BACKGROUND:Despite the prognostic relevance of cachexia in pancreatic cancer, individual body composition has not been routinely integrated into treatment planning. In this multicenter study, we investigated the prognostic value of sarcopenia and myosteatosis automatically extracted from routine computed tomography (CT) scans of patients with advanced pancreatic ductal adenocarcinoma (PDAC). PATIENTS AND METHODS:We retrospectively analyzed clinical imaging data of 601 patients from three German cancer centers. We applied a deep learning approach to assess sarcopenia by the abdominal muscle-to-bone ratio (MBR) and myosteatosis by the ratio of abdominal inter- and intramuscular fat to muscle volume. In the pooled cohort, univariable and multivariable analyses were carried out to analyze the association between body composition markers and overall survival (OS). We analyzed the relationship between body composition markers and laboratory values during the first year of therapy in a subgroup using linear regression analysis adjusted for age, sex, and American Joint Committee on Cancer (AJCC) stage. RESULTS:Deep learning-derived MBR [hazard ratio (HR) 0.60, 95% confidence interval (CI) 0.47-0.77, P < 0.005] and myosteatosis (HR 3.73, 95% CI 1.66-8.39, P < 0.005) were significantly associated with OS in univariable analysis. In multivariable analysis, MBR (P = 0.019) and myosteatosis (P = 0.02) were associated with OS independent of age, sex, and AJCC stage. In a subgroup, MBR and myosteatosis were associated with albumin and C-reactive protein levels after initiation of therapy. Additionally, MBR was also associated with hemoglobin and total protein levels. CONCLUSIONS:Our work demonstrates that deep learning can be applied across cancer centers to automatically assess sarcopenia and myosteatosis from routine CT scans. We highlight the prognostic role of our proposed markers and show a strong relationship with protein levels, inflammation, and anemia. In clinical practice, automated body composition analysis holds the potential to further personalize cancer treatment.

Background In a previous study from our group, CT biomarkers derived from fully automated body composition analysis (BCA) correlated with overall survival in patients with idiopathic pulmonary fibrosis (IPF). The aim of the present study was to verify whether fully automated BCA derived biomarkers correlated with overall survival also in patients with NSIP.

Zielsetzung Das Ziel dieser Studie war es, die Voraussagekraft einer vollautomatisierten Analyse der Körperzusammensetzung (BCA) in Bezug auf das Gesamtüberleben von Patienten mit idiopathischer pulmonaler Fibrose (IPF) zu überprüfen.

Objectives The aim of this study is to use virtual contrast enhancement to reduce the amount of hepatobiliary gadolinium-based contrast agent in magnetic resonance imaging with generative adversarial networks (GANs) in a large animal model. Methods With 20 healthy Göttingen minipigs, a total of 120 magnetic resonance imaging examinations were performed on 6 different occasions, 50% with reduced (low-dose; 0.005 mmol/kg, gadoxetate) and 50% standard dose (normal-dose; 0.025 mmol/kg). These included arterial, portal venous, venous, and hepatobiliary contrast phases (20 minutes, 30 minutes). Because of incomplete examinations, one animal had to be excluded. Randomly, 3 of 19 animals were selected and withheld for validation (18 examinations). Subsequently, a GAN was trained for image-to-image conversion from low-dose to normal-dose (virtual normal-dose) with the remaining 16 animals (96 examinations). For validation, vascular and parenchymal contrast-to-noise ratio (CNR) was calculated using region of interest measurements of the abdominal aorta, inferior vena cava, portal vein, hepatic parenchyma, and autochthonous back muscles. In parallel, a visual Turing test was performed by presenting the normal-dose and virtual normal-dose data to 3 consultant radiologists, blinded for the type of examination. They had to decide whether they would consider both data sets as consistent in findings and which images were from the normal-dose study. Results The pooled dynamic phase vascular and parenchymal CNR increased significantly from low-dose to virtual normal-dose (pooled vascular: P < 0.0001, pooled parenchymal: P = 0.0002) and was found to be not significantly different between virtual normal-dose and normal-dose examinations (vascular CNR [mean ± SD]: low-dose 17.6 ± 6.0, virtual normal-dose 41.8 ± 9.7, and normal-dose 48.4 ± 12.2; parenchymal CNR [mean ± SD]: low-dose 20.2 ± 5.9, virtual normal-dose 28.3 ± 6.9, and normal-dose 29.5 ± 7.2). The pooled parenchymal CNR of the hepatobiliary contrast phases revealed a significant increase from the low-dose (22.8 ± 6.2) to the virtual normal-dose (33.2 ± 6.1; P < 0.0001) and normal-dose sequence (37.0 ± 9.1; P < 0.0001). In addition, there was no significant difference between the virtual normal-dose and normal-dose sequence. In the visual Turing test, on the median, the consultant radiologist reported that the sequences of the normal-dose and virtual normal-dose are consistent in findings in 100% of the examinations. Moreover, the consultants were able to identify the normal-dose series as such in a median 54.5% of the cases. Conclusions In this feasibility study in healthy Göttingen minipigs, it could be shown that GAN-based virtual contrast enhancement can be used to recreate the image impression of normal-dose imaging in terms of CNR and subjective image similarity in both dynamic and hepatobiliary contrast phases from low-dose data with an 80% reduction in gadolinium-based contrast agent dose. Before clinical implementation, further studies with pathologies are needed to validate whether pathologies are correctly represented by the network.

