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Jiang X, Chen J, Gu FF, Li ZR, Song YS, Long JJ, Zhang SZ, Xu TT, Tang YJ, Gu JY, Fang XM. Evaluating the efficacy of percutaneous puncture biopsy guided by contrast-enhanced ultrasound for peripheral pulmonary lesions. World J Clin Cases 2024; 12:3791-3799. [PMID: 38994323 PMCID: PMC11235426 DOI: 10.12998/wjcc.v12.i19.3791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 05/14/2024] [Accepted: 05/24/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND The incidence and mortality of lung cancer have increased annually. Accurate diagnosis can help improve therapeutic efficacy of interventions and prognosis. Percutaneous lung biopsy is a reliable method for the clinical diagnosis of lung cancer. Ultrasound-guided percutaneous lung biopsy technology has been widely promoted and applied in recent years. AIM To investigate the diagnostic value of contrast-enhanced ultrasound (CEUS)-guided percutaneous biopsy in peripheral pulmonary lesions. METHODS We retrospectively collected data on 237 patients with peripheral thoracic focal lesions who underwent puncture biopsy at Wuxi People's Hospital. The patients were randomly divided into two groups: The CEUS-guided before lesion puncture group (contrast group) and conventional ultrasound-guided group (control group). Analyze the diagnostic efficacy of the puncture biopsy, impact of tumor size, and number of puncture needles and complications were analyzed and compared between the two groups. RESULTS Accurate pathological results were obtained for 92.83% (220/237) of peripheral lung lesions during the first biopsy, with an accuracy rate of 95.8% (113/118) in the contrast group and 89.9% (107/119) in the control group. The difference in the area under the curve (AUC) between the contrast and the control groups was not statistically significant (0.952 vs 0.902, respectively; P > 0.05). However, when the lesion diameter ≥ 5 cm, the diagnostic AUC of the contrast group was higher than that of the control group (0.952 vs 0.902, respectively; P < 0.05). In addition, the average number of puncture needles in the contrast group was lower than that in the control group (2.58 ± 0.53 vs 2.90 ± 0.56, respectively; P < 0.05). CONCLUSION CEUS guidance can enhance the efficiency of puncture biopsy of peripheral pulmonary lesions, especially for lesions with a diameter ≥ 5 cm. Therefore, CEUS guidance has high clinical diagnostic value in puncture biopsy of peripheral focal lung lesions.
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Affiliation(s)
- Xiao Jiang
- Department of Ultrasonography, Shidong Hospital, Yangpu District, Shidong Hospital Affiliated to University of Shanghai for Science and Technology, Shanghai 200438, China
- Department of Ultrasonography, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi People's Hospital, Wuxi Medical Center, Nanjing Medical University, Wuxi 214023, Jiangsu Province, China
| | - Jun Chen
- Department of Ultrasonography, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi People's Hospital, Wuxi Medical Center, Nanjing Medical University, Wuxi 214023, Jiangsu Province, China
| | - Fang-Fang Gu
- Department of Ultrasonography, Shidong Hospital, Yangpu District, Shidong Hospital Affiliated to University of Shanghai for Science and Technology, Shanghai 200438, China
| | - Zhong-Rong Li
- Department of Ultrasonography, Shidong Hospital, Yangpu District, Shidong Hospital Affiliated to University of Shanghai for Science and Technology, Shanghai 200438, China
| | - Yu-Shan Song
- Department of Ultrasonography, Shidong Hospital, Yangpu District, Shidong Hospital Affiliated to University of Shanghai for Science and Technology, Shanghai 200438, China
| | - Jing-Jing Long
- Department of Ultrasonography, Shidong Hospital, Yangpu District, Shidong Hospital Affiliated to University of Shanghai for Science and Technology, Shanghai 200438, China
| | - Shu-Zhen Zhang
- Department of Ultrasonography, Shidong Hospital, Yangpu District, Shidong Hospital Affiliated to University of Shanghai for Science and Technology, Shanghai 200438, China
| | - Ting-Ting Xu
- Department of Ultrasonography, Shidong Hospital, Yangpu District, Shidong Hospital Affiliated to University of Shanghai for Science and Technology, Shanghai 200438, China
| | - Yong-Jun Tang
- Department of Ultrasonography, Shidong Hospital, Yangpu District, Shidong Hospital Affiliated to University of Shanghai for Science and Technology, Shanghai 200438, China
| | - Ji-Ying Gu
- Department of Ultrasonography, Shidong Hospital, Yangpu District, Shidong Hospital Affiliated to University of Shanghai for Science and Technology, Shanghai 200438, China
