Cardiac magnetic resonance imaging (CMRI) is a versatile diagnostic tool. One of its main advantages is the possibility of tissue characterization. T1-weighted images for scar and T2-weighted images for edema visualization are key methods for tissue characterization. Otherwise these sequences are strongly limited for the detection of diffuse myocardial pathologies. Recently, rapid technical innovations have generated new techniques. T1, T2 mapping and evaluation of the extracellular volume fraction (ECV) allow quantification of diffuse myocardial pathologies and showed great potential in the visualization of fibrosis, edema, amyloid, iron overload and lipid. In the future these techniques might enable the detection of early cardiac involvement, even act as a prognosticator. Moreover, therapy monitoring and follow-up might be possible due to versatile parameter quantification with these new techniques. Key points: • CMR allows for tissue characterization via T1- and T2-weighted sequences. • In cases of diffuse, global myocardial pathologies, correct image interpretation with traditional CMR sequences might be difficult. • T1, T2 mapping and ECV can quantify diffuse, global myocardial pathologies. • Alterations of myocardial T1 and T2 relaxation times occur in various myocardial diseases (e. g. acute myocarditis). • In the future mapping might act as a prognosticator or therapy monitoring tool. Citation Format: • Roller FC, Harth S, Schneider C et al. T1, T2 Mapping and Extracellular Volume Fraction (ECV): Application, Value and Further Perspectives in Myocardial Inflammation and Cardiomyopathies. Fortschr Röntgenstr 2015; 187: 760 – 770 Die kardiale Magnetresonanztomografie (MRT) ist eine sehr vielseitig einsetzbare diagnostische Modalität. Einer ihrer Hauptvorteile liegt in der Möglichkeit Gewebecharakterisierung zu betreiben. Bisher wurden standardmäßig vor allem T1-gewichtete Sequenzen zur Bildgebung von fokalen myokardialen Narben bzw. Schädigungen und T2-gewichtete Bilder für die Ödembildgebung genutzt. Andererseits sind diese Techniken insbesondere bei der Visualisierung von globalen myokardialen Veränderungen technisch bedingt stark limitiert. Aktuell entwickelte Techniken wie das T1- und das T2-Mapping oder auch die Bestimmung des „Extrazellulären Volumens“ ermöglichen uns hingegen eine Quantifizierung von globalen myokardialen Veränderungen und Pathologien wie bereits für Fibrose und Ödem aber auch für Amyloidose, Fett- bzw. Eisenspeichererkrankungen gezeigt werden konnte. Aufgrund der vielversprechenden Ergebnisse, ihrer Robustheit sowie einer Quantifizierung von T1- und T2-Zeiten erlauben uns diese Techniken in Zukunft eine Detektion von frühen Krankheitsstadien oder eignen sich darüber hinaus vielleicht auch für eine Therapiemonitoring und eine Prognoseabschätzung im Rahmen von Verlaufskontrollen. Kernaussagen: • Die kardiale MRT ermöglicht eine Gewebecharakterisierung mittels T1- und T2-gewichteten Sequenzen. • Bei globalen bzw. diffusen myokardialen Veränderungen sind diese Sequenzen jedoch limitiert und schränken die korrekte Bildinterpretation ein. • Im Gegensatz dazu ermöglichen T1-, T2-Mapping und ECV eine Quantifizierung globaler myokardialer Veränderungen. • Bei sehr vielen unterschiedlichen Erkrankungen konnten Veränderungen von T1 und T2 Relaxationszeiten gezeigt werden (z.B. Myokarditis) • Zukünftig könnte Mapping auch in der Prognose und im Therapiemonitoring eine bedeutende Rolle zukommen

The aim of this monocentric, retrospective clinical study was to evaluate the status of osseous union in uni- and poly-segmental mandible reconstructions regarding conventional angle-stable manually bent osteosynthesis plates (Unilock 2.0 mm) versus titan laser-melted PSI patient-specific implant’s (PSI). The clinical impact of PSI’s high stiffness fixation methods on bone healing and regeneration is still not well addressed. The special interest was in evaluating the ossification of junctions between mandible and fibula and between osteotomized fibula free flap (FFF) segments. Panoramic radiograph (OPT), computed tomography (CT) scans, or cone-beam CTs (CBCT) of patients who underwent successful FFF for mandible reconstruction from January 2005 to December 2020 were analyzed. A total number of 89 cases (28 females (31.5%), 61 males (68.5%), mean age 58.2 ± 11.3 years, range: 22.8–82.7 years) fulfilled the chosen inclusion criteria for analysis (conventional: n = 44 vs. PSI: n = 45). The present study found an overall incomplete ossification (IOU) rate of 24.7% (conventional: 13.6% vs. PSI: 35.6%; p = 0.017) for mandible to fibula and intersegmental junctions. Between osteotomized FFF segments, an IOU rate of 16% was found in the PSI-group, while no IOU was recorded in the conventional group (p = 0.015). Significant differences were registered for IOU rates in poly-segmental (p = 0.041), and lateral (p = 0.016) mandibular reconstructions when PSI was used. Multivariate logistic regression analysis identified plate exposure and type of plate used as independent risk factors for IOU. Previous or adjuvant radiotherapy did not impact incomplete osseous union in the evaluated study sample. PSI is more rigid than bent mini-plates and shields functional mechanical stimuli, and is the main reason for increasing the rate of incomplete ossification. To enhance the functional stimulus for ossification it has to be discussed if patient-specific implants can be designed to be thinner, and should be divided into segmental plates. This directs chewing forces through the bone and improves physiological bone remodeling.

