Clinical Hemorheology and Microcirculation - Volume Pre-press, issue Pre-press

Authors: Michalik, Katharina | Beyer, Lukas | Zeman, Florian | Wendl, Christina | Rennert, Janine | Fellner, Claudia | Stroszczynski, Christian | Wiggermann, Philipp

Article Type: Research Article

Abstract: Gadolinium ethoxybenzyl-diethylenetriaminepentaacetic acid (Gd-EOB-DTPA) is a hepatocyte-specific, linear ionic contrast agent for MRI. In comparison to other linear contrast agents Gd-EOB-DTPA is excreted equally through liver and kidneys. This prospective longitudinal study investigates the signal intensity (SI) in the dentate nucleus (DN) on unenhanced T1-weighted images after repetitive application of Gd-EOB-DTPA. 46 patients were included into the study and 107 MRI examinations were performed. Statistical analysis of 25 patients showed no significant correlation between cumulative dose of Gd-EOB-DTPA and SI change and between the DN/Pons ratiolast and the mean DN/Pons ratiofirst . Subgroup analysis however revealed a significant correlation …for one out of two readers. Gd-EOB-DTPA deposition could not be proven in the framework of this study. Show more

DOI: 10.3233/CH-209219

Citation: Clinical Hemorheology and Microcirculation, vol. Pre-press, no. Pre-press, pp. 1-8, 2020

Authors: Xian, Meng-Fei | Pan, Kang-Ming | Zhang, Jian-Chao | Chen, Mei-Qing | Huang, Hui | Chen, Li-Da | Wang, Wei

Article Type: Research Article

Abstract: Tumor-induced osteomalacia (TIO) is a vanishingly rare paraneoplastic syndrome which is usually caused by phosphaturic mesenchymal tumors (PMTs). The conventional treatment for PMTs is total resection, and ultrasound-guided radiofrequency ablation (RFA) can also be used for the treatment of PMTs patients, especially for patients in whom complete resection may lead to serious complications. We report two cases with PMT who presented syndrome with progressive musculoskeletal complaints and performed ultrasound-guided biopsy and RFA. Ultrasound-guided RFA, which is a safe and effective minimally invasive treatment option, appears to be a valuable alternative to surgery for patients presenting with PMT. We are the …first reported case of RFA guided by ultrasonography in the treatment of PMT. Show more

Keywords: Tumor-induced osteomalacia, oncogenic osteomalacia, phosphaturic mesenchymal tumor, radiofrequency ablation, ultrasound

DOI: 10.3233/CH-200921

Citation: Clinical Hemorheology and Microcirculation, vol. Pre-press, no. Pre-press, pp. 1-9, 2020

Authors: Tian, Bing | Li, Wenzheng | Wu, Zheng | Gong, Minglian | Liu, Jinghua

Article Type: Research Article

Abstract: OBJECTIVE: This study applied pressure measurement to measure the hemodynamic changes in right coronary artery (RCA) donor vessels before and after the opening of the vessel in patients with left anterior descending chronic total occlusion (LAD-CTO) interventional therapy. METHODS: A total of 45 patients with LAD-CTO were divided into two groups of percutaneous coronary intervention (PCI) to observe the hemodynamic changes (fractional flow reserve [FFR] and instantaneous wave-free ratio [iFR]) before and after opening the chronic total occlusion (CTO), in order to provide collateral circulating donor vessels to the CTO, and observe the changes in iFR and FFR. …The results of these two measures were compared to determine the significance of the donor vascular function. RESULTS: A total of 45 patients with LAD-CTO successfully underwent LAD-CTO interventional therapy, and were immediately measured for FFR and iFR of the donor vessels. The FFR changes before right coronary artery flow reserve (RCAFR) was 0.73±0.083, and after the operation, this was 0.77±0.073. The iFR changes before RCAFR was 0.90±0.048, and after the operation, this was 0.93±0.034. Before and after the opening of the RCA, the FFR change (Δ FFR) and iFR change (Δ iFR) were also correlated with r  = 0.033 (0.041–0.568: P  <  0.05). A total of 19 cases had a FFR value of <0.75 before the operation, and the average FFR before and after the PCI was 0.65±0.048 and 0.72±0.057, respectively. Furthermore, the Δ FFR was 0.076±0.057 (n  = 19), and FFR was >0.75 in 26 cases. The Δ FFR was 0.017±0.0088 (n  = 26). These two groups were compared, P  = 0.0032 (P  <  0.05). CONCLUSION: The FFR and iFR results were the same in terms of RCA hemodynamic changes, after the LAD-CTO was opened. For the RCA with a preoperative FFR of <0.75, the increase in RCAFR after LAD-CTO PCI was more obvious. Show more