| | - Xiang-Ming Fang
- Department of Radiology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi People's Hospital, Wuxi Medical Center, Nanjing Medical University, Wuxi 214023, Jiangsu Province, China
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Jiménez-Serrano S, Páez-Carpio A, Doménech-Ximenos B, Cornellas L, Sánchez M, Revzin MV, Vollmer I. Conventional and Contrast-enhanced US of the Lung: From Performance to Diagnosis. Radiographics 2024; 44:e230171. [PMID: 38935548 DOI: 10.1148/rg.230171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2024]
Abstract
In recent years, lung US has evolved from a marginal tool to an integral component of diagnostic chest imaging. Contrast-enhanced US (CEUS) can improve routine gray-scale imaging of the lung and chest, particularly in diagnosis of peripheral lung diseases (PLDs). Although an underused tool in many centers, and despite inherent limitations in evaluation of central lung disease caused by high acoustic impedance between air and soft tissues, lung CEUS has emerged as a valuable tool in diagnosis of PLDs. Owing to the dual arterial supply to the lungs via pulmonary and bronchial (systemic) arteries, different enhancement patterns can be observed at lung CEUS, thereby enabling accurate differential diagnoses in various PLDs. Lung CEUS also assists in identifying patients who may benefit from complementary diagnostic tests, including image-guided percutaneous biopsy. Moreover, lung CEUS-guided percutaneous biopsy has shown feasibility in accessible subpleural lesions, enabling higher histopathologic performance without significantly increasing either imaging time or expenses compared with conventional US. The authors discuss the technique of and basic normal and pathologic findings at conventional lung US, followed by a more detailed discussion of lung CEUS applications, emphasizing specific aspects of pulmonary physiology, basic concepts in lung US enhancement, and the most commonly encountered enhancement patterns of different PLDs. Finally, they discuss the benefits of lung CEUS in planning and guidance of US-guided lung biopsy. ©RSNA, 2024 Supplemental material is available for this article.
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Affiliation(s)
- Sergio Jiménez-Serrano
- From the Department of Radiology, Imaging Diagnostic Center, Hospital Clinic Barcelona, Villarroel 170, 08036 Barcelona, Spain (S.J.S., A.P.C., B.D.X., L.C., M.S.); Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (M.V.R.); and Department of Radiology, Hospital de la Vall d'Hebron, Barcelona, Spain (I.V.)
| | - Alfredo Páez-Carpio
- From the Department of Radiology, Imaging Diagnostic Center, Hospital Clinic Barcelona, Villarroel 170, 08036 Barcelona, Spain (S.J.S., A.P.C., B.D.X., L.C., M.S.); Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (M.V.R.); and Department of Radiology, Hospital de la Vall d'Hebron, Barcelona, Spain (I.V.)
| | - Blanca Doménech-Ximenos
- From the Department of Radiology, Imaging Diagnostic Center, Hospital Clinic Barcelona, Villarroel 170, 08036 Barcelona, Spain (S.J.S., A.P.C., B.D.X., L.C., M.S.); Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (M.V.R.); and Department of Radiology, Hospital de la Vall d'Hebron, Barcelona, Spain (I.V.)
| | - Lluria Cornellas
- From the Department of Radiology, Imaging Diagnostic Center, Hospital Clinic Barcelona, Villarroel 170, 08036 Barcelona, Spain (S.J.S., A.P.C., B.D.X., L.C., M.S.); Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (M.V.R.); and Department of Radiology, Hospital de la Vall d'Hebron, Barcelona, Spain (I.V.)
| | - Marcelo Sánchez
- From the Department of Radiology, Imaging Diagnostic Center, Hospital Clinic Barcelona, Villarroel 170, 08036 Barcelona, Spain (S.J.S., A.P.C., B.D.X., L.C., M.S.); Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (M.V.R.); and Department of Radiology, Hospital de la Vall d'Hebron, Barcelona, Spain (I.V.)
| | - Margarita V Revzin
- From the Department of Radiology, Imaging Diagnostic Center, Hospital Clinic Barcelona, Villarroel 170, 08036 Barcelona, Spain (S.J.S., A.P.C., B.D.X., L.C., M.S.); Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (M.V.R.); and Department of Radiology, Hospital de la Vall d'Hebron, Barcelona, Spain (I.V.)
| | - Ivan Vollmer
- From the Department of Radiology, Imaging Diagnostic Center, Hospital Clinic Barcelona, Villarroel 170, 08036 Barcelona, Spain (S.J.S., A.P.C., B.D.X., L.C., M.S.); Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (M.V.R.); and Department of Radiology, Hospital de la Vall d'Hebron, Barcelona, Spain (I.V.)
