, without compromising the quality of life, while the effect of class II compression stockings on volume reduction was significantly better than that of class I.

Focal cartilage lesions are common pathologies at the knee joint that are considered important risk factors for the premature development of osteoarthritis. A wide range of surgical options, including but not limited to marrow stimulation, osteochondral auto- and allografting, and autologous chondrocyte implantation, allows for targeted treatment of focal cartilage defects. Arthroscopy is the standard of reference for the assessment of cartilage integrity and quality before and after repair. However, deep cartilage layers, intrachondral composition, and the subchondral bone are only partially or not at all visualized with arthroscopy. In contrast, magnetic resonance imaging offers noninvasive evaluation of the cartilage repair site, the subchondral bone, and the soft tissues of the joint pre- and postsurgery. Radiologists need to be familiar with the different surgical procedures available and their characteristic postsurgical imaging appearances to assess treatment success and possible complications adequately. We provide an overview of the most commonly performed surgical procedures for cartilage repair at the knee and typical postsurgical imaging characteristics.

Despite being noninvasive and painless, MRI is recurrently associated with stress and anxiety in patients. This adversely affects patient experience and may be associated with negative outcomes for the health care provider. This study examined the psychological and physiological response of patients to MRI and how these response levels relate, the role of different potentially influencing factors, and the relation to procedural outcomes.Data of 96 patients (mean 48.77 ± 15.11 years; 61.5% female) were included. The patients' psychological or physiological response was assessed before and after MRI via questionnaires on anxiety, strain, agitation, and mood and salivary α-amylase, and cortisol. Data on potentially influencing factors and outcomes of the clinical workflow were collected via questionnaires.We observed significant improvements of all psychological measures from pre- to post-MRI (all P.001) but not of the physiological stress markers (all P.258). The psychological response correlated with levels of cortisol but not α-amylase. The valence of previous MRI experiences was particularly predictive of the patients' reaction. Stress and anxiety in patients significantly predicted the probability of scan repetitions (Nagelkerke's RThese findings imply that various factors contribute to the patients' response to MRI. Stress and anxiety in patients, in turn, may impact the clinical workflow. Therefore, these factors should be considered in the medical treatment to provide both a positive patient experience and smooth clinical workflows.

Objective We aimed to further improve knowledge about volar plate (VP) motion of the finger proximal interphalangeal joint (PIP), by analyzing the dynamic VP shape during a full range of finger flexion using magnetic resonance cinematography of the fingers (MRCF), and to compare the results with anatomical cross sections from cadaver specimens. Materials and methods The dynamic sagittal VP shape was visualized with MRCF in a total number of 23 healthy volunteers. The length, angle, and thickness as well as the contact length of the VP to the PIP joint base were measured. Statistical analysis included t-test or rank-sum testing. Anatomical cross sections with differing degrees of PIP joint flexion were obtained from 12 cadaver specimens (fingers) for comparison. Results Significant positive correlations between PIP joint flexion angle and VP area, length, depth and the VP contact length were found. This matched histologically to fiber rearrangements especially within the loose third VP layer. Conclusion Our study analyzed the full range of motion dynamic VP shape of the PIP joint using MRCF. This contributes to a more precise understanding of the complex interaction of the VP with the PIP joint and may facilitate evaluation of clinical cases such as VP avulsion or pulley rupture.

