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

Authors: Bimpong-Buta, Nana-Yaw | Jirak, Peter | Wernly, Bernhard | Lichtenauer, Michael | Knost, Thorben | Abusamrah, Thaer | Kelm, Malte | Jung, Christian

Article Type: Research Article

Abstract: BACKGROUND: Parabolic flights offer a unique platform for human experiments in short-term weightlessness. It is generally known that human organ systems react to changes of gravity. Yet, little is known about alterations of blood parameters under these conditions with special emphasis on blood rheology. OBJECTIVE: We investigated the alterations of distinct blood parameters after exposure to weightlessness. METHODS: 14 healthy volunteers underwent short-term phases of weightlessness induced by parabolic flight. At different time points (baseline, t2:1 hour after landing, and t3:24 hours after baseline), venous blood was drawn and analyzed. RESULTS: Analysis of red …blood count revealed significant decreases of hemoglobin and hematocrit post flight. While total white blood counts were unaltered, differential subset analysis revealed significant decreases of eosinophil granulocytes and monocytes. Cortisole levels were unchanged and lacked physiologic circadian decrease. Parameters of renal function were found significantly improved (GFR (ml/min/1,73m2 ): Baseline: 105 [89;109], t2:117 [98;125], t3:110 [102;119]; p = 0.0013. In the sense of mild myocytolysis, levels of myoglobin were significantly elevated post-flight with fast recovery to baseline levels. CONCLUSIONS: In the current analysis, significant alterations of blood parameters after exposure to weightlessness could be detected. These results contribute to the understanding of physiologic adaptations of the human body to weightlessness. Show more

Keywords: Blood parameter analysis, weightlessness, parabolic flight

DOI: 10.3233/CH-189314

Citation: Clinical Hemorheology and Microcirculation, vol. Pre-press, no. Pre-press, pp. 1-10, 2018

Authors: Vahldiek, Janis L. | Erxleben, Christoph | Bressem, Keno Kyrill | Gemeinhardt, Ole | Poch, Franz | Hiebl, Bernhard | Lehmann, Kai S. | Hamm, B. | Niehues, Stefan M.

Article Type: Research Article

Abstract: BACKGROUND: Radiofrequency ablation (RFA) is an important treatment option for hepatic tumors and metastases. Post-ablation recurrence rates are reported up to 36.5 percent and seem to depend on tumor size, intrahepatic localization of tumors and adjacent hepatic vessels. Multipolar RFA has the potential to overcome/reduce these limitations. Experimental and standardized data on achievable lesion sizes, influence of hepatic vessels and non-invasive evaluation of complete ablation is still insufficient. OBJECTIVES: The aim of this study was to evaluate the influence of intrahepatic vessels on shape and size of multipolar RF-ablation zones in healthy porcine liver and to evaluate the …appropriateness of immediate post-ablation contrast-enhanced computed tomography (CECT) in detecting RF-ablation dimensions. MATERIAL AND METHODS: We conducted multipolar RFAs in each of the livers of 10 healthy, narcotized and laparotomized domestic pigs by inserting three parallel probes with a constant probe distance and a constant energy supply. In 4 ablations we interrupted hepatic blood flow using Pringle’s maneuver. Immediate post-ablation CECT scans were acquired. After euthanasia the livers were sliced perpendicularly to the probes at the probes’ active centers. CECT scans were reconstructed equivalently in order to compare RF-lesion size and shape to the macroscopic sections. RESULTS: In total, 19 RF-lesions were analyzed. Every RF-lesion that was ablated during physiological liver perfusion showed an irregular and cloverleaf-like shape (n = 15). Interrupting the hepatic blood flow during RFA led to well-defined, round and homogeneous ablation zones which were 3.8 times larger compared to RF-lesions ablated during continuous hepatic perfusion (n = 4). We found an excellent correlation between immediate post-ablation CECT slices and macroscopic sections when comparing RF-lesion diameters and area, although CECT tended to overestimate ablation dimensions. CONCLUSIONS: The interruption of hepatic blood flow using Pringle’s maneuver during multipolar RFA with three applicators significantly reduces heat sink effects of hepatic vessels and generates large and coherent ablation zones. This approach should be considered in each case of ablation planning adjacent to larger hepatic vessels or when ablating larger tumor volumes. Immediate post-ablation CECT has limited value in detecting incomplete RFA periprocedurally. Show more

