To identify factors associated with non-alcoholic fatty liver disease over a 5-year period. Three hundred seven participants, including 165 women, with a mean age of 55.6 ± 12.0 years underwent continuous quantitative MRI of the liver using the proton-density fat fraction (PDFF). The liver’s fat fractions were determined at baseline and 5 years later, and the frequency of participants who developed fatty liver disease and potential influencing factors were explored. Based on significant factors, a model was generated to predict the development of fatty liver disease. After excluding participants with pre-existing fatty liver, the baseline PDFF of 3.1 ± 0.9

ObjectiveHepatobiliary surgery bares obstacles to informed consent for the patients due to its complexity and related risk of postoperative complications. 3D visualization of the liver has been proven to facilitate comprehension of the spatial relationship between anatomical structures and to assist in clinical decision-making. Our objective is to utilize individual 3D-printed liver models to enhance patient satisfaction with surgical education in hepatobiliary surgery.Design, settingWe conducted a prospective, randomized pilot study comparing 3D liver model-enhanced (3D-LiMo) surgical education against regular patient education during preoperative consultation at the department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Dresden, Germany.ParticipantsOf 97 screened patients, undergoing hepatobiliary surgery, 40 patients were enrolled from July 2020 to January 2022.ResultsThe study population (n = 40) was predominantly of male gender (62.5%) with a median age of 65.2 years and a high prevalence of preexisting diseases. Underlying disease, warranting hepatobiliary surgery, was malignancy in the majority of cases (97.5%). Patients in the 3D-LiMo group were more likely to feel very thoroughly educated and exhibited a higher level of satisfaction following surgical education than the control group (80 vs. 55%, n.s.; 90 vs. 65%, n.s.; respectively). Applying 3D models was also associated with enhanced understanding of the underlying disease with regard to amount (100% vs. 70%, p = 0.020) and location of liver masses (95 vs. 65%, p = 0.044). 3D-LiMo patients also demonstrated enhanced understanding of the surgical procedure (80 vs. 55%, n.s.), leading to better awareness for the occurrence of postoperative complications (88.9, vs. 68.4%, p = 0.052). Adverse event profiles were similar.ConclusionIn conclusion, individual 3D-printed liver models increase patient satisfaction with surgical education and facilitate patients' understanding of the surgical procedure as well as awareness of postoperative complications. Therefore, the study protocol is feasible to apply to an adequately powered, multicenter, randomized clinical trial with minor modifications.

To investigate the accuracy of liver diameters for estimation of liver size and to evaluate their application as tool for assessment of parenchymal liver disease. In the course of a population-based study, (SHIP) one thousand nine hundred thirty-nine volunteers underwent magnetic resonance imaging (MRI) of the liver including 3D gradient echo MRI sequences. Maximum liver diameters were measured in cranio-caudal (CC), anterior–posterior (AP), medial–lateral (ML) orientation. Diameters were compared with true liver volume assessed by liver segmentation. Additionally, age-dependent reference values for diameters were defined. Finally, accuracy of liver diameters was assessed to discriminate volunteers with healthy livers and participants with parenchymal changes, measured by MRI and laboratory. Reference values of liver diameters within the healthy population (n = 886) were defined as follows (mean ± standard deviation, confidence interval CI in cm): CC 17.2 ± 2, CI 13.6/21.2; AP 15.8 ± 1.9, CI 12.6/19.8; ML 19.7 ± 2.3, CI 15.8/24.6. There was a poor correlation using linear regression between liver diameter and true liver volume; CC 0.393, AP 0.359; ML 0.137. The AP direction shows the best correlation to discriminate between healthy and pathologic liver changes; AUC 0.78; p < 0.001, CC AUC 0.53; p < 0.001 and ML AUC 0.52; p = 0.008. Measurement of liver diameter, especially in the anterior–posterior direction is a simple option to detect chronic liver disease but less suitable for prediction of liver volume.