Zielsetzung Zur lokalen Tumorkontrolle können Lebermetastasen bei Aderhautmelanom durch die Leberarterienchemoinfusion behandelt werden. Aufgrund diffuser Metastasierung ist die kurzfristige Bewertung nach den Kriterien der Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 oft schwierig. Die diffuse Organbeteiligung führt häufig zu einer Hepatomegalie, die sich durch Lebervolumetrie (LV) unkompliziert nachweisen lässt. Ziel dieser Studie ist der Vergleich von RECIST 1.1 und LV für die Bewertung des Ansprechens auf die Leberarterienchemoinfusion.

BACKGROUND AND PURPOSE:Data on the temporal distribution of the bleeding time of intracranial aneurysms are limited to a few small studies. With this study, the aim was to analyze time patterns of the occurrence of aneurysmal subarachnoid hemorrhage (SAH), particularly focusing on the impact of patients' socio-demographic and clinical characteristics on the ictus timing.METHODS:The study is based on an institutional SAH cohort with 782 consecutive cases treated between January 2003 and June 2016. Data were collected on the ictus time, patients' socio-demographic and clinical characteristics, as well as the initial severity and outcome. Univariate and multivariate analyses were performed on the bleeding timeline.RESULTS:There were two peaks in the circadian rhythm of SAH, one in the morning (7-9 a.m.) and the other in the evening (7-9 p.m.). The strongest alterations in the bleeding time patterns were observed for weekdays, patients' age, sex and ethnicity. Individuals with chronic alcohol and painkiller consumption showed a higher bleeding peak between 1 and 3 p.m. Finally, the bleeding time showed no impact on the severity, clinically relevant complications and the outcome of SAH patients.CONCLUSIONS:This study is one of the very few detailed analyses of the impact of specific socio-demographic, ethnic, behavioral and clinical characteristics on the rupture timing of aneurysms. Our results point to the possible relevance of the circadian rhythm for the rupture event, and therefore might be useful in the elaboration of preventive measures against aneurysm rupture.

