Clinical Hemorheology and Microcirculation - Volume 79, issue 1

Authors: Küpper, J.-H. | Krüger-Genge, A. | Jung, F.

Article Type: Editorial

DOI: 10.3233/CH-219100

Citation: Clinical Hemorheology and Microcirculation, vol. 79, no. 1, pp. 1-2, 2021

Authors: Jung, E.M. | Kammerer, S. | Brandenstein, M. | Putz, F.J. | Stroszczynski, C. | Jung, F.

Article Type: Research Article

Abstract: AIM: To evaluate the possibilities of flow detection using high resolution flow (HR Flow) and Glazing Flow technique in patients with liver parenchymal changes and flow changes in comparison to color-coded Doppler sonography (CCDS). MATERIAL AND METHODS: All examinations were performed using a multi frequency matrix convex probe with high resolution technique (SC6-1U/Resona7, Mindray, Shenzhen, China) by one experienced examiner to evaluate the venous, portal venous and arterial liver flow with digital documentation of the dynamic flow parameters like peak systolic flow, end-diastolic flow and resistance index. For liver parenchymal stiffness changes shear wave elastography was performed with …at least 10 measurements. By two independent readers an elevation was performed to evaluate the image quality and the degree of flow artefacts, from 0 = not available to 5 points with excellent image quality without flow artefacts. RESULTS: All 40 patients (24 men, 16 women, age 27–83 years, mean 56±5 years) showed morphology changes from B-Mode of the liver parenchyma to inhomogeneous tissue with higher stiffness evaluated by the shear wave elastography (1.45 m/s up to 2.79 m/s±1.79 m/s, considering F1 up to F4 fibrosis) and in 15 cases histopathologically proven liver cirrhosis. In 9 cases after non-acute thrombosis flow reduction of the portal vein was the reason for the diameter less than 5 mm. Flow parameters for the venous flow were between 8 cm/s up to 29 cm/s, mean 14±4 cm/s, for the hepatic portal vein 5 cm/s up to 57 cm/s, mean 17±5 cm/s, for the hepatic artery systolic flow between 50 cm/s up to 127±33 cm/s, end-diastolic flow from 22 cm/s up to 47±8 cm/s. Resistance index for the hepatic artery was between 0.41 up to 0.73, mean 0.67±0.25. The image quality for CCDS over all cases was evaluated for CCDS between 1 up to 4. The mean quality was 2.5±0.5, for HR Flow in combination with Glazing Flow 3±0.5, with significant differences for the 2 readers (P  < 0.01). CONCLUSION: Combination of HR Flow with Glazing Flow could be helpful to evaluate morphological und hemodynamic changes of liver arterial flow, portal venous and venous flow. Reduction of flow artefacts in combination with a higher image quality could be helpful for optimizing the digital measurements also for follow up examinations. Show more

Keywords: Liver vascular imaging, high resolution flow (HR), Glazing Flow, imaging quality, artefact reduction

DOI: 10.3233/CH-219102

Citation: Clinical Hemorheology and Microcirculation, vol. 79, no. 1, pp. 3-17, 2021

Authors: Rio Bartulos, Carolina | Lier, Dennis | Sahl, Harald | Abu-Mugheisib, Mazen | Spreer, Annette | Wiggermann, Philipp

Article Type: Research Article

Abstract: BACKGROUND: Mechanical thrombectomy (MT) is a standard stroke treatment for patients with large vessel occlusions (LVOs). A decisive factor for a successful outcome is, among other things, timely treatment. OBJECTIVE: The objective was to analyze several time points in relation to outcomes and/or surrogate parameters. Furthermore, our data was placed in the context of other clinical trial data. METHODS: We retrospectively evaluated 133 data sets from patients who underwent MT. The correlation of various time periods with parameters, such as the ASPECTS, NIHSS, mRS, and, particularly, the TICI score, was investigated. RESULTS: A correlation …was found for both the NIHSS score at discharge and the TICI score with the time periods of arrival and/or start to groin puncture as well as with arrival to the end of the intervention and the duration of the intervention. CONCLUSIONS: This retrospective study is consistent with large randomized clinical trials investigating stroke management and provides data from daily clinical practice. Show more

Keywords: Acute ischemic stroke, thrombectomy, time to treatment

DOI: 10.3233/CH-219107

Citation: Clinical Hemorheology and Microcirculation, vol. 79, no. 1, pp. 19-26, 2021

Authors: Brandenstein, M. | Wiesinger, I. | Jung, F. | Stroszczynski, C. | Jung, E.M.

