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  1. Article ; Online: LI-RADS in Patients with Solitary Resected Hepatocellular Carcinoma: Glancing beyond Diagnosis.

    Kartalis, Nikolaos / Grigoriadis, Aristeidis

    Radiology

    2023  Volume 310, Issue 2, Page(s) e240161

    MeSH term(s) Humans ; Carcinoma, Hepatocellular/diagnostic imaging ; Carcinoma, Hepatocellular/surgery ; Liver Neoplasms/diagnostic imaging ; Liver Neoplasms/surgery
    Language English
    Publishing date 2023-07-13
    Publishing country United States
    Document type Editorial
    ZDB-ID 80324-8
    ISSN 1527-1315 ; 0033-8419
    ISSN (online) 1527-1315
    ISSN 0033-8419
    DOI 10.1148/radiol.240161
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  2. Article ; Online: Oral Manganese Chloride Tetrahydrate: A Novel Magnetic Resonance Liver Imaging Agent for Patients With Renal Impairment: Efficacy, Safety, and Clinical Implication.

    Brismar, Torkel B / Geisel, Dominik / Kartalis, Nikolaos / Madrazo, Beatrice L / Persson Hedman, Hanna / Norlin, Andreas

    Investigative radiology

    2023  Volume 59, Issue 2, Page(s) 197–205

    Abstract: Abstract: Manganese-based contrast agents (MBCAs) show promise to complement gadolinium-based contrast agents (GBCAs) in magnetic resonance imaging (MRI) of the liver. Management of patients with focal liver lesions and severely impaired renal function ... ...

    Abstract Abstract: Manganese-based contrast agents (MBCAs) show promise to complement gadolinium-based contrast agents (GBCAs) in magnetic resonance imaging (MRI) of the liver. Management of patients with focal liver lesions and severely impaired renal function uses unenhanced liver MRI or GBCA-enhanced MRI. However, unenhanced MRI risks reducing patient's survival.Gadolinium-based contrast agents, which help to detect and visualize liver lesions, are associated with increased risk of nephrogenic systemic fibrosis in renally impaired patients, a severe adverse event (AE) with potentially fatal outcome. Therefore, use of GBCA in patients with impaired renal function requires careful consideration. Other concerns are related to tissue deposition in the brain and other organs due to lack of gadolinium clearance, which could lead to concerns also for other patient populations, for example, those exposed to multiple procedures with GBCA. Of particular concern are the linear chelates that remain available for liver MRI, where there is no replacement technology. This has highlighted the urgency for safer alternatives.An alternative may be the drug candidate Ascelia-MBCA (ACE-MBCA, Orviglance), oral manganese chloride tetrahydrate. This candidate effectively visualizes and detects focal liver lesions, as demonstrated in 8 clinical studies on 201 adults (healthy or with known or suspected focal liver lesions). ACE-MBCA has a low and transient systemic exposure, which is likely the reason for its beneficial safety profile. The AEs were primarily mild and transient, and related to the gastrointestinal tract. This new, orally administered product may offer a simple imaging approach, allowing appropriate patient management in renally impaired patients when use of GBCA requires careful consideration.In this review, we highlight the clinical development of ACE-MBCA-a novel, liver-specific contrast agent. We begin with a brief overview of manganese properties, addressing the need for MBCAs and describing their optimal properties. We then review key findings on the novel agent and how this allows high-quality MRIs that are comparable to GBCA and superior to unenhanced MRI. Lastly, we provide our view of future perspectives that could advance the field of liver imaging, addressing the medical needs of patients with focal liver lesions and severe renal impairment.Our review suggests that ACE-MBCA is a promising, effective, and well-tolerated new tool in the radiologist's toolbox.
    MeSH term(s) Adult ; Humans ; Contrast Media ; Gadolinium ; Liver Neoplasms ; Magnetic Resonance Imaging/methods ; Magnetic Resonance Spectroscopy ; Manganese
    Chemical Substances 3-methoxybutylcyanoacrylate (37870-87-4) ; Contrast Media ; Gadolinium (AU0V1LM3JT) ; Manganese (42Z2K6ZL8P) ; manganese chloride (QQE170PANO)
    Language English
    Publishing date 2023-11-07
    Publishing country United States
    Document type Review ; Journal Article
    ZDB-ID 80345-5
    ISSN 1536-0210 ; 0020-9996
    ISSN (online) 1536-0210
    ISSN 0020-9996
    DOI 10.1097/RLI.0000000000001042
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  3. Article ; Online: ABC om Intraduktal papillär mucinös neoplasi och andra vanliga cystor i pankreas.