Introduction Subarachnoid hemorrhage is a common finding, ranging from 5.2% to 15.2% in ischemic stroke patients after mechanical thrombectomy. Aim of Study We aimed to evaluate neurological outcomes in patient groups without intracranial hemorrhage (non-ICH), with isolated subarachnoid hemorrhage (i-SAH) and with other types of intracranial hemorrhage (o-ICH) than i-SAH after thrombectomy. Methods Stroke data from 2018 to 2021 in a tertiary care centre were retrospectively analysed. Patients with anterior large vessel occlusion were included. Neurological impairment was assessed using NIHSS. Outcomes were compared using Mann-Whitney-U-test. Results In a total of 268 patients, i-SAH and o-ICH were found in 10.4% and 10.8%, respectively. NIHSS scores at admission were not significantly different among i-SAH, o-ICH and non-ICH groups. NIHSS scores of i-SAH patients at discharge were comparable to o-ICH patients (median 18 versus 21, p=0.578) and were significantly higher than non-ICH patients (18 versus 7, p=0.008). In patients experiencing complete reperfusion (TICI=3), i-SAH patients tended to have more severe neurological impairment than non-ICH patients (median NIHSS 10 versus 5, p=0.3), although NIHSS at discharge compared to admission decreased similarly between both groups (median reduction 5 versus 6, p=0.866). In patients with successful but incomplete reperfusion (TICI=2b), i-SAH patients showed significantly worse neurological outcomes at discharge than non-ICH patients (NIHSS 23.5 versus 8, p=0.03) and even deterioration of their neurological deficit after thrombectomy (NIHSS increase of 5 versus reduction of 4, p=0.017). Conclusion Post-thrombectomy i-SAH is an important complication as it might aggravate patient's neurological impairment, particularly in case of incomplete reperfusion. Disclosure of Interest Nothing to disclose.

Zielsetzung Bewertung der 68GA-DOTATOC-PET/MRT hinsichtlich diagnostischer Sicherheit und Einschätzung der lokalen Infiltration bei Patienten mit Meningeomen der Schädelbasis und des intraorbitalen Raumes.

In this retrospective study, we aimed to predict the body height and weight of pediatric patients using CT localizers, which are overview scans performed before the acquisition of the CT. We trained three commonly used networks (EfficientNetV2-S, ResNet-18, and ResNet-34) on a cohort of 1009 and 1111 CT localizers of pediatric patients with recorded body height and weight (between January 2013 and December 2019) and validated them in an additional cohort of 116 and 127 localizers (acquired in 2020). The best-performing model was then tested in an independent cohort of 203 and 225 CT localizers (acquired between January 2021 and March 2023). In addition, a cohort of 1401 and 1590 localizers from younger adults (acquired between January 2013 and December 2013) was added to the training set to determine if it could improve the overall accuracy. The EfficientNetV2-S using the additional adult cohort performed best with a mean absolute error of 5.58 ± 4.26 cm for height and 4.25 ± 4.28 kg for weight. The relative error was 4.12 ± 4.05% for height and 11.28 ± 12.05% for weight. Our study demonstrated that automated estimation of height and weight in pediatric patients from CT localizers can be performed.

PurposeMultimodal endovascular therapy (EVT) of carotid cavernous fistula (CCF) with different approaches and a variety of available embolization material enable high occlusion rates with good clinical and functional outcome but until now there is still little evidence available. This retrospective single-center study aims to evaluate EVT of CCF with different neuroendovascular techniques regarding occlusion rates, complications and outcomes.Materials and methodsFrom 2001 to 2021 59 patients with CCF were treated at our tertiary university hospital. Patient records and all imaging data including angiograms were reviewed for demographic and epidemiological data, symptoms, fistula type, number of EVTs, complications of EVT, type of embolic materials, occlusion rates and recurrences.ResultsEtiology of the CCF were spontaneous (41/59, 69.5%) post-traumatic (13/59, 22%) and ruptured cavernous aneurysms (5/59, 8.5%). Endovascular therapy was completed in one session in 74.6% (44/59). Transvenous access was most frequent (55.9% 33/59) followed by transarterial catheterization in 33.9% (20/59) and a combination of both (6/59, 10.2%). Exclusively coils were used in 45.8% (27/59), a combination of ethylene vinyl alcohol (EVOH) copolymer (Onyx) and coils in 42.4% (25/59). Complete obliteration was achieved in 96.6% of patients (57/59) with an intraprocedural-related complication rate of 5.1% (3/59) and no mortality.ConclusionEndovascular therapy of CCF has been shown to be safe and effective with high cure rates and low rates of intraprocedural complications and morbidity even in complex scenarios.