Keywords: Liver perfusion, animals, catheter ablation, electrodes, imaging, three-dimensional/*methods, multidetector computed tomography, radiography, Interventional/methods, *contrast media

DOI: 10.3233/CH-189313

Citation: Clinical Hemorheology and Microcirculation, vol. Pre-press, no. Pre-press, pp. 1-10, 2018

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

Article Type: Research Article

Abstract: BACKGROUND: Ultrasound is the method of choice for preoperative evaluation of masses of the parotid glands. However, existing methods do not allow for definite differentiation between the most common benign and malignant tumors. OBJECTIVE: Thus, we evaluated the benefits of Virtual Touch Quantification (VTQ) and Virtual Touch imaging quantification (VTIQ) for improving preoperative evaluation of parotid tumors. METHODS: We investigated eight lymph nodes and 41 tumors of the parotid gland via ultrasound, color Doppler ultrasound, VTIQ and VTQ shear wave imaging. Each examination consisted of pictures and videos, which were evaluated by twelve examiners. Initially, each …examiner predicted whether the mass was benign or malignant based on B-mode and Doppler images. Then each examiner viewed the VTIQ and VTQ shear wave images and reevaluated the predictions, which were then compared with the histopathological outcomes. RESULTS: In tumors, the sensitivity was 36% based only on B-mode and color Doppler sonography, which increased to 42% with the addition of VTIQ and VTQ. Likewise, the specificity also increased from 78% to 85%. CONCLUSIONS: VTQ and VTIQ provide additional data that improve the capability to distinguish between benign and malignant tumors allowing for an increase in both the sensitivity and specificity. Show more

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

DOI: 10.3233/CH-189312

Citation: Clinical Hemorheology and Microcirculation, vol. Pre-press, no. Pre-press, pp. 1-10, 2018

Authors: Schwarze, V. | Mueller-Peltzer, K. | Negrão de Figueiredo, G. | Lindner, F. | Rübenthaler, J. | Clevert, D.-A.

Article Type: Research Article

Abstract: BACKGROUND: Hepatic echinococcosis (HE) is a zoonosis and depicts a rare but potentially lethal disease caused by larval infestation of E. multilocularis ( alveolar echinococcosis, AE) and E. granulosus ( cystic echinocococcosis, CE). In many countries, HE is a critical public health problem. Clinically, HE patients initially are often asymptomatic for years. Depending on the echinococcal manifestations patients can later develop unspecific symptoms as fatigue, abdominal pain and may present with elevated transaminases, jaundice and hepatomegaly. The combination of grey scale ultrasound and serological tests has been the gold standard for the screening and diagnosis of HE. Besides MRI, CT …and FDG-PET scans, safe and directly accessible contrast-enhanced ultrasound (CEUS) may easily help to indirectly describe perilesional inflammation. Upon diagnosis of HE, an appropriate therapeutical strategy should be evaluated in a multidisciplinary way. OBJECTIVE: The aim of the present retrospective monocenter study is to assess the diagnostic performance of CEUS examination in the evaluation of hepatic echinococcal manifestation by comparison with CT, MRI, FDG-PET scans and histopathology. METHODS: Out of 36 patients with echinococcal disease (16 patients with E. multilocularis infection, 12 patients with E. granulosus infection and 8 patient with unspecified Echinococcus infection) 8 HE patients (4 patients with E. multilocularis , 2 patients with E. granulosus and 2 patients with unspecified echinococcal liver disease) were included in this study on whom CEUS was performed between 2008–2016. The applied contrast agent was a second-generation blood pool agent (SonoVue ® , Bracco, Milan, Italy). CEUS examinations were performed and interpreted by a single experienced radiologist with more than 15 years of experience. RESULTS: All patients were examined without occurrence of any side effects. In all 4 AE patients, contrast enhancement could be detected by means of CEUS and was confirmed by MRI or PET-CT scan. In the remaining 4 patients (CE and unspecified echinococcosis), doppler ultrasonography, CEUS and corresponding CT or MRI scans could not detect any hypervascularization of the lesions of interest. The histopathological analysis did not reveal any viable parasite material. CEUS showed a sensitivity of 100% and a specificity of 100% compared to MRI, CT or FDG-PET-CT. CONCLUSIONS: CEUS depicts a safe method for the evaluation of echinococcal liver disease. In addition to serological tests and grey scale ultrasound, CEUS imaging could be integrated as an easily accessible tool helping to describe hypervascularization as a sonomorphological correlate for active perilesional inflammation of echinococcal manifestations. CEUS may further help to differentiate between CE and AE and also to evaluate treatment outcome. Show more

