Clinical Hemorheology and Microcirculation - Volume 67, issue 3-4

Authors: Beyer, L.P. | Pregler, B. | Verloh, N. | Brünn, K. | Haimerl, M. | Stroszczynski, C. | Jung, E.M. | Wiggermann, P.

Article Type: Research Article

Abstract: OBJECTIVES: Irreversible electroporation (IRE) is a novel focal ablation technique applicable for treatment of prostate cancer (PCa). We aim to evaluate imaging findings of T1-weighted contrast-enhanced MRI after percutaneous IRE of low-risk PCa. METHODS: A total of 13 male patients underwent IRE of focal low-risk PCa and were included in this analysis. Prostate IRE was conducted using 2–4 electrodes being placed under CT-fluoroscopy guidance. Dynamic contrast-enhanced 3D isotropic fat-saturated T1-weighted MRI (DCE-MRI) was performed 24–72 hours before and 24–72 hours after ablation. RESULTS: Ablated prostate was either homogeneously (8/13 [62%]) or heterogeneously (5/13 [38%]) hypo attenuating. …Peripheral contrast enhancement manifesting as a hyper attenuating margin was observed during the arterial (60 sec) (3/13 [23%]) and venous (240 sec) (10/13 [77%]) phase. The ablation defect showed a sharp (8/13 [62%]) or blurry (5/13 [38%]) margin. CONCLUSIONS: The results show a venous peripheral rim enhancement in most of the cases, indicating reactive hyperaemia. The heterogeneous appearance of the defect zone in some cases may be secondary to sustained vascularization. Show more

Keywords: MRI, irreversible electroporation (IRE), prostate cancer, imaging findings

DOI: 10.3233/CH-179220

Citation: Clinical Hemorheology and Microcirculation, vol. 67, no. 3-4, pp. 399-405, 2017

Authors: Mueller-Peltzer, K. | Rübenthaler, J. | Fischereder, M. | Habicht, A. | Reiser, M. | Clevert, D.-A.

Article Type: Research Article

Abstract: BACKGROUND: Vascular complications in renal transplant patients are a well-known issue in post transplant patient care. If malfunctioning of the renal transplant is suspected to be caused by vascular complications an early diagnosis and therapy is required to maintain the renal transplant. Computed tomography (CT), digital substraction angiography (DSA) and radioisotope renography are the gold standard imaging modalities to diagnose vascular complications. OBJECTIVE: To analyse the sensitivity and specificity of contrast-enhanced ultrasound (CEUS) in comparison to the standard imaging modalities CT, DSA and radioisotope renography in the diagnosis of vascular complications in renal transplant patients. Methods: …A total of 33 renal transplant recipients with elevated kidney function parameters with initial diagnostic imaging between 2006 and 2017 were included in the study. The imaging studies and clinical data were analysed retrospectively. The diagnostic accuracy of CEUS was compared to CT, DSA and renal scintigraphy respectively which are classified as gold standard for diagnosis of vascular complications in renal transplant patients. Out of 23 patients 15 patients showed vascular complications in CT, DSA or radioisotope renography and in 15 out of 15 patients CEUS detected the vascular complication. RESULTS: CEUS showed a sensitivity of 100%, a specificity of 66.7%, a positive predictive value (PPV) of 71.4%, and a negative predictive value (NPV) of 100%. CONCLUSIONS: CEUS is a non-nephrotoxic and safe method for the initial imaging of vascular complications in renal transplant recipients. Compared to the gold standard imaging modalities CT, DSA and radioisotope renography CEUS shows a high sensitivity and NPV in detecting vascular complications. In cases with suspected stenosis of the transplant renal artery additional DSA might be needed. Show more

Keywords: Contrast-enhanced ultrasound, CEUS, CT, DSA, renal transplant, vascular complications

DOI: 10.3233/CH-179221

Citation: Clinical Hemorheology and Microcirculation, vol. 67, no. 3-4, pp. 407-413, 2017

Authors: Putz, Franz Josef | Hautmann, Matthias G. | Banas, Miriam C. | Jung, Ernst Michael

