Paracelsus Medizinische Privatuniversität

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Objectives: During cardiac magnetic resonance imaging (cMRI) exams in patients with congenital heart disease (CHD), incidental liver abnormalities are increasingly found. However, no systematic data exist on the incidence of liver lesions in patients with different CHDs. In order to gain a first overview, we retrospectively analyzed cMRI examinations from the last 10 years at our institution. Methods: CMRI examinations including T2-weighted images covering parts of the liver were performed on 899 patients with CHD at our institution between 2014 and 2024. The cMRI examinations were analyzed by a medical student, a pediatrician, a radiologist, and a pediatric cardiologist. Liver lesions were defined as atypical liver parenchyma, showing T2 hyper- or hypointensity compared to the surrounding liver tissue. Results: Liver lesions were found in 9.5% (85/899) of all cMRI studies; of these, 89% ((76/85) of cases) were unknown at time of cMRI, 96% (82/85) were T2 hyperintense, and 38% (32/85) were larger than 1 cm. The patients with liver lesions were older (29 years vs. 22 years, p < 0.0001). There were no sex differences in the incidence of liver lesions or differences in right or left ventricular function (LVEF: 57% vs. 58%, p = 0.78; RVEF: 55% vs. 54%, p = 0.35). The patients with univentricular hearts, transposition of great arteries after atrial switch operation, and atrial septal defects showed the highest incidence (18%, 17%, and 21%, respectively). However, 9% of patients with left heart-sided valve disease also showed liver lesions. Conclusions: Incidental findings of liver lesions in cMRI examinations of patients with CHD are reasonably high with almost 10%. In the growing population of adults with CHD, liver monitoring might be helpful to assure overall patient health.

This study examines the association between fetal macrosomia (>5,000 g) and pregnancy and birth outcomes. This was a retrospective cohort study using data from the perinatal survey of Lower Saxony, Germany (2001-2009). Pregnancies complicated by advanced maternal age (>35 years), elevated BMI (>25.0), and excessive gestational weight gain were significantly more likely to result in macrosomic births. Additionally, pregnancies involving macrosomic fetuses were characterized by prolonged gestation and an increased likelihood of cesarean delivery. Neonates with macrosomia exhibited significantly lower Apgar scores at 1, 5, and 10 min (<7) compared to the control group (<5,000 g), though umbilical artery pH values did not differ significantly between groups. These findings highlight the need for targeted prenatal monitoring and risk assessment in pregnancies predisposed to fetal macrosomia.

Abstract Allogeneic hematopoetic stem cell transplantation (allo SCT) is a treatment option with a unique chance of cure for patients with high-risk AML or MDS. However, the optimal path for an individual patient on its way to allo SCT is far from clear and subject of ongoing debates. Upfront transplantation "as soon as possible" competes with strategies to achieve deep remission or at least stabilization of the disease. In this context, we performed a survey among German transplant centers to assess their preferred strategies for patients before SCT in five typical scenarios of AML and MDS. We obtained replies from 22 centers, revealing a heterogenous use of possible strategies. Upfront transplantation was a preferred option (68%) in intermediate risk MDS, chemotherapy was preferred (64%) as bridging for AML in remission, whereas hypomethylating agents (HMA) and induction chemotherapy for relapsed AML were highly controversial. Further prospective evaluation of different options is desirable.

Previous research has highlighted the benefits of reducing contrast media (CM), demonstrating positive impacts on patient safety, environmental sustainability, and health care costs. The 10-to-10 rule, introduced by a single-center study, adjusts CM dose to total body weight and tube voltage. This approach resulted in a reduced overall CM volume, with homogeneous attenuation and consistent diagnostic image quality (IQ) across varying tube voltages. This study aimed to evaluate the effectiveness of the 10-to-10 rule in achieving consistent and homogeneous attenuation in vascular and parenchymal CT in a multicenter clinical practice setting across Europe. A total of 1,037 patients scheduled for CT of the coronary arteries (high-pitch and sequential CCTA), pulmonary arteries (CTPA), aorta (CTA aorta), and abdominal CT in portal venous phase or venous phase scans of the neck were included in this nonrandomized multicenter trial, conducted at 5 centers in the Netherlands, Germany, and Switzerland. Each center followed its standard scan and reconstruction protocol based on the clinical request. CM protocols were based on the 10-to-10 rule: A 10kV reduction in tube voltage should be accompanied by a 10% decrease in iodine delivery rate for vascular studies or total iodine load in parenchymal studies, and vice versa. Objective image quality (IQ) was assessed by drawing region of interests, measuring attenuation [Hounsfield Unit (HU)], and calculating signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR). In vascular studies, a reference line was included, representing the threshold for sufficient diagnostic IQ (CCTA-325HU, CTPA-200HU, and CTA Aorta-250HU). 95% CI of the mean attenuation was calculated, and the lower bound of each 95% CI was used as the reference to assess whether attenuation met these thresholds. Generalized mixed models tested for significant differences in objective IQ across varying tube voltages, presented both unadjusted and multivariate adjusted by age and gender. Results demonstrated no significant differences in attenuation for distal high-pitch CCTA, proximal sequential CCTA, distal CTPA, CTA aorta, abdominal portal venous phase scans, and the thyroid gland and sternocleidomastoid muscle in venous phase scans of the neck after adjusting for age and gender. Proximal high-pitch CCTA, distal sequential CCTA, and proximal CTPA yielded significant results ( P =0.030, P <0.001, and P =0.002, respectively). SNR and CNR showed no significant differences for all scan protocols. The majority of 95% CI lower bounds exceeded the predefined threshold for sufficient diagnostic IQ. Exceptions included high-pitch CCTA scans, where only the 90kV level met the threshold, as well as in sequential CCTA at 120kV, and CTPA at 110 and 120kV, for which the lower bounds remained below the threshold. This study demonstrates the generalizability and effectiveness of the 10-to-10 rule in a multicenter trial setting and a large patient population, showing limited significant deviations in iodine attenuation across varying tube voltages for both vascular and parenchymal CT studies.

Acute myeloid leukemia (AML) is the most common indication for allogeneic hematopoietic cell transplantation (alloHCT), yet graft-versus-host disease (GVHD) remains a major post-transplant complication. Conditioning regimens, particularly reduced-intensity approaches, are critical in optimizing outcomes. This subgroup analysis of the phase 3 MC-FludT.14/L trial compared treosulfan-fludarabine with reduced-intensity busulfan-fludarabine in 352 AML patients (aged 31-70) undergoing alloHCT. The primary endpoint was 24-month event-free survival (EFS); secondary endpoints included overall survival (OS), GVHD incidence, relapse/progression, and non-relapse mortality (NRM). Treosulfan compared to busulfan demonstrated superiority: 24-month EFS was 65% vs. 53% (p = 0.01), and OS was 73% vs. 65%. EFS benefits were consistent across AML risk categories and notably higher in patients with hematopoietic cell transplantation comorbidity index >2 (62% vs. 42%, p = 0.02). Treosulfan also showed lower NRM and relapse rates. GVHD outcomes favored treosulfan, with a significantly lower incidence of extensive chronic GVHD at 24 months (15.1% vs. 28.1%, p = 0.01). GVHD-free and relapse-free survival was also improved (53% vs. 40%, p = 0.02). The safety profile was more favorable with treosulfan. These findings support treosulfan-fludarabine as a more effective and safer conditioning regimen than busulfan-fludarabine for AML patients undergoing alloHCT, particularly those at higher risk.