This is a monocentric, retrospective study of patients who underwent successful immediate or delayed maxilla or mandible reconstructions with FFF from January 2005 to December 2021. Panoramic radiograph, computed tomography scans, and cone-beam CTs were analyzed concerning the osseous union of the intersegmental junctions between maxillary or mandibular native jaw and fibular bone. The primary parameter was to estimate the status of osseous union according to osteosynthesis type. A total number of 133 patients (PSI: n = 64, non-PSI: n = 69) were included in the present study. The mean age was 56.7 ± 14.0 (Range: 14.7–82.7); the primary diagnosis was in 105 patients a malignant (78.9%) and in 20 patients a benign (15.0%) tumor. Mandible reconstruction was performed on 103 patients (77.4%), and on 30 patients (22.6%), maxilla reconstruction was performed. The radiographic images provided a rate of incomplete osseous union (IOU) of about 90% in both groups in the first 6 months. Imaging between 6 and 12 months reveals an IOU rate in the non-PSI group of 46.3% vs. 52.5% in the PSI group, between 12 and 24 months, an IOU rate of 19.6% vs. 26.1%, between 24 and 36 months 8.9% vs. 21.7%, and after 36 months the IOU rate decreases to 4.2% vs. 18.2%. Multivariate logistic regression shows that only osteosynthesis type (OR = 3.518 [95%-CI = 1.223–10.124], p = 0.02) and adjuvant radiotherapy (OR = 4.804 [95%-CI = 1.602–14.409], p = 0.005) are independent risk factors for incomplete osseous union. Cox regression revealed that the variables plate-system (Hazard ratio, HR = 5.014; 95 %-CI: 1.826–3.769; p = 0.002) and adjuvant radiotherapy (HR = 5.710; 95 %-CI: 2.066–15.787; p < 0.001) are predictors for incomplete osseous union. In our study, the rate of incomplete bony fusion was significantly higher in the PSI group. Jaw-to-fibula apposition zones were significantly more affected than intersegmental zones. In multivariate analysis, a combination of osteosynthesis with PSI and adjuvant radiotherapy could be identified as a risk constellation for incomplete ossification.

Cardiopulmonary exercise testing (CPET) is an important tool for assessing functional capacity and prognosis in pulmonary arterial hypertension (PAH). However, the associations of CPET parameters with the adaptation of right ventricular (RV) function to afterload remain incompletely understood.In this study, 37 patients with PAH (idiopathic in 31 cases) underwent single-beat pressure–volume loop measurements of RV end-systolic elastance (Ees), arterial elastance (Ea) and diastolic elastance (Eed). Pulmonary arterial stiffness was assessed by magnetic resonance imaging. The results were correlated to CPET variables. The predictive relevance of RV function parameters for clinically relevant ventilatory inefficiency, defined as minute ventilation/carbon dioxide production (V′_E/V′CO₂) slope >48, was evaluated using logistic regression analysis.The median (interquartile range) of theV′_E/V′CO₂slope was 42 (32–52) and theV′_E/V′CO₂nadir was 40 (31–44). The mean±sdof peak end-tidal carbon dioxide tension (PETCO₂) was 23±8 mmHg. Ea, Eed and parameters reflecting pulmonary arterial stiffness (capacitance and distensibility) correlated with theV′_E/V′CO₂slope,V′_E/V′CO₂nadir,PETCO₂and peak oxygen pulse. RV Ees and RV–arterial coupling as assessed by the Ees/Ea ratio showed no correlations with CPET parameters. Ea (univariate OR 7.28, 95% CI 1.20–44.04) and Eed (univariate OR 2.21, 95% CI 0.93–5.26) were significantly associated with ventilatory inefficiency (p<0.10).Our data suggest that impaired RV lusitropy and increased afterload are associated with ventilatory inefficiency in PAH.