Article Type: Research Article

Abstract: AIM: To improve preoperative diagnostics of solid non-cystic thyroid lesions by using new high-performance ultrasound techniques: optimized B-mode morphology, elastography, Color-Coded Doppler-Sonography (CCDS) and contrast enhanced ultrasound (CEUS) MATERIALS AND METHODS: In 33 cases solid, non-cystic thyroid lesions were rated as TIRADS 3 and up from conventional B-mode examinations. Additional high resolution Power Doppler including HR- and Glazing-Flow as optimized macrovascularization techniques, shear wave elastography and CEUS were performed on these patients by one experienced examiner. For CEUS a bolus of 1–2.4 ml Sulfurhexafluorid microbubbles (SonoVue®, Bracco, Milan, Italy) was injected into a cubital vein and then the distribution …kinetics of the contrast agent were documented from the early arterial phase (10 to 15 seconds after injection) to the late venous phase (5 minutes after injection). Postoperative histopathology was the diagnostic gold standard as it provides the most reliable proof. RESULTS: 33 patients (13 males, 20 females; age 29 –77 years; mean 55 years; SD 13 years) were included in this study. 28 of them had benign regressive thyroid nodules, 3 had adenomas and 4 were diagnosed with carcinomas (3 were histologically identified as papillary thyroid carcinomas, one as a medullary thyroid carcinoma). The volume of the thyroid gland ranged from 6.6 to 401.3 cm2 (mean 72.6±92.0 cm2 ). The adenoma diameters ranged from 9 to 40 mm (mean 22±16 mm) and the carcinoma diameters ranged from 19 to 33 mm (mean 26±6 mm). The 3 adenomas had different echogenicities: One was completely echofree, one was hypoechoic and one isoechoic. The 4 carcinomas however were equally characterized as hypoechoic and echofree. Two of three adenomas and all of the carcinomas showed an incomplete or diffuse margin. Micro-calcifications were found in one adenoma and in every carcinoma. However, no micro-calcifications were observed in cases of benign regressive nodules. Performing shear-wave elastography the adenomas showed lower values than the carcinomas: The tissue velocity of the adenomas ranged from 2.86 m/s to 3.85 m/s (mean 3.32±0.5 m/s) and in carcinomas from 3.89 m/s to 5.66 m/s (mean 4.18±0.3 m/s). Marginal hypervascularization was detected in two adenomas after applying CCDS. One adenoma was hypovascularized. The four carcinomas showed an irregular extreme hypervascularization along their margins as well as an irregular central normo- or hypervascularization in CCDS. The additional HR-Flow helped reducing artefacts. In CEUS the dynamic capillary microvascularization of all carcinomas was very irregular with early enhancement and followed by partial or complete wash-out. In CEUS two adenomas had no wash-out and the other one showed a partial wash-out. CONCLUSION: Using modern multimodal imaging offers new possibilities for the differentiation between benign and malignant thyroid lesions. It is a very important diagnostic tool in addition to the B-Mode TIRADS classification and eases the decision between TIRADS 3, 4 and 5. However, additional multicenter studies are required for more detailed evaluations. Show more

Keywords: Solid thyroid lesions, high-resolution ultrasound, HR-flow, elastography, CEUS, histopathology

DOI: 10.3233/CH-219101

Citation: Clinical Hemorheology and Microcirculation, vol. 79, no. 1, pp. 27-38, 2021

Authors: Rennert, Janine | Grosse, Jirka | Einspieler, Ingo | Bäumler, Wolf | Stroszczynski, Christian | Jung, Ernst Michael