Keywords: Coronary artery diseas, coronary blood flow, CTO, fractional flow reserve, percutaneous coronary intervention

DOI: 10.3233/CH-200885

Citation: Clinical Hemorheology and Microcirculation, vol. Pre-press, no. Pre-press, pp. 1-7, 2020

Authors: Georgieva, M. | Kammerer, S. | Prantl, L. | Jung, F. | Stroszczynski, C. | Jung, E.M.

Article Type: Research Article

Abstract: BACKGROUND: In recent years, follow-up after breast reconstruction with silicone implants and the detection of complications have been relieved by the possibility of improved diagnostic methods. METHODS: Between January 2015 and December 2019 a total of 40 patients (29–84 years) with silicone implants were included in this retrospective study. The implants were examined clinically and with modern imaging: general ultrasound imaging (US), magnetic resonance imaging (MRI), high resolution computed tomography (CT) and positron emission tomography –computed tomography (PET-CT). If necessary, a histological/cytological sample was taken. The breast implants were assessed by three radiologists specialized in breast imaging. The …grade of capsular contracture was classified according to the Baker classification. RESULTS: All 40 women obtained a clinical examination and an US diagnostic to identify early and more common complications such as implant folding and capsular fibrosis. Depending on the clinical examination and ultrasound findings additional MRI (n  = 10), CT (n  = 9) and/or PET-CT (n  = 2) were performed. 16 patients had implants folding proven with US (n  = 16), MRI (n  = 6) and CT (n  = 1). The grade of capsular fibrosis was determined according to the Baker classification. The following results were obtained in our study: 25 breast implants with Baker grade I and eleven breast implants with Baker grade II, both proven with US; one breast implants with Baker grade III and one breast implant with Baker grade IV, proven with US (n  = 2), MRI (n  = 1) and CT (n  = 1). One patient had intracapsular rupture and one patient had extracapsular rupture, both detected on CT and surgically proven. No patient had a silicone accumulation in the lymph nodes. One patient had pathologically enlarged axillary lymph nodes, which were evaluated as inflammatory changes in PET-CT. Long-term complications such as the development of malignant breast tumors could not be observed. CONCLUSION: To detect early complications after breast implant surgery, a regular clinical examination is indispensable. Imaging methods complement each other and if they are used multimodal, it is easier to identify early complications. Modern diagnostic modalities like ultrasound and magnetic resonance imaging expand the spectrum and improve diagnostic safety. Show more

Keywords: Breast implant, ultrasound, magnetic resonance imaging, capsular contracture

DOI: 10.3233/CH-209218

Citation: Clinical Hemorheology and Microcirculation, vol. Pre-press, no. Pre-press, pp. 1-11, 2020

Authors: Zhang, Hong-jun | Zheng, Bo-wen | Gu, Shi-jie | Wu, Tao | Wu, Li-li | Lian, Yu-fan | Tong, Ge | Yi, Shu-hong | Ren, Jie