To evaluate the suitability of volume index measurement (VI) by either ultrasound (US) or computed tomography (CT) for the assessment of liver volume. Fifty-nine patients, 21 women, with a mean age of 66.8 ± 12.6 years underwent US of the liver followed immediately by abdominal CT. In US and CT imaging dorsoventral, mediolateral and craniocaudal liver diameters in their maximum extensions were assessed by two observers. VI was calculated by multiplication of the diameters divided by a constant (3.6). The liver volume determined by a manual segmentation in CT (“true liver volume”) served as gold standard. True liver volume and calculated VI determined by US and CT were compared using Bland–Altman analysis. Mean differences of VI between observers were − 34.7% (− 90.1%; 20.7%) for the US-based and 1.1% (− 16.1%; 18.2%) for the CT-based technique, respectively. Liver volumes determined by semi-automated segmentation, US-based VI and CT-based VI, were as follows: 1.500 ± 347cm 3 ; 863 ± 371cm 3 ; 1.509 ± 432cm 3 . Results showed a great discrepancy between US-based VI and true liver volume with a mean bias of 58.3 ± 66.9%, and high agreement between CT-based VI and true liver volume with a low mean difference of 4.4 ± 28.3%. Volume index based on CT diameters is a reliable, fast and simple approach for estimating liver volume and can therefore be recommended for clinical practice. The usage of US-based volume index for assessment of liver volume should not be used due to its low accuracy of US in measurement of liver diameters.

Abstract Hepatobiliary surgery is technically challenging due to a complex internal anatomy, further amplified by recent advancements in resection techniques. 3D visualization of the liver has been proven to facilitate comprehension of the spatial relationship between anatomical structures and to assist in clinical decision making. The aim of this study was to evaluate the educational and satisfiable value of individual 3D-printed liver models during surgical education. In this prospective, monocentric, randomized, controlled trial, n=40 patients, undergoing liver surgery, were enrolled and either randomized to standard (control group) or 3D liver model-enhanced (3D-LiMo) education before surgery. Primary endpoint was patient satisfaction following surgical education. Secondary endpoints included patients’ apprehension and satisfaction in the ongoing process, occurrence of postoperative complications as well as length of hospital stay. Patients in the 3D-LiMo group were more likely to feel very thoroughly educated and exhibited a higher level of satisfaction following surgical education than the control group (80 vs. 55%, n.s.; 90% vs. 65%, n.s.; respectively). Applying 3D models was also associated with enhanced understanding of the underlying disease with regard to amount (100% vs. 70%, p=0.020) and location of liver masses (95% vs. 65%, p=0.044). 3D-LiMo patients also demonstrated enhanced understanding of the surgical procedure (80% vs. 55%, n.s.), leading to better awareness for the occurrence of postoperative complications (88.9%, vs. 68.4%, p=0.052). In conclusion, individual 3D printed liver models increase patient satisfaction with surgical education and facilitate patients’ understanding of the surgical procedure as well as awareness of postoperative complications.

Aim of this study was to investigate frequency, incidence and risk factors of liver cysts in the general population in a longitudinal survey. Cyst frequency was investigated in 607 adult volunteers (288 women, 319 men, mean age 55 years) using strong T2-weighted magnetic resonance imaging. Risk factors were investigated for occurrence, frequency and size of cystic lesions at baseline. Incidence and physiological growing of the lesions were observed in a 5-years follow-up. At baseline, 431 volunteers had 1,479 cysts (71.0%). The mean number of cysts per person was 3.4 ± 9.0. The mean size of cysts was 13.1 ± 11.7 mm. Women had a higher number of cysts than men (p = 0.026). Older and male volunteers demonstrated a higher cyst frequency (p = 0.002 and p = 0.025). Per one-year increase in age the chance for a liver cyst increased by 2%. Four-hundred seventeen volunteers had cysts in the follow-up, in 24.6% new lesions had occurred. Lesion size significantly increased in follow-up (p < 0.001). Age and male sex were associated with the occurrence of at least one liver cyst. Women had a higher average number of cysts. Cystic lesion progression is a physiological phenomenon in the long-term follow-up.

Zielsetzung Evaluation der Genauigkeit von Leberdurchmessern zur Schätzung des Lebervolumens und Bewertung ihrer Rolle bei der Erkennung parenchymatöser Lebererkrankungen.