Article Type: Research Article

Abstract: AIM: To evaluate the effectiveness of complementary imaging of high-resolution ultrasound including CEUS with PET/CT for tissue characterization and tumor detection. MATERIAL AND METHODS: 100 patients were examined with PET/CT and US/CEUS between January 2018 until February 2020. All patients underwent PET/CT followed by selective US/CEUS within 4 weeks. Comparison regarding concordant or diverging findings in PET/CT and US. Analysis of the differences concerning the lesions number of found by PET/CT and US/CEUS or the possibility of a secured diagnosis following ultrasound causing therapeutic changes. RESULTS: Diverging findings regarding the number of liver lesions in PET/CT …and CEUS were found in 35 out of 64 patients (54%). Regarding renal lesions, a more definite diagnosis following ultrasound, causing a change of therapeutic approach, was achieved in 89%. Concordant results in PET/CT and US were found in 83% of patients with splenic and nodal findings. In 78% of patients with increased musculoskeletal or soft tissue tracer uptake, US was able to make a secured diagnosis with therapeutic changes. CONCLUSION: The present results indicate a strong benefit of complementary imaging of PET/CT and selective, high-resolution ultrasound especially in patients with liver, renal and musculoskeletal or soft tissue findings. Show more

Keywords: PET/CT, ultrasound, complementary imaging

DOI: 10.3233/CH-219105

Citation: Clinical Hemorheology and Microcirculation, vol. 79, no. 1, pp. 39-54, 2021

Authors: Krusche, Cornelius | Rio Bartulos, Carolina | Abu-Mugheisib, Mazen | Haimerl, Michael | Wiggermann, Philipp

Article Type: Research Article

Abstract: BACKGROUND: In clinical practice, decisions often must be made rapidly; therefore, automated software is useful for diagnostic support. Perfusion computed tomography and follow-up evaluation of perfusion data are valuable tools for selecting the optimal recanalization therapy in patients with acute ischemic stroke. OBJECTIVE: This study aimed to compare commercially available software used to evaluate stroke patients prior to thrombectomy. METHODS: The performance of Olea Sphere (OlS) software vs. CT Neuro Perfusion from Syngo (Sy), as well as the electronic Alberta Stroke Program Early Computed Tomography Score (e-ASPECTS) software vs. an experienced radiologist, were compared using descriptive …statistics including significance analysis, Spearman’s correlation, and the Bland-Altman agreement analysis. For this purpose, 43 data sets of patients with stroke symptoms related to the middle cerebral artery territory were retrospectively post-processed with both tools and analyzed. RESULTS: The automatic e-ASPECTS showed high agreement with an expert rater assessment of the ASPECTS. Using OlS and Sy, we compared the parameters for the ischemic core (relative cerebral blood flow), Time to maximum (Tmax) for the penumbra, and the relative mismatch between these two values. Overall, both software tools achieved good agreement, and their respective values correlated well with each other. However, OlS predicted significantly smaller infarct core volumes compared with Sy. CONCLUSIONS: Although the absolute values have a certain degree of variation, both software programs have good agreement with each other. Show more

Keywords: Acute ischemic stroke, computed tomography, perfusion imaging, software comparison

DOI: 10.3233/CH-219106

Citation: Clinical Hemorheology and Microcirculation, vol. 79, no. 1, pp. 55-63, 2021

Authors: Marschner, Constantin A. | Schwarze, Vincent | Stredele, Regina | Froelich, Matthias F. | Rübenthaler, Johannes | Geyer, Thomas | Clevert, Dirk-André

Article Type: Research Article

Abstract: BACKGROUND: Vesicoureteral reflux (VUR) represents a common pediatric anomaly in children with an upper urinary tract infection (UTI) and is defined as a retrograde flow of urine from the bladder into the upper urinary tract. There are many diagnostic options available, including voiding cystourethrography (VCUG) and contrasted-enhanced urosonography (ceVUS). ceVUS combines a diagnostic tool with a high sensitivity and specificity which, according to previous study results, was even shown to be superior to VCUG. Nevertheless, despite the recommendation of the EFSUMB, the ceVUS has not found a widespread use in clinical diagnostics in Europe yet. MATERIALS AND METHODS: …Between 2016 and 2020, 49 patients with a marked female dominance (n  = 37) were included. The youngest patient had an age of 5 months, the oldest patient 60 years. The contrast agent used in ceVUS was SonoVue ®, a second-generation blood-pool agent. All examinations were performed and interpreted by a single experienced radiologist (EFSUMB Level 3). RESULTS: The 49 patients included in the study showed no adverse effects. 51% of patients (n  = 26) were referred with the initial diagnosis of suspected VUR, while 49% of patients (n  = 23) came for follow-up examination or to rule out recurrence of VUR. The vast majority had at least one febrile urinary tract infection in their recent medical history (n  = 45; 91,8%). CONCLUSION: ceVUS is an examination method with a low risk profile which represents with its high sensitivity and specificity an excellent diagnostic tool in the evaluation of vesicoureteral reflux, especially in consideration of a generally very young patient cohort. Show more