Background: Alteration in kidney perfusion is an early marker of renal damage. The purpose of this study was to evaluate if changes in renal blood flow (RBF) could be detected using MRI with arterial spin labeling (ASL) technique. Methods: RBF as assessed by cortical (CRBF), medullary, and total renal blood flow (TRBF) were measured by MRI with arterial spin labeling (ASL-MRI) using flow-sensitive alternating inversion recovery true fast imaging with steady-state precession sequence. In 11 normotensive healthy individuals (NT) and 11 hypertensive patients (HT), RBF was measured at baseline and after both feet were covered with cold ice packs (cold pressor test) that activates the sympathetic nervous system. In another experiment, RBF was measured in 10 patients with CKD before and after a pharmacological intervention. We compared RBF measurements between the 3 study populations. Results: A significant reduction in CRBF (p = 0.042) and a trend in TRBF (p = 0.053) were observed in response to the activation of the sympathetic nervous system. A trend toward reduction of CRBF (p = 0.051) and TRBF (p = 0.059) has been detected after pharmacological intervention. TRBF was significantly lower in patients with HT and CKD patients compared to NT individuals (NT vs. HT, p = 0.014; NT vs. CKD, p = 0.004). TRBF was lower in patients with CKD compared to HT (p = 0.047). Conclusion: Our data indicate that both acute and short-term changes in RBF could be detected using ASL-MRI. We were able to detect differences in RBF between healthy and diseased individuals by needing only small sample size per group. Thus, ASL-MRI offers an advantage in conducting clinical trials compared to other technologies.

Purpose To share our experiences in implementing a dedicated magnetic resonance (MR) scanner for radiotherapy (RT) treatment planning using a novel coil setup for brain imaging in treatment position as well as to present developed core protocols with sequences specifically tuned for brain and prostate RT treatment planning. Materials and methods Our novel setup consists of two large 18-channel flexible coils and a specifically designed wooden mask holder mounted on a flat tabletop overlay, which allows patients to be measured in treatment position with mask immobilization. The signal-to-noise ratio (SNR) of this setup was compared to the vendor-provided flexible coil RT setup and the standard setup for diagnostic radiology. The occurrence of motion artifacts was quantified. To develop magnetic resonance imaging (MRI) protocols, we formulated site- and disease-specific clinical objectives. Results Our novel setup showed mean SNR of 163 ± 28 anteriorly, 104 ± 23 centrally, and 78 ± 14 posteriorly compared to 84 ± 8 and 102 ± 22 anteriorly, 68 ± 6 and 95 ± 20 centrally, and 56 ± 7 and 119 ± 23 posteriorly for the vendor-provided and diagnostic setup, respectively. All differences were significant (p > 0.05). Image quality of our novel setup was judged suitable for contouring by expert-based assessment. Motion artifacts were found in 8/60 patients in the diagnostic setup, whereas none were found for patients in the RT setup. Site-specific core protocols were designed to minimize distortions while optimizing tissue contrast and 3D resolution according to indication-specific objectives. Conclusion We present a novel setup for high-quality imaging in treatment position that allows use of several immobilization systems enabling MR-only workflows, which could reduce unnecessary dose and registration inaccuracies.

This study aimed to develop a tool for the classification of masses in breast MRI, based on ultrafast TWIST-VIBE Dixon (TVD) dynamic sequences combined with DWI. TVD sequences allow to abbreviate breast MRI protocols, but provide kinetic information only on the contrast wash-in, and because of the lack of the wash-out kinetics, their diagnostic value might be hampered. A special focus of this study was thus to maintain high diagnostic accuracy in lesion classification. Sixty-one patients who received breast MRI between 02/2014 and 04/2015 were included, with 83 reported lesions (60 malignant). Our institute’s standard breast MRI protocol was complemented by an ultrafast TVD sequence. ADC and peak enhancement of the TVD sequences were integrated into a generalised linear model (GLM) for malignancy prediction. For comparison, a second GLM was calculated using ADC and conventional DCE curve type. The resulting GLMs were evaluated for standard diagnostic parameters. For easy application of the GLMs, nomograms were created. The GLM based on peak enhancement of the TVD and ADC was as equally accurate as the GLM based on conventional DCE and ADC, with no significant differences (sensitivity, 93.3%/93.3%; specificity, 91.3%/87.0%; PPV, 96.6%/94.9%; NPV, 84.0%/83.3%; all, p ≥ 0.315). This study presents a method to integrate ultrafast TVD sequences into a breast MRI protocol, allowing a reduction of the examination time while maintaining diagnostic accuracy. A GLM based on the combination of TVD-derived peak enhancement and ADC provides high diagnostic accuracy, and can be easily applied using a nomogram. • Ultrafast TWIST-VIBE Dixon sequence protocols in combination with diffusion-weighted imaging allow to shorten breast MRI examinations, while diagnostic accuracy is maintained. • Integrating peak enhancement from the TWIST-VIBE Dixon sequence and the apparent diffusion coefficient into a generalised linear model provides a comprehensible image evaluation approach. • This approach is further facilitated by nomograms.