Article Type: Research Article

Abstract: BACKGROUND: Broad hemodynamic changes, is believed to have a profoundly damaging effect on donor livers after brain death (DBD) or cardiac death (DCD). It remains unclear whether Doppler ultrasonography (DUS) and contrast-enhanced ultrasonography (CEUS), the imaging modalities to evaluate perfusion, could provide more information of liver discarded. OBJECTIVE: To evaluate the ability of DUS and CEUS to predict the risk of DBD or DCD liver discarded. METHODS: The consecutive DBD or DCD donors with DUS/CEUS examinations before surgical procurement from February 2016 to June 2018 at our institution were included. The US and CEUS images of …each donor liver were analyzed and the parameters were recorded. RESULTS: Among the 67 eligible donor livers, 15 (22.4%) were discarded and 52 (77.6%) were used. The discarded livers showed prolonged SAT of hepatic artery (0.08s vs 0.06s, OR = 2.169, P  = 0.008) on DUS, less cases with homogeneous enhancement (40.0% vs 73.1%, OR = 0.243, P  = 0.028) on CEUS, more cases with decreased enhancement (46.7% vs 15.4%, OR = 4.813, P  = 0.011), and less difference of the peak time between portal vein and liver parenchymal (0.5s vs 6.7s, OR = 4.260, P  = 0.015). The multivariable analysis showed that donor liver with prolonged SAT of hepatic artery (OR = 7.304, 95% CI: 1.195–44.655, P  = 0.031) and decreased enhancement (OR = 2.588, 95% CI: 1.234–5.426, P  = 0.012) were independent factors of liver discarded. CONCLUSIONS: DUS/CEUS could be applied as a promising predictive tool to screen high-risk liver donors. The prolonged SAT of hepatic artery on DUS and the decrease of liver donor in enhancement on CEUS, indicating hemodynamic changes in DBD and DCD donor livers, were risk factors of liver discarded. Show more

Keywords: Ultrasonography, doppler, liver transplantation, tissue and organ procurement, donor selection

DOI: 10.3233/CH-200950

Citation: Clinical Hemorheology and Microcirculation, vol. Pre-press, no. Pre-press, pp. 1-8, 2020

Authors: Jung, E.M. | Wertheimer, T. | Putz, F.J. | Jung, F. | Kammerer, S. | Pregler, B. | Luerken, L. | Stroszczynski, C. | Beyer, L.

Article Type: Research Article

Abstract: AIM: To evaluate the use of dynamic contrast enhanced ultrasound (CEUS) with parametric color-coded imaging and time intensity curve analysis (TIC) for planning and follow-up after prostate arterial embolization (PAE). MATERIAL/METHOD: Before and after selective iliacal embolization by PAE with a follow up of 6 months 18 male patients (43–78 years, mean 63±3.5 years) with histopathological proven benign prostate hyperplasia were examined by one experienced examiner. A multifrequency high resolution probe (1–6 MHz) was used for transabdominal ultrasound and CEUS with bolus injections of 2.4 ml sulphur-hexafluoride microbubbles. Independent evaluation of color-coded parametric imaging before and after PAE by in …PACS stored DICOM loops from arterial phase (10–15 s) up to 1min were performed. Criteria for successful treatment were reduction of early arterial enhancement by changes of time to peak (TTP) and area under the curve (AUC) by measurements in 8 regions of interest (ROI) of 5 mm in diameter at the margin and in the center and changes from hyperenhancement in parametric imaging (perfusion evaluation of arterial enhancement over 15 s) from red and yellow to blue and green by partial infarctions. Reference imaging method was the contrast high resolution 3 tesla magnetic resonance tomography (MRI) using 3D vibe sequences before and after PAE and for the follow up after 3 and 6 months. RESULTS: PAE was technically and clinically successful in all 18 patients with less clinical symptoms and reduction of the gland volume. In all cases color-coded CEUS parametric imaging was able to evaluate partial infarction after embolization with changes from red and yellow to green and blue colors in the embolization areas. Relevant changes could be evaluated for TIC-analysis of CEUS with reduced arterial enhancement in the arterial phase and prolonged enhancement of up to 1 min with significant changes (p  = 0.0024). The area under the curve (AUC) decreased from 676±255.04 rU (160 rU–1049 rU) before PAE to 370.43±255.19 rU (45 rU–858 rU) after PAE. Time to peak (TTP) did not change significantly (p  = 0.6877); TTP before PAE was 25.82±9.04 s (12.3 s–42.5 s) and after PAE 24.43±9.10 s (12–39 s). Prostate volume decreased significantly (p  = 0.0045) from 86.93±34.98 ml (30–139 ml) before PAE to 50.57±26.26 ml (19–117 ml) after PAE. There were no major complications and, in most cases (14/18) a volume reduction of the benign prostate hyperplasia occurred. CONCLUSION: Performed by an experienced examiner CEUS with parametric imaging and TIC-analysis is highly useful to further establish prostatic artery embolization (PAE) as a successful minimal invasive treatment of benign prostatic hyperplasia. Show more

