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Spiesecke P, Thiemann J, Conen P, Clevert DA. Contrast enhanced ultrasound of cystic renal lesions, from diagnosis up to treatment. Clin Hemorheol Microcirc 2024:CH248102. [PMID: 39365320 DOI: 10.3233/ch-248102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2024]
Abstract
Ultrasound is the most used interdisciplinary imaging technique in clinical routine for assessment of renal pathologies. This includes the monitoring of cystic renal lesions, which can be classified as non-complicated or complicated and by means of occurrence as solitary or multifocal lesions. The Bosniak-classification (I-IV) classifies renal cysts in 5 different categories and is used for decisions of further clinical treatment. This classification was developed for computed tomography and has been adopted for magnetic resonance imaging as well as contrast-enhanced ultrasound. In the following review article, cystic kidney lesions and their differentiation using contrast-enhanced ultrasound are presented and an overview of the therapy options is given. In interventional procedures, CEUS can make a valuable contribution in histological sampling, reduce radiation exposure and, under certain circumstances, the number of interventions for the patient.
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Affiliation(s)
- P Spiesecke
- Department of Radiology, Interdisciplinary Ultrasound Center, Campus Charité Mitte, Charité, Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - J Thiemann
- Department of Radiology, Ludwig-Maximilians-University Munich, Germany
| | - P Conen
- Department of Radiology, Ludwig-Maximilians-University Munich, Germany
| | - D-A Clevert
- Department of Radiology, Ludwig-Maximilians-University Munich, Germany
- Interdisciplinary Ultrasound-Center, Ludwig-Maximilians-University Munich, Germany
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Evaluation of renal lesions using contrast-enhanced ultrasound (CEUS); a 10-year retrospective European single-centre analysis. Eur Radiol 2018; 28:4542-4549. [PMID: 29744641 DOI: 10.1007/s00330-018-5504-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 04/12/2018] [Accepted: 04/18/2018] [Indexed: 10/16/2022]
Abstract
OBJECTIVE To investigate the usefulness of contrast-enhanced ultrasound (CEUS) in the evaluation of renal masses. METHODS This study included 255 patients with renal masses. Ages ranged from 18-86 years. CEUS was used for determining malignancy or benignancy and findings were correlated with the histopathological outcome. Out of 255 lesions, 212 lesions were malignant (83.1%) and 43 were benign (16.9%). Diagnostic accuracy was tested using the histopathological diagnosis as the gold standard. RESULTS CEUS showed a sensitivity of 99.1% [95% confidence interval (CI): 96.7%, 99.9%], a specificity of 80.5% (CI: 65.1%, 91.2%), a positive predictive value of 96.4% (CI: 93.0%, 98.4%) and a negative predictive value of 94.3% (CI: 80.8%, 99.3%). Kappa for diagnostic accuracy was κ = 0.85 (CI: 0.75, 0.94). Of 212 malignant lesions, 200 renal cell carcinomas and 12 other malignant lesions were diagnosed. Out of 43 benign lesions, 10 angiomyolipomas, 3 oncocytomas, 8 renal cysts and 22 other benign lesions were diagnosed. CONCLUSION CEUS is an useful method to differentiate between malignant and benignant renal lesions. To date, to our knowledge, this is the largest study in Europe for the evaluation of renal lesions using CEUS with a histopathological validation. KEY POINTS • CEUS helps clinicians detect and characterise unclear solid and cystic renal lesions • CEUS shows a high diagnostic accuracy in the characterization of these lesions • Proper surgical treatment or follow-up can be given with better diagnostic confidence.