Keywords: Hepatic echinococcosis, alveolar echinococcosis, cystic echinococcosis, contrast-enhanced ultrasound, CEUS

DOI: 10.3233/CH-189310

Citation: Clinical Hemorheology and Microcirculation, vol. Pre-press, no. Pre-press, pp. 1-7, 2018

Authors: Aung, T. | Taeger, C. | Geis, S. | Schiltz, D. | Brix, E. | Wenzel, C. | Lamby, P. | Kehrer, A. | Prantl, L. | Brebant, V.

Article Type: Research Article

Abstract: INTRODUCTION: Supermicrosurgical lymphaticovenular anastomosis (LVA) toward becoming a treatment alternative for treatment and for surgical management of refractory lymphedema. Effective LVA requires supermicrosurgical systems to detect and anastomose lymphatic vessels, as they have a small vessel gauge measuring less than 0.5 mm. METHOD: The antro- and retrograd deep LVAs were performed with the combination of superior-edge-of-the-knee incision method and ventral ankle joint incision method. The direction of lymphatic flow and lymphatic vessels were evaluated intraoperatively with OPMI Pentero Infrared 900 microscope. In postoperative conditions, all 10 patients had undergone intensive Manual Lymphatic Drainage (MLD) and compression therapy. …RESULTS: Total 29 LVAs and 16 skin incisions were performed with intraoperative microscopic ICG lymphography on 10 lower limbs. No lymphatic vessel was detected in one patient at superior-edge-of-the-knee incision. 1 of 29 LVAs showed no patency and 2 of 29 LVAs showed lower patency in intraoperative ICG lymphography. All patients showed reduction in the lymphedema clearly and softer tissues could also be found in postoperative stages. CONCLUSION: Intraoperative microscope integrated with ICG fluorescence camera can takes shorter time for a lymphatic supermicrosurgeon to discover and dissect deeper lymphatic collector and evaluate anastomosis patency. Manual Lymphatic Drainage and compression therapy should start in early postoperative stages. Show more

DOI: 10.3233/CH-189311

Citation: Clinical Hemorheology and Microcirculation, vol. Pre-press, no. Pre-press, pp. 1-7, 2018

Authors: Schlenker, B. | Apfelbeck, M. | Buchner, A. | Stief, C. | Clevert, D.-A.