PURPOSE:To investigate whether adrenal gland radiodensities alone or compared to the inferior vena cava (IVC) can correctly predict hospital mortality in patients in intensive care.METHODS:One hundred thirteen intensive care patients (76 males, age: 67.2 ± 14.0 years) with an acute clinical deterioration were included in this retrospective analysis. For the venous and the arterial phase CT attenuation (Hounsfield units) of adrenal glands and IVC was ROI-based evaluated by two radiologists separately. ROC analysis, combined with the Matthews Correlation Coefficient (MCC) as a classifier, was used to assess whether one of the parameters is suitable for predicting short and medium-term mortality and, if so, which parameter is most appropriate. Interrater agreement was assessed using the intraclass correlation coefficient.RESULTS:Twenty-one patients (18.6%) died within three days in the ICU. Measurements of the adrenal glands in the portal venous phase yielded the highest discriminative power (=AUC) to distinguish between deceased and survivors. A threshold ratio of >95.5 predicted 72-hour mortality with a sensitivity of 76.19% and a specificity of 92.39% (AUC = 0.84; p < 0.0001). The positive likelihood ratio was 10.1; the positive predictive value was 69%. The predictive power for 24-hour mortality was slightly lower. Venous adrenal-to-IVC ratios and arterial measurements as a whole were substantially less suitable. All intraclass correlation coefficients indicated a high interrater agreement.CONCLUSIONS:In the portal venous phase, hyperattenuating of the adrenal glands on contrast-enhanced CT can predict short and intermediate ICU mortality quite well and may serve as a reproducible prognostic marker for individual patient outcomes.

Objectives The aim of the study was to evaluate the effect of bolus-tracking ROI positioning on coronary computed tomography angiography (CCTA) image quality. Methods In this retrospective monocentric study, all patients had undergone CCTA by step-and-shoot mode to rule out coronary artery disease within a cohort at intermediate risk. Two groups were formed, depending on ROI positioning (left atrium (LA) or ascending aorta (AA)). Each group contained 96 patients. To select pairs of patients, propensity score matching was used. Image quality with regard to coronary arteries as well as pulmonary arteries was evaluated using quantitative and qualitative scores. Results In terms of the coronary arteries, there was no significant difference between both groups using quantitative (SNR AA 14.92 vs. 15.46; p = 0.619 | SNR LM 19.80 vs. 20.30; p = 0.661 | SNR RCA 24.34 vs. 24.30; p = 0.767) or qualitative scores (4.25 vs. 4.29; p = 0.672), respectively. With regard to pulmonary arteries, we found significantly higher quantitative (SNR RPA 8.70 vs. 5.89; p < 0.001 | SNR LPA 9.06 vs. 6.25; p < 0.001) and qualitative scores (3.97 vs. 2.24; p < 0.001) for ROI positioning in the LA than for ROI positioning in the AA. Conclusions ROI positioning in the LA or the AA results in comparable image quality of CT coronary arteriography, while positioning in the LA leads to significantly higher image quality of the pulmonary arteries. These results support ROI positioning in the LA, which also facilitates triple-rule-out CT scanning. Key Points • ROI positioning in the left atrium or the ascending aorta leads to comparable image quality of the coronary arteries. • ROI positioning in the left atrium results in significantly higher image quality of the pulmonary arteries. • ROI positioning in the left atrium is feasible to perform triple-rule-out CTA.

An 80-year-old man developed high-risk prostate cancer after 7 years of active surveillance. For staging and treatment planning, a Ga-PSMA PET/MRI was performed. Besides the PSMA-positive primary tumor and a solitary bone metastasis in the fifth thoracic vertebral body, an intensive intrahepatic PSMA expression (SUVmax, 16.3) was suspicious for a liver metastasis. The results of a previously performed contrast-enhanced CT, a consecutively performed contrast-enhanced ultrasound, and a follow-up PSMA PET/CT after 4 months with a stable lesion during androgen deprivation lead to the diagnosis of a vascular malformation metabolically mimicking a hepatic metastasis of the prostate tumor.

Non-rigid registration is a key component in soft-tissue navigation. We focus on laparoscopic liver surgery, where we register the organ model obtained from a preoperative CT scan to the intraoperative partial organ surface, reconstructed from the laparoscopic video. This is a challenging task due to sparse and noisy intraoperative data, real-time requirements and many unknowns - such as tissue properties and boundary conditions. Furthermore, establishing correspondences between pre- and intraoperative data can be extremely difficult since the liver usually lacks distinct surface features and the used imaging modalities suffer from very different types of noise. In this work, we train a convolutional neural network to perform both the search for surface correspondences as well as the non-rigid registration in one step. The network is trained on physically accurate biomechanical simulations of randomly generated, deforming organ-like structures. This enables the network to immediately generalize to a new patient organ without the need to re-train. We add various amounts of noise to the intraoperative surfaces during training, making the network robust to noisy intraoperative data. During inference, the network outputs the displacement field which matches the preoperative volume to the partial intraoperative surface. In multiple experiments, we show that the network translates well to real data while maintaining a high inference speed. Our code is made available online.