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Putz FJ, Hautmann MG, Banas MC, Jung EM. Investigation of the acute plantar fasciitis with contrast-enhanced ultrasound and shear wave elastography - first results. Clin Hemorheol Microcirc 2018; 67:415-423. [PMID: 28885209 DOI: 10.3233/ch-179222] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The plantar fasciitis is a common disease with a high prevalence in public and a frequent cause of heel pain. OBJECTIVE In our pilot study, we wanted to characterise the feasibility of shear-wave elastography and contrast-enhanced ultrasound (CEUS) in the assessment of the plantar fasciitis. METHODS 23 cases of painful heels were examined by B-Mode ultrasound, Power Doppler (PD), shear wave elastography and contrast-enhanced ultrasound before anti-inflammatory radiation. Time-intensity-curves were analysed by the integrated software. The results for area-under-the-curve (AUC), peak, time-to-peak (TTP) and mean-transit-time (MTT) were compared between the plantar fascia and the surrounding tissue. RESULTS All cases showed thickening of the plantar fascia, in most cases with interstitial oedema (87.0%). Shear wave elastography showed inhomogeneous stiffness of the plantar fascia. 83.3% of cases showed a visible hyperperfusion in CEUS at the proximal plantar fascia in comparison to the surrounding tissue. This hyperperfusion could also be found in 75.0% of cases with no signs of vascularisation in PD. AUC (p = 0.0005) and peak (p = 0.037) were significantely higher in the plantar fascia than in the surrounding tissue. CONCLUSION CEUS and shear wave elastography are new diagnostic tools in the assessment of plantar fasciitis and can provide quantitative parameters for monitoring therapy.
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Affiliation(s)
- Franz Josef Putz
- Department of Nephrology, University Hospital Regensburg, Regensburg, Germany
| | - Matthias G Hautmann
- Department of Radiotherapy, University Hospital Regensburg, Regensburg, Germany
| | - Miriam C Banas
- Department of Nephrology, University Hospital Regensburg, Regensburg, Germany
| | - Ernst Michael Jung
- Department of Radiology and Interdisciplinary Ultrasound, University Hospital Regensburg, Regensburg, Germany
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Rübenthaler J, Paprottka KJ, Marcon J, Reiser M, Clevert DA. MRI and contrast enhanced ultrasound (CEUS) image fusion of renal lesions. Clin Hemorheol Microcirc 2017; 64:457-466. [PMID: 27886003 DOI: 10.3233/ch-168116] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Ultrasound is a common and established imaging method for the initial characterization of renal lesions. The widespread used Bosniak classification (I-IV) classifies renal lesions in five individual groups using contrast-enhanced computer tomography (CE-CT), magnetic resonance imaging (MRI) and/or contrast-enhanced ultrasound (CEUS) imaging criteria. For complex pathologies, CEUS/MRI image fusion is a novel imaging technique for the differentiation of benign and malignant renal lesions. Compared to CE-CT and MRI alone, ultrasound image fusion offers the additional possibility of being a real-time imaging technique that can be used together with other cross-sectional imaging techniques.This article describes the newest possibilities of image fusion with CEUS and MRI in detection and characterization of unclear renal lesions.
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Affiliation(s)
- J Rübenthaler
- Department of Clinical Radiology, Interdisciplinary Ultrasound Center, Ludwig-Maximilians-University of Munich-Grosshadern Campus, Marchioninistr., Munich, Germany
| | - K J Paprottka
- Department of Clinical Radiology, Interdisciplinary Ultrasound Center, Ludwig-Maximilians-University of Munich-Grosshadern Campus, Marchioninistr., Munich, Germany
| | - J Marcon
- Department of Urology, Ludwig-Maximilians-University of Munich-Grosshadern Campus, Marchioninistr., Munich, Germany
| | - M Reiser
- Department of Clinical Radiology, Interdisciplinary Ultrasound Center, Ludwig-Maximilians-University of Munich-Grosshadern Campus, Marchioninistr., Munich, Germany
| | - D A Clevert
- Department of Clinical Radiology, Interdisciplinary Ultrasound Center, Ludwig-Maximilians-University of Munich-Grosshadern Campus, Marchioninistr., Munich, Germany
