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RISS 인기검색어
- 검색키워드
- 저자 : Wolfgang G. Kunz (검색결과 3 건)
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Wolfgang G. Kunz,Peter B. Sporns,Marios N. Psychogios,Jens Fiehler,René Chapot,Franziska Dorn,Astrid Grams,Andrea Morotti,Patricia Musolino,Sarah Lee,André Kemmling,Hans Henkes,Omid Nikoubashman,Marti 대한뇌졸중학회 2022 Journal of stroke Vol.24 No.1
Background and Purpose The Save ChildS Study demonstrated that endovascular thrombectomy (EVT) is a safe treatment option for pediatric stroke patients with large vessel occlusions (LVOs) with high recanalization rates. Our aim was to determine the long-term cost, health consequences and cost-effectiveness of EVT in this patient population. Methods In this retrospective study, a decision-analytic Markov model estimated lifetime costs and quality-adjusted life years (QALYs). Early outcome parameters were based on the entire Save ChildS Study to model the EVT group. As no randomized data exist, the Save ChildS patient subgroup with unsuccessful recanalization was used to model the standard of care group. For modeling of lifetime estimates, pediatric and adult input parameters were obtained from the current literature. The analysis was conducted in a United States setting applying healthcare and societal perspectives. Probabilistic sensitivity analyses were performed. The willingness-to-pay threshold was set to $100,000 per QALY. Results The model results yielded EVT as the dominant (cost-effective as well as cost-saving) strategy for pediatric stroke patients. The incremental effectiveness for the average age of 11.3 years at first stroke in the Save ChildS Study was determined as an additional 4.02 lifetime QALYs, with lifetime cost-savings that amounted to $169,982 from a healthcare perspective and $254,110 when applying a societal perspective. Acceptability rates for EVT were 96.60% and 96.66% for the healthcare and societal perspectives. Conclusions EVT for pediatric stroke patients with LVOs resulted in added QALY and reduced lifetime costs. Based on the available data in the Save ChildS Study, EVT is very likely to be a cost-effective treatment strategy for childhood stroke.
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Storz, Corinna,Kolb, Manuel,Kim, Jong Hyo,Weiss, Jakob,Kunz, Wolfgang G.,Nikolaou, Konstantin,Bamberg, Fabian,Othman, Ahmed E. Elsevier 2018 Academic radiology Vol.25 No.3
<P><B>Rationale and Objectives</B></P> <P>To determine the intraindividual impact of radiation dose reduction in abdominal computed tomography (CT) on diagnostic performance in patients with suspected appendicitis.</P> <P><B>Materials and Methods</B></P> <P>This study was approved by the institutional review board. Seventy-five patients who underwent standard contrast-enhanced abdominal CT for suspected appendicitis between 2004 and 2009 were retrospectively included. Low-dose CT reconstructions with 75%, 50%, and 25% of the original radiation dose level were generated by applying realistic reduced-dose simulation. Two blinded, independent readers assessed image quality, signal-to-noise ratio, and diagnostic confidence on each dataset. Diagnostic accuracy for detection of appendicitis and complications were calculated for each reader. Paired univariate tests were used to determine intraindividual differences.</P> <P><B>Results</B></P> <P>Among 75 subjects included in the analysis (57% female, mean age: 41 ± 18 years), the prevalence of histopathologically confirmed appendicitis was 59%. Signal-to-noise ratio and subjective image quality of 50% and 25% reduced-dose CTs were significantly lower than the reference datasets (all <I>P</I> < .005). Appendicitis was correctly identified in all reference and low-dose datasets (sensitivity: 100%, negative predictive value: 100%). Presence of complications was correctly detected in all reference, 75%, and 50% datasets, but was decreased in 25% datasets (sensitivity: 77.8% and negative predictive value: 97.4%). Diagnostic confidence was high for original and 75% datasets, but significantly lower for 50% and 25% datasets (<I>P</I> < .001).</P> <P><B>Conclusions</B></P> <P>Our results indicate that diagnostic accuracy in abdominal CT acquisitions acquired at 75% and 50% of radiation dose is maintained in patients with suspected appendicitis, whereas further reduction of radiation exposition is associated with decreased diagnostic performance.</P>
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Peter B. Sporns,Marco Höhne,Lennart Meyer,Christos Krogias,Volker Puetz,Kolja M. Thierfelder,Marco Duering,Daniel Kaiser,Sönke Langner,Alex Brehm,Lukas T. Rotkopf,Wolfgang G. Kunz,Jens Fiehler,Walter 대한뇌졸중학회 2022 Journal of stroke Vol.24 No.3
Background and Purpose Many patients with stroke cannot receive intravenous thrombolysis because the time of symptom onset is unknown. We tested whether a simple method of computed tomography (CT)-based quantification of water uptake in the ischemic tissue can identify patients with stroke onset within 4.5 hours. Methods This retrospective analysis of the MissPerfeCT study (August 2009 to November 2017) includes consecutive patients with known onset of symptoms from seven tertiary stroke centers. We developed a simplified algorithm based on region of interest (ROI) measurements to quantify water uptake of the ischemic lesion and thereby quantify time of symptom onset within and beyond 4.5 hours. Perfusion CT was used to identify ischemic brain tissue, and its density was measured in non-contrast CT and related to the density of the corresponding area of the contralateral hemisphere to quantify lesion water uptake. Results Of 263 patients, 204 (77.6%) had CT within 4.5 hours. Water uptake was significantly lower in patients with stroke onset within (6.7%; 95% confidence interval [CI], 6.0% to 7.4%) compared to beyond 4.5 hours (12.7%; 95% CI, 10.7% to 14.7%). The area under the curve for distinguishing these patient groups according to percentage water uptake was 0.744 with an optimal cut-off value of 9.5%. According to this cut-off the positive predictive value was 88.8%, sensitivity was 73.5%, specificity 67.8%, negative predictive value was 42.6%. Conclusions Ischemic stroke patients with unknown time of symptom onset can be identified as being within a timeframe of 4.5 hours using a ROI-based method to assess water uptake on admission non-contrast head CT.
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