Purpose Oropharyngeal squamous cell carcinoma (OPSCC) may be treated with primary surgery or primary (chemo)radiation. While surgery with concurrent neck dissection provides definitive pathological staging of the neck, non-surgical treatment relies on clinical staging for treatment planning. To assess the accuracy of clinical neck staging, we compared clinical to surgical staging after primary surgery in patients with p16-negative and p16-positive OPSCC. Methods Retrospective analysis of clinical, pathological, and oncologic outcome data of patients with OPSCC treated with primary surgery and bilateral neck dissection. Clinical and pathological nodal status were compared for p16-negative and p16-positive patients. Patients with occult metastatic disease were analyzed in detail. Results 95 patients were included. 60.5% of p16-negative patients and 66.6% of p16-positive patients had pathologically confirmed metastatic neck disease. p16-positive patients had improved 24-month recurrence-free survival compared to p16-negative patients at 93.3% vs. 69.6%. Pathological N-status differed from clinical N-status in 36.8% of p16-negative patients vs. 31.6% of p16-positive patients. Occult metastatic disease was more common in p16-negative patients at 18.4% vs. 8.8% for p16-positive patients. Clinical detection sensitivity for extranodal extension was low overall; sensitivity was 27.3% and specificity was 91.6% for p16-negative patients vs. 61.5% and 80.0% for p16-positive patients, respectively. Conclusion Our data show a considerable degree of inaccuracy of clinical neck staging results in all OPSCC patients which needs to be taken into consideration during therapy planning. For p16-positive patients, these findings warrant attention in the context of therapy deintensification to avoid undertreatment.

Zielsetzung Die Strahlenexposition von Kindern durch Computertomographien (CT) ist nur unzureichend untersucht und diagnostische Referenzwerte (DRW) sind wenig publiziert. Ziel dieser Studie ist die Aufstellung lokaler DRWs für CT-Untersuchungen des Thorax bei Kindern in Abhängigkeit von Patientengröße und Alter.

Zielsetzung Ziel dieser Studie ist es, die Auswirkungen des neu entwickelten Similar Patient Search (SPS) Web Service auf die Diagnosegenauigkeit von Assistenzärzten zu untersuchen. SPS unterstützt die Befundung komplexer Lungenerkrankungen in der Computertomographie (CT).

Background Data on the frequency and outcome of mechanical thrombectomy (MT) for large vessel occlusion (LVO) in patients with COVID-19 is limited. Addressing this subject, we report our multicenter experience. Methods A retrospective cohort study was performed of consecutive acute stroke patients with COVID-19 infection treated with MT at 26 tertiary care centers between January 2020 and November 2021. Baseline demographics, angiographic outcome and clinical outcome evaluated by the modified Rankin Scale (mRS) at discharge and 90 days were noted. Results We identified 111 out of 11 365 (1%) patients with acute or subsided COVID-19 infection who underwent MT due to LVO. Cardioembolic events were the most common etiology for LVO (38.7%). Median baseline National Institutes of Health Stroke Scale score and Alberta Stroke Program Early CT Score were 16 (IQR 11.5–20) and 9 (IQR 7–10), respectively. Successful reperfusion (mTICI ≥2b) was achieved in 97/111 (87.4%) patients and 46/111 (41.4%) patients were reperfused completely. The procedure-related complication rate was 12.6% (14/111). Functional independence was achieved in 20/108 (18.5%) patients at discharge and 14/66 (21.2%) at 90 days follow-up. The in-hospital mortality rate was 30.6% (33/108). In the subgroup analysis, patients with severe acute COVID-19 infection requiring intubation had a mortality rate twice as high as patients with mild or moderate acute COVID-19 infection. Acute respiratory failure requiring ventilation and time interval from symptom onset to groin puncture were independent predictors for an unfavorable outcome in a logistic regression analysis. Conclusion Our study showed a poor clinical outcome and high mortality, especially in patients with severe acute COVID-19 infection undergoing MT due to LVO.