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Rübenthaler J, Paprottka K, Marcon J, Hameister E, Hoffmann K, Joiko N, Reiser M, Clevert DA. Comparison of magnetic resonance imaging (MRI) and contrast-enhanced ultrasound (CEUS) in the evaluation of unclear solid renal lesions. Clin Hemorheol Microcirc 2017; 64:757-763. [PMID: 27767985 DOI: 10.3233/ch-168034] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE To compare the sensitivity and specificity of contrast-enhanced ultrasound (CEUS) and magnetic resonance imaging (MRI) in the evaluation of unclear renal lesions to the histopathological outcome. MATERIALS AND METHODS A total of 36 patients with a single unclear solid renal lesion with initial imaging studies between 2005 and 2015 were included. CEUS and MRI were used for determining malignancy or benignancy and initial findings were correlated with the histopathological outcome. Out of the 36 renal masses a total of 28 lesions were malignant (77.8%) and 8 were found to be benign (22.2%). Diagnostic accuracy was testes by using the histopathological diagnosis as the gold standard. RESULTS CEUS showed a sensitivity of 96.4%, a specificity of 100.0%, a positive predictive value (PPV) of 100.0% and a negative predictive value (NPV) of 88,9%. MRI showed a sensitivity of 96.4%, a specificity of 75.0%, a PPV of 93.1% and a NPV of 85.7%. Out of the 28 malignant lesions a total of 18 clear cell renal carcinomas, 6 papillary renal cell carcinomas and 4 other malignant lesions, e.g. metastases, were diagnosed. Out of the 8 benign lesions a total 3 angiomyolipomas, 2 oncocytomas, 1 benign renal cyst and 2 other benign lesions, e.g. renal adenomas were diagnosed. Using CEUS, 1 lesion was falsely identified as benign. Using MRI, 2 lesions were falsely identified as benign and 1 lesion was falsely identified as malignant. CONCLUSION CEUS is an useful method which can be additionally used to clinically differentiate between malignant and benign renal lesions. CEUS shows a comparable sensitivity, specificity, PPV and NPV to MRI. In daily clinical routine, patients with contraindications for other imaging modalities can particularly benefit using this method.
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Affiliation(s)
- J Rübenthaler
- Department of Clinical Radiology, Ludwig-Maximilians-University of Munich-Grosshadern Campus, Munich, Germany
| | - K Paprottka
- Department of Clinical Radiology, Ludwig-Maximilians-University of Munich-Grosshadern Campus, Munich, Germany
| | - J Marcon
- Department of Urology, Ludwig-Maximilians-University of Munich-Grosshadern Campus, Munich, Germany
| | - E Hameister
- Department of Clinical Radiology, Ludwig-Maximilians-University of Munich-Grosshadern Campus, Munich, Germany
| | - K Hoffmann
- Department of Clinical Radiology, Ludwig-Maximilians-University of Munich-Grosshadern Campus, Munich, Germany
| | - N Joiko
- Department of Clinical Radiology, Ludwig-Maximilians-University of Munich-Grosshadern Campus, Munich, Germany
| | - M Reiser
- Department of Clinical Radiology, Ludwig-Maximilians-University of Munich-Grosshadern Campus, Munich, Germany
| | - D A Clevert
- Department of Clinical Radiology, Ludwig-Maximilians-University of Munich-Grosshadern Campus, Munich, Germany
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Reimann R, Rübenthaler J, Hristova P, Staehler M, Reiser M, Clevert DA. Characterization of histological subtypes of clear cell renal cell carcinoma using contrast-enhanced ultrasound (CEUS). Clin Hemorheol Microcirc 2017; 63:77-87. [PMID: 26484711 DOI: 10.3233/ch-152009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
INTRODUCTION The aim of this study was to analyze the histological subtypes of clear cell renal cell carcinoma (RCC) examined by means of contrast-enhanced ultrasound (CEUS) and a second generation blood pool agent (SonoVue®, Bracco, Milan, Italy) during the pre-operative phase. MATERIALS AND METHODS 29 patients with histologically proven subtypes of clear cell RCC were examined. A total of three patients were diagnosed with highly differentiated clear cell RCC, 21 out of 29 cases with moderately differentiated clear cell RCC and five out of 29 patients had insufficiently differentiated clear cell RCC. An experienced radiologist examined the patients with CEUS. The following parameters were analyzed: maximum signal intensity (PEAK), time elapsed until PEAK is reached (MTT), local blood flow (RBF), area under the time intensity curve (AUC) and the signal intensity (SI) during the course of time. For the groups all comparisons are made based on healthy renal parenchyma. RESULTS In the clear cell RCC significant differences (significance level p < 0.05) between cancerous tissue and the healthy renal parenchyma were noticed in all four parameters. Therefore, the clear cell RCC stands out due to its reduced blood volume. However, it reached the PEAK reading relatively rapidly and its signal intensity was always lower than that of the healthy renal parenchyma. In the arterial phase retarded absorption of the contrast agent was observed, followed by fast washing out of the contrast agent bubbles.In all three histological subgroups no significant differences were noticed in PEAK and SI. However, the diagrams showed the possible bias, that the group of the insufficiently differentiated clear cell RCC had the highest PEAK-value and the highest signal intensity when compared with highly and moderately differentiated clear cell RCC. CONCLUSION Our study suggests that CEUS may be an additional tool for non-invasive characterisation and differentiation of the three histological subtypes of clear cell RCC. Furthermore, it seems to have an additional diagnostic value in daily clinical.