Article Type: Research Article

Abstract: INTRODUCTION: Prostate cancer (PCa) is one of the most common malignancies in men. The diagnostic standard to confirm prostate cancer is the transrectal ultrasound-guided biopsy. However, this procedure is associated with the underdetection of clinically significant prostate cancer and therefore needs to be improved. In the last years MRI fusion based targeted biopsy gained importance as consequence. In this study, we evaluated the quality of MRI ultrasound image fusion and evaluated factors influencing the image fusion quality. This was done by comparing fusion quality with the histopathological findings in the defined MRI target on the one hand and the PIRADS …score on the other hand. MATERIALS AND METHODS: Single arm study including patients with elevated prostate specific antigen (PSA) and a multiparametric MRI showing a suspicious lesion underwent a MRI fusion targeted biopsy at our institution. MRI fusion targeted biopsy and an additional 12-core transrectal ultrasound (TRUS) guided biopsy was performed using the Philips Percunav device (Philips Medical Systems, Bothell, WA). The fusion accuracy was rated by two experienced clinicians (1 radiologist, 18 years of experience, 1 urologist, 5 years of experience) using a five-point rank scale (1 = best) and comparing the result with the histological findings in the target and the PIRADS score. RESULTS: The detection rate of clinically significant cancer (Gleason 7a or greater) by MRI-ultrasound fusion targeted biopsy was 58.6% (17/29) compared to 50% (19/38) in the standard transrectal ultrasound-guided approach. PCa was found in 36.4% (4/11 patients) of patients with a PIRADS 3 lesion, in 57.7% (15/26 patients) of patients with a PIRADS 4 lesion. In 76.9% (10/13 patients) of patients with a PIRADS 5 lesion PCa was diagnosed. No statistical significance was found comparing the quality of registration either with the PIRADS (p = 0.7873) nor with the Gleason score (p = 0.4376). The study is limited by the small number of patients. CONCLUSIONS: MRI fusion based targeted biopsy improves the identification of clinical significant cancer. The Gleason score of detected PCa is not influenced by the quality of fusion. Show more

Keywords: Transrectal ultrasound-guided biopsy, image fusion, prostate, prostate cancer, multiparametric MRI

DOI: 10.3233/CH-189308

Citation: Clinical Hemorheology and Microcirculation, vol. Pre-press, no. Pre-press, pp. 1-8, 2018

Authors: Aung, T. | Heidekrueger, P.I. | Geis, S. | Von Kunow, F. | Taeger, C. | Strauss, C. | Wendl, C. | Brebant, V. | Prantl, L. | Hillmann, A.

Article Type: Research Article

DOI: 10.3233/CH-189309

Citation: Clinical Hemorheology and Microcirculation, vol. Pre-press, no. Pre-press, pp. 1-1, 2018

Authors: Platz Batista da Silva, Natascha | Michael Jung, Ernst | Jung, Friedrich | Schlitt, Hans J. | Hornung, Matthias

Article Type: Research Article

Abstract: AIM: Aim of this study was to firstly describe reproducible, objective perfusion parameters of contrast-enhanced ultrasound (CEUS) kinetics of parathyroid gland adenoma (PA) using perfusion analysis software (VueBox® , Bracco, Italy). Thereby the efficiency of quantitative CEUS for characterization of PA should be evaluated comparing US to postoperative histopathological findings after PA resection. MATERIAL AND METHODS: 42 patients with symptoms/lab work suggestive of pHPT presented a parathyroid gland lesion in B-mode US, which was consequently analyzed by dynamic CEUS. CEUS was performed by one experienced examiner after i.v.-injection of max. 2.4 ml sulphurhexaflouride microbubbles saving digital DICOM cine …loops (up to 25 s) and images. PA were evaluated during arterial, venous and late phase (up to 3 min.) for perfusion characterization. A retrospective, blinded VueBox® perfusion analysis of arterial phase of 28/42 PA was performed by a second, independent examiner placing 3 ROIs manually in the PA (center, rim of PA, surrounding thyroid gland tissue) to objectify findings. US findings were correlated to postoperative histology after PA resection. RESULTS: Out of 42 patients with PA findings in CEUS, perfusion analysis could be performed in 28/42 cases only as some CEUS cine loops had too much moving. In three cases the second examiner could not detect PA retrospectively, in 25 cases PA were characterized correctly resulting in a sensitivity rate of 89.3 %. VueBox® perfusion analysis confirmed that PA present a persisting hypervascularization of the rim with higher TTP (mean 7.93 s centrally, 8.36 s rim-sided), mTT (mean 56.6 s centrally, 64.5 s rim-sided) and lower PE (mean 10542.93 rm2 centrally, 8909.21 rm2 rim-sided) peripherally followed by a central wash-out during later phases. RT was comparable in all defined regions. CONCLUSION: VueBox® analysis of parathyroid gland CEUS examinations seemed to be a valuable tool for quantification of a PA’s perfusion and can help to detect and localize hyperfunctional parathyroid glands prior to surgery. Show more