Article Type: Research Article

Abstract: BACKGROUND: The plantar fasciitis is a common disease with a high prevalence in public and a frequent cause of heel pain. OBJECTIVE: In our pilot study, we wanted to characterise the feasibility of shear-wave elastography and contrast-enhanced ultrasound (CEUS) in the assessment of the plantar fasciitis. METHODS: 23 cases of painful heels were examined by B-Mode ultrasound, Power Doppler (PD), shear wave elastography and contrast-enhanced ultrasound before anti-inflammatory radiation. Time-intensity-curves were analysed by the integrated software. The results for area-under-the-curve (AUC), peak, time-to-peak (TTP) and mean-transit-time (MTT) were compared between the plantar fascia and the surrounding …tissue. RESULTS: All cases showed thickening of the plantar fascia, in most cases with interstitial oedema (87.0%). Shear wave elastography showed inhomogeneous stiffness of the plantar fascia. 83.3% of cases showed a visible hyperperfusion in CEUS at the proximal plantar fascia in comparison to the surrounding tissue. This hyperperfusion could also be found in 75.0% of cases with no signs of vascularisation in PD. AUC (p  = 0.0005) and peak (p  = 0.037) were significantely higher in the plantar fascia than in the surrounding tissue. CONCLUSION: CEUS and shear wave elastography are new diagnostic tools in the assessment of plantar fasciitis and can provide quantitative parameters for monitoring therapy. Show more

Keywords: CEUS, plantar fasciitis, shear wave elastography, TIC-Analysis

DOI: 10.3233/CH-179222

Citation: Clinical Hemorheology and Microcirculation, vol. 67, no. 3-4, pp. 415-423, 2017

Authors: Zengel, Pamela | Notter, Florian | Reichel, Christoph A. | Clevert, Dirk A.

Article Type: Research Article

Abstract: BACKGROUND: It is difficult to assess tumors of the parotid gland preoperatively. However, it is essential for the surgeon to know which kind of tumor is present. Ultrasound is the method of choice, but there is still no reliable differential diagnostic tool for determining whether a tumor is malignant or benign. OBJECTIVE: The aim of our study was to examine the value of Virtual Touch imaging quantification (VTIQ) elastograpy in distinguishing between malignant and benign tumors as well as in identifying the most common benign tumor types. METHODS: The parenchyma of 100 parotid glands and 12 …lymph nodes of healthy volunteers and 50 tumors of the parotid gland were analyzed via ultrasound, color Doppler ultrasound, and VTIQ, and the results were then compared with histopathology. RESULTS: In comparison with benign tumors, in malignant tumors the tumor border was diffuse, the perfusion higher, and the VTIQ quality much lower. Share wave velocity of the user-defined region of interest was more frequently higher than 6.8 m/s in malignant tumors in comparison to benign tumors. CONCLUSIONS: VTIQ in combination with ultrasound examination provides additional information for distinguishing between benign and malignant tumors and shows promise for integration into preexisting ultrasound protocols. Show more

Keywords: Parotid tumors, ultrasound, elastography, ARFI imaging, Virtual Touch IQ, pleomorphic adenoma

DOI: 10.3233/CH-179223

Citation: Clinical Hemorheology and Microcirculation, vol. 67, no. 3-4, pp. 425-434, 2017

Authors: Kehrer, Andreas | Mandlik, Veronika | Taeger, Christian | Geis, Sebastian | Prantl, Lukas | Jung, Ernst-Michael