Purpose Dynamic contrast-enhanced ultrasound (DCE-US) was used to monitor early response to sorafenib therapy in patients with liver metastases from uveal melanoma. Methods In total, 21 patients with liver metastases were recruited within a prospective trial and underwent daily sorafenib therapy. DCE-US of a target lesion was performed before initiation of treatment, on day 15 and 56. Two independent blinded investigators performed software analysis for DCE-US parameters and inter-observer-correlation was calculated. Response to treatment was evaluated on day 56. DCE-US parameters were correlated with clinical response and RECIST1.1 criteria. Results Inter-observer-correlation (r) of DCE-US parameters [time-to-peak (TTP), mean-transit-time (MTT), peak intensity (PI), regional blood volume (RBV), regional blood flow (RBF)] at baseline, day 15, and day 56 was highly significant (r-range 0.73–0.97, all p p = 0.034) and at day 56 for both investigators (p = 0.028/0.028). MTT had increased significantly in the cRE group on day 56 (p = 0.037/0.022). In the cNR group changes for TTP and MTT remained insignificant. Thus, increase of the DCE-US parameters TTP and MTT are associated with response to treatment and prognosis. Conclusion An increase of TTP and MTT at frequent intervals could serve as a surrogate marker for early response evaluation to anti-angiogenic treatment of metastatic uveal melanoma.

In MR-based radiotherapy (RT), MRI images are co-registered to the planning CT to leverage MR image information for RT planning. Especially in brain stereotactic RT, where typical CTV-PTV margins are 1-2 mm, high registration accuracy is critical. Several factors influence the registration accuracy, including the acquisition setup during MR simulation and the registration methods.In this work, the impact of the MRI acquisition setup and registration method was evaluated in the context of brain RT, both geometrically and dosimetrically.MRI of 20 brain radiotherapy patients was acquired in two MRI acquisition setups (RT and diagnostic). Three different automatic registration tools provided by three treatment planning systems were used to rigidly register both MRIs and CT in addition to the clinical registration. Segmentation-based evaluation using Hausdorff Distance (HD)/Dice Similarity Coefficient and landmark-based evaluation were used as evaluation metrics. Dose-volume-histograms were evaluated for target volumes and various organs at risks.MRI acquisition in the RT setup provided a similar head extension as compared to the planning CT. The registration method had a more significant influence than the acquisition setup (Wilcoxon signed-rank test, p0.05). When registering using a less optimal registration method, the RT setup improved the registration accuracy compared to the diagnostic setup (Difference: ΔMHD = 0.16 mm, ΔHDBoth MRI acquisition setup and registration method influence the MRI-CT registration accuracy in brain RT patients geometrically and dosimetrically. MR-simulation in the RT setup assures optimal registration accuracy if automatic registration is impaired, and therefore recommended for brain RT.