Keywords: Vesicoureteral reflux, contrasted-enhanced urosonography, voiding cystourethrography, safety profile

DOI: 10.3233/CH-219110

Citation: Clinical Hemorheology and Microcirculation, vol. 79, no. 1, pp. 65-72, 2021

Authors: Senk, Karin | Wilcke, Juliane | Haimerl, Michael | Verloh, Niklas | Rio Bartulos, Carolina | Bäumler, Wolf | Stroszczynski, Christian | Wiggermann, Philipp

Article Type: Research Article

Abstract: BACKGROUND AND OBJECTIVE: Liver function is one of the most important parameters for the outcome of transarterial chemoembolization (TACE). The liver maximum capacity (LiMAx) test is a bedside test that provides a real-time option for liver function testing. The objective of this pilot study was to investigate the suitability of the LiMAX test for predicting the TACE outcome. METHODS: 20 patients with intermediate-stage hepatocellular carcinoma (HCC) received a LiMAx test 24 h pre and post TACE. In addition, laboratory values were collected to determine liver function and model for endstage liver disease (MELD) scores. The success of TACE was …assessed 6 weeks post intervention by morphological imaging tests using modified response evaluation criteria in solid tumors (mRECIST). RESULTS: Patients with an objective response (OR = CR + PR) according to mRECIST post TACE had significantly higher values in the pre-interventional LiMAx test than patients with a non-OR (PD or SD) post TACE (r (14) = 0.62, p  = 0.01). Higher pre-interventional LiMAx values therefore indicate OR. Patients with a disease control (DC = CR + PR + SD) according to mRECIST post TACE had significantly higher values in the pre-interventional LiMAx test than patients with a non-DC (PD) post TACE (r (14) = 0.65, p  = 0.01). Higher pre-interventional LiMAx values therefore indicate DC. The point biserial correlations of LiMAx values pre and post TACE with the outcome OR or DC were descriptively stronger than those of MELD with OR or DC. This suggests that the LiMAx test correlates better with the treatment response than the MELD score. CONCLUSIONS: For the first time, we were able to show in our study that patients who are scheduled for TACE could benefit from a LiMAx test to be able to estimate the benefit of TACE. The higher the pre-interventional LiMAx values, the higher the benefit of TACE. On the other hand, laboratory parameters summarized in the form of the MELD score had significantly less descriptive correlation with the TACE outcome. Show more

Keywords: TACE, LiMAx, HCC, MRECIST, methacetin breath test, liver function, outcome

DOI: 10.3233/CH-219118

Citation: Clinical Hemorheology and Microcirculation, vol. 79, no. 1, pp. 73-80, 2021

Authors: Burdenski, Thomas | Bressem, Keno K. | Adams, Lisa C. | Grauhan, Nils F. | Niehues, Stefan M.