    Bergquist, Erik / Kartalis, Nikolaos / Sparrelid, Ernesto / Löhr, Matthias / Ghorbani, Poya

    Lakartidningen

    2021  Volume 118

    Abstract: Pancreatic cysts are common. Some harbor malignant potential but are not always distinguishable from benign lesions. Premalignant cysts offer an opportunity for preventive surgery. Pancreatic surgery is associated with morbidity and mortality; hence ... ...

    Title translation Intraductal papillary mucinous cystic neoplasm and other common cystic pancreatic lesions.
    Abstract Pancreatic cysts are common. Some harbor malignant potential but are not always distinguishable from benign lesions. Premalignant cysts offer an opportunity for preventive surgery. Pancreatic surgery is associated with morbidity and mortality; hence appropriate patient selection is mandated. The most common pancreatic cystic neoplasms are intraductal papillary mucinous neoplasm and mucinous cystic neoplasm, both of which have a malignant potential, while serous cystic neoplasm is benign. Clinical, biochemical and radiological signs of increased risk for malignancy may constitute an absolute or relative indication for surgery. All patients fit for surgery with newly discovered cysts should be evaluated at a tertiary center. Follow up MRI (or EUS) and S-CA19-9 is recommended 6 months from diagnosis for premalignant cysts, and - if there is no progress - annually, for as long as the patient is fit for surgery.
    MeSH term(s) Humans ; Magnetic Resonance Imaging ; Pancreatic Cyst/diagnostic imaging ; Pancreatic Cyst/surgery ; Pancreatic Neoplasms/diagnostic imaging ; Pancreatic Neoplasms/surgery ; Precancerous Conditions/diagnostic imaging
    Language Swedish
    Publishing date 2021-10-05
    Publishing country Sweden
    Document type Journal Article
    ZDB-ID 391010-6
    ISSN 1652-7518 ; 0023-7205
    ISSN (online) 1652-7518
    ISSN 0023-7205
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  4. Article ; Online: Assessment of prognostic value and interreader agreement of ANALI scores in patients with primary sclerosing cholangitis.

    Grigoriadis, Aristeidis / Ringe, Kristina I / Andersson, Mats / Kartalis, Nikolaos / Bergquist, Annika

    European journal of radiology

    2021  Volume 142, Page(s) 109884

    Abstract: Purpose: ANALI-scores are two prognostic magnetic resonance imaging (MRI)-based scores developed for patients with primary sclerosing cholangitis (PSC). Our study aims to assess the interreader agreement between expert radiologists of the two ANALI- ... ...

    Abstract Purpose: ANALI-scores are two prognostic magnetic resonance imaging (MRI)-based scores developed for patients with primary sclerosing cholangitis (PSC). Our study aims to assess the interreader agreement between expert radiologists of the two ANALI-scores and of the radiological parameters they utilize, and to test the prognostic performance of the scores in our population.
    Method: Three radiologists evaluated MRIs of 98 PSC-patients from a prospectively collected cohort with median follow-up of 6.7 years. Each parameter of ANALI-scores was assessed, and the scores were calculated. Interreader agreement was assessed with intraclass correlation coefficient (ICC). After consensus reading was reached, the prognostic value of ANALI-scores was assessed with Cox regression, and outcome-free survival rates were evaluated with Kaplan-Meier estimates.
    Results: The ANALI-score without gadolinium had poor to moderate (ICC = 0.56, 95 %CI: 0.42-0.68) and with gadolinium poor (ICC = 0.30, 95 %CI: 0.16-0.44) agreement. Liver deformity (ICC = 0.28, 95 %CI: 0.13-0.44) and parenchymal enhancement heterogeneity (ICC = 0.24, 95 %CI: 0.12-0.38) had poor agreement. Portal hypertension had poor to moderate (ICC = 0.48, 95 %CI: 0.36-0.59) and dilatation of the intrahepatic ducts had moderate (ICC = 0.64, 95 %CI: 0.54-0.73) agreement. Hazard ratios for liver-related death, transplantation or cirrhosis decompensation of the ANALI-scores with and without gadolinium were 3.53 (95 %CI: 1.40-8.93) and 2.25 (95 %CI: 1.56-3.24), respectively. Outcome-free survival was better for patients with low ANALI-scores.
    Conclusions: The ANALI-scores show poor to moderate agreement, which challenges their usefulness in clinical practice. They are associated with clinical outcomes, confirming the value of imaging in prognosis of PSC, but need further multicenter evaluation.
    MeSH term(s) Cholangitis, Sclerosing/diagnostic imaging ; Humans ; Hypertension, Portal ; Magnetic Resonance Imaging ; Prognosis ; Prospective Studies
    Language English
    Publishing date 2021-07-31
    Publishing country Ireland
    Document type Journal Article
    ZDB-ID 138815-0
    ISSN 1872-7727 ; 0720-048X
    ISSN (online) 1872-7727
    ISSN 0720-048X
    DOI 10.1016/j.ejrad.2021.109884
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  5. Article ; Online: Publisher Correction: Branch-duct intraductal papillary mucinous neoplasm (IPMN): Are cyst volumetry and other novel imaging features able to improve malignancy prediction compared to well-established resection criteria?