Objectives Contrast-enhanced (CE) magnetic resonance imaging (MRI) is the most effective imaging modality for breast cancer detection. A contrast agent-free examination technique would be desirable for breast MRI screening. The purpose of this study was to evaluate the capability to detect and characterize suspicious breast lesions with an abbreviated, non-contrast-enhanced MRI protocol featuring ultra-high b-value diffusion-weighted imaging (DWI) compared with CE images. Materials and methods The institutional review board-approved prospective study included 127 female subjects with different clinical indications for breast MRI. Magnetic resonance imaging examinations included DWI sequences with b-values of 1500 s/mm2 (b1500) and 2500 s/mm2 (b2500), native T1- and T2-weighted images, and CE sequences at 1.5 T and 3 T scanners. Two reading rounds were performed, including either the b1500 or the b2500 DWI in consecutive assessment steps: (A) maximum intensity projections (MIPs) of DWI, (B) DWI and apparent diffusion coefficient maps, (C) as (B) but with additional native T1- and T2-weighted images, and (D) as (C) but with additional CE images (full-length protocol). Two readers independently determined the presence of a suspicious lesion. Histological confirmation was obtained for conspicuous lesions, whereas the full MRI data set was obtained for inconspicuous and clearly benign lesions. Statistical analysis included calculation of diagnostic accuracy and interrater agreement via the intraclass correlation coefficient. Results The cohort comprised 116 cases with BI-RADS 1 findings and 138 cases with BI-RADS ≥2 findings, including 38 histologically confirmed malignancies. For (A), breasts without pathological findings could be recognized with high diagnostic accuracy (negative predictive value, ≥97.0%; sensitivity, ≥92.1% for both readers), but with a limited specificity (≥58.3%; positive predictive value, ≥28.6%). Within the native readings, approach (C) with b2500 performed best (negative predictive value, 99.5%; sensitivity, 97.4%; specificity, 88.4%). The intraclass correlation coefficient was between 0.683 (MIP b1500) and 0.996 (full protocol). Conclusions A native abbreviated breast MRI protocol with advanced high b-value DWI might allow nearly equivalent diagnostic accuracy as CE breast MRI and seems to be well suited for lesion detection purposes.

The aim of this study was to evaluate 7 Tesla (7T) magnetic resonance imaging (MRI) for direct visualization and specific characterization of the finger flexor pulleys A2, A3, and A4 before and after ex vivo pulley rupture. Thirty fingers of human cadavers were examined before and after pulley disruption with a 26 min clinical 7T pulse sequence protocol. Images were assessed by two experienced radiologists for the presence of pulley rupture. Injury characterization included definition of rupture location, morphology, and complications. Image quality was evaluated according to a 4-point Likert-type scale from “not evaluable” to “excellent”. Macroscopic preparations were used as the reference standard. Direct characterization of intact A2, A3, and A4 pulleys and the corresponding pulley lesions was possible in all cases. The rupture location was distributed equally at the radial, ulnar, and central parts of the pulleys. A dislocation and intercalation of the pulley stump between the flexor tendon and finger phalanges was observed as a complication in 62.5% of cases. The average Likert score for direct visualization of pulleys was 2.67 before rupture and 2.79 after rupture creation, demonstrating adequate image quality for routine application. 7T MRI enables a direct characterization of A2, A3, and A4 pulleys before and after artificial disruption, including the definition of rupture morphology and location as well as the detection of rupture complications. This promises a precise presurgical evaluation of pulley injuries and complicated pulley stump dislocations.

BACKGROUND AND PURPOSE: The high diagnostic value of DWI for cholesteatoma diagnostics is undisputed. This study compares the diagnostic value of readout-segmented echo-planar DWI and single-shot TSE DWI for cholesteatoma diagnostics. MATERIALS AND METHODS: Thirty patients with newly suspected cholesteatoma were examined with a dedicated protocol, including readout-segmented echo-planar DWI and single-shot TSE DWI at 1.5T. Acquisition parameters of both diffusion-weighted sequences were as follows: b=1000 s/mm,(2) axial and coronal section orientations, and section thickness of 3 mm. Image quality was evaluated by 2 readers on a 5-point Likert scale with respect to lesion conspicuity, the presence of susceptibility artifacts mimicking cholesteatomas, and overall subjective image quality. Sensitivity and specificity were calculated using histology results as the gold standard. RESULTS: Twenty-five cases of histologically confirmed cholesteatomas were included in the study group. Lesion conspicuity was higher and fewer artifacts were found when using TSE DWI (both P

Background Diffusion weighted magnetic resonance imaging (DWI) is known to differentiate between malignant and benign lesions via the apparent diffusion coefficient (ADC). Here, the value of diffusion kurtosis imaging (DKI) for differentiation and further characterization of benign and malignant breast lesions and their subtypes in a clinically feasible protocol is investigated. Material and methods This study included 85 patients (with 68 malignant and 73 benign lesions) who underwent 3 T breast DWI using three b values (50, 750, 1500 s/mm2), with a total measurement time Results ADC, DK and K showed significant differences between malignant and benign lesions (p Conclusion DKI parameters and conventional ADC can differentiate between malignant and benign lesions. Differentiation performance was best for ADC. Different tumor grades were significantly different in ADC and DK, which may have an impact on therapy planning and monitoring. In our study, K did not add value to the diagnostic performance of DWI in a clinical setting.