Characterization of intraabdominal fluid collections as postoperative complication is a challenging task. The aim was to develop and validate a new score to differentiate infected from sterile postoperative abdominal fluid collections and to compare it with a published score. From May to November 2015, all patients with postoperative CT and C-reactive protein (CRP) 24 hours before CT-guided drainage were retrospectively included (Group A). HU, gas entrapment and wall enhancement of fluid collections were evaluated in the CT. All parameters were correlated with microbiology. To validate the score and to compare it with a published score, a second patient cohort was retrospectively recruited (Group B; January 2013–April 2015; December 2015–September 2016). In Group A (50 patients), univariate analysis confirmed that the four parameters were significantly associated with infected fluid collections. Based on binary logistic regression analysis, a score from 0 to 11 was developed (CRP </≥ 150 mg/l: 0/4 points; HU </≥ 20: 0/2 points; wall enhancement no/yes: 0/2 points; gas entrapment no/yes: 0/3 points). The best cutoff to diagnose infected fluid collections was ≥ 5 points (sensitivity 85%, specificity 79%, PPV 82%, NPV 79%). In Group B (425 patients), this score yielded sensitivity, specificity, PPV and NPV of 93%, 80%, 90% and 86%, respectively. For the published score, values were in the same range (93%, 44%, 77%, 77%). The score provides good discrimination between infected and sterile postoperative abdominal fluid collections. It yields comparable accuracy as the published score.

Regardless of its high positron energy, 68 Ga-labeled PSMA ligands have become standard of care in metabolic prostate cancer imaging. 64 Cu, a radionuclide with a much longer half-life (12.7 h), is available for PSMA labeling allowing imaging much later than 68 Ga. In this study, the diagnostic performance of 64 Cu-labeled PSMA was compared between early and late scans. Sixteen men (median age: 70 y) with prostate cancer in different stages underwent 64 Cu-PSMA-617-PET/CT 2 and 22 hours post tracer injection. Pathologic and physiologic uptakes were analyzed for both points of time. Pathologic tracer accumulations occurred in 12 patients. Five patients presented with pathologic uptake in 17 different lymph nodes, two patients showed pathologic bone uptake in nine lesions, and seven patients had pathologic PSMA uptake in eight prostatic lesions. Physiologic uptake of the renal parenchyma, urine bladder, and salivary glands decreased over time, while the physiologic uptake of liver and bowel increased. In the present study, 64 Cu-PSMA-617-PET demonstrated to be feasible for imaging prostate cancer for both the primary tumor site and metastases. Later imaging showed no additional, clinically relevant benefit compared with the early scans. At least the investigated time points we chose did not vindicate the additional expenditure.

& xfeff;Aim (68) Ga-PSMA-11 is the gold standard for molecular imaging of prostate cancer. However, recurrent tumor manifestations or metastases cannot be detected in every case. Therefore, we investigated if there is an additive value of the gastrin-releasing peptide receptor (GRP-R) ligand (68) Ga-RM2 compared to the well-established (68) Ga-PSMA-11 in patients with (Group 1) and without (Group 2) pathologic PSMA-expression in different tumor stages. Patients and Methods Sixteen men (median age: 74 years, range 50-80 years) with prostate cancer in different stages who had a recent negative (n = 8) or pathologic (n = 8) PSMA PET underwent a subsequent (68) Ga-RM2 PET. Both examinations were analyzed qualitatively and quantitatively and compared in terms of pathologic and physiologic tracer distribution. Results None of the PSMA-negative patients showed any pathological RM2-accumulation. Pathologic PSMA-uptake was observed in 8 patients of whom 5 had pathologic RM2-uptake. The number of patients with a local recurrence was equal in both scans (n = 3). Bone metastases and lymph node metastases were detected in less patients in RM2 PET compared to PSMA PET (n = 4 vs. 7 and n = 2 vs. 5, respectively). In one patient, PSMA-positive liver metastases were not detected in RM2. RM2 PET revealed two additional lesions indicative for bone metastases in two patients with multiple PSMA-positive bone metastases, which had no therapeutic consequence. Conclusion At least in our small and heterogeneous patient population, (68) Ga-RM2 showed no clinically relevant, additional benefit compared to (68) Ga-PSMA-11 PET.

