Numerous studies showed that habitat fragmentation can affect the constitution of species by impairing living conditions, impeding gene flow and thereby reducing genetic variability. However, populations of the same species may react less sensitive to fragmentation in the core than in the periphery of its distribution range. In the core they are assumed to be more euryoecious compared to the periphery, where they are assumed to be stenoecious with lower genetic diversity and higher genetic differentiation. We tested this hypothesis by comparing the genetic variability of 215 individuals of ten populations of Lacerta viridis from fragmented habitats within its distribution center in Bulgaria using genotype data of 19 microsatellite loci. We could not detect significant alteration of genetic variation, regardless of patch size and isolation by distance, indicating that fragmentation indeed did not have a strong impact on L. viridis in the core area of its historical and recent distribution range. We cannot rule out that the time elapsed since habitat fragmentation occurred was too short to yield a genetic response. However, in a similar study on L. agilis, which is stenoecious in Bulgaria, all genetic diversity indices declined with patch size. This provides indications that fragmentation at present does not have a strong effect on the genetic variation of Bulgarian L. viridis populations.

Species show different sensitivity to habitat loss and fragmentation depending on their specialization. Populations of a species at the range margin are generally assumed to be more stenoecious than populations at the core of the distribution and should therefore be more sensitive to habitat fragmentation.

Ziel war es, mittels der für die Endoleak-Detektion sehr sensitiven dynamischen CTA nachzuweisen, welche klinische Relevanz Typ-II-Endoleaks hinsichtlich der Größenentwicklung der Aneurysmasack-Diameter haben und ob stattgehabte Re-Interventionen einen Einfluss auf die Endoleakhäufigkeit haben.

Beurteilung aortaler Wachstumsmuster und Identifikation von Einflussgrößen auf die aortale Wachstumsrate in der Computertomografie

Intramyocardial haemorrhage (IMH) and microvascular obstruction (MVO) represent reperfusion injury after reperfused ST-elevation myocardial infarction (STEMI) with prognostic impact and “hypointense core” (HIC) appearance in T2-weighted images. We aimed to distinguish between IMH and MVO by using T2 *-weighted cardiovascular magnetic resonance imaging (CMR) and analysed influencing factors for IMH development.

Background. The aim of this study was to analyze the angle between the left ventricular (LV) long axis and the LV outflow tract (alpha LV-LVOT) on cardiac computed tomography and to describe its effect on the occurrence of paravalvular leakage (PL), fluoroscopy time, and postoperative creatine kinase-MB levels in transapical transcatheter aortic valve replacement (TA-TAVR).Methods. High-risk patients with severe aortic stenosis scheduled for TA-TAVR using an Edwards SAPIEN (Edwards Lifesciences, Irvine, CA) prosthesis were retrospectively included. The alpha LV-LVOT was measured during systole and diastole as far as retrospectively gated data sets were available. The alpha LV-LVOT was correlated with the occurrence of PL, total fluoroscopy time, and postoperative creatine kinase-MB levels. Interobserver variability was assessed in all cases.Results. The study included 81 patients (57 women [70.4%], 24 men [29.6%]) with an average age of 81.9 +/- 5.8 years. The mean alpha LV-LVOTs were 61.8 +/- 9.9 degrees during systole and 61.1 +/- 10.0 degrees during diastole. There was a minimal, nonsignificant change in the alpha LV-LVOT between systole and diastole of 0.2 +/- 4.1 degrees (p = 0.7). PL was found in 39 patients: grade 0 in 42 (51.9%), grade I in 30 (37.0%), and grade II in 9 (11.1%). Patients with a clinically significant PL (grade >= II) showed a significantly greater mean alpha LV-LVOT than patients with grade I or without PL (mean difference, 13.8 +/- 3.2 degrees; p < 0.001). No significant correlation was found between the alpha LV-LVOT and total fluoroscopy time (r = -0.17, p = 0.16) and postoperative creatine kinase-MB levels (r = -0.1, p = 0.44).Conclusions. During TA-TAVR, greater alpha LV-LVOTs were associated with significantly higher grades of PL. Thus, the alpha LV-LVOT might influence the selection of the transapical implantation path and could have a significant effect on designs for future stents or novel delivery devices. (C) 2014 by The Society of Thoracic Surgeons