Article Type: Research Article

Abstract: BACKGROUND AND OBJECTIVES: Facial paralysis causes excruciating impairments including facial asymmetry, limited eye closure, oral incontinence and social dysfunction. Modern plastic surgical reconstructions render favorable results with well-perfused dynamic muscle flaps. Post-operative tissue monitoring is a critical determinant for success. Contrast-enhanced Ultrasound (CEUS) and elastography have proven superior properties to evaluate tissue perfusion in various organs. We evaluated their role for functional muscle flaps positioned at the sub-skin level in facial palsy patients. METHODS: From 2016–2017 five patients received muscle flap reconstructions. Flaps included four free transplants and one pedicled transfer. Postoperatively tissue vitality and blood flow were …assessed with CEUS. One experienced examiner using linear probes (6–9, 6–15 MHz) and bolus injections of Sulphur-hexafluoride microbubbles evaluated tissue perfusion. Using the time intensity curve- (TIC)-analysis measurements were recorded for TTP (time to peak) and AUC (Area under curve). Tissue elasticity was assessed with ultrasound elastography. RESULTS: All flaps were successful and showed no major complications. TTP-values in flap tissue showed slightly decreased values of 35.12±33.99 s and 25.04±10.86 s compared to surrounding tissue with 19.88±6.94 s. AUC-analysis however revealed higher values of 292.25±169.52 RU and 274.51±115.88 RU than surrounding tissue with 150.90±40.21 RU. Elastography demonstrated predominantly elastic flap tissue whereas surrounding tissue confirmed a slightly harder tissue quality. CEUS in combination with elastography verified tissue vitality and blood flow in a safe and reproducible manner. CONCLUSIONS: Post-operative perfusion monitoring in muscle flaps positioned at a sub-skin level may be performed superiorly by CEUS and elastography in a quick, reproducible and minimally-invasive fashion. Show more

Keywords: Facial paralysis, functional muscle flaps, contrast-enhanced ultrasound (CEUS), elastography, tissue perfusion monitoring, blood flow

DOI: 10.3233/CH-179224

Citation: Clinical Hemorheology and Microcirculation, vol. 67, no. 3-4, pp. 435-444, 2017

Authors: Bruenn, K. | Beyer, L. | Haimerl, M. | Pregler, B. | Stroszczynski, C. | Jung, E.M. | Wiggermann, P.

Article Type: Research Article

Abstract: OBJECTIVE: To compare contrast-enhanced computed tomography (CT) and contrast-enhanced ultrasound (CEUS) for the quantitative evaluation of an ablation defect following radiofrequency ablation of malignant liver lesions in a prospective study. MATERIALS AND METHODS: 22 radiofrequency ablations of malignant liver tumors were performed. The ablation defects were then measured and evaluated by two independent examiners via contrast-enhanced computed tomography (CT) and contrast-enhanced ultrasound (CEUS) using a 1–5 MHz multifrequency convex ultrasound transducer (LOGIQ E9, GE) with respect to the short-axis diameter, the long-axis diameter, and the area. RESULTS: Quantitative evaluation of ablation defects is possible with both contrast-enhanced …CT and CEUS. The average long-axis diameter was 47.1 mm (±11.08;±23,5%) on CEUS and 56.48 mm (±14.14;±25,0%) on CT; the short-axis diameter was 39.72 mm (±11.14;±28,05%) on CEUS and 40.27 mm (±10.50;±26,07%) on CT; the area was 1439.82 mm2 (±678.57;±47,13%) on CEUS and 2392.68 mm2 (1147.67;±48,0%) on CT. On average, ablation defects are assessed to be larger on CT than on CEUS. A significant correlation between the modalities could not be achieved for all measurement axes. CONCLUSION: CEUS can be used for the postinterventional detection and evaluation of ablation defects. However, these are always assessed to be larger on contrast-enhanced CT than CEUS. Show more

Keywords: CEUS, CT, ablation, RFA, HCC

DOI: 10.3233/CH-179225

Citation: Clinical Hemorheology and Microcirculation, vol. 67, no. 3-4, pp. 445-451, 2017

Authors: Kauffmann, P. | Troeltzsch, M. | Cordesmeyer, R. | Heidekrueger, P.I. | Schliephake, H. | Canis, M. | Wolff, H.A. | Rave-Fraenk, M. | Stroebel, P. | Kehrer, A. | Prantl, L. | Aung, T.