New protocols for coronary computed tomography angiography (CCTA) could lower the radiation dose for patients but influence the image quality. To compare image quality and radiation exposure in step-and-shoot CCTA and high-pitch spiral CCTA. Fifty-nine pairs of patients matched for weight, height, sex and heart rate were included in this study (74 m, 44 f, average age 60 years, age range 29–94 years). Step-and-shoot CCTA and high-pitch spiral CCTA was performed on a third generation dual-source CT in equally sized patient groups. The signal-to-noise ratio (SNR) in the ascending aorta and the coronary arteries were determined for each dataset. Image quality was rated using a five-point scale. We used the t-test for paired samples to compare SNR and effective dose, and the Wilcoxon test to compare image quality scores. Mean effective dose for the step-and-shoot protocol (4.15 ± 3.07 mSv) was significantly higher in comparison to the high-pitch spiral protocol (1.2 ± 0.69 mSv; p < 0.0001). Mean SNR was higher with the step-and-shoot protocol compared to the high-pitch spiral protocol in the aorta, in the left main and peripheral coronary arteries (p < 0.01), in the proximal right coronary artery (p = 0.027). Image quality scores were significantly better for the step-and-shoot protocol (p = 0.0003). Step-and-shoot CCTA has significantly better SNR and overall image quality compared to high-pitch spiral CCTA, but with a mean effective dose more than thrice as high.

A 55-year-old woman with newly diagnosed hepatocellular carcinoma (HCC) was hospitalized in our department for the evaluation of selective internal radiotherapy (SIRT), which consists of an angiography, an intra-arterial technetium (Tc)-99m-macroaggregated albumin application and Tc-99m sulfur colloid scintigraphy to assess liver function. Besides the modest intratumoral tracer accumulation, F-18-fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET/CT) imaging showed two intense focal cuneiform splenic FDG accumulations which turned out to be splenic infarctions. Four months later, both hypermetabolic foci were completely regressive in the first follow-up PET/CT after SIRT. This is the first report of a complete metabolic regression of splenic infarctions within just 4 months, whereas regression on CT is commonly seen after more than 2 years.

A 68-year-old woman who underwent a thyroidectomy for bilateral goiter 20 years ago was referred to our department. The examination revealed a newly occurred thyroid nodule in the right central lobe. Unexpectedly the Tc-pertechnetate scan revealed several extrathyroidal foci right-sided supraclavicular, beside a cold thyroid nodule in the right lower lobe. Consecutive surgery and histology confirmed the suspected diagnosis of follicular thyroid cancer with multiple bone metastases. Whole-body scintigraphy performed after the following radioiodine therapy indicated disseminated osseous metastases.

Purpose: To investigate factors influencing liver size and to determine reference values of liver volume (LV) for healthy subjects. Methods: 2773 volunteers underwent magnetic resonance imaging (MRI) of the liver in the setting of the population based Study of Health in Pomerania. Based on measurement of maximum diameters in three orientations, LVs were calculated and correlated with demographic factors such as age, gender, and body mass index. In addition, LVs of healthy volunteers and participants with parenchymal liver diseases such as fatty liver disease, iron overload, fibrosis/cirrhosis were compared. Adjusted reference values of liver volumes were defined for the group of healthy participants. Results: In general, mean LV (mean +/- standard deviation) was 1505 +/- 385 cm(3). Age, gender and body mass index correlated significantly with the liver volume (p <= 0.001). Parenchymal liver diseases significantly influence LV (with: 1624 +/- 420 cm(3), n = 1525 and without parenchymal liver diseases: 1360 +/- 273 cm(3); n = 1.248, p <= 0.001). Compared to LV of participants without liver diseases, LV was increased in volunteers with hepatic steatosis (1717 +/- 419 cm(3); n = 1111), liver iron overload (1558 +/- 367 cm(3); n = 553; p <= 0.001) as well as in participants with fibrosis/cirrhosis (1494 +/- 459 cm(3); n = 383). Conclusions: LV is influenced by age, body mass index and parenchymal liver diseases. Reference values were established to aid in the diagnosis of parenchymal liver diseases.