    Pozzi Mucelli, Raffaella M / Moro, Carlos Fernández / Del Chiaro, Marco / Valente, Roberto / Blomqvist, Lennart / Papanikolaou, Nikolaos / Löhr, Johannes-Matthias / Kartalis, Nikolaos

    European radiology

    2022  Volume 33, Issue 4, Page(s) 3005–3006

    Language English
    Publishing date 2022-12-10
    Publishing country Germany
    Document type Published Erratum
    ZDB-ID 1085366-2
    ISSN 1432-1084 ; 0938-7994 ; 1613-3749
    ISSN (online) 1432-1084
    ISSN 0938-7994 ; 1613-3749
    DOI 10.1007/s00330-022-09309-x
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  6. Article ; Online: Branch-duct intraductal papillary mucinous neoplasm (IPMN): Are cyst volumetry and other novel imaging features able to improve malignancy prediction compared to well-established resection criteria?

    Pozzi Mucelli, Raffaella M / Moro, Carlos Fernández / Del Chiaro, Marco / Valente, Roberto / Blomqvist, Lennart / Papanikolaou, Nikolaos / Löhr, Johannes-Matthias / Kartalis, Nikolaos

    European radiology

    2022  Volume 32, Issue 8, Page(s) 5144–5155

    Abstract: Objectives: Current guidelines base the management of intraductal papillary mucinous neoplasms (IPMN) on several well-established resection criteria (RC), including cyst size. However, malignancy may occur in small cysts. Since branch-duct (BD) IPMN are ...

    Abstract Objectives: Current guidelines base the management of intraductal papillary mucinous neoplasms (IPMN) on several well-established resection criteria (RC), including cyst size. However, malignancy may occur in small cysts. Since branch-duct (BD) IPMN are not perfect spheres, volumetric and morphologic analysis might better correlate with mucin production and grade of dysplasia. Nonetheless, their role in malignancy (high-grade dysplasia/invasive cancer) prediction has been poorly investigated. Previous studies evaluating RC also included patients with solid-mass-forming pancreatic cancer (PC), which may affect the RC yield. This study aimed to assess the role of volume, morphology, and other well-established RC in malignancy prediction in patients with BD- and mixed-type IPMN after excluding solid masses.
    Methods: Retrospective ethical review-board-approved study of 106 patients (2008-2019) with histopathological diagnosis of BD- and mixed-type IPMN (without solid masses) and preoperative MRI available. Standard imaging and clinical features were collected, and the novel imaging features cyst-volume and elongation value [EV = 1 - (width/length)] calculated on T2-weighted images. Logistic regression analysis was performed. Statistical significance set at two-tails, p < 0.05.
    Results: Neither volume (odds ratio (OR) = 1.01, 95% CI: 0.99-1.02, p = 0.12) nor EV (OR = 0.38, 95% CI: 0.02-5.93, p = 0.49) was associated with malignancy. Contrast-enhancing mural nodules (MN), main pancreatic duct (MPD) ≥ 5 mm, and elevated carbohydrate antigen (CA) 19-9 serum levels (> 37 μmol/L) were associated with malignancy (MN OR: 4.32, 95% CI: 1.18-15.76, p = 0.02; MPD ≥ 5 mm OR: 4.2, 95% CI: 1.34-13.1, p = 0.01; CA19-9 OR: 6.72; 95% CI: 1.89 - 23.89, p = 0.003).
    Conclusions: Volume and elongation value cannot predict malignancy in BD- and/or mixed-type IPMN. Mural nodules, MPD ≥ 5 mm and elevated CA19-9 serum levels are associated with higher malignancy risk even after the exclusion of solid masses.
    Key points: • Novel and well-established resection criteria for IPMN have been evaluated after excluding solid masses. • BD-IPMN volume and elongation value cannot predict malignancy. • Main pancreatic duct ≥ 5 mm, mural nodules, and elevated carbohydrate antigen 19-9 levels are associated with malignancy.
    MeSH term(s) Adenocarcinoma, Mucinous/diagnostic imaging ; Adenocarcinoma, Mucinous/surgery ; CA-19-9 Antigen ; Carbohydrates ; Carcinoma, Pancreatic Ductal/diagnostic imaging ; Carcinoma, Pancreatic Ductal/surgery ; Cysts/pathology ; Humans ; Pancreatic Ducts/pathology ; Pancreatic Intraductal Neoplasms/diagnostic imaging ; Pancreatic Intraductal Neoplasms/surgery ; Pancreatic Neoplasms/diagnostic imaging ; Pancreatic Neoplasms/surgery ; Retrospective Studies
    Chemical Substances CA-19-9 Antigen ; Carbohydrates
    Language English
    Publishing date 2022-03-11
    Publishing country Germany
    Document type Journal Article
    ZDB-ID 1085366-2
    ISSN 1432-1084 ; 0938-7994 ; 1613-3749
    ISSN (online) 1432-1084
    ISSN 0938-7994 ; 1613-3749
    DOI 10.1007/s00330-022-08650-5
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  7. Article ; Online: Acute management of paroxysmal atrial fibrillation with beta-blockers plus intravenous flecainide using the real-world Chios registry (BETAFLEC-CHIOS).