Article Type: Research Article

Abstract: The chorioallantoic membrane of fertilized chicken eggs in an early phase of breeding presents an approved test situation for the growth and treatment of human cancer cells. These models work due to the inoculation of cells into the membrane that stays within the egg shell during the time of investigation. In this study a modification of this model is presented. Samples of native tumors, rather than cell lines, are transplanted into the membrane and the body of the egg is taken out of the shell and placed in a plastic bowl. These modifications lead to an enhanced accessibility to …the chorioallantoic membrane and the surrounding vessels thus facilitating intra venous access and application of pharmaceuticals and a focused radiotherapy. With the current modifications the embryo was kept alive and additionally, the vascularized tumor environment was preserved. Show more

DOI: 10.3233/CH-179226

Citation: Clinical Hemorheology and Microcirculation, vol. 67, no. 3-4, pp. 453-457, 2017

Authors: Heine, Norbert | Koch, Christoph | Brebant, Vanessa | Kehrer, Andreas | Anker, Alexandra | Prantl, Lukas

Article Type: Research Article

Abstract: BACKGROUND: Breast Carcinoma is the most common malign tumor disease in women. 20–30% of these tumors have to be treated by removing all of the breast tissue. After that kind of therapeutic procedure, most of the women are severely traumatized and ask for reconstruction. The goldstandard of breast reconstruction is the free perforator flap from the lower abdomen (DIEAP-flap), which can provide body-own tissue and natural shape for the reconstructed breast. Many studies evaluate the shape of the reconstructed breast but neglect the skin sensitivity. Claim of this study was to compare this important part of reconstruction on two different …techniques of mastectomy. OBJECTIVE: In this retrospective study we evaluated which technique of mastectomy and breast reconstruction with DIEAP-Flap offers the highest outcome for sensibility of the reconstructed breast. Skin sparing mastectomy was compared with conventional mastectomy and the results of skin sensitivity were measured. METHODS: Ten patients underwent breast reconstruction with free abdominal perforator flap between 2011 and 2015 after conventional mastectomy (CM) and were compared with ten patients, who had a skin sparing mastectomy (SSM) with immediate reconstruction by DIEAP-flap during the same time interval. These two groups were matched by age, height, weight and the time between reconstruction and examination. The sensitivity of the skin was measured by Semmes-Weinstein-Filaments in the strength beginning from 0,07 g till 300 g for deep sensation. The logarithmic profile of these measurements had been transferred into a continuous data system beginning from 1 point, which stands for no sensation, till 7 points for pressure threshold of 0,07 g. RESULTS: Patients who underwent DIEAP-reconstruction after skin sparing mastectomy showed a higher sensation at all regions of the new breast in comparison to reconstruction after conventional mastectomy, beginning from the nipple to the areola and the breast skin. The results in the CM-group were 1.0 points at the mamilla, 1.33 pts. at the areola and 1.78 pts. at the breast skin. In the SSM-group, the findings were 3 pts. at the mamilla, 3.25 pts. at the areola and 5.25 pts. at the breast skin. CONCLUSION: The skin sparing mastectomy combined with immediate reconstruction by DIEAP-flap provides an excellent therapeutic option for patients, who are suitable for this technique, which takes into account not only the form but also the sensitivity of the breast. Show more

Keywords: Breast reconstruction, DIEP, skin sensation, breast cancer, skin sparing mastectomy

DOI: 10.3233/CH-179227

Citation: Clinical Hemorheology and Microcirculation, vol. 67, no. 3-4, pp. 459-465, 2017

Authors: Daeschlein, Georg | Langner, Inga | Wild, Thomas | von Podewils, Sebastian | Sicher, Claudia | Kiefer, Thomas | Jünger, Michael