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Boccatonda A, Guagnano MT, D’Ardes D, Cipollone F, Vetrugno L, Schiavone C, Piscaglia F, Serra C. The Role of Contrast-Enhanced Ultrasound in the Differential Diagnosis of Malignant and Benign Subpleural Lung Lesions. J Clin Med 2024; 13:2302. [PMID: 38673575 PMCID: PMC11051455 DOI: 10.3390/jcm13082302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 03/30/2024] [Accepted: 04/05/2024] [Indexed: 04/28/2024] Open
Abstract
Background: The application of transthoracic contrast-enhanced ultrasound (CEUS) to the study of peripheral lung lesions is still a topic of debate. The main objective of this review was to evaluate the diagnostic accuracy of CEUS in the diagnosis of malignant subpleural pulmonary consolidations and, therefore, differentiate them from benign ones. Methods: Papers published before December 2023 were detected through a search of PubMed, Cochrane library, and Embase. The pooled specificity and sensitivity, summary receiver operating characteristic (SROC) curve and diagnostic odds ratio (DOR) were used. Results: CEUS is characterized by a pooled sensitivity of 0.95 (95% CI: 0.93-0.97) and a pooled specificity of 0.93 (95% CI: 0.90-0.95) in differentiating benign and malignant subpleural lung diseases; the AUC of SROC was 0.97. Homogeneous CE was characterized by a pooled sensitivity of 0.43 (95% CI: 0.40-0.45) and the pooled specificity of 0.49 (95% CI: 0.46-0.52). Non-homogeneous CE displayed a pooled sensitivity of 0.57 (95% CI: 0.55-0.60) and a pooled specificity of 0.51 (95% CI: 0.48-0.54). The lack of CE displayed a pooled sensitivity of 0.01 (95% CI: 0.00-0.06) and a pooled specificity of 0.76 (95% CI: 0.64-0.85). Marked CE displayed a pooled sensitivity of 0.41 (95% CI: 0.37-0.44) and a pooled specificity of 0.54 (95% CI: 0.50-0.58). Non-marked CE displayed a pooled sensitivity of 0.59 (95% CI: 0.56-0.63) and a pooled specificity of 0.46 (95% CI: 0.42-0.50). The early AT displayed a pooled sensitivity of 0.04 (95% CI: 0.02-0.08) and a pooled specificity of 0.83 (95% CI: 0.77-0.87). The early wash out displayed a pooled sensitivity of 0.61 (95% CI: 0.48-0.72) and a pooled specificity of 0.98 (95% CI: 0.92-1.00). The delayed wash out displayed a pooled sensitivity of 0.15 (95% CI: 0.10-0.20) and a pooled specificity of 0.69 (95% CI: 0.62-0.75). Conclusions: CEUS is characterized by excellent diagnostic accuracy for the diagnosis of the malignancy of subpleural lung lesions. By separately analyzing the CEUS findings, the diagnostic accuracy values are considerably lower and not significant in some cases. The simultaneous evaluation of multiple CEUS features allows us to reach an excellent diagnostic accuracy. Non-homogeneous CE with early wash out are the most indicative features of malignancy of a lung lesion.
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Affiliation(s)
- Andrea Boccatonda
- Internal Medicine, Bentivoglio Hospital, AUSL Bologna, 40010 Bentivoglio, Italy
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy;
| | - Maria Teresa Guagnano
- Department of Medicine and Aging Science, Institute of “Clinica Medica”, “G. d’Annunzio” University of Chieti, 66100 Chieti, Italy; (M.T.G.); (F.C.)
| | - Damiano D’Ardes
- Department of Medicine and Aging Science, Institute of “Clinica Medica”, “G. d’Annunzio” University of Chieti, 66100 Chieti, Italy; (M.T.G.); (F.C.)
| | - Francesco Cipollone
- Department of Medicine and Aging Science, Institute of “Clinica Medica”, “G. d’Annunzio” University of Chieti, 66100 Chieti, Italy; (M.T.G.); (F.C.)