Surfing is becoming increasingly popular, and the economic market for surfing products is growing. The performance of the surfboards and the fins has evolved continuously through the experience and innovative spirit of surfers and shapers. However, provided performance characteristics are only subjective and of descriptive nature. Therefore, we apply and analyze objective performance indicators as (1) lift and drag coefficient for each fin and the entire configuration and (2) lift-to-drag ratio for the entire fin configuration. This numerical study investigated a commercial 3-fin configuration, mounted into a rectangular simulation region, considering the flow at several different angles of attack between 0°and 45°. RANS and URANS simulations were performed with the SST k − ω turbulence model at an inflow velocity of 5 m/s. Simulation results showed that the fins have an optimal range of attack angles where they produce the most lift. The lift forces generate a turning moment which forces the board to be turned in direction to the shore favoring the controllability and stability of the surfboard. The higher the angle of attack, the higher is the drag coefficient. Lift-to-drag ratio values showed that for speeding up small attack angles with low drag forces are preferable. Furthermore, unsteady effects as flow separation combined with vortex shedding occur at high angles of attack above 20°which can only be resolved by URANS simulations. These unsteady effects have high negative influences on stability due to high fluctuation amplitudes for lift and drag forces. In summary, this study presents, to the best of the authors’ knowledge, for the first time, steady and unsteady forces on surfboard fins and discusses their potential influences on the surfer’s controllability and stability of the surfboard during typical surfing maneuvers.

Objective.Rheumatoid arthritis (RA) is associated with damage of the articular cartilage and the periarticular bone. While imaging of bone damage has substantially improved in recent years, direct imaging of the articular cartilage of the hand joints in patients with RA is still challenging. The study used T2 mapping of the finger joints to assess cartilage damage in RA.Methods.Magnetic resonance imaging (MRI) at 3 Tesla was done in 30 patients with RA, and T2 relaxation times visualizing alteration in the collagen network and hydration of articular cartilage were mapped in 6 cartilage regions of the metacarpophalangeal (MCP) joints 2 and 3. Values were related to autoantibody status [anticitrullinated protein antibodies (ACPA), rheumatoid factor (RF)], disease duration, and disease activity as well as sex and age of the patients.Results.T2 relaxation times could be reliably measured in the 6 regions of the MCP joints. Significantly higher relaxation times indicating more advanced cartilage alterations were observed in the metacarpal heads of ACPA-positive (p = 0.001–0.010) and RF-positive patients (p = 0.013–0.025) as well as those with longer disease duration (> 3 yrs; p = 0.028–0.043). Current disease activity, sex, and age did not influence T2 relaxation times.Conclusion.These data show that cartilage damage can be localized and quantified in the hand joints of patients with RA by T2 mapping. Further, ACPA and RF positivity as well as disease duration appear to be the crucial factors influencing cartilage damage.