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Affiliation(s)
- R Reimann
- Department of Clinical Radiology, Ludwig-Maximilians-University of Munich-Grosshadern Campus, Marchioninistr., Munich, Germany
| | - J Rübenthaler
- Department of Clinical Radiology, Ludwig-Maximilians-University of Munich-Grosshadern Campus, Marchioninistr., Munich, Germany
| | - P Hristova
- Department of Clinical Radiology, Ludwig-Maximilians-University of Munich-Grosshadern Campus, Marchioninistr., Munich, Germany
| | - M Staehler
- Department of Urology, Ludwig-Maximilians-University of Munich-Grosshadern Campus, Marchioninistr., Munich, Germany
| | - M Reiser
- Department of Clinical Radiology, Ludwig-Maximilians-University of Munich-Grosshadern Campus, Marchioninistr., Munich, Germany
| | - D A Clevert
- Department of Clinical Radiology, Ludwig-Maximilians-University of Munich-Grosshadern Campus, Marchioninistr., Munich, Germany
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Rübenthaler J, Reimann R, Hristova P, Staehler M, Reiser M, Clevert DA. Parametric imaging of clear cell and papillary renal cell carcinoma using contrast-enhanced ultrasound (CEUS). Clin Hemorheol Microcirc 2017; 63:89-97. [PMID: 26484712 DOI: 10.3233/ch-152010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
PURPOSE The aim of this study was to analyse clear cell and papillary renal cell carcinoma (RCC) examined with contrast-enhanced ultrasound (CEUS) and a second generation blood pool agent (SonoVue®, Bracco, Milan, Italy) before clinical intervention. MATERIALS AND METHODS A total of 41 patients with histologically proven subtypes of RCC were examined. 29 patients had a clear cell RCC and 12 patients showed a papillary RCC. Average size in the clear cell RCC group was 6.07 cm and 1.88 cm in the papillary RCC group. An experienced radiologist examined all patients with CEUS. The following parameters were analysed: maximum signal intensity (PEAK), time elapsed until PEAK is reached (MTT), local blood flow (RBF), area under the time intensity curve (AUC) and the signal intensity (SI) during the course of time. For both groups all comparisons were made based on healthy renal parenchyma. RESULTS In the clear cell RCC significant differences (significance level p < 0.05) between cancerous tissue and the healthy renal parenchyma were noticed in all four parameters. The clear cell RCC showed a significant reduced blood volume. It reached the PEAK reading relatively rapidly and its signal intensity was always lower than that of the healthy renal parenchyma. In the arterial phase retarded absorption of the contrast agent was observed, followed by fast washing out of the contrast agent bubbles.In the papillary RCC group, significant findings as to PEAK and RBF as well as a slightly significant difference as to AUC were recorded. The papillary RCC had a lower blood supply and reached its PEAK reading later. Its signal intensity was also reduced. The signal intensity of papillary NCC was significantly lower compared with clear cell RCC; absorption and washing out of the contrast agent was delayed. CONCLUSION CEUS seems to be an useful additional method to clinically differentiate between clear cell and papillary RCC. In daily clinical use, patients with contraindication for other imaging methods, especially the magnetic resonance imaging, might particularly benefit from this method.