    Kartalis, Athanasios / Afendoulis, Dimitrios / Moutafi, Maria / Voutas, Petros / Papagiannis, Nikolaos / Garoufalis, Stefanos / Kartalis, Nikolaos / Smyrnioudis, Nikolaos / Andrikopoulos, Georgios / Didagelos, Matthaios

    Kardiologia polska

    2022  Volume 81, Issue 4, Page(s) 394–397

    MeSH term(s) Humans ; Flecainide/therapeutic use ; Atrial Fibrillation/drug therapy ; Anti-Arrhythmia Agents/therapeutic use ; Adrenergic beta-Antagonists/therapeutic use ; Administration, Intravenous
    Chemical Substances Flecainide (K94FTS1806) ; Anti-Arrhythmia Agents ; Adrenergic beta-Antagonists
    Language English
    Publishing date 2022-11-29
    Publishing country Poland
    Document type Journal Article
    ZDB-ID 411492-9
    ISSN 1897-4279 ; 0022-9032
    ISSN (online) 1897-4279
    ISSN 0022-9032
    DOI 10.33963/KP.a2022.0267
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  8. Article ; Online: Inter-reader agreement of interpretation of radiological course of bile duct changes between serial follow-up magnetic resonance imaging/3D magnetic resonance cholangiopancreatography of patients with primary sclerosing cholangitis.

    Grigoriadis, Aristeidis / Morsbach, Fabian / Voulgarakis, Nikolaos / Said, Karouk / Bergquist, Annika / Kartalis, Nikolaos

    Scandinavian journal of gastroenterology

    2020  Volume 55, Issue 2, Page(s) 228–235

    Abstract: Objectives: ...

    Abstract Objectives:
    MeSH term(s) Adult ; Aged ; Bile Duct Neoplasms/diagnosis ; Bile Ducts/pathology ; Bile Ducts, Intrahepatic/diagnostic imaging ; Bile Ducts, Intrahepatic/pathology ; Cholangiopancreatography, Endoscopic Retrograde ; Cholangiopancreatography, Magnetic Resonance/methods ; Cholangitis, Sclerosing/diagnosis ; Clinical Competence ; Constriction, Pathologic/diagnosis ; Diagnosis, Differential ; Expert Testimony ; Female ; Humans ; Image Interpretation, Computer-Assisted/methods ; Imaging, Three-Dimensional ; Liver Cirrhosis/diagnosis ; Male ; Middle Aged ; Reproducibility of Results
    Language English
    Publishing date 2020-02-05
    Publishing country England
    Document type Journal Article
    ZDB-ID 82042-8
    ISSN 1502-7708 ; 0036-5521
    ISSN (online) 1502-7708
    ISSN 0036-5521
    DOI 10.1080/00365521.2020.1720281
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  9. Article: Autoimmune Pancreatitis Type 1 with Biliary, Nasal, Testicular, and Pulmonary Involvement: A Case Report and a Systematic Review.

