Objective To investigate the outcome and safety data of chemosaturation with percutaneous hepatic perfusion (CS-PHP) of melphalan in patients with liver-dominant metastatic uveal melanoma. Material and methods This is a HIPAA compliant, IRB approved, retrospective study. A total of 28 CS-PHPs were performed in 16 individual patients (six men and ten women, median age 63.1 years [range 49.1 to 78.7 years], one to six CS-PHP procedures per patient) for treatment of liver-dominant metastatic uveal melanoma between June, 2015 and December, 2018. All patients received cross-sectional imaging at baseline and during follow-up. CS-PHP was performed with the Hepatic CHEMOSAT® Delivery System (Delcath Systems, Inc., NY, USA) facilitating extracorporeal filtration of hepatic blood for melphalan removal. Ideal body weight-adjusted melphalan doses were administered into the hepatic arteries. Serious adverse events (SAE), progression-free survival based on response criteria in solid tumors, and overall survival were noted. Survival data were analyzed using Kaplan-Meier estimates. Results Partial response after first CS-PHP was observed in nine patients (60%), stable disease in five patients (33%) and progressive disease in one patient (7%). Median overall survival was 27.4 months (95% CI 4.1 to 35.4 month) after first CS-PHP. Median progression-free survival was 11.1 months after first CS-PHP (95% CI 4.9 to 23.6 months). SAEs were observed in the majority of patients with most SAEs limited to grades one and two. Thirteen SAEs of grades three and four were observed in seven individual patients. No grade five SAE was observed. Conclusion CS-PHP is an efficacious and safe treatment for patients presenting with liver-dominant metastatic uveal melanoma.

OSR values at a frequency offset of 2000 Hz demonstrated a better sensitivity and specificity for detecting mild and severe stages of tendinopathy compared to T2 * and particularly when compared to T1 relaxation times.

The observed decreased tendon volume and increased OSR directly after exercise indicates a short-term change in tendinous proton compartments, most likely a loss of free water molecules within the tendon.

PCASL MRI can detect changes of the key perfusion parameters Phyp , TTP, and Thyp after successful PTA of the calf muscles during reactive hyperemia and seems to be a promising tool for monitoring of interventional treatments.

A 5-minute MR screening protocol for prostate cancer in men with elevated prostate-specific antigen levels before biopsy is applicable for clinical routine with similar diagnostic performance as the full diagnostic mpMRI approach.

Off‐resonance radiofrequency saturation pulses applied prior to regular excitation in MR sequences can be used to modify signal contrast based on magnetization transfer and direct saturation effects. Clinical applicability and value of ultrashort echo time sequences combined with off‐resonance saturation pulses was tested in 16 healthy and 14 tendinopathic as well as paratendinopathic Achilles tendons in vivo at 3 T. A 3D ultrashort echo time sequence in combination with a gaussian off‐resonance saturation pulse (frequency offset: 1000–5000 Hz) was used to modify the detectable MR signal intensity from the Achilles tendon. Off‐resonance saturation ratio was calculated as the relative reduction in signal intensity under selective off‐resonance saturation in relation to a reference measurement without any saturation pulse. Off‐resonance saturation ratio in tendons of healthy volunteers ranged from 0.52 ± 0.06 (1000 Hz) to 0.24 ± 0.02 (5000 Hz), whereas symptomatic tendinopathic tendons (0.35 ± 0.04 to 0.17 ± 0.02) and asymptomatic tendinopathic tendons (0.41 ± 0.06 to 0.21 ± 0.02) showed significantly lower mean off‐resonance saturation ratio values. Off‐resonance saturation ratio values might provide a sensitive and quantitative marker for assessment of pathological microstructure alterations of the Achilles tendon. Magn Reson Med, 2013. © 2012 Wiley Periodicals, Inc.

MT effects in human Achilles tendons can be reliably assessed in-vivo using a 3D UTE sequence at 3 T. All healthy tendons showed similar MTR values (coefficient of variation 10.0 ± 1.2 %). The examined patient showed a clearly different MT effect revealing a changed microstructure in the case of tendinopathy.

Purpose: To evaluate a novel monoenergetic post-processing algorithm (MEI+) in patients with poor intrahepatic contrast enhancement. Materials and Methods: 25 patients were retrospectively included in this study. Late-phase imaging of the upper abdomen, which was acquired in dual-energy mode (100/140?kV), was used as a model for poor intrahepatic contrast enhancement. Traditional monoenergetic images (MEI), linearly weighted mixed images with different mixing ratios (MI), sole 100 and 140?kV and MEI+ images were calculated. MEI+ is a novel technique which applies frequency-based mixing of the low keV images and an image of optimal keV from a noise perspective to combine the benefits of both image stacks. The signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of the intrahepatic vasculature (IHV) and liver parenchyma (LP) were objectively measured and depiction of IHV was subjectively rated and correlated with portal venous imaging by two readers in consensus. Results: MEI+ was able to increase the SNR of the IHV (5.7???0.4?at 40keV) and LP (4.9???1.0?at 90keV) and CNR (2.1???0.6?at 40keV) greatly compared to MEI (5.1???1.1?at 80keV, 4.7???1.0?at 80keV, 1.0???0.4?at 70keV), MI (5.2???1.1 M5:5, 4.8???1.0 M5:5, 1.0???3.5 M9:1), sole 100?kV images (4.4???1.0, 3.7???0.8, 1.0???0.3) and 140?kV images (2.8???0.5, 3.1???0.6, 0.1???0.2). Subjective assessment rated MEI+ of virtual 40 keV superior to all other images. Conclusion: MEI+ is a very promising algorithm for monoenergetic extrapolation which is able to overcome noise limitations associated with traditional monoenergetic techniques at low virtual keV levels and consequently does not suffer from a decline of SNR and CNR at low keV values. This algorithm allows an improvement of IHV depiction in the presence of poor contrast. Key points: ??The evaluated new image-based algorithm for virtual monoenergetic imaging allows calculating low virtual keV images from dual energy datasets with significantly improved contrast-to-noise ratios. ??The image based novel monoenergetic extrapolation algorithm applies frequency-based mixing of the low keV images and an image of optimal keV from a noise perspective to combine the benefits of both image stacks. ??When compared to traditional monoenergetic images, the novel monoenergetic algorithm has improved contrast-to-noise ratios for both low and high virtual keV images. ??Contrast-enhanced dual energy images with poor contrast conditions can be significantly improved, e.g. late phase imaging of the liver. Citation Format: ??Schabel C, Bongers M, Sedlmair M et?al. Assessment of the Hepatic Veins in Poor Contrast Conditions using Dual Energy CT: Evaluation of a Novel Monoenergetic Extrapolation Software Algorithm. Fortschr R?ntgenstr 2014; 186: 591???597