Article Type: Research Article

Abstract: Monitoring of perfusion is a cornerstone in surgery, phlebology and basic science to proof wound healing by interventions. In chronic wound management it is of utmost importance to realize and parametrize wound bed perfusion to verify actual, and plan further treatment by noninvasive diagnostics. Up to now monitoring is based on visual inspection of wounds as conventionally practiced over more than decades. The main problems of visual inspection are the lack of standardization and comparability because of interindividual variations. Therefore technical performance with contact free probes based on standardized perfusion measuring is strongly needed. Hyperspectral imaging (HSI) was investigated to …overcome manual and visual wound inspection in monitoring of wound healing. HSI works noninvasive, and imaging of relevant perfusion parameters is possible without the need of contrast enhancing drugs. METHODS: HSI technology uses imaging spectroscopic analysis in visual and near infrared spectrum to get information on imaged tissue in less than 10 s. Tissue is radiated by broad spectrum light and the following parameters are calculated from remitted spectra: the grade of oxygenation and the volume proportion of hemoglobin (in superficial and also deeper (8 mm) tissues. The calculated data comprise the “Tissue hemoglobin oxygen saturation” (StO2 ) as percental oxygenation index to assess superficial perfusion (VIS-spectrum), the “Near infrared perfusion” (NIR) to assess deeper perfusion (near infrared spectrum) and the “Tissue hemoglobin index” (THI) to measure the percental volume of hemoglobin of surface perfusion (VIS-spectrum). The measurements of these parameters are calculated as false color-coded perfusion results on screen. We investigated different kind of wounds (combustion, infection, ulcer wounds, wounds in immune disorders, trauma wounds) determining superficial and deeper oxygen saturation, hemoglobin distribution and water content using hyperspectral imaging with TIVITA™ Tissue system. RESULTS: Hyperspectral Imaging allowed easy real time determination and visualization of hemodynamically relevant parameters- superficial and deeper oxygen saturation, total hemoglobin and tissue water content. In the patient with scleroderma, acral lesions with decreased perfusion correlated well with necrotic skin aspects. HSI clearly revealed macroscopic conspicuous suture wounds after Dupuytren surgery, infected soft tissue wounds with strong inflammatory hyperemia, edema in burn injuries, spatial geometry of abscess formation and chronic ulcer wounds. All measurements influenced further surveillance decisions. Hyperspectral imaging seems suitable for routine diagnostics and monitoring of skin and soft tissue lesions like acute and chronic wounds. It allows surveillance of postoperative suture wounds and burn wounds. Special indications may be transplant surveillance and monitoring of therapeutical interventions. Show more

Keywords: Hemodynamic alteration, microcirculation, oxygen saturation, wound healing, wound medicine

DOI: 10.3233/CH-179228

Citation: Clinical Hemorheology and Microcirculation, vol. 67, no. 3-4, pp. 467-474, 2017

Authors: Braun, Diana | Dietze, Stefanie | Pahlitzsch, Tamara M.J. | Wennysia, Inggrid C. | Persson, Pontus B. | Ludwig, Marion | Patzak, Andreas

Article Type: Research Article

Abstract: BACKGROUND: Descending vasa recta (DVR) supply the inner part of outer renal medulla an area at risk for hypoxic damages. OBJECTIVE: We hypothesize increased vasoreactivity after hypoxia/re-oxygenation (H/R) in DVR, which might contribute to the reduced medullary perfusion after an ischemic event. METHODS: Live kidney slices (200μ m) from SD rats were used for functional experiments. TUNEL assay and H&E staining were used to estimate slice viability. Kidney slices were treated with carbogen or hypoxia (1% O2 ) for 60 or 90 min and vasoreactivity to Ang II (10–7 M) was recorded by DIC microscopy after …re-oxygenation with carbogen. Expression of NOS and NADPH enzymes mRNA were determined in iron-perfusion isolated VR. RESULTS: Percentage of apoptotic cells increased in control and H/R after 90 min in the medulla. Ang II– induced constriction of DVR was reduced after 90 min in control (compared to 60 min), but not after H/R. NOS enzymes mRNA expression levels decreased over 90 min hypoxia. CONCLUSIONS: Increased reactivity of DVR to Ang II after H/R compared to control (90 min) suggest a role of DVR in renal ischemia/reperfusion injury. Show more

Keywords: Vasa recta, acute kidney injury, live kidney slices, hypoxia

DOI: 10.3233/CH-179230

Citation: Clinical Hemorheology and Microcirculation, vol. 67, no. 3-4, pp. 475-484, 2017