    Kourie, Mourad / Bogdanovic, Darko / Mahmutyazicioglu, Kamran / Ghazi, Sam / Panic, Nikola / Fjellgren, Eva / Hellkvist, Laila / Thiel, Tomas / Kjellman, Anders / Kartalis, Nikolaos / Danielsson, Olof / Dani, Lara / Löhr, J-Matthias / Vujasinovic, Miroslav

    Journal of clinical medicine

    2023  Volume 12, Issue 19

    Abstract: Introduction: Immunoglobulin G4-related disease (IgG4-RD) is an immune-mediated condition associated with fibroinflammatory lesions that can occur at almost any anatomical site. It often presents as a multiorgan disease that may mimic malignancy, ... ...

    Abstract Introduction: Immunoglobulin G4-related disease (IgG4-RD) is an immune-mediated condition associated with fibroinflammatory lesions that can occur at almost any anatomical site. It often presents as a multiorgan disease that may mimic malignancy, infection, or other immune-mediated conditions. Autoimmune pancreatitis (AIP) type 1 is the most prominent manifestation of IgG4-RD in the digestive tract, with common extra-pancreatic inflammation. We present the first patient with AIP and involvement of the testicles and nasal cavity.
    Patient and methods: A case of a patient with AIP type 1 and other organ involvement (bile ducts, testicles, nasal polyps, and lungs) is described. Additionally, a systematic review of AIP type 1 with testicular and nasal involvement was conducted.
    Results: The systematic review found two cases of AIP type 1 with testicular involvement and 143 cases with AIP type 1 with nasal cavity involvement. None of them had both testicular and nasal involvement.
    Conclusions: This is the first case of AIP type 1 with other organ involvement, including testicular and nasal involvement, to be described. The number of patients with nasal and testicular involvement described in the literature is low. Creating awareness of this rare clinical condition is necessary, especially due to the very effective available treatment with corticosteroids and rituximab.
    Language English
    Publishing date 2023-10-03
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2662592-1
    ISSN 2077-0383
    ISSN 2077-0383
    DOI 10.3390/jcm12196340
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  10. Article ; Online: The role of contrast-enhanced computed tomography to detect renal stones.

    Odenrick, Alice / Kartalis, Nikolaos / Voulgarakis, Nikolaos / Morsbach, Fabian / Loizou, Louiza

    Abdominal radiology (New York)

    2018  Volume 44, Issue 2, Page(s) 652–660

    Abstract: Purpose: To investigate the detectability of renal stones in corticomedullary and nephrographic phases on contrast-enhanced computed tomography (CT).: Methods: All consecutive patients between January 2012 and February 2016 undergoing CT of the ... ...

    Abstract Purpose: To investigate the detectability of renal stones in corticomedullary and nephrographic phases on contrast-enhanced computed tomography (CT).
    Methods: All consecutive patients between January 2012 and February 2016 undergoing CT of the kidneys according to our department's standard four-phase protocol and having at least one stone in the NC-phase (NCP) were included. Fifty patients with altogether 136 stones were eligible. Two radiologists in consensus evaluated the NCP from each examination and documented the number, location, and size of stones. Three abdominal radiologists blinded to the findings of the NCP reviewed independently the corticomedullary and nephrographic phases on two different occasions. They reported the number and location of stones in each kidney. For the inter-observer agreement the intra-class correlation coefficient (ICC) was estimated. The detection rate of renal stones was calculated for the three radiologists and compared between the two contrast-enhanced phases and the results were analyzed with concern to the size of the stones.
    Results: The ICC was 0.86. There was no statistically significant difference between corticomedullary and nephrographic phases (p = 0.94). The detection rate for stones measuring 3-5 mm was 82-88% and 98% for stones ≥ 6 mm.
    Conclusion: The detectability of renal stones ≥ 6 mm on contrast-enhanced CT is extremely high. This means that stones with a higher risk of not passing spontaneously can be safely diagnosed.
    MeSH term(s) Aged ; Contrast Media ; Female ; Humans ; Kidney/diagnostic imaging ; Kidney Calculi/diagnostic imaging ; Male ; Multidetector Computed Tomography/methods ; Radiographic Image Enhancement/methods ; Reproducibility of Results
    Chemical Substances Contrast Media
    Language English
    Publishing date 2018-09-17
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2839786-1
    ISSN 2366-0058 ; 2366-004X
    ISSN (online) 2366-0058
    ISSN 2366-004X
    DOI 10.1007/s00261-018-1778-7
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