The Sand lizard Lacerta agilis inhabits a huge area across Eurasia with several subspecies. Nine subspecies are generally approved, L. a. agilis, L. a. argus, L. a. bosnica; L. a. chersonensis, L. a. exigua, L. a. grusinica, L. a. iorinensis, L. a. brevicaudata and L. a. boemica, but several more have been described. The emergence of this large number of subspecies is connected with the phylogeographic history of this species, defined by geographic and climatic processes. A study revealing phylogenetic relationships of this species was already conducted with a broad taxon sampling and coverage. However, the latter study was based solely on the cytochrome b gene and, furthermore, the Balkan Peninsula inhabited by the subspecies L. a. bosnica was underrepresented. This peninsula is a centre of European herpetofaunal endemism with high levels of phenotypic and genotypic variation. Therefore, the inclusion of the subspecies L. a. bosnica is important to clarify the overall view of the phylogenetic relations within the Lacerta agilis subspecies complex and to investigate the level of population differentiation within this highly diverse area. Thus, the aim of the present study was a more thorough analysis of the Balkan Peninsula with a broader taxon sampling. Furthermore, we extended the available datasets by adding the mitochondrial d-loop region and by further samples of different areas of the distribution range apart from the Balkan Peninsula. Our study reveals that the Balkan Peninsula is apparently inhabited by several differentiated lineages, whereby the Central Greek lineage might deserve subspecies status. Furthermore, the distribution area of the two subspecies L. a. agilis and L. a. argus should be revised, as the results of our study raise doubt about the commonly assumed distribution of both subspecies. As the most important outcome our results support that L. a. boemica deserves species status.

Abstract Purpose: To compare the performance of server-based (CSS) versus stand-alone post-processing software (ES) for the evaluation of cardiovascular CT examinations (cvCT) and to determine the crucial steps. Materials and Methods: Data of 40 patients (20 patients for coronary artery evaluation and 20 patients prior to transcatheter aortic valve implantation [TAVI]) were evaluated by 5 radiologists with CSS and ES. Data acquisition was performed using a dual-source 128-row CT unit (SOMATOM Definition Flash, Siemens, Erlangen, Germany) and a 64-row CT unit (Brilliance 64, Philips, Hamburg, Germany). The following workflow was evaluated: Data loading, aorta and coronary segmentation, curved multiplanar reconstruction (cMPR) and 3 D volume rendering technique (3D-VRT), measuring of coronary artery stenosis and planimetry of the aortic annulus. The time requirement and subjective quality for the workflow were evaluated. Results: The coronary arteries as well as the TAVI data could be evaluated significantly faster with CSS (5.5 ± 2.9 min and 8.2 ± 4.0 min, respectively) than with ES (13.9 ± 5.2 min and 15.2 ± 10.9 min, respectively, p≤ 0.01). Segmentation of the aorta (CSS: 1.9 ± 2.0 min, ES: 3.7 ± 3.3 min), generating cMPR of coronaries (CSS: 0.5 ± 0.2 min, ES: 5.1 ± 2.6 min), aorta and iliac vessels (CSS: 0.5 ± 0.4 min and 0.4 ± 0.4 min, respectively, ES: 1.6 ± 0.7 min and 2.8 ± 3 min, respectively) could be performed significantly faster with CSS than with ES with higher quality of cMPR, measuring of coronary stenosis and 3D-VRT (p < 0.05). Conclusion: Evaluation of cvCT can be accomplished significantly faster and better with CSS than with ES. The segmentation remains the most time-consuming workflow step, so optimization of segmentation algorithms could improve performance even further. Key points: • With client-server-based (CSS) and stand-alone solutions (ES), cardiovascular CT datasets can be evaluated reliably. • Evaluation of cardiovascular CT can be performed faster and better with CSS than with ES. • In particular the generating of curved reconstructions is faster with CSS than with ES. • Segmentation of data is a crucial step for semiautomatic software (CSS and ES). Citation Format: • Lücke C, Foldyna B, Andres C et al. Post-Processing in Cardiovascular Computed Tomography: Performance of a Client Server Solution versus a Stand-Alone Solution. Fortschr Röntgenstr 2014; 186: 1111 – 1121

