ZUSAMMENFASSUNGZielsetzung Das Ziel dieser Studie war, die diagnostische Genauigkeit der Dual-energy CT Angiographie (DE-CTA) bei Patienten mit symptomatischer peripherer arterieller Verschlusskrankheit (pAVK) zu erfassen, und Faktoren zu identifizieren, die die diagnostische Genauigkeit negativ beeinflussen. Material und Methoden ABSTR AC TPurpose The purpose of this study was to assess the diagnostic performance of dual-energy CT angiography (DE-CTA) in patients with symptomatic peripheral artery occlusive disease (PAOD) and to identify factors that impede its diagnostic accuracy. This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.Materials and Methods Dual-source DE-CTA scans of the lower extremities of 94 patients were retrospectively compared to the diagnostic reference standard, digital subtraction angiography (DSA). Two independent observers assessed PAOD incidence, image quality, artifacts, and diagnostic accuracy of DE-CTA in 1014 arterial segments on axial, combined 80/140 kVp reconstructions and on 3 D maximum intensity projections (MIP) after automated bone and plaque removal. The impact of calcifications, image quality, and image artifacts on the diagnostic accuracy was evaluated using Fisher's exact test. Furthermore, interobserver agreement was analyzed.Results Two observers achieved sensitivities of 98.0 % and 93.9 %, respectively, and specificities of 75.0 % and 66.7 %, respectively, for detecting stenoses of > 50 % of the lower extremity arteries. Calcifications impeded specificity, e. g. from 81.2 % to 46.2 % for reader 1 (p < 0.001). Specificity increased with higher image quality, e. g. from 70.0 % to 76.4 % for reader 1 (p < 0.001). Artifacts decreased the specificity of reader 2 (p < 0.001). The overall interobserver agreement ranged between moderate and substantial for stenosis detection and calcified plaques.Conclusion DE-CTA is accurate in the detection of arterial stenoses of > 50 % in symptomatic PAOD patients. Calcified atherosclerotic plaques, image quality, and artifacts may impede specificity. Key Points:▪ Sensitivities of DE-CTA were 98.0 and 93.9 %, specificities 75.0 % and 66.7 %. ▪ Interobserver agreement was moderate to substantial for stenosis and plaque detection. ▪ Calcified atherosclerotic plaques, image quality, and artifacts may impede specificity.
Diffusion tensor imaging (DTI) offers an in vivo view into the microarchitecture of the brain. Furthermore it allows a three-dimensional reconstruction of fiber tracts. We will discuss the principles of DTI and possibilities for sequence optimization. Finally we will give an overview of DTI and its application in Alzheimer's disease.
Background In response to students´ poor ratings of emergency remote lectures in internal medicine, a team of undergraduate medical students initiated a series of voluntary peer-moderated clinical case discussions. This study aims to describe the student-led effort to develop peer-moderated clinical case discussions focused on training cognitive clinical skill for first and second-year clinical students. Methods Following the Kern Cycle a didactic concept is conceived by matching cognitive learning theory to the competence levels of the German Medical Training Framework. A 50-item survey is developed based on previous evaluation tools and administered after each tutorial. Educational environment, cognitive congruence, and learning outcomes are assessed using pre-post-self-reports in a single-institution study. Results Over the course of two semesters 19 tutors conducted 48 tutorials. There were 794 attendances in total (273 in the first semester and 521 in the second). The response rate was 32%. The didactic concept proved successful in attaining all learning objectives. Students rated the educational environment, cognitive congruence, and tutorials overall as “very good” and significantly better than the corresponding lecture. Students reported a 70%-increase in positive feelings about being tutored by peers after the session. Conclusion Peer-assisted learning can improve students´ subjective satisfaction levels and successfully foster clinical reasoning skills. This highlights successful student contributions to the development of curricula.
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