Keywords: Contrast enhanced ultrasound (CEUS), parametric imaging, time intensity curve analysis (TIC), prostate arterial embolization (PAE)

DOI: 10.3233/CH-209202

Citation: Clinical Hemorheology and Microcirculation, vol. Pre-press, no. Pre-press, pp. 1-11, 2020

Authors: Kanda, Hideaki | Yamakuchi, Munekazu | Mastumoto, Kazuhisa | Mukaihara, Kosuke | Shigehisa, Yoshiya | Tachioka, Shuji | Okawa, Masashi | Takenouchi, Kazunori | Oyama, Yoko | Hashiguchi, Teruto | Imoto, Yutaka

Article Type: Research Article

Abstract: BACKGROUND AND OBJECTIVE: Turbulent blood flow in patients with aortic valve stenosis (AS) results in morphological and functional changes in platelets and coagulation factors. The aim of this study is to determine how shear stress affects platelets and coagulation factors. METHODS: We retrospectively evaluated data from 78 patients who underwent AVR to treat AS between March 2008 and July 2017 at Kagoshima University Hospital. RESULTS: Platelet (PLT) count obviously decreased at three days after AVR, and increased above preoperative levels at the time of discharge. In contrast, platelet distribution width (PDW), mean platelet volume (MPV), and …platelet large cell ratio (P-LCR) increased three days after AVR, then decreased to below preoperative levels. No differences were evident between groups with higher (HPPG >  100 mmHg) and lower (LPPG <  100 mmHg) peak pressure gradients (PPG) before AVR, whereas PLT count, PDW, MPV and P-LCR improved more in the HPPG group. Plateletcrit (PCT), which represents the total volume of platelets, increased after AVR due to decreased shear stress. High increasing rate of PCT was associated with lower PLT count, higher PDW and lower fibrinogen. CONCLUSION: Shear stress affects PLT count, PDW, and fibrinogen in patients with AS. Show more

Keywords: Aortic valve stenosis, platelet, plateletcrit, shear stress, pressure gradient

DOI: 10.3233/CH-200928

Citation: Clinical Hemorheology and Microcirculation, vol. Pre-press, no. Pre-press, pp. 1-11, 2020

Authors: Mrowietz, C. | Sievers, H. | Pindur, G. | Hiebl, B. | Jung, F.

Article Type: Research Article

Abstract: In patients with peripheral arterial occlusive disease (PAOD) a restricted circulation in cutaneous microvessels has been reported. In this study the velocity of erythrocytes (very) in finger nailfold capillaries - a vascular area without upstream macroangiopathy - and also in toe nailfold capillaries - a post-stenotic area –was investigated using capillary microscopy in apparently healthy subjects and patients with PAOD. Already in finger nailfold capillaries very of patients with PAOD under resting conditions was significantly lower than in capillaries of healthy subjects. This was also true for the circulation in toe capillaries. In addition, the erythrocyte velocities under resting conditions …in the toe capillaries were significantly lower than in the finger capillaries. Similar results were found for the duration and the maximum velocity of postocclusive hyperemia. It is concluded that the resting blood flow in the skin microcirculation is impaired in PAOD patients, both under resting conditions and during postocclusive hyperemia in finger as well in toe nailfold capillaries. Show more

Keywords: Microcirculation, peripheral arterial occlusive disease, capillary microscopy

DOI: 10.3233/CH-209220

Citation: Clinical Hemorheology and Microcirculation, vol. Pre-press, no. Pre-press, pp. 1-7, 2020

Authors: Teusch, V.I. | Wohlgemuth, W.A. | Uller, W. | Piehler, A.P. | Goessmann, H. | Stroszczynski, C. | Jung, E.M.