Article Type: Research Article

Abstract: BACKGROUND: Computed tomographic (CT) imaging in suspected pulmonary artery embolism represents the standard procedure. Studies without iterative reconstruction proved beneficial using increased iodine delivery rate (IDR). This study compares image quality in pulmonary arteries on iteratively reconstructed CT images of patients with suspected pulmonary embolism using different IDR. MATERIAL AND METHODS: 1065 patients were included in the study. Patients in group A (n  = 493) received an iodine concentration of 40 g/100 ml (IDR 1.6 g/s) and patients in group B (n  = 572) an iodine concentration of 35 g/100 ml (IDR 1.4 g/s) at a flow rate of 4 ml/s. A 80-detector spiral CT scanner with …iterative reconstruction was used. We measured mean density values in truncus pulmonalis, both pulmonary arteries and segmental pulmonary arteries. Subjectively, the contrast of apical and basal pulmonary arteries was determined on a 4-point Likert scale. RESULTS: Radiodensity was significantly higher in all measured pulmonary arteries using the increased IDR (p  < 0.001). TP: 483.0 HU vs. 393.4 HU; APD: 452.1 HU vs. 372.1 HU; APS: 448.2 HU vs. 374.4 HU; ASP: 443.9 vs. 374.4 HU. Subjectively assessed contrast enhancement in apical (p  = 0.077) and basal (p  = 0.429) lung sections showed no significant differences. CONCLUSION: Higher IDR improves objective image quality in all patients with significantly higher radiodensities by iterative reconstruction. Subjective contrast of apical and basal lung sections did not differ. The number of non-sufficient scans decreased with high IDR. Show more

Keywords: Computed tomography, pulmonary embolism, contrast media, iodine concentration

DOI: 10.3233/CH-219115

Citation: Clinical Hemorheology and Microcirculation, vol. 79, no. 1, pp. 81-89, 2021

Authors: Junge, Florian | Konschake, Wolfgang | Haase, Hermann | Jünger, Michael

Article Type: Research Article

Abstract: BACKGROUND: Edema caused by orthostasis is a common clinical picture in the medical and occupational context. Medical compression therapy with compression stockings (CS) is considered a conservative therapeutic standard in edema therapy. The effect of CS on leg discomfort and the increase of the lower leg volume during a standing load still remains questionable. In addition, it is not entirely known whether there is a correlation between volume increase and discomfort in these individuals. METHOD: A timed, controlled standing load of 15 min was conducted by the participants in this non-randomized controlled study to analyze the change in and …correlation between lower leg volume increase and the occurrence of lower leg discomfort under compression therapy. Below-knee CS with an interface pressure of 23–32 mmHg were used. The lower leg volume was measured following previous studies using an optical three-dimensional volume (ml) measurement system, and sensations of discomfort and the urge to move were asked about using a numerical rating scale (NRS) of 0–10. The subjects conducted a leg movement for 15 s immediately after the standing period; the data were collected again subsequently. A correlation was calculated between the lower leg volume and the data regarding the discomfort and urge to move for each participant. The experiments had already been performed as part of a previous study including the same subjects who did not wear CS. The results of the study conducted here were compared with those of the participants who did not wear CS to investigate the effect of the CS. RESULTS: Lower leg volume increased by an average of 27 ml (p  < 0.001) (without CS: by 63 ml) during standing load in the right leg. During the leg movement after standing load, the lower leg volume increased by 5 ml (n.s.). The sensations of discomfort during the orthostasis increased by 2.6 points on the NRS (p  < 0.001) (without CS: by 3.46 points) and decreased by 1.67 points (p  < 0.001) during the leg movement shortly after the standing period. Participants’ urge to move increased by 3.73 points on the NRS (p  < 0.001) (without CS: by 3.47 points) while the participants performed the standing period and decreased by 2.73 points (p  < 0.001) during the final movement exercise. A weakly significant correlation could be demonstrated between the increase in the lower leg volume and the occurrence of discomfort in 6 out of 13 subjects (p  < 0.1), and between the increase in the lower leg volume and the urge to move in 8 out of 15 subjects (p  < 0.1). CONCLUSION: Standing loads and lack of movement lead to an increase in the lower leg volume and sensation of discomfort in venous healthy subjects wearing CS, which are reduced by wearing them (p  < 0.001). A weakly significant mathematical correlation (Pearson’s correlation coefficient) could be shown between the increase in the lower leg volume and the occurrence of the urge to move in 8 out of 15 subjects (p  < 0.1) and between the increase in lower leg volume and the occurrence of leg discomfort in 6 out of 13 subjects (p  < 0.1). Show more

Keywords: Leg complaints, volume measurements, orthostasis, edema, urge to move, healthy volunteers, lack of movement

DOI: 10.3233/CH-219108

Citation: Clinical Hemorheology and Microcirculation, vol. 79, no. 1, pp. 91-101, 2021