| | - Luigi Vetrugno
- Department of Anesthesiology, Critical Care Medicine and Emergency, SS. Annunziata Hospital Chieti, 66100 Chieti, Italy;
| | - Cosima Schiavone
- Internistic Ultrasound Unit, SS Annunziata Hospital, “G. d’Annunzio” University, 66100 Chieti, Italy;
| | - Fabio Piscaglia
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy;
- Division of Internal Medicine, Hepatobiliary and Immunoallergic Diseases, IRCCS Azienda Ospedaliero—Universitaria di Bologna, 40138 Bologna, Italy
| | - Carla Serra
- Interventional, Diagnostic and Therapeutic Ultrasound Unit, IRCCS Azienda Ospedaliero—Universitaria di Bologna, 40138 Bologna, Italy;
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Romero Romero B, Vollmer Torrubiano I, Martín Juan J, Heili Frades S, Pérez Pallares J, Pajares Ruiz V, Wangüemert Pérez A, Cristina Ramos H, Cases Viedma E. Ultrasound in the Study of Thoracic Diseases: Innovative Aspects. Arch Bronconeumol 2024; 60:33-43. [PMID: 37996336 DOI: 10.1016/j.arbres.2023.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 10/11/2023] [Accepted: 10/25/2023] [Indexed: 11/25/2023]
Abstract
Thoracic ultrasound (TU) has rapidly gained popularity over the past 10 years. This is in part because ultrasound equipment is available in many settings, more training programmes are educating trainees in this technique, and ultrasound can be done rapidly without exposure to radiation. The aim of this review is to present the most interesting and innovative aspects of the use of TU in the study of thoracic diseases. In pleural diseases, TU has been a real revolution. It helps to differentiate between different types of pleural effusions, guides the performance of pleural biopsies when necessary and is more cost-effective under these conditions, and assists in the decision to remove thoracic drainage after talc pleurodesis. With the advent of COVID19, the use of TU has increased for the study of lung involvement. Nowadays it helps in the diagnosis of pneumonias, tumours and interstitial diseases, and its use is becoming more and more widespread in the Pneumology ward. In recent years, TU guided biopsies have been shown to be highly cost-effective, with other advantages such as the absence of radiation and the possibility of being performed at bedside. The use of contrast in ultrasound to increase the cost-effectiveness of these biopsies is very promising. In the study of the mediastinum and peripheral pulmonary nodules, the introduction of echobronchoscopy has brought about a radical change. It is a fully established technique in the study of lung cancer patients. The introduction of elastography may help to further improve its cost-effectiveness. In critically-ill patients, diaphragmatic ultrasound helps in the assessment of withdrawal of mechanical ventilation, and is now an indispensable tool in the management of these patients. In neuromuscular patients, ultrasound is a good predictor of impaired lung function. Currently, in Neuromuscular Disease Units, TU is an indispensable tool. Ultrasound study of the intercostal musculature is also effective in the study of respiratory function, and is widely used in Respiratory Rehabilitation. In Intermediate Care Units, thoracic ultrasound is indispensable for patient management. In these units there are ultrasound protocols for the management of patients with acute dyspnoea that have proven to be very effective.
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Affiliation(s)
- Beatriz Romero Romero
- Unidad Médico Quirúrgica Enfermedades Respirartorias, Hospital Vírgen del Rocío de Sevilla, Sevilla, Spain.
| | | | - Jose Martín Juan
- Unidad Médico Quirúrgica Enfermedades Respirartorias, Hospital Vírgen del Rocío de Sevilla, Sevilla, Spain
| | - Sarah Heili Frades
- Servicio de Neumología, Unidad de Cuidados Intermedios Respiratorios, Hospital Fundación Jiménez Díaz, Madrid, Spain
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Peng JZ, Bie ZX, Li YM, Li B, Guo RQ, Wang CE, Xu S, Li XG. Diagnostic performance and safety of percutaneous fine-needle aspiration immediately before microwave ablation for pulmonary ground-glass nodules. Quant Imaging Med Surg 2023; 13:3852-3861. [PMID: 37284082 PMCID: PMC10240005 DOI: 10.21037/qims-22-1001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 04/07/2023] [Indexed: 06/08/2023]
Abstract
Background This study sought to evaluate the safety and diagnostic performance of computed tomography (CT)-guided fine-needle aspiration (FNA) immediately before microwave ablation (MWA) for pulmonary ground-glass nodules (GGNs). Methods This retrospective study analyzed the synchronous CT-guided biopsy and MWA data of 92 GGNs (male to female ratio 37:55; age 60.4±12.5 years; size 1.4±0.6 cm). FNA was performed in all patients, and sequential core-needle biopsy (CNB) was performed in 62 patients. The positive diagnosis rate was determined. The diagnostic yield was compared on the basis of the biopsy methods (FNA, CNB, or both), the nodule diameter (<1.5 and ≥1.5 cm), and the lesion component (pure GGN or part-solid GGN). The procedure-related complications were recorded. Results The technical success rate was 100%. The positive rates of FNA and CNB were 70.7% and 72.6% respectively, but did not differ significantly (P=0.8). Sequential FNA and CNB showed better diagnostic performance (88.7%) than did either alone (P=0.008 and P=0.023, respectively). The diagnostic yield of CNB for pure GGNs was significantly lower than that for part-solid GGNs (P=0.016). The diagnostic yield was lower for smaller nodules (78.3% vs. 87.5%; P=0.28), but the differences were not significant. Grade 1 pulmonary hemorrhages were observed in 10 (10.9%) sessions after FNA, including 8 cases of hemorrhage along the needle track and 2 cases of perilesional hemorrhage, but these hemorrhages did not hamper the accuracy of the antenna placement. Conclusions FNA immediately before MWA is a reliable technique for the diagnosis of GGNs that does not alter the accuracy of the antenna placement. Sequential FNA and CNB improves the diagnostic ability of GGNs compared to either method used alone.