Comparing the diagnostic value of multi-sequential cardiac magnetic resonance imaging (CMR) with endomyocardial biopsy (EMB) for sub-clinical cardiac allograft rejection.

PURPOSETo determine the time course of enhancement patterns in the aorta and endoleaks at dynamic computed tomographic (CT) angiography as well as their effect on the endoleak detection rate in patients who have undergone abdominal aortic endovascular aneurysm repair (EVAR).MATERIALS AND METHODSThis retrospective study was approved by the local ethics committee and compliant with the Declaration of Helsinki. All patients gave written informed consent for the scientific analysis of their data. Seventy-one patients (mean age, 72 years ± 8 [standard deviation]) were retrospectively included after EVAR of the abdominal aorta. All patients underwent dynamic CT angiography with 10 unidirectional scan phases, followed by a venous phase. Endoleaks were detected visually in all scan phases; the magnitude of enhancement was assessed by using region-of-interest measurements in the aorta and the detectable endoleaks. Statistical analysis was performed with the χ(2) test, the paired t test, and analysis of variance with repeated measurements.RESULTSThe highest mean aortic enhancement was achieved 12 seconds after the bolus-tracking threshold, and the highest mean endoleak enhancement was achieved 22 seconds after the bolus-tracking threshold. In total, 44 endoleaks were detected. The detection rates differed significantly in between the dynamic CT angiography phases (minimum, seven endoleaks at 2 seconds after the bolus-tracking threshold; maximum, 44 endoleaks at 27 seconds after the bolus-tracking threshold; P = .001). The highest detection rate was achieved when the contrast between aortic and endoleak enhancement reached its maximum.CONCLUSIONDynamic CT angiography revealed that the peak enhancement of endoleaks is significantly different than that of the aorta and that endoleaks may not be adequately evaluated with conventional biphasic CT protocols. The use of dynamic CT angiography is associated with a significantly increased detection rate of endoleaks compared with the detection rates at the time points of conventional biphasic CT.

UNLABELLED Transcatheter aortic valve implantation (TAVI) is currently considered an acceptable alternative for the treatment of patients with severe aortic stenosis and a high perioperative risk or a contraindication for open surgery. The benefit of TAVI significantly outweighs the risk of the procedure in patients requiring treatment that are not suitable for open surgery, and leads to a lower mortality in the one-year follow-up. The absence of a direct view of the aortic root and valve remains a challenge for the transcatheter approach. While direct inspection of the aortic valve during open surgery allows an adequate prosthesis choice, it is crucial for TAVI to know the individual anatomical details prior to the procedure in order to assure adequate planning of the procedure and proper prosthesis choice and patient selection. Among the imaging modalities available for the evaluation of patients prior to TAVI, computed tomography (CT) plays a central role in patient selection. CT reliably visualizes the dimensions of the aortic root and allows a proper choice of the prosthesis size. The morphology of the access path and relevant comorbidities can be assessed. The present review summarizes the current state of knowledge regarding the value of CT in the evaluation of patients prior to TAVI. CT plays a central role in patient selection and planning prior to TAVI. CT reliably detects the dimensions of the aortic root including the size of the aortic annulus, the degree of valve calcification and the morphology of the access routes. KEY POINTS CT plays a central role in patient selection and planning prior to TAVI. CT reliably detects the dimensions of the aortic root including the size of the aortic annulus, the degree of valve calcification and the morphology of the access routes. CT provides a more accurate measurement of the aortic annulus than 2D TEE and CT is the only imaging modality that allows a risk assessment for paravalvular leakages based on the calcification of the aortic valve.