OBJECTIVES Comparison of the diagnostic value of simultaneous multislice (SMS) accelerated diffusion-weighted echo planar imaging (EPI) of malignant and benign lesions of the breast compared with a reference EPI sequence. MATERIALS AND METHODS The study was approved by the institutional ethics committee. Sixty-eight patients were examined with a diffusion-weighted EPI (reference EPI; TE = 54 milliseconds; TR = 9000 milliseconds; TA, 3:27 minutes) and a diffusion-weighted SMS accelerated EPI (SMS EPI; acceleration factor 2; TE = 58 milliseconds; TR = 4300 milliseconds; TA, 1:53 minutes) in addition to the standard magnetic resonance imaging (MRI) protocol. Further acquisition parameters were as follows: 3 T MAGNETOM Skyra (Siemens Healthcare, Erlangen, Germany), 2.5-mm isotropic resolution, field of view = 185 to 190 × 350 mm, 62 slices, b = 50 and 800 s/mm with 1 and 4 averages, respectively. A dedicated 16-channel bilateral breast coil was used for imaging. Image quality was evaluated with respect to the presence of artifacts, signal voids, and quality of fat suppression. These parameters were rated using a 5-point Likert scale (1 = very strong to 5 = negligible). The apparent diffusion coefficient (ADC) was measured in 72 focal lesions (46 breast carcinomas and 26 benign lesions), and the diagnostic value of the 2 datasets was statistically evaluated and compared. The evaluation was performed a second time excluding cysts. RESULTS Artifacts and signal voids were negligible in both sequences (mean on Likert scale for reference EPI 4.68 vs SMS EPI 4.65, P = 0.52, and mean on Likert scale for reference EPI 4.85 vs SMS EPI 4.77, P = 0.14). Fat suppression was significantly better in SMS EPI (mean on Likert scale 3.28 vs 2.97, P < 0.001, Pearson r = 0.49). For benign lesions, the mean ADC in both EPI sequences was 1.86 · 10 mm/s. For malignant lesions, a mean ADC of 0.90 · 10 mm/s for the reference EPI and 0.89 · 10 mm/s for the SMS EPI was found. No significant difference between the EPI sequences was observed for ADC values (P = 0.75) and for the area under the curve (SMS, 0.985; no SMS, 0.975). The cutoff for differentiation of benign and malignant lesions was at ADC = 1.42 · 10 mm/s for SMS EPI (sensitivity, 1; specificity, 0.88) and at 1.23 · 10 mm/s for the reference EPI (sensitivity, 1; specificity, 0.92). Excluding the cysts, the cutoff for differentiation of benign and malignant lesions was at ADC = 1.11 · 10 mm/s for SMS EPI (sensitivity, 0.89; specificity, 0.93) and at 1.23 · 10 mm/s for the reference EPI (sensitivity, 1; specificity, 0.87). CONCLUSIONS Our data indicate that SMS acceleration can be used for diffusion imaging in breast MRI in clinical practice. Simultaneous multislice EPI achieved the same diagnostic accuracy in breast MRI, but in a substantially reduced scan time.

Die Knorpeldiagnostik der kleinen Gelenke gewinnt zunehmend an klinischer Beachtung, da eine fruhzeitige Erkennung von Knorpelschaden wichtig fur die optimale Therapieplanung ist. Ziel dieser Ubersichtsarbeit ist ein Update bezuglich moderner Knorpelbildung von kleinen Gelenken mit Betonung der MRT und Diskussion von Spezialuntersuchungen mittels CT-Arthrographie, der kompositionellen und der Hochfeld-MR-Bildgebung. Es erfolgte eine PubMed-Literaturrecherche fur den Zeitraum 2008–2018. Die Darstellung chondraler Defekte an kleinen Gelenken stellt weiterhin eine Herausforderung dar. Die konventionelle MRT bei 3 T kann in der klinischen Routine weiterhin als Referenz in der Knorpelbildgebung angesehen werden. Hinsichtlich der Sensitivitat ist die MR-Arthrographie (MR-A) und computertomographische Arthrographie (CT-A) der nativen MRT bei 1,5 T in der Detektion chondraler Defekte uberlegen. Fortgeschrittene degenerative Veranderungen der Finger und Zehen werden meist ausreichend mittels konventioneller Rontgendiagnostik detektiert. MRT bei 3 T oder bei 7 T konnen neben der rein morphologischen Information auch quantifizierbare, funktionelle und metabolische Informationen liefern. Eine standardisierte Knorpelbildgebung spielt am oberen Sprunggelenk aufgrund der Verfugbarkeit unterschiedlicher therapeutischer Konzepte eine wichtige Rolle in der klinischen Diagnostik. Im Gegensatz dazu erfolgt die schnittbildbasierte Knorpelbildgebung der ubrigen kleinen Gelenke aktuell meist im Rahmen klinischer Studien und ist im klinischen Alltag bisher kaum etabliert. Hinsichtlich der Anwendung neuer Verfahren sind weiterfuhrende Studien mit groseren Patientenkollektiven notwendig. Der radiologischen Diagnostik wird im Zusammenhang mit zunehmender Etablierung neuer Therapiekonzepte eine noch bedeutsamere Rolle in der Diagnostik von Knorpellasionen kleiner Gelenke zukommen.