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Affiliation(s)
- Jin-Zhao Peng
- Department of Minimally Invasive Tumor Therapies Center, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Zhi-Xin Bie
- Department of Minimally Invasive Tumor Therapies Center, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Yuan-Ming Li
- Department of Minimally Invasive Tumor Therapies Center, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Bin Li
- Department of Minimally Invasive Tumor Therapies Center, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Run-Qi Guo
- Department of Minimally Invasive Tumor Therapies Center, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Cheng-En Wang
- Department of Minimally Invasive Tumor Therapies Center, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Sheng Xu
- Department of Minimally Invasive Tumor Therapies Center, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiao-Guang Li
- Department of Minimally Invasive Tumor Therapies Center, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
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Schleder S, Jung EM, Schicho A, Schreyer AG, Habicher W, Grassinger J, Dollinger M. Efficacy and safety of ultrasound-guided core needle biopsies (US-CNBs) in cervical lymphadenopathy in patients with suspected head and neck cancer during the COVID-19 pandemic. Clin Hemorheol Microcirc 2023; 83:397-408. [PMID: 36683499 DOI: 10.3233/ch-221680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Cervical lymphadenopathy can be benign or malignant. Its accurate diagnosis is necessary to determine appropriate treatment. Ultrasound-guided core needle biopsies (US-CNBs) are frequently used as a percutaneous sampling approach. OBJECTIVES Our aim was to identify the efficacy and safety of US-CNBs in 125 patients with cervical lymphadenopathy and clinically suspected head and neck cancer during the COVID-19 pandemic with limited surgical resources. METHODS US-CNBs of pathological lymph nodes were performed in 146 lymph nodes on 125 patients. Biopsies were performed ultrasound-guided with a reusable gun core biopsy system and a 10-cm-long 16-G needle. Standard of reference for the histological findings were panendoscopy, clinical and sonographic follow-up, surgical biopsy or a repeat US-CNB. RESULTS Adequate material for histologic diagnosis was obtained in 111 patients (89%), of these 83 patients (75%) were diagnosed as malignant, whereas benign lymphadenopathy accounted for 28 patients (25%). Therefore, US-CNB was able to identify malignant or benign lymphadenopathy with an overall accuracy of 88% and 90%, respectively. CONCLUSIONS Percutaneous US-CNB is a safe and effective alternative to surgical biopsy in the management of cervical lymphadenopathy in patients with clinically suspected head and neck cancer in a setting with limited resources.
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Affiliation(s)
- Stephan Schleder
- Department of Diagnostic and Interventional Radiology, Merciful Brothers Hospital St. Elisabeth, Straubing, Germany
| | - Ernst-Michael Jung
- Department of Radiology, University Medical Center Regensburg, Regensburg, Germany
| | - Andreas Schicho
- Department of Radiology, University Medical Center Regensburg, Regensburg, Germany
| | - Andreas G Schreyer
- Department of Diagnostic and Interventional Radiology, University Hospital Brandenburg, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Werner Habicher
- Department of Othorhinolaryngology, Merciful Brothers Hospital St. Elisabeth, Straubing, Germany
| | - Jochen Grassinger
- Department of Hematology and Oncology, Merciful Brothers Hospital St. Elisabeth, Straubing, Germany
| | - Marco Dollinger
- Department of Radiology, University Medical Center Regensburg, Regensburg, Germany
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