Article Type: Research Article

Abstract: INTRODUCTION: Percutaneous sclerotherapy is a well-established treatment option for venous malformations (VM). A recently established sclerosing agent is ethanol-gel. Aim of this study was to identify, if contrast-enhanced ultrasound (CEUS) with an integrated perfusion analysis allows for differentiation between untreated VM, healthy tissue, and with gelified ethanol treated malformation tissue. MATERIAL AND METHODS: In this institutional review board approved prospective study symptomatic VM patients underwent CEUS at exactly the same position before and after sclerotherapy with ethanol-gel. Two experienced sonographers performed all examinations after the bolus injection of microbubbles using a multi-frequency probe with 6 –9 MHz of …a high-end ultrasound machine. An integrated perfusion analysis was applied in the center of the VM and in healthy, surrounding tissue. For both regions peak enhancement (peak), time to peak (TTP), area under the curve (AUC), and mean transit time (MTT) were evaluated. Wilcoxon signed rank test was executed; p -values <0.05 were regarded statistically significant. RESULTS: In 23 patients including children (mean age 25.3 years, 19 females) before treatment all identified parameters were significantly higher in the VM center compared to healthy tissue (peak: p  <  0.01; TTP: p  <  0.01; AUC: p  <  0.01; MTT: p  <  0.01). Comparing the VM center before and after treatment, TTP (p  <  0.02) and MTT (p  <  0.01) reduced significantly after sclerotherapy. In surrounding tissue only peak changed after treatment in comparison to pre-treatment results (p  = 0.04). Comparing data in the VM center with surrounding tissue after sclerotherapy, results still differed significantly for peak (p  <  0.01), TTP (p  <  0.01), and AUC (p  <  0.01), but assimilated for MTT (p  = 0.07). CONCLUSION: All with CEUS identified parameters seem to be excellent tools for differentiating between VM and healthy tissue. TTP and MTT could distinguish between with ethanol-gel sclerotized VM portions and untreated malformation parts and thereby might assist the monitoring of sclerotherapy with ethanol-gel. Show more

Keywords: Contrast-enhanced ultrasound, perfusion analysis, venous malformation, sclerotherapy, ethanol-gel

DOI: 10.3233/CH-209215

Citation: Clinical Hemorheology and Microcirculation, vol. Pre-press, no. Pre-press, pp. 1-10, 2020

Authors: Lonic, Daniel | Heidekrueger, Paul I. | Bosselmann, Talia | Niclas Broer, P. | Gertler, Ralph | Wolfgang Martin, Klaus | Prantl, Lukas | Ninkovic, Milomir | Giunta, Riccardo | Ehrl, Denis

Article Type: Research Article

Abstract: BACKGRUND: The coagulation status of burn patients is generally impaired and is a major factor of the deteriorating burn patients’ overall situation. In trauma and other patient groups, the differential diagnosis of coagulation impairment has been largely improved by the use of rotational thromboelastometry (ROTEM®). The aim of this prospective observational study was the differentiated observation of coagulopathy in severely burned patients using standard parameters and ROTEM® thrombelastometry during the relevant stages of burn disease. PATIENTS AND METHODS: Twelve patients that sustained at least 20% third degree burns of total body surface area (TBSA) were included in the …study. Standard and ROTEM® coagulation analyses were performed on admission and then twice daily during the first 14 days following burn trauma. RESULTS: Although the initial assessment of DIC was similar for both standard labs and ROTEM® measurements, more patients were detected to be in a state of worsening coagulation status for a longer time in ROTEM® than in standard measurements. In addition, one patient was rated in to be in decompensated DIC for 3 days according to ROTEM® measurements, while no patient was rated to be in a decompensated DIC based on standard parameters. CONCLUSION: This study points towards a more complex picture and higher occurrence of DIC in burn patients when thrombelastometric measurements like ROTEM® are taken into account in addition to standard coagulation parameters. Show more

Keywords: Thrombelastometry, coagulation, burn injury

DOI: 10.3233/CH-209210

Citation: Clinical Hemorheology and Microcirculation, vol. Pre-press, no. Pre-press, pp. 1-10, 2020