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Affiliation(s)
- J Rübenthaler
- Department of Clinical Radiology, Ludwig-Maximilians-University of Munich-Grosshadern Campus, Marchioninistr., Munich, Germany
| | - R Reimann
- Department of Clinical Radiology, Ludwig-Maximilians-University of Munich-Grosshadern Campus, Marchioninistr., Munich, Germany
| | - P Hristova
- Department of Clinical Radiology, Ludwig-Maximilians-University of Munich-Grosshadern Campus, Marchioninistr., Munich, Germany
| | - M Staehler
- Department of Urology, Ludwig-Maximilians-University of Munich-Grosshadern Campus, Marchioninistr., Munich, Germany
| | - M Reiser
- Department of Clinical Radiology, Ludwig-Maximilians-University of Munich-Grosshadern Campus, Marchioninistr., Munich, Germany
| | - D A Clevert
- Department of Clinical Radiology, Ludwig-Maximilians-University of Munich-Grosshadern Campus, Marchioninistr., Munich, Germany
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Abstract
CLINICAL/METHODICAL ISSUE For diagnostic and interventional procedures ultrasound (US) image fusion can be used as a complementary imaging technique. METHODICAL INNOVATIONS Image fusion has the advantage of real time imaging and can be combined with other cross-sectional imaging techniques. PERFORMANCE With the introduction of US contrast agents sonography and image fusion have gained more importance in the detection and characterization of liver lesions. ACHIEVEMENTS Fusion of US images with computed tomography (CT) or magnetic resonance imaging (MRI) facilitates the diagnostics and postinterventional therapy control. PRACTICAL RECOMMENDATIONS In addition to the primary application of image fusion in the diagnosis and treatment of liver lesions, there are more useful indications for contrast-enhanced US (CEUS) in routine clinical diagnostic procedures, such as intraoperative US (IOUS), vascular imaging and diagnostics of other organs, such as the kidneys and prostate gland.
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Affiliation(s)
- E M Jung
- Institut für Röntgendiagnostik, Universitätsklinikum Regensburg (UKR), Regensburg, Deutschland
| | - D-A Clevert
- Institut für Klinische Radiologie, Klinikum der Ludwig-Maximilians-Universität München, Campus Großhadern, Marchioninistr. 15, 81377, München, Deutschland.
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[Modern imaging of renal tumors - application in diagnostics and therapy. Characterization, operation planning and therapy monitoring of renal lesions]. Radiologe 2016; 56:285-95; quiz 296. [PMID: 26961228 DOI: 10.1007/s00117-016-0087-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
This article elucidates the various tools used for the diagnostics and characterization of renal lesions. The advantages and limitations of ultrasound, contrast-enhanced ultrasound (CEUS), computed tomography (CT) and magnetic resonance imaging (MRI) are presented and discussed. In addition, modern imaging features of CT and MRI, such as iodine quantification in CT as well as diffusion-weighted and perfusion imaging in MRI are presented. Lastly, recent developments in standardized reporting of renal tumors regarding the intraoperative surgical risk are presented.
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Abstract
Accurate identification of the location of carcinoma in the prostate is essential for long-term therapeutic success, in particular for minimally invasive procedures. In recent years many new positive study results for prostate imaging have been reported which must be compared and evaluated and previous conservative assessments may need to be re-evaluated. In addition, combinations of different imaging techniques are increasingly being used in daily clinical routine. Due to technical advancements in sonographic imaging, such as elastography and contrast-enhanced ultrasound (CEUS), the detection rate of prostate cancer can be increased. An overview of the different imaging modalities and current literature are presented in this article.
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Affiliation(s)
- B Schlenker
- Urologische Klinik und Poliklinik des Klinikums der Universität München, Marchioninistraße 15, 81377, München, Deutschland,
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Nuhn P, Sterzik A, Stief C, Staehler M, D’Anastasi M. Schnittbildgebung der Nierentumoren. Urologe A 2015; 54:972-82. [DOI: 10.1007/s00120-015-3866-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Abstract
CLINICAL/METHODICAL ISSUE Optimization of ultrasound guided interventional procedures of the liver and kidneys using new imaging methods. STANDARD RADIOLOGICAL METHODS Punctures, biopsies, drainage, intraoperative ultrasound, fusion, embolization in correlation with ultrasound and other imaging methods. METHODICAL INNOVATIONS Real-time-sonography, contrast-enhanced ultrasound (CEUS) and fusion for planning, monitoring and postinterventional control. PERFORMANCE The use of CEUS enables better detection, characterization and execution of interventional procedures. Fusion facilitates detection. ACHIEVEMENTS The CEUS procedure is superior for detection and characterization of smaller lesions in comparison to the B scan. Fusion enables the performance of difficult interventional procedures. PRACTICAL RECOMMENDATIONS The B scan is the standard imaging method but CEUS and fusion could be helpful for smaller lesions.
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Affiliation(s)
- D-A Clevert
- Institut für Klinische Radiologie, Klinikum der Ludwigs-Maximilian-Universität München, Campus Großhadern, München, Deutschland
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