Keywords: Contrast-enhancend ultrasonography, 99mTechnetium-sestamibi scintigraphy, diagnostics of primary hyperparathyroidism, VueBox® , CEUS perfusion quantification, parathyroid gland adenoma

DOI: 10.3233/CH-189307

Citation: Clinical Hemorheology and Microcirculation, vol. Pre-press, no. Pre-press, pp. 1-9, 2018

Authors: Sardinha, Joel | MacKinnon, Sean | Lehmann, Christian

Article Type: Research Article

Abstract: RATIONALE: Alterations in human microcirculation occur in many disease states leading to morbidity and mortality, however assessing the microcirculation is not standard clinical practice. Standard microcirculation analysis using semi-automated analysis is expensive, time consuming, and expertise dependent making it unfeasible. We proposed a novel visual scoring system (microVAS) for the analysis of microcirculation videos that can be performed at the patient bedside in real time. OBJECTIVE: Validate our microVAS score by training health professionals unfamiliar with the microcirculation field to use our microVAS score and compare their scores to the standard method of semi-automated analysis using …AVA3 software. METHODS: Using a prospective double-blind study design, we recruited and trained 20 participants to use our microVAS score. Participants scored 40 videos (from 22 healthy and 18 septic patients) for MFI and PPV. The same 40 videos were analysed by an expert using the gold standard semi-automated method of analysis. The results of the participants and the expert were analysed by Pearson’s linear regression. Krippendorff’s alpha was used to assess inter-rater reliability of the participants. RESULTS: Overall correlation of MFI was r = 0.33 (95% CI 0.27–0.39), p  <  0.05; overall correlation of PPV was r = –0.11 (95% CI –0.18 to –0.04), p  <  0.05. The Krippendorff’s alpha for MFI was 0.56 (healthy videos: α = 0.34, sepsis videos: α = 0.31). For PPV Krippendorff’s alpha was 0.43 (healthy videos: α = 0.56, sepsis videos: α = 0.17). CONCLUSIONS: Overall for both MFI and PPV, there was a small correlation between our microVAS score and AVA 3 scores. Regarding inter-rater reliability both MFI and PPV showed fair agreement between raters. Going forward multiple improvements to the microVAS scoring system as well as the training program are suggested to improve reliability and consistency. Show more

DOI: 10.3233/CH-180427

Citation: Clinical Hemorheology and Microcirculation, vol. Pre-press, no. Pre-press, pp. 1-10, 2018

Authors: Gori, Tommaso | Anadol, Remzi

Article Type: Research Article

Abstract: Up to 50% of the patients undergoing coronary angiography present no epicardial disease. Most of these patients are women. Takotsubo cardiomyopathy, coronary microvascular dysfunction, and spontaneous coronary artery dissection are the most common syndromes that affect these patients. Their mechanisms are complex, with a interplay between neurohormonal factors and a number of other systems. The present review describes how changes in the estrogen state may lead to changes in vasomotor tone and endothelial dysfunction which result in coronary epicardial and microvascular spasm and coronary arterial wall instability in these three conditions. The sex-dependent differences in prevalence, pathogenesis, and prognosis are …described. Show more

Keywords: Tako-tsubo, microvascular disease, sex

DOI: 10.3233/CH-189302

Citation: Clinical Hemorheology and Microcirculation, vol. Pre-press, no. Pre-press, pp. 1-5, 2018