Mineralocorticoid receptor antagonists have beneficial effects on left ventricular remodeling, cardiac fibrosis, and arrhythmia in heart failure, but efficacy and safety in dialysis patients is less clear. We evaluated the effect of spironolactone on left ventricular mass (LVM), an independent predictor of all-cause and cardiovascular mortality, in hemodialysis patients. In this placebo-controlled, parallel-group trial, 97 hemodialysis patients (23% female; mean age 60.3 years) were randomized to spironolactone 50 mg once daily (n=50) or placebo (n=47). The primary efficacy endpoint was change in LVM index (LVMi) from baseline to 40 weeks as determined by cardiac magnetic resonance imaging. Safety endpoints were development of hyperkalemia and change in residual renal function. There was no significant change in LVMi in participants randomized to spironolactone compared to placebo (-2.86±11.87 vs. 0.41±10.84 g/m2). There was also no difference in the secondary outcomes of mean 24-hour systolic or diastolic ambulatory blood pressure, left ventricular ejection fraction, 6-minute walk test distance, or New York Heart Association functional class. Moderate hyperkalemia (pre-dialysis potassium levels of 6.0-6.5 mmol/L) was more frequent with spironolactone treatment (155 vs. 80 events), but severe hyperkalemia (≥6.5 mmol/L) was not (14 vs. 24 events). Changes in residual urine volume and measured glomerular filtration rate did not differ between groups. There were no deaths in the spironolactone group and 4 deaths in the placebo group. Thus, treatment with 50 mg spironolactone did not change left ventricular mass index, cardiac function, or blood pressure in hemodialysis patients. Spironolactone increased the frequency of moderate hyperkalemia, but did not increase severe hyperkalemia.

Kidney international / Reports 4(2), 267-274 (2019). doi:10.1016/j.ekir.2018.10.004, Published by Elsevier, Amsterdam

Purpose The study aims to detect regions at risk for (pre-)osteoarthritis in the tibiofemoral joint of young professional soccer players by evaluating cartilage composition by T2 mapping in a 3 T magnetic resonance imaging setting. Methods In this longitudinal study, 20 professional adolescent soccer players were included. Tibiofemoral cartilage was assessed by quantitative T2 mapping and T2 values were evaluated by regions of interest analysis. Statistical evaluation, using Wilcoxon signed-rank tests, was performed to compare global T2 values and subregional T2 values between a baseline and a follow-up investigation 4.3 years later. Based on the average of playing time (15 years) we divided the cohort in 2 groups and differences were evaluated. Results When comparing baseline and follow-up, our findings showed statistically significant increases of the global medial tibial and femoral T2 values. The most noticeable results of the subregional T2 analysis were statistically significant increases in the medial posterior zones (deep femoral 36.1 vs. 39.5, P = 0.001; superficial femoral 57.0 vs. 62.4, P = 0.034; deep tibial 28.3 vs. 34.1, P = 0.009; superficial tibial 43.2 vs. 55.3, P = 0.002). Conclusion The elevation of T2 values in the medial, especially medial posterior, compartment of the knee joint indicates that these regions are at risk for early cartilage degeneration already at the time of adolescence. The findings can help individualize and optimize training concepts and to be aware of the chronic stress on these vulnerable areas. Prevention programs should be established in young players to avoid further cartilage damage.