Ziele: Untersuchung des Winkels zwischen linksventrikulärer Längsachse und Ausflusstrakt (LV-LVOT) und seines Einflusses auf das Auftreten von postoperativen paravalvulären Lecks (PL), eine verlängerte OP-Dauer und einen postoperativen Anstieg der Creatinin-Kinase (CK-MB) in der CT bei Patienten nach TA-AVI. Methode: 74 Hochrisiko-Patienten mit schwerer AS, die eine TA-AVI (Prothese: Edwards SapienTM) und eine präoperative, EKG-getriggerte CT erhielten, wurden retrospektiv in unsere Studie eingeschlossen. Der LV-LVOT wurde jeweils in Systole und Diastole mittels multiplanarer Rekonstruktion der CT Daten ermittelt und mit dem Grad der PL, der OP-Dauer und des postoperativen CK-MB-Spiegels korreliert. Alle Messungen wurden von zwei erfahrenen Radiologen durchgeführt und die Interobservervariabilität wurde berechnet. Ergebnis: Präoperative CT-Daten standen bei 74 Patienten (Alter 81,9 ± 5,8 Jahre, weiblich = 71%) zur Verfügung. Der mittlere LV-LVOT betrug 61,8° ± 9,8° in der Systole und 61,3° ± 10,1° in der Diastole, in paarweiser Analyse ohne signifikante Veränderung (p = 0.79) während des Herzzyklus. PL traten bei 35 Patienten auf (I°:n = 29 [38,7%], II°:n = 6 [8%], III°:n = 0). Relevante PL traten signifikant häufiger bei LV-LVOT auf, die oberhalb ihres Medians lagen (p = 0.013). Patienten mit relevanten PL (>= II°) wiesen im Durschnitt einen signifikant steileren LV-LVOT als Patienten mit PL

Katheterbasierte Aortenklappenimplantationen (TAVI) gelten mittlerweile als akzeptierte Alternative zur Behandlung von Patienten mit hochgradiger Aortenklappenstenose und hohem perioperativem Risiko oder einer Kontraindikation für einen offen-chirurgischen Aortenklappenersatz (AKE). Der Nutzen der TAVI überwiegt das Risiko des Eingriffs deutlich bei behandlungsbedürftigen Patienten, die nicht für einen offenchirurgischen AKE geeignet sind, und führt zu einem Absinken der Mortalität im 1-Jahres-Followup. Eine Herausforderung bei der kathetergestützten Vorgehensweise stellt das Fehlen einer direkten Sicht auf die Aortenwurzel und -klappe während der Implantation dar. Während beim offen-chirurgischen AKE die Aortenklappe direkt inspiziert und eine Prothesenwahl getroffen werden kann, ist es bei der TAVI erforderlich, die individuellen anatomischen Details vor der Prozedur zu kennen, um eine adäquate Planung der Prozedur, eine geeignete Prothesenwahl und Patientenselektion zu ermöglichen. Unter den für eine Evaluation von Patienten vor TAVI verfügbaren bildgebenden Modalitäten nimmt die Computertomografie (CT) mittlerweile eine zentrale Rolle bei der Patientenselektion ein, da mit ihr zuverlässig die Dimensionen der Aortenwurzel einschließlich der Wahl der Prothesengröße, die Morphologie des Zugangswegs und relevante Komorbiditäten erfasst werden können. Die vorliegende Übersichtsarbeit fasst den aktuellen Stand des Wissens zum Stellenwert der CT bei der Evaluation von Patienten vor TAVI zusammen. Kernaussagen: ▶ Die CT nimmt eine zentrale Rolle bei der Patientenselektion und Prozedurenplanung vor TAVI ein . ▶ Die CT erfasst zuverlässig die Dimensionen der Aortenwurzel einschließlich der Größe des Aortenanulus, dem Verkalkungsgrad der Klappe und der Morphologie der möglichen Zugangswege. ▶ Die CT erlaubt eine genauere Vermessung des Aortenanulus als die 2D-TEE und ermöglicht als einziges bildgebendes Verfahren eine Einschätzung des Risikos paravalvulärer Leckagen anhand des Verkalkungsgrades der Aortenklappe. Zitierweise: ▶ Lehmkuhl L, Foldyna B, Haensig M et al. Role of Preprocedural Computed Tomography in Transcatheter Aortic Valve Implantation. Fortschr Röntgenstr 2013; 185: 941–949

Die Inzidenz der infektiösen Endokarditis beträgt je nach geografischer Lage 3 – 10/100 000 Personen pro Jahr. Das epidemiologische Profil der infektiösen Endokarditis hat sich in den vergangenen Jahren substanziell geändert, insbesondere in den industrialisierten Nationen. Handelte es sich früher um eine Erkrankung, die junge Menschen betraf, welche meistens an einer rheumatischen Klappenerkrankung litten, so betrifft die infektiöse Endokarditis heute häufiger ältere Patienten, die die Erkrankung als Folge eines medizinischen Eingriffs ohne vorbestehende Klappenerkrankung oder nach Klappenersatz erleiden. Das Geschlechterverhältnis männlich/weiblich beträgt hierbei ≥ 2/1.

Objectives: To examine whether the angle between the left ventricular long axis and left ventricular outflow tract (· LV-LVOT) allows prediction of the occurrence of paravalvular leakage (PL), its impact on procedural time as well as myocardial damage and elevated postoperative CK-MB levels in patients undergoing transapical valve implantation (TA-AVI).

Ziel der Studie ist es, den Einfluss verschiedener EKG-Qualitäten auf das Scanverhalten bei prospektiv getriggerten CT-Untersuchungen des Herzens hinsichtlich der applizierten Strahlendosis zu untersuchen.

Ziele: Vergleich der Abstände der Koronarostien von den basalen Insertionsstellen der Aortenklappentaschen (AT) zur Länge der AT mittels Computertomographie (CT) vor transapikaler Aortenklappenimplantation (TA-AVI) zur Beurteilung einer potentiellen intraproceduralen Obstruktion der Koronarostien durch die native AT. Methode: Es wurden 56 Patienten (40/16m/w, Durchschnittsalter 81±6.8y) mit schwerer Aortenstenose, geplanter TA-AVI und vorliegender präoperativer CT eingeschlossen. Die Entfernungen des rechten und linken Koronarostiums zu den basalen Insertionsstellen der jeweiligen AT wurden in systolischer und diastolischer Phase gemessen und mit der Länge der diastolischen AT verglichen. Eine mögliche Überlappung eines Koronarostiums wurde mittels paarweiser Analyse ermittelt. Ergebnis: Die paarweise Analyse ergab eine mögliche Überlappung von Teilen des rechten Koronarostiums durch die rechtskoronare AT (Mittlere Überlappung 1,7±2,2mm, p<0,001) während der Implantation. Linkskoronar betrug die mittlere Überlappung 0,2±2,7mm, ohne das der Abstand von der basalen Insertionsstelle der AT zum linken Koronarostium sich signifikant unterschied (p=0,66). Es wurden bei den eingeschlossenen Patienten keine intraoperativen Koronarverschlüsse beobachtet. Schlussfolgerung: Die rechtskoronare Klappentasche überschreitet in der Länge den Abstand der basalen Insertionsstelle zum rechtskoronaren Ostium und stellt somit ein intraoperatives Risiko für eine Obstruktion eines großen Teils des rechtskoronaren Ostiums dar.